1/19. Infectious disease emergencies in primary care.Infectious disease emergencies can be described as infectious processes that, if not recognized and treated immediately, can lead to significant morbidity or mortality. These emergencies can present as common or benign infections, fooling the primary care provider into using more conservative treatment strategies than are required. This review discusses the pathophysiology, history and physical findings, diagnostic criteria, and treatment strategies for the following infectious disease emergencies: acute bacterial meningitis, ehrlichiosis, rocky mountain spotted fever, meningococcemia, necrotizing soft tissue infections, toxic shock syndrome, food-borne illnesses, and infective endocarditis. Because most of the discussed infectious disease emergencies require hospital care, the primary care clinician must be able to judge when a referral to a specialist or a higher-level care facility is indicated.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/19. Molecular basis and enzymatic properties of glucose 6-phosphate dehydrogenase volendam, leading to chronic nonspherocytic anemia, granulocyte dysfunction, and increased susceptibility to infections.We have investigated the blood cells from a woman with a low degree of chronic nonspherocytic hemolytic anemia and frequent bacterial infections accompanied by icterus and anemia. The activity of glucose 6-phosphate dehydrogenase (G6PD) in her red blood cells (RBCs) was below detection level, and in her leukocytes less than 3% of normal. In cultured skin fibroblasts, G6PD activity was approximately 15% of normal, with 4- to 5-fold increased Michaelis constant (Km) for nadp and for glucose 6-phosphate. Activated neutrophils showed a decreased respiratory burst. family studies showed normal G6PD activity in the RBCs from all family members, including both parents and the 2 daughters of the patient. Sequencing of polymerase chain reaction (PCR)-amplified genomic dna showed a novel, heterozygous 514C-->T mutation, predicting a Pro172-->Ser replacement. Analysis of G6PD rna from the patient's leukocytes and fibroblasts showed only transcripts with the 514C-->T mutation. This was explained by the pattern of X-chromosome inactivation, studied by means of the human androgen receptor (HUMARA) assay, which proved to be skewed in the patient, her mother, and one of the patient's daughters. Thus, the patient has inherited a de novo mutation in G6PD from her father and an X-chromosome inactivation determinant from her mother, causing exclusive expression of the mutated G6PD allele. Purified mutant protein from an escherichia coli expression system showed strongly decreased specific activity, increased Km for nadp and for glucose 6-phosphate, and increased heat lability, which indicates that the defective phenotype is due to 2 synergistic molecular dysfunctions: decreased catalytic efficiency and protein instability.- - - - - - - - - - ranking = 2.5keywords = infection (Clic here for more details about this article) |
3/19. The role of infections in primary hemophagocytic lymphohistiocytosis: a case series and review of the literature.There is a paucity of literature addressing infection-related morbidity and mortality in children with primary hemophagocytic lymphohistiocytosis (HLH), a rare condition characterized by abnormal proliferation of macrophages, hypercytokinemia, and T cell immunosuppression. Therefore, a retrospective chart review was done of patients diagnosed with primary HLH over a 15-year period. Significant infections present at diagnosis, during the course of illness, and just prior to death or at autopsy were noted. Of the 18 children identified with primary HLH, an infectious agent was documented at the initial presentation of HLH in 5. Significant infections occurred during therapy in 10 (56%) of 18. Of the 12 fatal cases, invasive infection was the cause of death in 8 children, and 6 of these deaths were directly attributable to invasive fungal infection. Significant infections were common during therapy in children with primary HLH, and fungal infections were an important cause of mortality in this group.- - - - - - - - - - ranking = 5.5keywords = infection (Clic here for more details about this article) |
4/19. 9: Infections in the returned traveller.The usual presentation of a returned traveller is with a particular syndrome - fever, respiratory infection, diarrhoea, eosinophilia, or skin or soft tissue infection - or for screening for asymptomatic infection. Fever in a returned traveller requires prompt investigation to prevent deaths from malaria; diagnosis of malaria may require up to three blood films over 36-48 hours. Diarrhoea is the most common health problem in travellers and is caused predominantly by bacteria; persistent diarrhoea is less likely to have an infectious cause, but its prognosis is usually good. While most travel-related infections present within six months of return, some important chronic infections may present months or years later (eg, strongyloidiasis, schistosomiasis). Travellers who have been bitten by an animal require evaluation for rabies prophylaxis.- - - - - - - - - - ranking = 2.5keywords = infection (Clic here for more details about this article) |
5/19. Concomitant or consecutive infection with coxiella burnetii and tickborne diseases.BACKGROUND: q fever is a worldwide zoonosis caused by coxiella burnetii, which can be isolated from ticks. Reports of people with both q fever and other tickborne diseases are rare. In this study, we describe 6 patients with q fever who were infected with 1 of the following tickborne pathogens: rickettsia conorii (2 patients), Rickettsia slovaca (2), Rickettsia africae (1), and francisella tularensis (1). methods: Diagnoses were made on the basis of results of microimmunofluorescence assays for detection of C. burnetii, R. conorii, R. slovaca, R. africae, and F. tularensis antigens. Cross-adsorption studies and Western blots were used to confirm dual infections. RESULTS: Among the 6 cases presented, 3 were probably due to a concomitant infection after a tick bite, whereas the remaining 3 were more likely consecutive infections. CONCLUSIONS: Because acute q fever is often asymptomatic, we recommend that patients infected with the tickborne pathogens mentioned above also undergo routine testing for concurrent infections with C. burnetii.- - - - - - - - - - ranking = 4keywords = infection (Clic here for more details about this article) |
6/19. Is pneumocystis carinii pneumonia after stem cell transplantations a contagious disease?We report of twins who underwent hematopoietic stem cell transplantation (HSCT) for neonatal acute leukemia. Hospitalized in the same room from the time the first one demonstrated respiratory symptoms, they both developed Pneumocystis jiroveci (formerly carinii) pneumonia (PCP) 2 wk apart. This observation suggests that PCP may be a contagious disease in HSCT recipients. This may be especially true for infants and young children who are at risk of primary P. jiroveci infection, and should be avoided.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
7/19. Early autoimmune complications after thymomectomy in a patient with interstitial lung disease. Case report.thymoma has been associated with a variety of autoimmune disorders. We report a case of myasthenia gravis and pancytopenia in a 53-year-old man with lymphoepithelial thymoma and interstitial lung disease. Preoperative examination revealed neither hematologic abnormality nor myasthenia gravis. The patient had enteritis prior to thymomectomy, sternal infection in the first month of operation, and urinary infection at the third month. About three months after thymomectomy, he required mechanical ventilation support due to myasthenia gravis-related respiratory failure. One month later, a rapidly progressing pancytopenia developed. The patient died within two weeks of overwhelming septicemia unresponsive to treatment with antibiotics and steroids. The possible onset of myasthenia gravis or pancytopenia after thymomectomy should be kept in mind during follow-up. Recurrent infections in the early stages of thymomectomy may suggest a lethal onset of pancytopenia.- - - - - - - - - - ranking = 1.5keywords = infection (Clic here for more details about this article) |
8/19. Community-acquired methicillin-resistant staphylococcus aureus skin infection presenting as a periumbilical folliculitis.Community-acquired methicillin-resistant staphylococcus aureus (CAMRSA) infection is a clinical problem of increasing global incidence. CAMRSA most commonly presents as abscess and cellulitis of the skin and soft tissue. However, the lesions of cutaneous CAMRSA infection are pleomorphic and may appear as erythematous pustules of superficial folliculitis. This report presents the cases of 2 patients with CAMRSA skin infection that presented as a superficial folliculitis. The distribution of CAMRSA-related, erythematous, folliculocentric pustules was periumbilical, in contrast to the lesional location of methicillin-susceptible S. aureus (MSSA)-associated folliculitis, which typically appears on the axillae, bearded area, buttocks, and extremities. CAMRSA should be considered in the diagnosis of periumbilical folliculitis or superficial folliculitis arising in areas not typically affected by MSSA-related folliculitis, such as the chest, flanks, and scrotum.- - - - - - - - - - ranking = 3.5keywords = infection (Clic here for more details about this article) |
9/19. Autochthonous hepatitis e virus infection in germany with sequence similarities to other European isolates.hepatitis e virus (HEV) is a common cause of acute hepatitis in endemic areas. Yet reports on autochthonous cases in other areas such as middle europe are increasing. Here we report on a patient, who obviously acquired his HEV infection in germany. sequence analysis of the virus gained from his serum revealed homologies to other European isolates and swine isolates.- - - - - - - - - - ranking = 2.5keywords = infection (Clic here for more details about this article) |
10/19. Postinfectious glomerulonephritis in renal allograft recipients.Postinfectious glomerulonephritis (PIGN) is a rare etiology of de novo glomerulonephritis following kidney transplantation. To date, there have only been eight cases reported in the literature. We report an additional three patients transplanted at our institution between January 2000 and October 2004 who had clinical and pathologic findings consistent with posttransplant PIGN. All three patients were type 1 diabetics. One had received a cadaveric kidney transplant, one a simultaneous kidney-pancreas transplant, and the third a living related kidney transplant followed by a pancreas transplant. All patients were on triple immunosuppressive therapy with tacrolimus, mycophenolate mofetil, and prednisone. In each case, an acute decline in allograft function developed in association with a known or suspected infectious process, and renal biopsies revealed an immune complex glomerulonephritis with features of PIGN. All regained renal function with treatment of their known or suspected infections and without specific therapies for their glomerulonephritis, including corticosteroids.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
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