1/109. Community-acquired methicillin-resistant staphylococcus aureus: a cause of musculoskeletal sepsis in children.Between August 1996 and August 1997, 130 children were admitted to our pediatric orthopaedic unit with Staphylococcus aureus musculoskeletal infection. Twenty-six of the 130 staphylococcal isolates were resistant to methicillin, an incidence of 20%. All but one of the infections, a femoral fixator-pin infection, were community-acquired. Twenty-two of the infections were superficial; however, there were four cases of deep musculoskeletal sepsis due to methicillin-resistant S. aureus. In areas where methicillin-resistant S. aureus is prevalent in the community, methicillin resistance should be considered in any overwhelming staphylococcal infection not responding to conventional antibiotics despite adequate surgical debridement.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/109. Fulminant psittacosis requiring mechanical ventilation and demonstrating serological cross-reactivity between legionella longbeachae and chlamydia psittaci.chlamydia psittaci infection typically causes a mild respiratory illness in humans. Severe respiratory failure requiring mechanical ventilation or intensive care therapy is an uncommon development. The aetiological agents causing severe community acquired pneumonia often remain undetermined. Serological tests may aid in diagnosis. We present two cases of fulminant psittacosis, one demonstrating early cross-reactivity with legionella longbeachae.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
3/109. hepatitis G virus infection as a possible causative agent of community-acquired hepatitis and associated aplastic anaemia.Aplastic anaemia complicating hepatitis is a rare but well-documented phenomenon; however in many patients the cause remains unknown. We present a 24-year-old man with a well-defined community-acquired hepatitis, probably due to hepatitis G virus (HGV), who developed severe aplastic anaemia. In this case, the absence of other agents likely to cause the clinical manifestations, and the detection of HGV rna at the time of illness, clearly point to this agent as being responsible for both the hepatitis and the aplastic anaemia. Further studies in serial serum samples and meticulous evaluation of the disorders associated with the infection will be needed to prove or dispute a causal association of HGV and aplastic anaemia.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
4/109. Relapsing life threatening community acquired pneumonia due to rare Legionella species responsive to ceftriaxone and aztreonam.A 24 year old Saudi housewife was admitted thrice with life threatening community acquired pneumonia. Even though she responded to an initial cocktail of cefriaxone, erythromcin, rifampicin and flucloxacillin during the second admission, she relapsed within four days of discharge when she was on erythromycin only. During the third admission she was put on ceftriaxone and aztreonam and recovered fully without any relapse. serology results received later showed Legionella IgM titres of more than 1:256 for Legionella micdadei and Legionella bozemanii, and IgG titres of Legionella hackeliae. This case demonstrates relapsing pneumonia due to Legionella micdadei and bozemanii infection, and previous exposure to Legionella hackeliae. Both species, that is, Legionella micdadei and bozemanii, are resistant to erythromycin, but responded very well to a combination of ceftriaxone and aztreonam have not been used previously for the treatment of Legionnaires diseases.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
5/109. Mixed infection in adult bacterial meningitis.12 adult patients suffering from bacterial meningitis caused by mixed infection were identified at Kaohsiung Chang Gung Memorial Hospital over a period of 13 years (1986-1998), and they accounted for 6.5% (12/184) of our culture-proven adult bacterial meningitis. The 12 cases included seven males and five females, aged 17-74 years. Six of the 12 cases had community-acquired infections and the other six had nosocomially-acquired infections. Ten of the 12 cases had associated underlying diseases, with head trauma and/or neurosurgical procedure being the most frequent. Both gram-negative and gram-positive pathogens were identified in these 12 cases with gram-negative pathogens outnumbering the gram-positive ones. The implicated pathogens, starting with the most frequent, included Enterobacter species (enterobacter cloacae, enterobacter aerogenes), Klebsiella species (klebsiella pneumoniae, klebsiella oxytoca), escherichia coli, Staphylococcus species (Staphylococcus aureus, staphylococcus haemolyticus), pseudomonas aeruginosa, acinetobacter baumannii, enterococcus, serratia marcescens, citrobacter diversus, proteus mirabilis, Streptococcus viridans and neisseria meningitidis. Six of the 12 cases were found to have multi-antibiotic-resistant strains, which included E. cloacae in one, A. baumannii in one, K. pneumoniae in one and S. aureus in three. The management of these 12 cases included appropriate antibiotics and neurosurgical procedures including shunt revision. Despite the complexity of implicated pathogens and the high incidence of emergence of resistant strains, the overall mortality rate (8.3%, 1/12) was not higher than that in adult bacterial meningitis. However, complete recuperation was difficult in adult patients with mixed bacterial meningitis.- - - - - - - - - - ranking = 1.4keywords = infection (Clic here for more details about this article) |
6/109. Streptoccocus pyogenes: a forgotten cause of severe community-acquired pneumonia.We report a case of severe community-acquired pneumonia caused by streptococcus pyogenes (Lancefield Group A streptoccocus) that was complicated by a streptococcal toxic shock syndrome. Although this micro-organism is an uncommon cause of community-acquired pneumonia, previously well individuals may be infected and the clinical course may be fulminant. A household contact was the likely point of infection. Invasive group A streptococcal disease continues to remain an important cause of morbidity and mortality in the community and therefore will continue to be encountered by intensive care physicians. Treatment of Group A streptococcal infection remains penicillin; however, clindamycin should be added in severe infection.- - - - - - - - - - ranking = 0.6keywords = infection (Clic here for more details about this article) |
7/109. A case of haemophilus parainfluenzae pneumonia.A 41 year old woman presented with community acquired pneumonia (CAP) which failed to resolve following treatment with amoxycillin and cefaclor prior to referral. Quantitative culture of sputum revealed a pure growth of haemophilus parainfluenzae and, following antibiotic susceptibility testing of the isolate, ciprofloxacin was prescribed resulting in resolution of the infection. Immunological investigations showed that the patient had a high titre of H parainfluenzae specific IgM. The combination of a pure growth of H parainfluenzae, a response to appropriate antimicrobial therapy, and the presence of a specific antibody response indicated that this organism had a pathogenic role in the patient's pneumonia and should be considered in the differential diagnosis of CAP.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
8/109. methicillin-resistant staphylococcus aureus infections in 2 pediatric outpatients.methicillin-resistant staphylococcus aureus (MRSA) infections are an emerging problem in children. The following are 2 case reports of unsuspected MRSA infections: the first is an infant with cervical adenitis and the second is a child with a deep infection of the toe. Both patients failed outpatient therapy with oral cephalosporins and required hospitalization for surgical drainage. Both patients had cultures positive for MRSA at surgery. Neither patient had any risk factors for acquiring MRSA. Thus, outpatients with presumed staphylococcal infections who fail oral therapy with cephalosporins may be infected with MRSA.- - - - - - - - - - ranking = 1.6keywords = infection (Clic here for more details about this article) |
9/109. A community pseudo-outbreak of invasive Staphylococcus aureus infection.Outbreaks of invasive infection caused by methicillin-susceptible and methicillin-resistant staphylococcus aureus occur in hospitals, long term care institutions, and in patients discharged from these settings. In contrast, epidemic S. aureus infection has not been reported in well persons in the community. Here, we describe a group of healthy young adults who resided in the same neighborhood and participated together in school sports, and who developed serious S. aureus infections within 3 weeks of each other, suggesting a true community outbreak. Timely use of molecular epidemiological tools, however, demonstrated that their illnesses were caused by unrelated bacterial strains.- - - - - - - - - - ranking = 1.4keywords = infection (Clic here for more details about this article) |
10/109. Community acquired methicillin-resistant staphylococcus aureus hand infections: case reports and clinical implications.We report a series of 4 cases of community acquired methicillin-resistant staphylococcus aureus hand infections in patients without risk factors. Methicillin-resistant S aureus infections commonly involve the skin and soft tissue; therefore, hand infections may become more common as the prevalence of this pathogen increases. hand surgeons must be aware of this emerging pathogen and obtain appropriate tissue cultures to diagnose and effectively treat this infection.- - - - - - - - - - ranking = 1.6keywords = infection (Clic here for more details about this article) |
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