1/18. candida glabrata fungemia. Clinical features of 139 patients.Candida species are now the fourth leading cause of nosocomial bloodstream infection in hospitalized patients, and non-candida albicans species now surpass candida albicans. The clinical features of the most common non-candida albicans species, Candida (Torulopsis) glabrata, have not been well studied. We retrospectively reviewed the clinical features of 139 patients with C. glabrata blood-stream infection over a period of 7 years. The mean age of patients was 62 years, and the most common admitting diagnoses were malignancy (28%) and coronary artery disease (18%). The most common identified portals of entry were abdominal (22%) and intravascular catheters (16%). At the time of fungemia, 63% of patients had fever, 45% had change in mental status, and 30% were in septic shock. Three of 50 patients examined by an ophthalmologist had chorioretinitis. The overall hospital mortality was 49%. Factors associated with increased mortality in a regression model were prior abdominal surgery (odds ratio [OR] = 2.8; 95% confidence interval [CI] = 1.2-6.3, p = 0.01), and an elevated creatinine (OR = 2.2; 95% CI = 1.0-4.7, p = 0.05). When early deaths (< or = 72 hours) were censored, amphotericin b treatment and total dose were associated with reduced mortality (OR = 0.2; 95% CI = 0.1-0.4, p < 0.001). Nosocomial C. glabrata fungemia is not just a disease of debilitated and neutropenic patients, but affects a wide variety of patients and is associated with a high mortality.- - - - - - - - - - ranking = 1keywords = shock, septic shock (Clic here for more details about this article) |
2/18. Infected mediastinitis secondary to perforation of superior vena cava by a central venous catheter.We describe the first case of infected mediastinitis associated with central venous catheter insertion. The rare occurrence of this complication may be explained by the fact that it results from central venous catheter-related bloodstream infection and catheter perforation of superior vena cava. The symptoms of this complication (chest pain, dyspnoea) are not specific. Diagnosis should be confirmed by chest x-ray and computerized tomography which show hydromediastinum and pleural effusion. Removal and subsequent culture of the catheter tip will confirm infection. Appropriate antibiotic therapy, guided by sensitivities of the cultured organisms, should be commenced. Any pleural effusion should be drained by thoracocentesis, and the pleural fluid cultured. In case of fever, bacteraemia or shock, a thoracotomy to drain mediastinal and pleural effusions may be considered.- - - - - - - - - - ranking = 0.57473177819171keywords = shock (Clic here for more details about this article) |
3/18. Fatal streptococcal necrotizing fasciitis as a complication of axillary brachial plexus block.A 74-yr-old diabetic woman developed necrotizing fasciitis of the right upper limb after axillary brachial plexus block for carpal tunnel decompression. Clinical signs included oedema, diffuse swelling and bullae; rapidly followed by toxic shock syndrome and multiorgan failure. The patient died 48 h after hospital admission, despite broad-spectrum antibiotics, surgical treatment and supportive measures for the management of shock and multiorgan failure. Cultures yielded group A streptococcus. Delay in antibiotic and surgical treatment probably affected the outcome. early diagnosis and treatment are essential to improve the outcome of streptococcal necrotizing fasciitis.- - - - - - - - - - ranking = 11.84996718919keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
4/18. Polymicrobial candidaemia revealed by peripheral blood smear and chromogenic medium.Candida spp are the fourth most common group of nosocomial pathogens isolated from patients on medical, surgical, and intensive care wards. Polymicrobial candidaemia has rarely been described. The diagnosis of candidaemia from peripheral blood smears has not been widely reported. This report describes the case of a young woman suffering from Ewing's sarcoma who developed a syndrome of septic shock. Deep fungal infection was diagnosed from a systematic peripheral blood smear and yeasts were isolated within 24 hours. A subculture on CHROMagar Candida allowed the differentiation and presumptive identification of candida tropicalis and Candida krusei. Species identification was confirmed by the ID 32C system. This report underlines the usefulness of peripheral blood smears in the diagnosis of fulminant deep fungal infections, and of a differential isolation medium in the rapid presumptive identification of clinically important yeast species from clinical samples. This medium is particularly useful for the detection of mixed fungal infections, allowing early and better adapted antifungal treatment.- - - - - - - - - - ranking = 1keywords = shock, septic shock (Clic here for more details about this article) |
5/18. Nosocomial infection of aeromonas hydrophila presenting as necrotizing fasciitis.aeromonas hydrophila is infrequently reported as a causative organism of necrotizing fasciitis. We report a case of necrotizing fasciitis due to A. hydrophila in a 44-year-old man with marfan syndrome who underwent valve replacement surgery twice. He was admitted due to a 2-day history of fever. The fever was attributed to hepatitis, and ingestion of herbal medication was suspected to be the cause. The fever relapsed on the 28th day of hospitalization with rapidly progressive erythematous patches on the bilateral lower extremities. Septic shock developed within a few hours, and 2 small diagnostic incisions on the skin lesions suggested necrotizing fasciitis. Surgical exploration further revealed extensive necrosis of the subcutaneous tissue and fascia, but the muscle was spared. blood cultures and cultures of the debrided tissue all yielded A. hydrophila. Pathological examination showed necrosis and degeneration of the soft tissue. Although appropriately managed with broad-spectrum antibiotics, fasciotomies and debridement, the patient's condition deteriorated rapidly and resulted in death 11 hours after the surgery. This case indicates that A. hydrophila can be a causative organism of nosocomial necrotizing fasciitis.- - - - - - - - - - ranking = 0.57473177819171keywords = shock (Clic here for more details about this article) |
6/18. Clusters of invasive group A streptococcal infections in family, hospital, and nursing home settings.The spread of group A streptococcal infection to close contacts of infected persons is well recognized. With the resurgence of invasive group A streptococcal infections, there is an increased potential for clusters of patients with invasive disease. We reviewed data collected since December 1988 at the Centers for Disease Control (Atlanta) to identify clusters of infection in which one or more patients had invasive disease. Twelve family clusters were identified. Infection in index cases included the toxic shock-like syndrome and septicemia. Infection in family contacts included invasive infections, pharyngitis, or asymptomatic carriage. Most invasive disease occurred in adults, while the majority of noninvasive infections were in children. Five nosocomial clusters with spread of infection from patients to hospital personnel were documented. All index patients had the toxic shock-like syndrome; secondary infections included the toxic shock-like syndrome, pneumonia, bullous cellulitis, lymphangitis, and pharyngitis. Clusters of invasive infections also were identified in five nursing homes. pneumonia, cutaneous infections, and the toxic shock-like syndrome occurred most commonly. Clustering by nursing home unit occurred in three outbreaks. In hospitals and nursing homes, improved infection control will likely decrease secondary spread; in families, spread of disease may be prevented by identifying and treating those harboring the organism or by chemoprophylaxis. Studies that characterize the rate of secondary infection are needed before definitive recommendations can be made.- - - - - - - - - - ranking = 8.1899448347782keywords = toxic shock, shock (Clic here for more details about this article) |
7/18. ethics roundtable debate: A patient dies from an ICU-acquired infection related to methicillin-resistant staphylococcus aureus--how do you defend your case and your team?An elderly patient dies from septic shock in the intensive care unit. This is perhaps not an unusual scenario, but in this case the sepsis happens to have been due to methicillin-resistant staphylococcus aureus, possibly related to a catheter, and possibly transmitted from a patient in a neighbouring room by less than adequate compliance with infection control procedures. The family decides to sue. We present how experts from four different countries assess the medicolegal issues involved in this case.- - - - - - - - - - ranking = 1keywords = shock, septic shock (Clic here for more details about this article) |
8/18. Endotoxic shock after gamete intrafallopian transfer.OBJECTIVE: To report an extremely rare case of endotoxic shock due to enterobacter cloacae that occurred after laparoscopy for gamete intrafallopian transfer (GIFT) in a nulligravid woman. DESIGN: Private fertility center in Cape Town, south africa. SETTING: Case report. PATIENT(S): A 34-year-old woman with primary infertility. INTERVENTION(S): Routine preparation for GIFT procedure, sonar aspiration to obtain oocytes, followed by GIFT. Endotoxic shock developed within hours after the procedure, followed by admission to the intensive care unit, intravenous antibiotic therapy, mechanical ventilation, and abdominal hysterectomy. MAIN OUTCOME MEASURE(S): Preventing patient mortality and morbidity. RESULT(S): Discharge from the intensive care unit occurred on day 11 after GIFT, which was day 8 after surgery. A medline search (1980 to 2003) found no previous literature on endotoxic shock associated with assisted reproduction. CONCLUSION(S): Gram-negative infection with subsequent endotoxic shock after assisted reproductive techniques is extremely rare. As this case report shows, early diagnosis and active management of these cases are mandatory to prevent serious complications and mortality.- - - - - - - - - - ranking = 16.379889669556keywords = toxic shock, shock (Clic here for more details about this article) |
9/18. Globicatella bacteraemia identified by 16S ribosomal rna gene sequencing.BACKGROUND: Globicatella are streptococcus-like organisms that have been rarely isolated from clinical specimens. Their epidemiology and clinical significance remain largely unknown. AIMS: To describe two cases of Globicatella bacteraemia identified by 16S ribosomal rna (rRNA) gene sequencing. methods: Two unidentified streptococcus-like bacteria isolated from blood cultures of patients were subject to 16S rRNA gene sequencing. RESULTS: Two cases of Globicatella bacteraemia were identified by 16S rRNA gene sequencing. In the first case, a gram positive coccus was isolated from the blood culture of an 80 year old woman with diabetes mellitus and nosocomial sepsis, who died the day after developing the bacteraemia. The bacterium was unidentified by conventional phenotypic tests, the Vitek (gram positive identification) and the ATB expression (ID32 Strep) systems. In the second case, a similar bacterium was isolated from the blood culture of a 92 year old woman with polymicrobial acute pyelonephritis complicated by septic shock, who subsequently recovered after antibiotic treatment. 16S rRNA gene sequencing of the two isolates showed 0.5% nucleotide difference from that of G. sulfidifaciens and 0.7% nucleotide difference from that of G. sanguinis, indicating that they were Globicatella species. CONCLUSIONS: Because Globicatella is rarely encountered in clinical microbiology laboratories, it may have been overlooked or misidentified in these cases. 16S rRNA gene sequencing is a useful tool to better characterise the epidemiology and clinical significance of Globicatella.- - - - - - - - - - ranking = 1keywords = shock, septic shock (Clic here for more details about this article) |
10/18. The clinical picture of neonatal infection with pantoea species.pantoea infections are uncommon in humans. Most reports have involved adults or children after thorn injuries. There are only a few reports of systemic infections with pantoea. This is the first report of the clinical picture of systemic pantoea spp. infection in neonates as observed during an outbreak in a neonatal intensive care unit caused by infected parenteral nutrition solutions. Even though detected early, the infections had a fulminant course, causing septicemic shock and respiratory failure. Pulmonary disease was prominent and presented mainly as pulmonary hemorrhage and adult respiratory distress syndrome. The organism was sensitive to most antibiotics used in neonatal intensive care units, but the clinical response to antibiotic therapy was poor. The fatality rate was very high: 7 out of 8 infected infants succumbed to the infection (87.5%).- - - - - - - - - - ranking = 0.57473177819171keywords = shock (Clic here for more details about this article) |
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