1/9. Improvement of c-reactive protein levels and body temperature of an elderly patient infected with pseudomonas aeruginosa on treatment with Mao-bushi-saishin-to.OBJECTIVE: To examine the effectiveness of Mao-bushi-saishin-to (Ma-Huang-Fu-Zi-Xi-Xin-Tang in Chinese medicine) (Tochimototenkaido Co. Ltd., Osaka, japan), one of the traditional herbal medicines, against resistant bacterial infection. SETTING: The nursing Center Himawari, Izumo, japan DESIGN, PATIENT, AND PREPARATION: Half of the standard dose of Mao-bushi-saishin-to was prescribed for 7 days to one elderly patient with fever and positive c-reactive protein (CRP) levels suffering from drug resistant pseudomonas aeruginosa. The daily standard dose of Mao-bushi-saishin-to is prepared from 1200 mg of dried extract obtained from three crude drugs, Ephedrae Herba (4 g), Asiasari Radix (3 g), and Aconiti Tuber (1 g). It is certified by the Japanese Ministry of health and Welfare. RESULTS: The patient's fever and CRP level returned to normal levels. CONCLUSIONS: In cases in which the fever does not fall in response to antibiotics for at least 3 days, half of the standard dose of Mao-bushi-saishin-to for 7 days might be worth trying to induce remission, especially for elder patients.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
2/9. A case of neurosyphilis with a florid Jarisch-Herxheimer reaction.A 37 year old man with a 2 year history of progressive cognitive decline, unilateral tinnitus and deafness presented with complex partial seizures and a fever. On examination there was a sluggish right pupillary response but no other abnormal findings. serum and CSF syphilis serology were both strongly positive. High dose intravenous penicillin therapy was complicated by a severe Jarisch-Herxheimer reaction (JHR) characterised by fever, obtundation, fluctuating upper motor neuron signs and complex visual and auditory hallucinations. These symptoms resolved over three days and the course of penicillin was completed. At discharge the patient's cognitive functioning was unchanged from the pretreatment state. He made gradual improvement over the following months but remains unable to live alone or work. Clinical, pathologic and radiologic findings of neurosyphilis are reviewed, as is the JHR, a self-limiting, systemic febrile response related to massive cytokine release that can occur in response to treatment of a number of bacterial infections. The similarities in pathophysiology of the JHR and the Septic shock syndrome are discussed, with particular reference to use of the JHR as a potential model for therapeutic agents in the treatment of septic shock.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
3/9. Yersinia septic shock following an autologous transfusion in a pediatric patient.Although the literature on infections transmitted via transfused blood focuses on viruses, yersinia enterocolitica can also cause severe infections in patients receiving transfusions. A 13-year-old patient developed severe sepsis after an autologous blood transfusion contaminated with Y. enterocolitica. The patient was an otherwise healthy female undergoing posterior spinal fusion for congenital scoliosis. Prior to surgery, the patient donated blood for perioperative and postoperative use. A few days before the donation, she had complained of abdominal pain and was experiencing mild diarrhea. The patient received four units of packed red blood cells (PRBCs) during the surgery. Intraoperatively, the patient developed fever up to 103.6 degrees F, became hypotensive requiring epinephrine and dopamine, and developed metabolic acidosis with serum bicarbonate concentration dropping to 16 mmol/l. The surgery team believed the patient was experiencing malignant hyperthermia and attempted to cool patient during the procedure. Postoperatively, the patient was transferred to the pediatric intensive care unit and treated for severe shock of unknown etiology. The patient further developed disseminated intravascular coagulation. The patient received supportive care and was started on ampicillin/sulbactam on postoperative day (POD) one which was changed to clindamycin, ciprofloxacin and tobramycin on POD two when blood cultures grew gram-negative bacilli. On POD three, cultures were identified as Y. enterocolitica and antibiotics were changed to tobramycin and cefotaxime based on susceptibility data. Sequelae of the shock included adult respiratory distress syndrome requiring intubation and a tracheostomy and multiple intracranial hemorrhagic infarcts with subsequent seizure disorder. Due to severe lower extremity ischemia, she required a bilateral below the knee amputation. The cultures of the snippets from the bags of blood transfused to the patient also grew Y. enterocolitica. This case illustrates the importance of considering transfusion related bacterial infections in patients receiving PRBCs. All patients in shock following any type of transfusion may require aggressive antibiotic therapy, until the diagnosis and etiology are known.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
4/9. Reduced febrile response to bacterial infection in anorexia nervosa patients.OBJECTIVE: To report a reduced febrile response to bacterial infections in anorexia nervosa (AN) patients. METHOD: Four cases were obtained from a retrospective review of charts from the St. Paul's Hospital eating disorders Program (Vancouver, canada). The patients had died or had been admitted to the hospital for treatment of a bacterial infection. In addition, one case was obtained from the Royal Prince Alfred Hospital (Sydney, australia). RESULTS: All patients suffered a bacterial infection during the course of AN. None of the patients had a temperature higher than 37 degrees C during the infectious illness. DISCUSSION: The absence of fever in AN may delay the diagnosis of bacterial infection and may be a marker of an impaired immune response. Therefore, alternative methods of investigation are necessary in patients with AN suspected of having a bacterial infection.- - - - - - - - - - ranking = 9keywords = bacterial infection (Clic here for more details about this article) |
5/9. fever, chills, and weakness in a 61-year-old man.A 61-year-old man presented to the emergency department of a community hospital with a 2-week history of fever, chills, and sudden extreme weakness of his right arm and lower extremities. He also had a cough, shortness of breath, nausea, abdominal pain, diarrhea, and myalgia. Though initially alert and cooperative, he quickly became unresponsive. In addition, he had hyponatremia, renal insufficiency, and compromised cardiopulmonary function. He was admitted to the intensive care unit for suspected bacterial infection and was started on broad-spectrum antibiotics. Chest radiograph revealed miliary infiltrates consistent with infectious emboli or metastatic carcinoma. Despite intensive resuscitation, the patient died 36 hours after admission. At autopsy multiple nodular lesions were observed on gross examination of the lungs, perihilar and paratracheal lymph nodes, and liver. Microscopic sections of the lung (Figure 1) and brain (Figures 2 and 3) are shown.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
6/9. Disseminated tuberculosis after renal transplantation. A report of two cases.Disseminated mycobacterial infections occurred in two female renal graft recipients late after transplantation. In the first patient, initially presenting with fever, diagnosis was made at autopsy. Temporary defervescence following antibiotic therapy with ofloxacin possibly contributed to the fatal diagnostic delay. In the second case, body temperature was normal throughout the protracted course of the patient's illness. Her presenting symptom was rapidly increasing ascites, attributed initially to chronic liver disease. These cases demonstrate that tuberculosis remains a serious complication after renal transplantation, in particular due to its sometimes atypical clinical manifestations. Response to antibacterial therapy has to be critically evaluated in order to avoid fatal diagnostic delay.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
7/9. Observations on the rate and mechanism of hemolysis in individuals with Hb Zurich [His E7(63)beta leads to Arg]: II. Thermal denaturation of hemoglobin as a cause of anemia during fever.Individuals with unstable hemoglobins may become more anemic during episodes of intercurrent viral or bacterial infections. Pathophysiologic mechanisms that are responsible for this phenomenon have not been elucidated. Recently we observed a patient with Hb Zurich [His E7(63)beta leads to Arg] whose anemia worsened during a febrile episode characterized by temperatures ranging between 40 degrees and 41 degrees C, splenomegaly, and the appearance of heinz bodies in the circulating erythrocytes. There was no history of self-medication and no drugs were administered during hospitalization. To determine the effect of a 3 degrees to 4 degrees temperature elevation above the physiologic range on the rate and degree of Heinz body formation, normal (Hb A) and Hb Zurich bloods were incubated in vitro at 4 degrees C, 37 degrees C, and 41 degrees C for 3, 6, 12, and 24 hours and stained for two minutes at the end of each incubation period with rhodanile blue. No heinz bodies appeared at 4 degrees C. The rate of Heinz body formation was significantly greater in Hb Zurich than normal blood, both at 37 degrees C and 41 degrees C. These observations suggest that in vivo exposure of red cells to temperatures in the biologic range of fever may contribute to the worsening of anemia that occurs during infections in individuals with unstable hemoglobins. Incubating whole blood at 41 degrees C for three hours and staining with rhodanile blue for two minutes appears to be a simple and effective screening test for Hb Zurich and possibly the other unstable hemoglobins. Also the technique is semi-quantitative and may be useful as a research tool for defining factors altering the in vivo stability of the unstable hemoglobins.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
8/9. Bacterial meningitis after MMR immunisation.Two children developed bacterial meningitis within five days of measles-mumps-rubella (MMR) immunisation. diagnosis was delayed because symptoms were attributed to the vaccine, although both had a raised c-reactive protein. fever or rash within five days of MMR vaccination are unlikely to be due to the vaccine and a raised c-reactive protein suggests bacterial infection.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
9/9. fever, hepatosplenomegaly and pancytopenia in a patient living in the mediterranean region.A 24 year old woman living in the mediterranean region of turkey present with a three-month history of weight loss and irregular fever that was peaking at 40 degrees C with shivering. No definite aetiology could be identified in a local hospital. A bacterial infection had been suspected, but antibiotic therapy, at first with sulbactam-ampicillin and later with azithromycin, had no influence on the fever. physical examination revealed an emaciated patient with fever (39 degrees C), pallor, and hepatosplenomegaly (spleen 9 cm and liver 5 cm palpable below the costal margin). No peripheral lymphadenopathy was present. The laboratory examinations are summarised in the table. Notably, a prominent increase of macrophages containing intracellular micro-organisms (figures 1 and 2) was seen in the bone marrow smears. The same micro-organisms were also identified within the kupffer cells in liver biopsy.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |