1/5. Increased risk of neisserial infections in systemic lupus erythematosus.survival in systemic lupus erythamatosus (SLE) continues to improve because of better ancillary care, earlier diagnosis, and earlier treatment. However, infection remains a leading cause of morbidity and mortality in this disease. Although corticosteroids and immunosuppresives increase the risk of opportunistic infection, the SLE patient is still most at risk from common bacterial pathogens. As the prototypic immune-complex disease, patients with active SLE have low circulating complement as well as a reticuloendothelial system (RES) saturated with immune complexes. It seems intuitive that SLE patients should be most at risk for organisms dependent for their removal on the RES or complement for opsonization or bacteriolysis. The current series presents four patients with SLE and disseminated neisseria infection and brings to 14 the number of patients in the literature with disseminated neisserial infection. They are typically young, female, with renal disease, and either congenital or acquired hypocomplementemia, and may present with all features of a lupus flare. Surprisingly, they are not all on corticosteroids or immunosuppressives and have some features that are unusual for non-SLE patients with these infections. There seems to be an over-representation of Nisseria meningitidis (despite potential reporting bias), and there ironically may be better tolerance with fewer fulminant complications in patients who have complement deficiencies. The best approach for the physician treating SLE is to immunize all SLE patients with available bacterial vaccines to N meningitidis and streptococcus pneumonia, have a low threshold of suspicion for the diagnosis of disseminated neisserial or other encapsulated bacterial infection in the SLE patient who is sick, and to treat empirically with third generation cephalosporins after appropriate cultures.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. neisseria gonorrhoeae dissemination and gonococcal meningitis.Disseminated infection is a serious complication in approximately 2 percent of primary gonococcal infections. Meningeal infection is very rare; only 23 cases have been reported since 1922. We report a sexually active teenager with an acute febrile illness. From her cerebrospinal fluid cultures, neisseria gonorrhoeae was identified. She recovered completely after treatment with ceftriaxone and penicillin. Possible explanations for gonococcal dissemination include unique strains of the organism as well as particular complement deficiencies of the host. Aggressive efforts by physicians to prevent, identify, and treat primary gonococcal diseases should continue because this will reduce the frequency of serious complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. pelvic inflammatory disease during pregnancy.pelvic inflammatory disease associated with pregnancy is not commonly reported. We present three illustrative cases at ten, 13, and 26 weeks of gestation. Unlike pelvic abscess, which may be discovered at any stage of gestation, acute salpingitis during pregnancy occurs more commonly in the first trimester. Both processes are associated with substantial fetal wastage. diagnosis may be difficult if the obstetrician is not aware that these infections can occur during pregnancy. The diagnosis is often made at laparotomy by a physician expecting appendicitis or another inflammatory condition. Since salpingitis during pregnancy, like salpingitis generally, is amenable to antibiotic therapy, surgery may be avoided if appropriate antibiotic therapy is quickly instituted. The pregnant patient and her fetus may be spared general anesthesia and the attendant risks of abdominal surgery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. Gonococcal conjunctivitis in a four-month-old infant.Classic neonatal gonococcal ophthalmia usually manifests during the first week of life with a purulent ocular discharge accompanied by periorbital edema and erythema. This case report describes a 4-month-old child with chronic but minimal ocular discharge and intermittent mild conjunctival infection who proved to be infected with neisseria gonorrhoeae. This experience emphasizes the need for the physician to evaluate for gonococcal infection any child with conjunctivitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. A case of gonococcal osteomyelitis. A complication of gonococcal arthritis.Gonococcal osteomyelitis is a rare complication of gonococcal infections since the advent of antibiotics. It is important that physicians be aware of this potential complication so that it is recognized and appropriate therapy promptly instituted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |