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1/330. flavobacterium meningosepticum sepsis in an infant with a diarrheal prodrome.

    A full term, previously normal 2 1/2-month-old black boy was transferred to our hospital from an outlying facility on hospital day 5 for failure to thrive. Three weeks before transfer, the infant was hospitalized for a diarrheal illness with fever. The baby received 3 days of ceftriaxone empirically and was discharged home after the sepsis evaluation was negative. Mild diarrhea and steady weight loss continued and the baby was readmitted. blood culture done on admission grew flavobacterium meningosepticum, an organism previously described as an uncommon cause of sepsis in neonates and immunocompromised individuals. As it is water-borne, it has been associated with infection via contaminated water. This organism is usually resistant to antibiotics commonly used for empiric treatment. To our knowledge, this is the first reported case of flavobacterium bacteremia associated with a prodromal and concurrent diarrheal illness.
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2/330. ochrobactrum anthropi bacteremia.

    ochrobactrum anthropi (O. anthropi ), formerly known as achromobacter CDC group Vd, is a gram-negative bacillus that is aerobic, oxidase producing, and nonlactose fermenting. This organism has been found in environmental and hospital water sources and has pathogenic potential in humans. Most reports in the literature of O. anthropi bacteremia are associated with intravenous line infections. We describe a case of bacteremia with O. anthropi in a 33-month-old boy with acute osteomyelitis. O. anthropi bacteremia also has been reported in immunocompromised hosts. Rarely, O. anthropi has been a cause of soft tissue or bone infection.
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3/330. Fulminant infection by uncommon organisms in animal bite wounds.

    In 1995 and 1996, 215 patients exposed to different species of animals were treated at the Amarnath Polyclinic, Balasore, in india. Among them were two children infected by uncommon organisms, i.e., capnocytophaga canimorsus and pasteurella multocida; the patients recovered with appropriate antibiotic therapy.
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4/330. chorioamnionitis with intact membranes caused by capnocytophaga sputigena.

    We report a case of chorioamnionitis with intact membranes caused by capnocytophaga sputigena. The pregnant woman was hospitalised in preterm labor without fever, neither tenderness, just regular contractions. In spite of the tocolitic treatment the patient gave birth to a girl at 29 weeks' gestation, weighing 1220 g and transferred to intensive care. The newborn had clinical and biological signs of infections and was initially treated by ampicillin, cephalosporin and metronidazol. capnocytophaga sputigena was found on membranes, cord, amniotic fluid and placenta. It was also identified in maternal endocervix culture. Histologic findings showed a focal chorioamnionitis. This was the fourteenth reported case of infection due to capnocytophaga species occurring in pregnancy. All the cases are reviewed.
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5/330. Two cases of chromobacterium violaceum infection after injury in a subtropical region.

    chromobacterium violaceum is a gram-negative rod and is isolated from soil and water in tropical and subtropical regions. The species have pigmented and nonpigmented colony types. Infections caused by nonpigmented strains are rare. We report on two cases of infection caused by both pigmented and nonpigmented strains of C. violaceum. Two 24-year-old korea Airline stewardesses were admitted to Inha University Hospital, Inchon, South korea, on 9 August 1997, 3 days after an airplane accident in guam. Both had multiple lacerations on exposed parts of their bodies. There was swelling, tenderness, and pus discharge. The wounds contained many small fragments of stones and weeds. A pigmented strain was isolated from the left hand and a nonpigmented strain was isolated from the left knee of one patient. For the other patient only a nonpigmented strain was isolated from a foot wound. The nonpigmented colonies from the left-knee and the left-foot wounds did not produce any pigment even after an extended period of incubation. The biochemical characteristics were the same for each strain except for oxidase and indole reactions. The pigmented strain was oxidase negative and indole positive, whereas the nonpigmented strains were oxidase positive and indole negative. The patients were successfully treated by debridement and with appropriate antibiotics.
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6/330. Arterial homografts in the management of infected axillofemoral prosthetic grafts.

    Two lower limb amputees with infected contralateral axillofemoral prosthetic grafts received preserved human arteries after removal of the infected materials. Both grafts grew organisms (enterococcus species, plus staphylococcus species in one). Long length arterial conduits were fashioned from freshly harvested (in one patient) and cryopreserved (in another one) cadaveric iliac and femoral arteries. One arterial homograft had ABO-compatibility with the recipient. No immunosuppressive drugs were administered after repeat arterial reconstructions. After 12 and 15 months both grafts are still patent, without parietal changes at ultrasonography; the patients have a viable remaining lower extremity and are free of symptoms or re-infection.
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7/330. Retroperitoneoscopic management of infected cysts in adult polycystic kidney disease.

    Conservative measures are the mainstay of therapy in adult polycystic kidney disease (APKD). Pain, infection and obstructive uropathy are the major indications for intervention. chronic pain has been treated with narcotic analgesics, needle aspiration of dominant cysts, and open renal cyst decortication. Laparoscopic cyst decortication, by either transperitoneal or retroperitoneal access, is a new emerging option with similar efficacy to open surgery and less morbidity. Cyst infection in these patients responds poorly to commonly used antibiotics. patients with refractory cyst infection may even require nephrectomy. Herein, we present 2 cases with APKD that were treated by retroperitoneoscopic decortication for painful and infected cysts. Both patients showed prompt and sustained improvement in symptoms, with minimal morbidity and short convalescence. This approach has not hitherto been described for infected cysts in APKD. The retroperitoneoscopic route should be preferred in the presence of infected cysts so as to prevent intraperitoneal contamination.
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ranking = 3
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8/330. Second-trimester abortion caused by capnocytophaga sputigena: case report.

    Intra-amniotic infection is often the cause of a second-trimester abortion. The bacterial species involved include bacteria with low pathogenicity like ureaplasma urealyticum and various mycoplasma species. In this case we describe an intra-amniotic infection caused by capnocytophaga sputigena, often found in the normal bacterial flora of the oral cavity, but not in the vagina. Oral sex during pregnancy was the most probable source of the infection. The aborted fetus showed signs of pneumonia upon histologic examination. The bacterial species was identified using broad-spectrum 16S rDNA polymerase chain reaction (PCR) directly from the amniotic fluid and after bacterial culture. amniotic fluid glucose was below detection level, confirming the presence of an intra-amniotic infection.
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ranking = 4
keywords = infection
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9/330. aeromonas sobria infection with severe soft tissue damage and segmental necrotizing gastroenteritis in a patient with alcoholic liver cirrhosis.

    A 49-year-old man, who had a 3-year history of liver dysfunction but had not been treated, was admitted to the hospital with a sudden onset of fever and generalized muscle pain. He subsequently developed generalized purpura with scattered hemorrhagic bullae of the skin and massive bloody stools. aeromonas sobria was proven by culture of both blood and bullous fluid. In spite of the extensive treatment with antibiotics and other medications in the intensive care unit (ICU), the patient went into septic shock and died 2 days after admission. Pathological examination on autopsy revealed segmental necrotizing gastroenteritis with bacterial colonies and alcoholic liver cirrhosis, in addition to extensive severe soft tissue damage involving cellulitis and rhabdomyolysis and epidermolysis. Although the prognosis for vibrio vulnificus infection with severe soft tissue damage in patients with liver cirrhosis, malignancy, diabetes mellitus or other pre-existing diseases is poor, the unfavorable progression of aeromonas species, especially A. sobria infection is rare. This is thought to be the first report of an autopsied case.
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ranking = 6
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10/330. stenotrophomonas maltophilia: an increasing problem in patients with acute leukaemia.

    stenotrophomonas maltophilia (previously pseudomonas maltophilia and xanthomonas maltophilia) is an increasing problem as an opportunistic pathogen in immunocompromised patients such as those with acute leukaemia. infection is difficult to treat and eradicate due to its inherent and quickly acquired resistance to many antibiotics. Presentation with unusual cutaneous lesions is not uncommon and can present diagnostic difficulties. We present two cases which highlight the classical features of this infection in leukaemic patients, and discuss the need for early antibiotic treatment with regimens including cotrimoxazole, and the consideration of prompt central venous catheter removal.
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