1/36. Emerging gram-negative pathogens in the immunocompromised host: agrobacterium radiobacter septicemia during hiv disease.Three out of 2,412 consecutive hiv-infected patients hospitalized since 1990, developed agrobacterium radiobacter septicemia. All patients were severely immunocompromised, showing a prior diagnosis of AIDS, concurrent opportunistic infections, a mean CD4 lymphocyte count below 100 cells/microL, and neutropenia. Nosocomial A. radiobacter sepsis occurred in two cases of three, and was related to a lower neutrophil and CD4 cell count. Antibiotic and cotrimoxazole treatment were carried out during the month preceding disease onset by two and three patients, respectively. Antimicrobial susceptibility assays showed resistance to ureidopenicillins and aztreonam, and complete sensitivity to carbapenems, amikacin, and ciprofloxacin. A therapeutic regimen including amikacin plus ceftriaxone or ceftazidime obtained clinical and microbiological cure in all cases, in the absence of related mortality or relapses. Only two episodes of hiv-associated A. radiobacter complications have been described to date: one case of sepsis and one patient with pneumonia. Despite their low frequency, gram-negative non-fermenting bacilli should be considered in hiv-infected patients with a suspected bacterial complication, because of their cumbersome identification procedures, and their unpredictable antibiotic susceptibility, with elevated resistance to many compounds expected to be effective against gram-negative organisms. A. radiobacter may play a pathogenic role in patients with advanced hiv disease, even when some commonly recognized risk factors are lacking (in-dwelling catheters and instrumentation), while a very low CD4 lymphocyte count, leukopenia-neutropenia, hospitalization, and concurrent AIDS-related infectious complications, may act as predisposing factors.- - - - - - - - - - ranking = 1keywords = sensitivity (Clic here for more details about this article) |
2/36. Substituting dexamethasone for prednisone complicates remission induction in children with acute lymphoblastic leukemia.BACKGROUND: The authors report the occurrence of fatal or near-fatal sepsis in 16 of 38 children with newly diagnosed acute lymphoblastic leukemia (ALL) treated with a new induction regimen that differed from its predecessor by the substitution of dexamethasone for prednisone. methods: The frequency of septic deaths among 38 children who received multiagent remission induction therapy, including dexamethasone (6 mg/m(2)) daily for 28 days (pilot protocol 91-01P), was compared with the frequency of septic deaths among children previously treated (protocol 87-01) and subsequently treated (protocol 91-01) in consecutive Dana-Farber Cancer Institute (DFCI) ALL trials with induction therapy that included 21 and 28 days of prednisone (40 mg/m(2)), respectively. Except for dexamethasone in protocol 91-01P, the remission induction agents used were identical in substance to those used in protocol 87-01. Protocol 91-01, the successor 91-01P, was also similar, with the exception of the deletion of a single dose of L-asparaginase. RESULTS: Sixteen of the 38 children (42%) treated on the DFCI 91-01P had documented gram positive or gram negative sepsis (17 episodes) during remission induction, including 4 toxic deaths (11%). In contrast, there were 4 induction deaths among 369 children (1%) treated on protocol 87-01 (P = 0.0035) and 1 induction death among 377 children (<1%) treated on protocol 91-01 (P = 0.0003). CONCLUSIONS: Substitution of dexamethasone for prednisone or methylprednisolone in an otherwise intensive conventional induction regimen for previously untreated children with ALL resulted in an alarmingly high incidence of septic episodes and toxic deaths. awareness of this complication, considering that the substitution has no apparent benefit in the efficacy of remission induction, argues against its routine use in intensive induction regimens for children with ALL.- - - - - - - - - - ranking = 0.0054798169766606keywords = contrast (Clic here for more details about this article) |
3/36. stenotrophomonas maltophilia endophthalmitis after intraocular lens implantation.BACKGROUND: stenotrophomonas maltophilia is an opportunistic, gram-negative bacillus. endophthalmitis induced by S. maltophilia has been described in only two cases after intraocular lens implantation. We report S. maltophilia endophthalmitis in two patients with diabetes mellitus after intraocular lens implantation and compare the characteristics of the S. maltophilia-induced endophthalmitis with two previous cases. methods: A 68-year-old woman and a 74-year-old man with diabetes mellitus developed S. maltophilia endophthalmitis within 5 days of intraocular lens implantation. We performed intraocular lens removal and vitrectomy, which resolved the inflammation. No recurrences were found. RESULTS: Cultures grew S. maltophilia in both cases, and one of the organisms was multi-resistant. The final visual acuity was counting fingers and 0.3. The first case revealed a tractional retinal detachment during vitrectomy. CONCLUSIONS: S. maltophilia is a potential opportunistic intraocular pathogen, and the incidence of multiresistant S. maltophilia is increasing. S. maltophilia causes acute endophthalmitis, and its prognosis may not be poor unless the eye has a history of serious disease before the cataract surgery. The combined procedure of intraocular lens removal and vitrectomy was useful in resolving the inflammation and preventing recurrences.- - - - - - - - - - ranking = 0.0042370298944244keywords = visual (Clic here for more details about this article) |
4/36. eikenella corrodens prosthetic valve endocarditis in a patient with ulcerative colitis.A 33-y-old male with ulcerative colitis developed prosthetic valve endocarditis (PVE) caused by eikenella corrodens. The outcome of conservative treatment was successful. Only 2 cases of E. corrodens PVE were found in a survey of the English-language medical literature. In contrast to previous data indicating that eikenella infections usually derive from the oral cavity, our patient most likely acquired the infection by colonoscopy and mucosal biopsies, which were performed a few days before onset of the disease.- - - - - - - - - - ranking = 0.0054798169766606keywords = contrast (Clic here for more details about this article) |
5/36. Alcaligenes xylosoxidans and propionibacterium acnes postoperative endophthalmitis in a pseudophakic eye.PURPOSE: To report a case of persistent polymicrobial postoperative endophthalmitis caused by Alcaligenes xylosoxidans and propionibacterium acnes in a pseudophakic eye. A. xylosoxidans is a gram-negative bacteria resistant to most antibiotics. methods: Case report. RESULTS: A 72-year-old man presented with clinical signs of endophthalmitis on the first postoperative day after a phacoemulsification procedure with posterior chamber intraocular lens, left eye. Initial treatment included topical, subconjunctival, and oral antibiotics. After initial clearing, there was recrudescence of infection on postoperative day 37 that prompted referral of the patient to the Cullen eye Institute. Treatment at that time included anterior chamber and vitreous taps with intravitreal antibiotic injections. Complete pars plana vitrectomy and intraocular lens explantation were eventually required because of persistent infection with a resistant organism. Cultures from the first procedure grew A. xylosoxidans and P. acnes. Cultures from the vitrectomy grew only A. xylosoxidans. At the final follow-up visit 6 months after the initial procedure. The eye was without inflammation with best-corrected visual acuity of 20/40. CONCLUSION: Both A. xylosoxidans and P. acnes can cause chronic progressive endophthalmitis after cataract extraction often resistant to corrective antibiotic therapy. Successful intervention may require complete vitrectomy with intraocular lens and capsule removal.- - - - - - - - - - ranking = 0.0042370298944244keywords = visual (Clic here for more details about this article) |
6/36. Recurrent achromobacter xylosoxidans bacteremia associated with persistent lymph node infection in a patient with hyper-immunoglobulin m syndrome.achromobacter xylosoxidans (formerly Alcaligenes xylosoxidans) is a rare but important cause of bacteremia in immunocompromised patients, and strains are usually multiply resistant to antimicrobial therapy. We report an immunocompromised patient with hyper-immunoglobulin m syndrome who suffered from 14 documented episodes of A. xylosoxidans bacteremia. Each episode was treated and resulted in rapid clinical improvement, with blood cultures testing negative for bacteria. Between episodes, A. xylosoxidans was isolated from an excised right axillary lymph node, whereas the culture of the central venous catheter, removed at the same time, was negative. Multiple cultures from sputum, stool, and urine samples, as well as from gastrointestinal biopsies or environmental sources, were negative. Results from antibiotic sensitivity testing and pulsed-field gel electrophoresis suggested that a single strain of A. xylosoxidans caused the recurrent bacteremias in this patient; this strain originated from persistently infected lymph nodes. Lymphoid hyperplasia is a prominent characteristic of hyper-IgM syndrome and may serve as a source of bacteremia with low-pathogenicity organisms.- - - - - - - - - - ranking = 1keywords = sensitivity (Clic here for more details about this article) |
7/36. comamonas acidovorans keratitis in a hydrogel contact lens wearer.PURPOSE: To present an unusual case of keratitis in a patient who wears hydrogel contact lenses that are replaced on a monthly basis. The agent isolated was comamonas acidovorans, a species of pseudomonas. methods AND RESULTS: A 40-year-old patient who wears hydrogel contact lenses that are replaced on a monthly basis presented with a red eye. The patient reported that the eye had been red for 2 days. A peripheral corneal stromal infiltrate was found and comamonas acidovorans was isolated in culture. The patient was initially treated with high-dose gentamicin. After the results of cultures and sensitivity studies were obtained, she was given ciprofloxacin, leading to the remission of the case. CONCLUSIONS: comamonas acidovorans should be considered as a possible agent of keratitis in hydrogel contact lens wearers-a culture and sensitivity studies may be indicated.- - - - - - - - - - ranking = 2keywords = sensitivity (Clic here for more details about this article) |
8/36. Postkeratoplasty endophthalmitis by alcaligenes faecalis: a case report.PURPOSE: To describe a postkeratoplasty endophthalmitis owing to alcaligenes faecalis that resolved with medical management. methods: Case report and review of literature. RESULTS: To best of our knowledge, postkeratoplasty endophthalmitis caused by A. faecalis has not been reported in literature. The source of infection was found to be the donor tissue. The organism isolated was resistant to gentamicin, which was the only antibiotic present in the storage medium (McCarey and Kaufman medium). The patient was treated aggressively with topical, systemic and intravitreal antibiotics. The endophthalmitis resolved completely within two weeks. CONCLUSION: A. faecalis is a gram negative, non-spore forming rod that can cause endophthalmitis if donor tissue is contaminated with the organism. Clinical suspicion, review of bacterial culture and sensitivity report from donor tissue, anterior chamber and vitreous taps, along with early therapy with appropriate antibiotics can lead to resolution of infection.- - - - - - - - - - ranking = 1keywords = sensitivity (Clic here for more details about this article) |
9/36. Two cases of stenotrophomonas maltophilia endophthalmitis.Two cases of stenotrophomonas maltophilia endophthalmitis, a rare cause of postoperative endophthalmitis, are reported in this study. Both of the patients underwent vitreus tap and intravitreal antibiotic injection. The therapy was augmented with systemic and subconjunctival injections. The response to this therapy protocol was excellent and the final visual acuity in both of the patients was 10/10. The results are discussed and the literature, which consists of only 8 reported cases of stenotrophomonas maltophilia endophthalmitis, is reviewed. Although endophthalmitis caused by this pathogen is a rare but important cataract surgery complication, with appropriate therapy, this clinical presentation can be cured without risk of reoccurrence.- - - - - - - - - - ranking = 0.0042370298944244keywords = visual (Clic here for more details about this article) |
10/36. capnocytophaga canimorsus endophthalmitis following cataract surgery.An elderly man developed endophthalmitis 1 week after cataract extraction and lens implantation. Intraocular samples were collected and the patient received intravitreal vanco-mycin and ceftazidime, and topical tobramycin. A Gram stain of vitreous humour revealed spindle-shaped Gram-negative bacilli. He was then given systemic clindamycin and topical ofloxacin. capnocytophaga canimorsus, a member of the oral flora of dogs and cats, was cultured after 3 days. The infection resolved leaving the patient with a visual acuity of 6/60. An attempt was made to culture the organism from the mouth of the patient's pet dog. This was unsuccessful and the source of the infection remains unknown.- - - - - - - - - - ranking = 0.0042370298944244keywords = visual (Clic here for more details about this article) |
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