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1/293. Systemic lupus erythematosus complicated by necrotizing fasciitis.

    A case of necrotizing fasciitis (NF) is described in a 46-year-old woman with recent onset systemic lupus erythematosus (SLE). Deep-tissue infections are more common in SLE patients on high-dose corticosteroids, but, to our knowledge, this is the second case described in association with SLE. Although NF may initially be difficult to diagnose, the presence of marked systemic symptoms out of proportion to the local findings should suggest the correct diagnosis. NF diagnostic criteria, treatment and prognosis are discussed.
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ranking = 1
keywords = infection
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2/293. Propionibacterium as a cause of postneurosurgical infection in patients with dural allografts: report of three cases.

    OBJECTIVE AND IMPORTANCE: Although propionibacterium acnes is a common inhabitant of human skin, it is an uncommon pathogen in postoperative infections. We report three cases of postoperative wound infection/osteomyelitis caused by P. acnes. CLINICAL PRESENTATION: Three patients underwent craniotomy for a supratentorial meningioma and had a dural allograft at the time of closure. The patients presented several weeks after surgery with clinical evidence of a wound infection. INTERVENTION: All patients were diagnosed with P. acnes infection and treated for this pathogen with appropriate antibiotics. The bone flap was removed in two patients. After antibiotic therapy, all patients demonstrated no further evidence of infection. CONCLUSION: To our knowledge, this is the first published report of P. acnes infection in patients with a dural substitute. The source of infection cannot be confidently ascertained; however, two patients had strains of P. acnes from one brand of graft, which were indistinguishable by pulsed field gel electrophoresis typing.
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ranking = 11
keywords = infection
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3/293. Destructive knee joint infection caused by peptostreptococcus micros: importance of early microbiological diagnosis.

    peptostreptococcus micros is a commensal of the oral cavity and the genitourinary tract that rarely causes serious infections. A case of a destructive knee joint infection with rapid progress caused by P. micros is presented. The significance of the microbiological findings was initially not acknowledged, which contributed to a nonsuccessful clinical outcome.
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ranking = 6
keywords = infection
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4/293. Bacterial complications of strongyloidiasis: streptococcus bovis meningitis.

    We report the case of a 64-year-old veteran who had streptococcus bovis meningitis as a result of a long latent strongyloides infection that became acute when he was treated with prednisone. We reviewed 38 reported cases of serious bacterial infections associated with strongyloidiasis. Patients most frequently had nonspecific gastrointestinal symptoms. Of these 38 patients, 21 (55%) had meningitis, and 28 (73%) had bacteremia that was polymicrobial in 3 cases (8%). Other sites of infection included lung, bone marrow, ascites, mitral valve, and lymph node. Most infections were due to enteric gram-negative bacteria. There is one previously reported case of S bovis meningitis. Thirty-four of the patients (89%) were immunosuppressed; 21 of these (55%) were taking pharmacologic doses of adrenal corticosteroids. Thirty-three of the 38 (87%) patients died. Patients with enteric bacterial infection without an obvious cause should be tested for the presence of strongyloidiasis.
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ranking = 5.0487483064565
keywords = infection, bacterial infection
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5/293. Clones of lactobacillus casei and Torulopsis glabrata associated with recurrent abdominal wall abscess.

    Infectious disease caused by Lactobacillus sp has not been previously reported in taiwan. We present a case of recurrent abdominal wall abscess in a chronically ill 36-year-old woman, and review the literature on Lactobacillus infection. Five isolates of L. casei were recovered from blood and pus samples, and two isolates of Torulopsis glabrata were isolated from two blood specimens 3 months apart. Two clones of L. casei and T. glabrata were identified by means of antibiotyping with the E test and molecular methods. The abscess was surgically removed because of poor response to 7 months of antimicrobial therapy for the second infectious episode. Recurrent Lactobacillus infection can occur in chronically ill or immunosuppressed patients. Treatment of these infections may require a longer duration of antibiotic therapy, or surgical intervention.
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ranking = 3
keywords = infection
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6/293. Three cases of serious infection caused by aerococcus urinae.

    Three cases of serious infection caused by aerococcus urinae are presented: a patient with endocarditis and two patients with soft-tissue infection (phlegmon and balanitis respectively). The literature on aerococcus urinae infections is reviewed and the antibiotic therapy discussed. aerococcus urinae is a pathogen isolated primarily from urine specimens of elderly patients with local or systemic predisposing conditions. Most infections are mild, but serious infections such as endocarditis and septicemia/urosepsis have been described. Penicillin or ampicillin in combination with an aminoglycoside and close monitoring of the patient's clinical status and laboratory results would seem to be the best strategy for management of cases of serious infection.
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ranking = 10
keywords = infection
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7/293. Outcome of a screening program for vancomycin-resistant enterococci in a hospital in victoria.

    OBJECTIVE: To screen for faecal colonisation with vancomycin-resistant enterococci (VRE) among potentially at-risk patients. DESIGN: infection control screening program. SETTING: Monash Medical Centre (a tertiary care hospital), Melbourne, victoria, in the seven months from June 1997. PATIENTS: Patients in the Renal, Oncology and intensive care (ICU) Units. MAIN OUTCOME MEASURES: Presence of VRE in a rectal swab or faecal specimen taken at admission and at regular intervals during inpatient stay; presence of vancomycin-resistance genes (vanA, vanB and vanC) assessed by polymerase chain reaction (PCR); genetic clonality of isolates assessed by pulsed-field gel electrophoresis (PFGE). RESULTS: 574 patients (356 renal, 134 ICU and 84 oncology) were screened; 12 were colonised with VRE--nine renal inpatients, two having peritoneal dialysis or incentre haemodialysis, and one ICU patient. Nine isolates were enterococcus faecalis (seven positive for vanB and two negative for all three resistance genes) and three were enterococcus faecium (all positive for vanB). Eight were high-level gentamicin resistant. PFGE suggested genetic clonality between the index isolate and five other isolates from renal patients. No specific clinical practice was associated with VRE colonisation. Attempts to clear rectal carriage with oral ampicillin/amoxycillin or bacitracin were of limited success. Although antibiotic prescribing in the Renal Unit was generally consistent with defined protocols, use of vancomycin and third-generation cephalosporins has been further restricted. CONCLUSIONS: Renal inpatients in our institution appear most at risk of VRE colonisation (4.6% overall) and therefore of VRE infection. Routine screening, especially of potentially high-risk patients, should be considered in major Australian hospitals.
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ranking = 1
keywords = infection
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8/293. Septic shock after liver transplantation for Caroli's disease: clinical improvement after treatment with C1-esterase inhibitor.

    The extent of complement and contact activation is related to outcome in sepsis. A low functional index of their main blocker C1-esterase inhibitor (C1-INH) is considered as a relative deficiency of C1-INH and might contribute to the development of fatal complications in the intensive care unit. The first results of therapeutic intervention with C1-INH concentrate in septic shock are promising. We report on our experience of C1-INH concentrate administration in a young woman with Caroli's disease as ultimate rescue therapy for septic shock with capillary leakage syndrome after combined liver and kidney transplantation. No focus of infection was detectable and thus surgical intervention was not indicated. Antibiotic therapy at that time included vancomycin, tobramycin, meropenem and fluconazol. Hemodynamic stabilization occurred within hours after administration of C1-INH concentrate. Simultaneously a reduction in vasopressor medication was possible and negative fluid balance was achieved.
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ranking = 1
keywords = infection
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9/293. leuconostoc species: a case-cluster hospital infection.

    leuconostoc species are members of the Streptococcacae family. They are generally regarded as non-pathogenic culture contaminants and are thought to be an uncommon cause of infection. We present a study of a case-cluster nosocomial infection due to leuconostoc spp. Three patients were hospitalized at the time of the infection with significant underlying diseases and all had a compromised skin and mucous barriers. Two had received previous antibiotic therapy. This report highlights the importance of leuconostoc spp. as an emerging pathogen, even though the modes of transmission and reservoirs of leuconostoc spp. are as yet unknown.
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ranking = 7
keywords = infection
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10/293. Isolation of beta-lactamase positive vancomycin resistant enterococcus faecalis; first case in australia.

    An increasing number of clinical isolates of vancomycin resistant enterococci (VRE) have been reported in the literature since 1988. Only a few cases of beta-lactamase producing VRE have been described worldwide. This article reports the first case of beta-lactamase positive VRE in australia. This strain of enterococcus faecalis was isolated from a patient with non-Hodgkin's lymphoma who subsequently underwent a bone marrow transplant. Screening of all ward contacts did not detect any further case of beta-lactamase producing VRE. With the development of multiple antibiotic resistance in enterococci, additional infection surveillance protocols have been implemented in the hospital. These include routine screening of 'at risk' patients, instigating relevant infection control measures for management of VRE positive patients and controlling the usage of vancomycin in order to limit the development of resistant isolates.
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ranking = 2
keywords = infection
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