1/9. Rapidly fatal Haemophilus influenzae serotype f sepsis in a healthy child.A previously healthy 4-year-old child became acutely ill with vomiting and low-grade fever. The following day she suddenly became limp and unresponsive. She experienced acute septic shock and despite aggressive treatment died. blood cultures grew ampicillin-resistant Haemophilus influenzae type f. There was no evidence of bacterial pneumonia or meningitis. To our knowledge, this represents the first case of fatal H. influenzae type f sepsis in a child without an identifiable focus or underlying predisposing condition. Despite the overwhelming success of the H. influenzae type b vaccine, physicians need to be aware of the potential for severe and fatal H. influenzae infections other than type b.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Paediatric acute epiglottitis re-visited.INTRODUCTION: Paediatric acute epiglottitis is rare in asia. The National University Hospital in singapore has seen only two cases of paediatric acute epiglottitis in the last 10 years. The topic is re-visited here to remind physicians of its acutely dramatic progression. CLINICAL PICTURE: Both boys presented with a viral prodrome which progressed within hours to life-threatening upper airway obstruction. Examination revealed an inflamed epiglottitis. Treatment: They were successfully intubated and treated with intravenous antibiotics. OUTCOME: Both recovered uneventfully. CONCLUSION: Paediatric acute epiglottitis has declined markedly in the West with widespread vaccination against HiB. In contrast, the incidence of invasive HiB disease in asia has always been low despite limited vaccination. Clinicians must remain vigilant of the possibility of acute epiglottitis in a child with "flu".- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Haemophilus influenzae infections in adults: report of nine cases and a review of the literature.Haemophilus influenzae is an aerobic pleomorphic gram-negative coccobacillus that requires both X and V factors for growth. It grows poorly, if at all, on ordinary blood agar unless streaked with Staph. aureus. It grows well on chocolate agar. Because this medium is often not used in culturing specimens from adults and because the organism may be overgrown by other bacteria, the frequency of H. influenzae infections has undoubtedly been seriously underestimated. This is aggravated by the failure of many physicians to obtain blood cultures in suspected bacterial infections and the failure of many laboratories to subculture them routinely onto chocolate agar. H. influenzae, along with streptococcus pneumoniae, is a major factor in acute sinusitis. It is probably the most frequent etiologic agent of acute epiglottitis. It is probably a common, but commonly unrecognized, cause of bacterial pneumonia, where it has a distinctive appearance on Gram stain. It is unusual in adult meningitis, but should particularly be considered in alcoholics; in those with recent or remote head trauma, especially with cerebrospinal fluid rhinorrhea; in patients with splenectomies and those with primary or secondary hypogammaglobulinemia. It may rarely cause a wide variety of other infections in adults, including purulent pericarditis, endocarditis, septic arthritis, obstetrical and gynecologic infections, urinary and biliary tract infections, and cellulitis. Antimicrobial susceptibility testing is somewhat capricious in part from the marked effect of inoculum size in some circumstances. in vitro and in vivo results support the use of ampicillin, unless the organism produces beta-lactamase. Alternatives in minor infections include tetracycline, erythromycin, and sulfamethoxazole-trimethoprim. For serious infections chloramphenicol is the best choice if the organism is ampicillin-resistant or the patient is penicillin-allergic.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. An office laboratory panel to assess vaginal problems.In determining the cause of vaginal complaints, the routine use of four simple tests ("the vagina panel") enables the physician to identify pathogens (candida, gardnerella, trichomonas), pathologic processes (inflammation, estrogen deficiency) and, in most instances, a healthy vagina. time and money are saved. The specimens can be collected in one minute during a pelvic examination. The panel can provide the answers to eight essential questions in two minutes of observer time, with supplies costing about $2.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. Haemophilus influenzae sepsis leading to pericarditis despite antimicrobial therapy.Acute purulent pericarditis is a well-recognized, though infrequently seen, manifestation of systemic haemophilus influenzae type b disease. We recently studied two pediatric patients who developed signs of this septic complication during appropriate antibiotic treatment for bacteremia. These case reports should alert physicians to the possibility that pericarditis may become clinically evident in patients with systemic H. influenzae infections many days after initiation of appropriate therapy. The pathophysiology, diagnostic modalities and therapy are briefly reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. Acute epiglottitis in adults: experience with fifteen cases.Fifteen adults with acute epiglottitis are discussed. Three required tracheostomy because of delayed diagnosis. There were no deaths. epiglottitis occurs more often in adults than is generally recognized. The early symptoms of epiglottitis in adults are sore throat and dysphagia. Any patient with acute, painful dysphagia should have indirect laryngoscopy to rule out epiglottitis. Throat and blood cultures were obtained from 14 of our cases. Cultures from only two patients were positive for Hemophilus influenzae, type B; cultures from the other 12 patients did not grow any bacterial pathogens. The primary treatment of adult epiglottitis is intravenous steroids, antibiotics, and humidified oxygen. observation by the managing physician is mandatory during the first four hours of treatment. tracheostomy is indicated in progressive disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Hemophilus influenzae pharyngitis and cellulitis in adults.Hemophilus influenzae infections in adults are becoming more common but are often unsuspected in this age group by the primary care physician. Two case reports illustrate pharyngitis, and pharyngitis associated with cellulitis of the neck, in which H influenzae was cultured from the blood. The throat and skin are only two of the many sites for H influenzae infections in adults. As no physical signs are pathognomonic for this organism, its possible role should influence the choice of antibiotics while awaiting culture results. Newer cephalosporins, especially cefamandole and cefoxitin, appear promising in the treatment of these infections.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. Unique case presentations of acute epiglottic swelling and a protocol for acute airway compromise.Acute epiglottitis is a well-described life-threatening disease. Since the generalized use of the haemophilus influenzae type b (HIB) vaccine, presentations of this disorder have decreased dramatically in children. Presentations of this and other acute epiglottic swelling can vary remarkably and may easily be misdiagnosed by physicians who have little or no experience with the acutely obstructed airway. Early suspicion and a proper evaluation is mandatory to prevent a life-threatening crisis. Six patients are presented with unusual presentations of acute epiglottic swelling from differing etiologies; these include the following: case 1, recurrent epiglottitis; case 2, chronic epiglottitis; case 3, traumatic epiglottitis; case 4, caustic ingestion; and cases 5 and 6, simultaneous infection of family members. Because the incidence of acute epiglottitis is decreasing, it has become rare at most institutions. To help primary care and emergency room physicians, a formal written protocol should be available at medical facilities that might be faced with patients presenting with acute airway obstruction. An "acute airway obstruction protocol" used successfully for the last decade is offered. Use of such a written document might be life-saving for patients with impending upper airway obstruction. The otolaryngologist is a key member of the recommended multidisciplinary team.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
9/9. Haemophilus segnis cholecystitis: a case report and literature review.Haemophilus segnis is a normal commensal of the human oropharynx which is occasionally associated with appendicitis, endocarditis or pancreatic abscess. Haemophilus segnis in the gall-bladder from a 58-year-old white female was recently encountered. The patient recovered from surgery without incident. This case is reported because the gall-bladder is now another site which has become infected with this organism. In order to provide guidance to physicians when H. segnis organism is identified, microbiologists should be aware of its behaviour in different sites.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |