1/6. rhodococcus equi infection in transplant recipients: a case of mistaken identity and review of the literature.The incidence of rhodococcus equi infection in solid-organ transplant recipients continues to rise throughout the world. Unfortunately, this opportunistic pathogen is still underestimated and potentially disregarded by physicians and microbiology laboratories due to its morphology on Gram staining. Pulmonary involvement is the most common finding in the immunocompromised host. We report a case of a 63-year-old heart-transplant recipient who presented with increasing fatigue and nonproductive cough for 3 weeks. After full evaluation, a lung abscess was demonstrated by thoracic computerized tomography (CT). blood and sputum cultures were remarkable for heavy "diphtheroids." Although the Gram-stain result was initially interpreted as a contaminant, a clinical suspicion for Rhodococcus assisted in further investigation. Broncheoalveolar lavage and CT-guided biopsy of the lung abscess revealed heavy growth of diphtheroids. However, further evaluation by a reference laboratory demonstrated mycolic acid staining consistent with R. equi. Surgical drainage and prolonged antibiotic therapy resulted in complete remission of the pneumonia and abscess. This represents the fourth reported case of R. equi infection in a heart transplant recipient. It is imperative that all physicians and laboratory staff consider R. equi when an immunocompromised patient has any type of pneumonia, especially with abscess formation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. clindamycin in the treatment of anaerobic lung abscess.A case of anaerobic lung abscess who had treatment failure after 4 weeks of supervised parenteral penicillin and oral metronidazole is described. Anaerobic pathogens resistant to one or the other of the above drugs were isolated. The patient had a striking clinical response to subsequent therapy with oral clindamycin. Failure of therapy should alert physicians to the possibility of infection with resistant anaerobic pathogens and in such situations, clindamycin is considered as an effective alternative.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/6. Percutaneous interventional catheter therapy for lesions of the chest and lungs.Percutaneous, nonsurgical interventions using angiographic catheter techniques and radiologic guidance were used in the management of seven cases of various lesions of the chest and lungs. Successful catheter therapy included the embolization of a large, acquired, postinflammatory vascular malformation causing massive hemoptysis and a cavernous hemangioma of the chest wall. Sixteen pulmonary arteriovenous fistulas (one patient), an iatrogenic internal mammary artery-to-innominate vein fistula, and a persistent, postbiopsy bronchopleural fistula were successfully closed. Percutaneous drainage of a pyogenic lung abscess and the nonoperative retrieval of an intravascular foreign body that had embolized to the left pulmonary artery were also successfully achieved. Performed under local anesthesia with minimal morbidity, stress, and risk, interventional catheter therapy is remarkably cost-effective. Primary chest physicians are encouraged to consider this mode of therapy whenever applicable.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/6. Multiple microaerophilic streptococcal lung abscesses after orthodontic treatment.An immunocompetent 12-year-old boy developed multiple microaerophilic streptococcal lung abscesses after application of orthodontic bands ("braces"). The dental work was done in the supine position. The data suggest that the patient aspirated the organisms and, possibly, flecks of dental cement, during orthodontic treatment. "rubber dams" should be used to help prevent aspiration in children who receive dental work in the supine position. When a rubber dam cannot be used, as with orthodontic treatment, physicians should advise patients who are at risk for developing pulmonary infection (eg, patients with neuromuscular diseases which compromise cough and/or gag, cystic fibrosis, sickle cell anemia, primary immunodeficiency, etc) to have this dental work, including orthodontic treatment, performed in the erect position.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/6. lemierre syndrome: postanginal sepsis.BACKGROUND: lemierre syndrome, or postanginal sepsis, was first described in the early part of this century and is characterized by pharyngitis, followed by high fever and rigors, cervical adenopathy, thrombophlebitis of the internal jugular vein, distant abscess formation, and icterus, associated with isolation of fusobacterium necrophorum from blood. methods: This report describes a case of postanginal sepsis and reviews the medical literature on postanginal sepsis obtained through the medline data base using Fusobacterium as the key search word. RESULTS: The features of lemierre syndrome have changed little since the original description, through the prognosis has improved dramatically since the development of antibiotics. Appropriate management includes prompt administration of an antibiotic with good anaerobic coverage, drainage of persistent abscesses, and continued antibiotic therapy until radiographic resolution of abscess is achieved. CONCLUSIONS: Although lemierre syndrome is a relatively uncommon disease, the primary care physician needs to be aware of the clinical features and management to treat appropriately.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/6. Transtracheal drainage of lung abscesses in children.Experience with three patients with primary lung abscesses indicates that transtracheal catheter drainage of lung abscesses is a safe and beneficial procedure in childhood. The ability to drain abscesses not easily reached percutaneously will promote emptying and collapse of the abscess and provide bacteriological information which will enable the physician to select the correct antibiotics.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |