1/5. Nosocomial meningococcemia in a physician.We report the case of a pediatrician who developed meningococcal meningitis after performing endotracheal intubation without protection on a child who was suspected of having meningoencephalitis. This case emphasizes the necessity for healthcare workers who perform high-risk procedures to use personal protection devices (i.e., respirators and protective goggles). Unprotected healthcare workers with high exposure to neisseria meningitidis should receive chemoprophylaxis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. The varied clinical presentations of meningococcal infection.The clinical presentation of neisseria meningitidis may include bacteremia, septic shock, or meningitis. The polysaccharide capsule of the organism appears to be the major determinant and is necessary for specific immunity. Colonization of the nasopharynx is required for invasion, and persons with complement component deficiencies are particularly at risk of infection. The organism can be detected by culture of blood or spinal fluid, or by antigen detection in spinal fluid. Prompt therapy with penicillin g is necessary for a good outcome. The occurrence of secondary cases requires that prophylactic therapy be administered to close contacts of index cases. The cases presented herein illustrate a variety of manifestations of meningococcal infection, and all of the patients initially were seen in primary care settings. It is important for physicians to be vigilant for these infections so that appropriate therapy may be instituted rapidly.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
3/5. Increased risk of neisserial infections in systemic lupus erythematosus.survival in systemic lupus erythamatosus (SLE) continues to improve because of better ancillary care, earlier diagnosis, and earlier treatment. However, infection remains a leading cause of morbidity and mortality in this disease. Although corticosteroids and immunosuppresives increase the risk of opportunistic infection, the SLE patient is still most at risk from common bacterial pathogens. As the prototypic immune-complex disease, patients with active SLE have low circulating complement as well as a reticuloendothelial system (RES) saturated with immune complexes. It seems intuitive that SLE patients should be most at risk for organisms dependent for their removal on the RES or complement for opsonization or bacteriolysis. The current series presents four patients with SLE and disseminated neisseria infection and brings to 14 the number of patients in the literature with disseminated neisserial infection. They are typically young, female, with renal disease, and either congenital or acquired hypocomplementemia, and may present with all features of a lupus flare. Surprisingly, they are not all on corticosteroids or immunosuppressives and have some features that are unusual for non-SLE patients with these infections. There seems to be an over-representation of Nisseria meningitidis (despite potential reporting bias), and there ironically may be better tolerance with fewer fulminant complications in patients who have complement deficiencies. The best approach for the physician treating SLE is to immunize all SLE patients with available bacterial vaccines to N meningitidis and streptococcus pneumonia, have a low threshold of suspicion for the diagnosis of disseminated neisserial or other encapsulated bacterial infection in the SLE patient who is sick, and to treat empirically with third generation cephalosporins after appropriate cultures.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
4/5. Meningococcal meningitis with a benign skin rash.A skin eruption may be one of the early clues to meningococcal meningitis. We treated a boy with meningococcal disease accompanied by an exanthemlike eruption. Although the skin lesions in meningococcal meningitis are traditionally described as petechial, purpuric, or ecchymotic, the absence of these findings should not deter the physician from a clinical suspicion of this potentially fatal infection.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
5/5. superinfection: another look.superinfection in the compromised host often poses a diagnostic and therapeutic dilemma for the physician who is concerned that a perplexing array of microorganisms might be involved. We believe that the differential diagnosis list can often be narrowed considerably by separating superinfection in the compromised host into five convenient categories: (1) infections due to the underlying disease itself; (2) infections due to the underlying disease plus therapy for that disease; (3) infections due solely to medicaments, operations, or procedures; (4) infections increased in severity but probably not in incidence; and (5) societally related infections. Use of this or a similar categorization should result in a more rational approach to differential diagnosis, should encourage a more focused diagnostic work-up, whould reduce the necessity for invasive procedures, should provide the microbiology laboratory information about specific organisms that should be sought sedulously, and should permit the selection of a more rational antimicrobial regimen prior to the availability of definitive microbiologic information.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |