1/64. purpura fulminans associated with streptococcus pneumoniae infection in a child.BACKGROUND: neisseria meningitidis is the most frequent isolate associated with purpura fulminans in children. Although streptococcus pneumoniae infection has been associated with purpura fulminans, with the exception of one adult, it has only been reported in immunocompromised hosts. PURPOSE: We report an apparently previously healthy child who presented with purpura fulminans associated with pneumococcal meningitis. methods: Case report and review of the medical literature from September 1966 to June 1997, using a medline search. CONCLUSION: While systemic pneumococcal infection is common in childhood, progression to purpura fulminans does not typically occur in overtly healthy children. Our patient illustrates that invasive pneumococcal infection should be considered and empirically treated in a child who presents with purpura fulminans, even in the absence of preexisting functional or anatomic asplenia.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/64. Isolation and characterization of vancomycin-tolerant streptococcus pneumoniae from the cerebrospinal fluid of a patient who developed recrudescent meningitis.The emergence of tolerance to vancomycin has recently been reported in streptococcus pneumoniae, the most common cause of bacterial meningitis. A vancomycin- and cephalosporin-tolerant strain of S. pneumoniae, the Tupelo strain, was isolated from the cerebrospinal fluid of a patient who then developed recrudescence of meningitis despite treatment with vancomycin and a third-generation cephalosporin. The Tupelo strain evidenced no lysis in the exponential or stationary phase of growth when exposed to vancomycin and only minimal loss of viability. Further characterization revealed normal autolysin expression, localization, and triggering by detergents, indicating that the defect leading to tolerance in the Tupelo strain is in the control pathway for triggering of autolysis. Because tolerance is a precursor phenotype to resistance and may lead to clinical failure of antibiotic therapy, these observations may have important implications for vancomycin use in infections caused by S. pneumoniae.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
3/64. Recurrent Pneumococcal bacteraemia and meningitis in an asplenic adult with possible unusual focus.An unusual case of a dental infection leading to osteitis of the mandible and possibly to 4 episodes of invasive pneumococcal disease in an asplenic adult is presented. The patient had 2 episodes of pneumococcal meningitis with bacteraemia and 2 episodes of bacteraemia without meningitis during a 1-y period. Investigations using bone and leukocyte scintigraphy revealed only a focal uptake in the right mandibular bone. The pneumococcal strains isolated during the 4 episodes were all serotype 23F, and fully susceptible to penicillin.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
4/64. Recurrent pneumococcal meningitis in homozygous C3 deficiency.Congenital deficiencies of complement system proteins are rare. A 4-year-old girl was admitted for meningitis. She had had repeated attacks of pneumococcal meningitis and otitis media at the age of 3 years. Analysis of cerebrospinal fluid showed that this meningitis was due to pneumococcal infection. Complement 3 and CH50 values of the proband and her brother were low, while her parents were normal. The patient was given polyvalent pneumococcal and anti-haemophilus vaccines plus ceftriaxone. Recovery was complete after 15 days of antibiotic therapy. This is the first description of a case of recurrent meningitis with C3 and CH50 deficiency in a Turkish family.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
5/64. Hearing preservation mastoidectomy in otogenic meningitis secondary to an enlarged vestibular aqueduct. Case report.In pyogenic meningitis resulting from a life-threatening ear infection, mastoidectomy is performed as part of the management of the disorder. A dilemma arises when the active ear is the only hearing ear. An active unsafe ear can lead to sensorineural hearing loss whereas ear surgery carries the risk of inner ear damage. We present the case of a 40-year-old woman admitted for severe purulent meningitis and sub-coma secondary to a left mastoiditis with mixed hearing loss on the left side and complete deafness on the right side. The study of this case shows that the intracranial complication was secondary to an abnormally enlarged left vestibular aqueduct. Because of the failure to control meningitis with medical treatment using highly specific antibiotherapy for two weeks, we proceeded with a left side mastoidectomy and closure of the external aperture of the vestibular aqueduct with a muscle graft. This surgery saved the patient's life, cured the meningitis and brought a recovery of a near normal hearing to the only hearing ear. Although demonstrating a rare etiology of intracranial complication, this case confirms that mastoidectomy, even on the only hearing ear, has to be done as early as possible to remove the source of infection, to prevent further intracranial complication, to arrest the progress of the ear disease and preserve or even recover almost normal hearing.- - - - - - - - - - ranking = 0.28571428571429keywords = infection (Clic here for more details about this article) |
6/64. Complement component deficiencies and infection: C5, C8 and C3 deficiencies in three families.Three families are described with complement component deficiencies. In one family, five children had C5 deficiency; in a second family, two children had C8 deficiency and one child in a third family had C3 deficiency. The index cases were identified during screening of patients with recurrent pyogenic infections, recurrent meningitis and meningococcaemia. Two of the five C5 deficient patients had recurrent meningitis and meningococcaemia, two had recurrent respiratory tract infections and otitis and one was healthy. One of the C8 deficient patients had meningitis, meningococcaemia and pneumonia, whereas his sibling with the same deficiency was healthy. The patient with C3 deficiency had four episodes of meningitis and recurrent otitis.- - - - - - - - - - ranking = 0.85714285714286keywords = infection (Clic here for more details about this article) |
7/64. Post-splenectomy meningitis in patients with lymphoid malignancy.This report describes pneumococcal meningitis in two splenectomized patients with lymphoid malignancy. early diagnosis and emergency treatment of pneumococcal infection in splenectomized patients is proven to be of significant value. Prophylactic antibiotics targeted against pneumococcus should be considered for the clinical management of such conditions in splenectomized patients, particularly during cytotoxic chemotherapy.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
8/64. Pneumococcal infection of the cavum septi pellucidi and cavum vergae in a pediatric patient.The cavum septi pellucidi and cavum vergae are unusual sites of intracranial infection. A child is reported with infection of the cavum septi pellucidi and cavum vergae associated with pneumococcal meningitis. The patient required surgical drainage of the abscess despite appropriate antibiotic therapy, and the clinical outcome was excellent.- - - - - - - - - - ranking = 0.85714285714286keywords = infection (Clic here for more details about this article) |
9/64. meningitis due to multiple-resistant penicillin- and cefotaxime-intermediate streptococcus pneumoniae in a German child after bone marrow transplantation.The incidence of infection with penicillin-non-susceptible streptococcus pneumoniae is increasing rapidly worldwide. spain and france are highly affected, whereas the level of penicillin resistance in germany, italy, The netherlands and scandinavia is low. We report a lethal episode of meningitis due to penicillin- and cefotaxime-intermediate S. pneumoniae in a 7-year-old, allogene bone marrow transplanted German boy, 5 weeks after a holiday in spain. Three days prior to the infection the patient showed good performance status. He was in complete remission without signs of graft-versus-host disease (GVHD). He died on day 341 post bone marrow transplant (BMT), 2 days after the onset of meningitis. Penicillin-non-susceptible S. pneumoniae should be regarded as a potential infectious agent even in countries with a low prevalence of resistance.- - - - - - - - - - ranking = 0.28571428571429keywords = infection (Clic here for more details about this article) |
10/64. Austrian syndrome in a child-aortic valve endocarditis following pneumococcal meningitis.A 7-year-old girl with a previously healthy heart underwent a Ross procedure after pneumococcal sepsis, meningitis and aortic valve endocarditis with extensive para-valvular involvement. While pneumococcal infections including respiratory tract infections, bacteraemia and meningitis are common in childhood, endocarditis caused by streptococcus pneumoniae occurs rarely. Pneumococcal meningitis and aortic valve endocarditis is a known combination, described as Austrian syndrome. We suggest that children with pneumococcal meningitis should be screened with echocardiography for an aortic valve endocarditis. In case of aortic valve endocarditis and persistent infection, surgery should be considered early.- - - - - - - - - - ranking = 0.42857142857143keywords = infection (Clic here for more details about this article) |
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