1/219. Pneumococcal arthritis.Twelve patients with pneumococcal arthritis are described. Seven of the 12 patients had underlying diseases which predisposed them to pneumococcal infections; five were alcoholics and two had hypogammaglobulinemia. Five patients had pre-existing joint disease prior to the onset of septic arthritis. Seven patients had co-existent pneumococcal infection, including meningitis and/or endocarditis in five. The other five patients had pneumococcal arthritis without evidence of other foci of pneumococcal infection. With penicillin therapy and drainage of the purulent joint fluid (by needle aspiration in four and surgical drainage in seven), the function of the involved joint returned to normal or to the previous baseline level in all but one patient.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/219. Pneumococcal polyarticular septic arthritis in a patient with rheumatoid arthritis.Rheumatoid arthritis is the most commonly reported host-related risk factor for septic arthritis. This risk is highest in severe, seropositive, long-standing (mean, 10 years) rheumatoid arthritis responsible for extraarticular symptoms and treated with systemic glucocorticoids. The clinical presentation of the joint infection is often atypical, leading to diagnostic wanderings. In 25% of cases, the infection is polyarticular, with 3.5 involved joints on average. staphylococcus aureus is the most common causative organism. streptococcus pneumoniae causes 5% of all cases of septic arthritis and is more often responsible for polyarticular infections than other organisms. Polyarticular septic arthritis carries a poor prognosis, with a mortality rate of 50% in rheumatoid arthritis patients. Despite its low incidence, polyarticular septic arthritis should be routinely considered in the differential diagnosis of rheumatoid flares. We report a case of pneumococcal septic arthritis involving five joints in a patient with known rheumatoid arthritis. Three other cases with involvement of more than four joints have been published.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
3/219. pneumococcal infections in hiv-infected adults.Bacterial pneumonia, specifically pneumococcal infection, is a frequent cause of morbidity and mortality in persons infected with human immunodeficiency virus (hiv). It causes morbidity directly and possibly progression of hiv infection. The clinical presentation and response to therapy are usually similar to that of patients without hiv infection, although radiographic presentations may be atypical. There is a higher incidence of invasive disease and extrapulmonary disease, and mortality may be increased in hiv-infected patients. hiv infection impairs the host response to pneumococcus in a variety of ways. Colonization with streptococcus pneumoniae may be prolonged for reasons that are incompletely understood. Concern about the rising prevalence of resistant pneumococcal strains is increasing, but the clinical relevance is uncertain. At least 90% of the strains that cause invasive disease are present in the 23-valent pneumococcal vaccine. The response to vaccination declines as immunodeficiency progresses; however, the potential benefit to responders is great and the risk is minimal. Therefore, this vaccine is recommended for all hiv-infected persons.- - - - - - - - - - ranking = 2.6666666666667keywords = infection (Clic here for more details about this article) |
4/219. Frequency of very late fatal sepsis after splenectomy for hereditary spherocytosis: impact of insufficient antibody response to pneumococcal infection.Very late sepsis in splenectomized patients with hereditary spherocytosis has been seen rarely up to now; the frequency and the immunodeficiency causing it are largely unknown. Within the past 7 years we have learned of four cases of sepsis or meningitis (three fatal) in adult patients with hereditary spherocytosis who had been splenectomized years earlier. The estimated frequency of very late postsplenectomy infections is 0.69 cases of sepsis or meningitis in 1000 patient-years (0.46 deaths in 1000 patient-years). Pneumococci were proven in two patients. The surviving patient showed low antibody titers against pneumococcal serotypes even after pneumococcal meningitis and subsequent vaccination. There have been several reports of an insufficient response to pneumococcal vaccination in patients with severe infections. We recommend determination of pneumococcal antibody titers after immunization in every splenectomized patient: Nonresponders to vaccination may be at high risk for overwhelming postsplenectomy infection. Our data demonstrate that there is a lifelong risk for severe postsplenectomy infections and therefore the lasting need for immediate antibiotic therapy in any case with sudden onset of high fever.- - - - - - - - - - ranking = 2.6666666666667keywords = infection (Clic here for more details about this article) |
5/219. streptococcus pneumoniae peritonitis postpartum.A peritonitis caused by an ascending infection is a rare complication postpartum. A 37-year-old woman presented with a secondary peritonitis due to streptococcus pneumoniae. The patient had given birth to a healthy boy 4 weeks before and showed no symptoms of a bronchitis on admission. An operation was performed after the patient developed an acute abdomen, showing a diffuse peritonitis. High vaginal swabs and blood cultures taken on admission were positive for S. pneumoniae as well as the specimen taken during the operation. Thus we concluded that this was a case of an ascending infection. After antibiotic therapy with penicillin the patient could be discharged 8 days after the operation.- - - - - - - - - - ranking = 0.66666666666667keywords = infection (Clic here for more details about this article) |
6/219. Pneumococcal bacteremia associated with an infected central venous catheter.Pneumococcus (streptococcus pneumoniae) bacteremia is a serious infection. Pneumococcus has never been implicated as a cause of a central venous catheter-related bacteremia. It has been isolated from the catheter tip only twice before, and in one case caused the infection of an infusion port device. We report case of a 41-year-old woman who developed pneumococcal bacteremia after 6 days of an indwelling central venous catheter. The catheter tip grew > 300 cfu of S pneumoniae by the roll-plate method described by Maki and colleagues. No other focus of infection could be found in this patient. To the best of our knowledge, this is the first reported case of pneumococcal bacteremia associated with an infected central venous catheter.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
7/219. streptococcus pneumoniae spinal infection in Nottingham, United Kingdom: not a rare event.Pneumonia and meningitis are the most frequent manifestations of streptococcus pneumoniae infection. Spinal infection is considered to be a rarity. Between 1985 and 1997, 8 patients with spinal infection (vertebral osteomyelitis, 3; spinal epidural abscess, 1; both, 4) due to S. pneumoniae were seen at University Hospital (Nottingham, U.K.). Predisposing factors for pneumococcal infection were documented for five patients and included diabetes mellitus, alcoholism, and corticosteroid therapy. One patient presented with concomitant meningitis and endocarditis. Clinical features of note were prolonged symptoms and a lack of febrile response. S. pneumoniae was isolated from the blood of five patients. magnetic resonance imaging was used to localize the spinal infection in five patients. Two cases were managed medically. Three patients died after a protracted illness. A literature search revealed 20 other cases of spinal infections due to S. pneumoniae. The salient features of the cases are summarized.- - - - - - - - - - ranking = 3.3333333333333keywords = infection (Clic here for more details about this article) |
8/219. Pneumococcal vaccine in patients with absent or dysfunctional spleen.Four patients (3 long-term hodgkin disease survivors and 1 recipient of an allogeneic bone marrow transplant) developed severe infections with streptococcus pneumoniae after staging splenectomy or due to functional hyposplenism after total body irradiation and bone marrow transplantation. Current guidelines for prevention of infection recommend pneumococcal immunization for patients with hodgkin disease treated with splenectomy and others with functional hyposplenism. Booster vaccination after 5 years is also advised. Hospital- and community-based vaccination initiatives may help identify at-risk patients.- - - - - - - - - - ranking = 0.66666666666667keywords = infection (Clic here for more details about this article) |
9/219. Familial systemic lupus erythematosus and congenital infection-like syndrome.We present two siblings with congenital and progressive encephalopathy associated with systemic lupus erythematosus. The two brothers presented soon after birth with an encephalopathy associated with intracranial calcification (=2), intrauterine growth retardation (= 2), hepatitis (= 1) and thrombocytopenia (= 1), mimicking a congenital virus infection. Within the first year of life both children developed hypocomplementaemia and systemic lupus erythematosus (SLE), the main features of which were a discoid lupus-like rash on the hands and feet and the progressive production of high levels of autoantibodies. Both children were severely handicapped and died in early childhood from streptococcal infections. There are many causes of congenital encephalopathy with intracranial calcification. The early development of systemic lupus in these children suggested that their cerebral disease formed part of an autoimmune process. Complement levels and autoantibody profiles should be considered part of the investigation of a child with congenital infection-like syndrome, particularly when there are progressive dermatological complications.- - - - - - - - - - ranking = 2.3333333333333keywords = infection (Clic here for more details about this article) |
10/219. Fatal early-onset neonatal sepsis due to streptococcus pneumoniae.Two cases of invasive early-onset neonatal pneumococcal sepsis are reported. One neonate was born at term with no risk factors and the other preterm at 35 weeks. sepsis was not detected at birth for either of these babies and diagnosis was made at the stage of severe sepsis. A fatal outcome resulted despite treatment. Pneumococcal sepsis was confirmed after death in both these cases. Although maternal carriage was not documented in either case, the ages at presentation and progression suggested perinatal acquisition of infection. Early onset neonatal pneumococcal sepsis presents similarly as early onset neonatal Group B streptococcal (GBS) sepsis. Vaginal carriage of pneumococcus is rare but the micro-organism may have a higher invasion to colonisation ratio (attack rate) than GBS. risk factors for invasive disease are similar to GBS.- - - - - - - - - - ranking = 0.33333333333333keywords = infection (Clic here for more details about this article) |
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