1/7. Streptoccocus pyogenes: a forgotten cause of severe community-acquired pneumonia.We report a case of severe community-acquired pneumonia caused by streptococcus pyogenes (Lancefield Group A streptoccocus) that was complicated by a streptococcal toxic shock syndrome. Although this micro-organism is an uncommon cause of community-acquired pneumonia, previously well individuals may be infected and the clinical course may be fulminant. A household contact was the likely point of infection. Invasive group A streptococcal disease continues to remain an important cause of morbidity and mortality in the community and therefore will continue to be encountered by intensive care physicians. Treatment of Group A streptococcal infection remains penicillin; however, clindamycin should be added in severe infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Fulminant pneumonia due to aeromonas hydrophila in a man with chronic renal failure and liver cirrhosis.A 40-year-old man on hemodialysis was admitted due to dyspnea and chest pain and was diagnosed with pneumonia and pericarditis. ampicillin was administered, but thereafter severe septic shock developed. The fulminant type of pneumonia progressed rapidly, and he died only 48 hours after the onset of symptoms. The autopsy and sputa culture revealed pneumonia due to aeromonas hydrophila. The source of this infection remained unkown. Interestingly, there were two types of A. hydrophila found during such a short period. The physician should suspect this disease by questioning the patient's history. Early treatment with adequate antibiotics is the only means of saving such a patient's life.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Endogenous endophthalmitis and necrotising pneumonia caused by klebsiella pneumoniae in a child with beta-thalassaemia major.A case beta-thalassaemia major complicated with klebsiella pneumoniae endogenous endophthalmitis is presented to increase physician awareness of the association of the two clinical conditions. Severe morbidity including subretinal abscess and retinal detachment may develop despite aggressive intravenous and intravitreal ceftriaxone therapy, along with vitrectomy and external drainage.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. bacillus cereus pneumonia in a patient with acute lymphoblastic leukemia.Reported here is a case of bacillus cereus pneumonia that occurred in a patient with acute lymphoblastic leukemia. The presentation was severe, essentially marked by respiratory distress and pleuritic chest pain. Classic empirical treatment initiated for febrile neutropenia did not cover this rare pathogen and appropriate therapy was therefore delayed. B. cereus is most often a culture contaminant, but it can also be responsible for self-limited gastrointestinal intoxication and, more rarely, severe systemic diseases. virulence in the case of systemic disease is attributed to tissue necrosis mediated by toxin release. B. cereus pneumonia, as described in the English-language literature, mainly affects immunocompromised patients and most often has a fatal outcome. Thus, the identification of B. cereus in clinical specimens of severely ill immunocompromised patients should lead physicians to question its clinical significance.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Fumbled handoffs: one dropped ball after another.Missed follow-up of abnormal test results and resultant delays in diagnosis is a safety issue that is gaining increasing attention. Despite increases in the numbers and types of available diagnostic tests, current systems in health care do not reliably ensure that test results are received and acted upon by ordering physicians. This article examines the case of a patient whose diagnosis of tuberculosis was substantially delayed because of systems problems, including poor continuity (with multiple-provider involvement), lack of communication of test results and other clinical information, and several handoffs. Strategies to ensure adequate communication of critical information and follow-up of test results are discussed, such as explicit criteria for communication of abnormal results, test-tracking systems for ordering providers, and use of information technologies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Transmission of Panton-Valentine leukocidin-producing staphylococcus aureus to a physician during resuscitation of a child.We report the first case of transmission of Panton-Valentine leukocidin-producing staphylococcus aureus to a physician during the resuscitation of an infant with fatal pneumonia. The physician exhibited numerous furuncles. This case highlights the necessity for health care workers to protect themselves against transmission of infectious diseases from patient to care giver.- - - - - - - - - - ranking = 6keywords = physician (Clic here for more details about this article) |
7/7. Ring down artefacts on abdominal sonography to predict pulmonary abnormalities in the emergency department.Ring down artefacts are sometimes found when emergency physicians perform abdominal ultrasound to differentiate between various abdominal problems. We describe a patient who presented with right upper quadrant abdominal pain and whose ultrasound examination showed ring down artefacts posterior to the right hemidiaphragm, which led to the eventual diagnosis of pneumonia. Ring down artefacts on ultrasound may be used to predict pulmonary abnormalities. awareness of this sonographic finding may assist in accurate diagnosis and administration of appropriate treatment without delay.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |