1/7. Pulmonary granuloma caused by Pseudomonas andersonii sp nov.Pulmonary granuloma is a common lesion for which gram-negative bacteria are rarely implicated as a cause. Hence, most physicians are unaware of this etiology. We isolated a gram-negative bacterium from a surgically resected pulmonary granuloma in a 42-year-old, nonimmunocompromised woman. Within the necrotizing granuloma, numerous organisms also were demonstrated by Gram stain, suggesting a cause-disease relationship. Characterization of the bacterium by sequence analysis of the 16S ribosomal gene, cellular fatty acid profiling, and microbiologic studies revealed a novel bacterium with a close relationship to Pseudomonas. We propose a new species for the bacterium, Pseudomonas andersonii. These results suggest that the differential diagnosis of a lung granuloma also should include this gram-negative bacterium as a potential causative agent, in addition to the more common infections caused by acid-fast bacilli and fungi. This bacterium was shown to be susceptible to most antibiotics that are active against gram-negative bacteria.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Thromboembolic and infectious complications of total artificial heart implantation.Thromboembolic and infectious events were found to be major complications of long-term total artificial heart implantation in two patients. Similar complications have been reported in other patients, as well as in animal studies. The thromboembolic events and the infectious complications appear to be interrelated. On the one hand, thrombi located on the valves and at the vascular anastomoses of the artificial heart were found to be infected at autopsy; such infections are known to exacerbate formation of thromboemboli. On the other hand, the generation of microthrombi may have contributed to the RES blockade seen in our patients. We hypothesize that this RES blockade led to a progressive decrease in lymphoid system function and impaired the patients' capacity to clear microorganisms from the circulation. These phenomena arose, in part, from the design of the artificial heart and were exacerbated by associated therapy, such as blood transfusions. Our data suggest several measures that might be taken in order to reduce the severity of both the thrombogenic and infectious complications. Improved anticoagulation regimens, which increase the ability of the physician to maintain the proper balance between thrombotic and hemorrhagic potential, are needed. This may require not only improved methods of monitoring anticoagulation and predicting changes in the effectiveness of various agents as other events supervene, but also new anticoagulant and antithrombotic drugs, for example, low molecular weight heparins and prostacyclin derivatives. It is also clear that the design of the artificial heart should be modified in order to improve fluid dynamics so that they will approximate as closely as possible those of the natural heart. This includes redesigning the mounting of the valves to eliminate crevices and discontinuities that allow stagnant flow and predispose to thrombus formation as well as imposing a dP/dt that minimizes shear-related hemolysis, thereby minimizing the need for blood transfusions. Prevention of infections presents a more difficult problem. Transcutaneous lines (regardless of their use) are an obvious route for infection, and attention should be given to minimizing the number and length of use of monitoring lines. However, until a totally implantable drive system is available, the drive lines will remain a potential avenue for the introduction of infections. The risk may be minimized by rigorous attention to care of the exit sites and by improved designs that will provide a better mechanical barrier by, for example, enhancing epithelial ingrowth into the materials of the drive line.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. pseudomonas infections associated with hot tubs and other environments.Infections due to pseudomonas aeruginosa are not confined to the hospital intensive care unit. This paper examines the association of P. aeruginosa and several community-acquired infections. Hot tub folliculitis is a recently described disorder occurring in outbreaks among persons who unknowingly immerse themselves in contaminated whirlpools, spas, or swimming pools. The green nail syndrome and other dermatoses are also reviewed. Infective endocarditis, invasive external otitis, and puncture would osteomyelitis are serious infections that carry high risks for the patient and challenge the physician's most potent therapies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Pseudomonal balanitis.Significant ecologic changes in the cutaneous flora during treatment may present a challenge both diagnostically and therapeutically. The development of an erosive balanitis due to pseudomonas aeruginosa presented an example of such a microbiologic shift in the case reported. The eruption developed during treatment with topical antibacterial, antifungal, and corticosteroid agents. The sudden exacerbation of any balanitis while under treatment should alert the physician to the possibility of superinfection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Malignant external otitis.Malignant external otitis (MEO) is a potentially life-threatening Pseudomonas infection of the external auditory canal in which rapid diagnosis is the key to proper treatment. We present an anatomic description of the ear and skull base, with a review of the literature on MEO, in the hope that it will enable primary care physicians to work more closely with otolaryngologists in dealing with this illness.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. The impact of bacteraemia on hiv infection. Nine years experience in a large Italian university hospital.The object of this case control study was to evaluate the frequency, the risk factors, the microbiological spectrum and the outcome of 249 cases of bacteraemia observed in 209 hiv-infected patients, most them affected by AIDS. The rate of bacteraemia in the total yearly hiv-related admissions increased from 4% in 1985 to 13% in 1993. The more common aetiological agents of bacteraemia were: staphylococcus aureus (29.7%), non-typhoidal species of salmonella (14.1%), staphylococcus epidermidis (10.9%), streptococcus pneumoniae (8.4%) and pseudomonas aeruginosa (7.6%). A mixed flora was found in 14% of the episodes. multivariate analysis of predisposing factors indicated that a low CD4 T-cell count (<0.2 x 10(9)/l) (P=0.01), use of central venous catheters (CVC) (P=0.01) and neutropenia (polymorphonuclear neutrophils <1.0 x 10(9)/l) (P=0.04) were independent risk factors for the development of bacteraemia. Logistic regression did not reveal any association of bacteraemia with intravenous drug abuse (on univariate analysis P=0.04). The response (31.8%). Recurrences to specific therapy was favourable in 170 episodes (68.2%); death occurred in 79 (31.8%). Recurrences arose in 40 patients, 17 (42.5%) of them died. The outcome of bacteraemia was influenced by a low number of CD4 T-cells (P<0.001) but not of polymorphonuclear cells. Our findings suggest that bacteraemia is a relatively common event in hiv-infected patients, especially under particular conditions (e.g. intravenous drug abuse, use of CVC, neutropenia and a low CD4-T-cell count). It requires special attention from physicians who must recognise and treat the condition promptly at an early stage.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. cystic fibrosis in an elderly woman.cystic fibrosis (CF) is thought of by most physicians as a disease of children. Advances in therapy have extended the life span of patients so that many pulmonary internists have responsibility for the care of young adults with CF. Nevertheless, the initial diagnosis of CF after the age of 30 years is unusual, and a diagnosis after the age of 60 years is rare. Such a case is reported here.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |