1/6. Idiopathic purpura fulminans and varicella gangrenosa of both hands, toes and integument in a child.Chicken pox is a common childhood illness and, though a vaccine is readily available, it is not routinely included in the vaccination schedule of most countries owing to its mild clinical nature. However, varicella gangrenosa is a rare complication of this disease, infrequently reported in the literature. We report the case of a child who developed purpura fulminans in the convalescent phase of chicken pox and subsequently presented with peripheral gangrene of both hands and the toes of the right foot, and skin gangrene. To our knowledge, bilateral gangrene of the hands has rarely been reported, and we present this case to highlight the serious nature of complications following varicella infection.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/6. Prolonged cutaneous herpes zoster in acquired immunodeficiency syndrome.We described the development of prolonged disseminated cutaneous herpes zoster in two patients with acquired immunodeficiency syndrome. Both patients developed hyperkeratotic, verrucous lesions that progressed despite acyclovir therapy. The biopsy specimens were typical of herpes infection. The development of acyclovir-resistant varicella-zoster virus during therapy was suspected clinically in the first patient and documented in vitro in the second patient. The inability to mount an effective cell-mediated immune response contributed to the prolonged course of cutaneous zoster in our patients. The hyperkeratotic nature of the skin lesions may reflect their chronic nature. Treatment with inadequate doses of acyclovir, allowing viral persistence and the selection of resistant strains of virus, may also be implicated. We recommend prolonged high-dose intravenous acyclovir therapy in the initial management of herpes zoster in patients with acquired immunodeficiency syndrome.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/6. Transient gastroparesis associated with cutaneous herpes zoster.We report a patient who developed delayed gastric emptying with vomiting and weight loss simultaneously with herpes zoster in the sixth right thoracic dermatome. Sequential radionuclide solid egg meal gastric emptying studies were used to document gastroparesis, the response to metoclopramide and its transient nature. We present a possible explanation for this phenomenon within the context of the known pathophysiology of varicella-zoster infection.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
4/6. Infections due to Lancefield group G streptococci.The group G streptococcus has surfaced in the past 10 to 15 years as an important opportunistic and nosocomial pathogen. Although more precise organism recognition accounts for a portion of these cases, there can be little doubt that the group G streptococcus has become a more prevalent pathogen. Commercial kits, utilizing staphylococcal coagglutination or latex agglutination, are now available, affording all clinical laboratories the opportunity to identify this organism easily. Published reviews encompassing the experiences of a single institution or even several institutions affiliated with a single medical center, particularly as they were influenced by referral patterns, did not reflect the broad scope of infections that we discovered by extending our survey into the community, beyond the medical center complex and its immediate affiliated hospitals. Although malignancy is the single most obvious background factor, alcoholism and diabetes are also important host determinants of infection. skin and soft-tissue infections (and surface sources of infection) are equally important among patients with or without the element of malignancy. Polymicrobial infection, including polymicrobial bacteremia, is an important feature, with S. aureus infections accounting for most of these cases, relating to the skin and soft tissue sources of infections so commonly seen. We saw a panorama of problems including endocarditis, septic arthritis, pleuropulmonary infections, bone and joint infections, puerperal sepsis and neonatal infection, peritonitis and ophthalmitis; we also saw a significant number of patients with bacteremia and no apparent primary source of infection. Response to antibiotic therapy was dictated by the nature of the underlying diseases, and individuals without a background of malignant disease did well, particularly those with skin and soft-tissue infections. While the literature suggests that patients with endocarditis and septic arthritis due to this organism respond poorly to antibiotic therapy, implying that such failures relate to in vitro antibiotic phenomena, we preferred to examine the problem from the viewpoint of the host(s) involved. Subacute endocarditis and acute endocarditis due to the group G streptococcus may be clinically separable, and thus require separate therapeutic approaches. In patients with septic arthritis, prosthetic devices, prior joint disease and immunosuppressive diseases and therapy often adversely influence the response to antibiotic therapy.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
5/6. steatocystoma multiplex: a case report.A severe case is reported of a rare skin disorder characterized by multiple intracutaneous cystic lesions; the condition is difficult to manage and impossible to cure. The complicating cystic infections that accompany the condition are treated acutely using sound surgical principles, yet long-term management remains a difficult and unsolved problem. Some of the approaches to treatment are discussed. Surgical cures are usually precluded by the extensive nature of the disease. Perhaps most disheartening is the devastating social and psychological damage resulting from the progressive facial and bodily disfigurement, for which there is at present no satisfactory treatment.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
6/6. pneumonia caused by Nocardia species.There are nine species of Nocardia. nocardia asteroides accounts for 80% of infections caused by this organism in man. N brasiliensis causes 3% to 9% of these infections, and N farcinica is being recognized with increasing frequency. We present three cases of Nocardia pneumonia two of which were caused by N asteroides and one was caused by N farcinica. These cases illustrate the diverse nature of nocardiosis and show that sometimes it is difficult to determine whether the Nocardia was community- or nosocomially-acquired.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |