1/25. Palinopsia with bacterial brain abscess and noonan syndrome.Though positive visual symptoms can be psychological in nature, or can result from a perceptive or anxious patients recognizing optical principals in the eye itself, this case illustrates how a thorough history is required to delineate those rarer signs which accompany serious macular or neuro-ophthalmic pathology.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/25. Sinogenic subdural empyema and streptococcus anginosus.Subdural empyema (SDE) is most commonly caused by sinusitis and, without early diagnosis and neurosurgical intervention, is associated with high mortality. In a patient with sinusitis who presents with mental status changes, the diagnosis of SDE should be suspected on clinical grounds, even in the absence of significant computed tomographic findings. Computed tomography with contrast is a useful aid in the diagnosis of SDE, but findings may be subtle, and contrasted magnetic resonance imaging is superior. The association of streptococcus anginosus sinusitis and related intracranial sequelae is important owing to the potentially catastrophic complications and should be recognized by otolaryngologists. In view of the rapidly progressing nature of sinogenic SDE, physicians should strongly consider early institution of aggressive therapy consisting of craniotomy with concurrent sinus drainage in patients in whom sinogenic SDE is suspected on clinical grounds, particularly in the presence of S. anginosus-positive sinus cultures.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/25. Infected chylothorax caused by streptococcus agalactiae: a case report.chylothorax is bacteriostatic in nature. Bacterial infection rarely develops in chylothorax and has never been reported in a non-immunocompromised host. A 33-year-old woman was admitted to National taiwan University Hospital because of fever and right pleuritic pain. Chest roentgenography and computed tomography revealed right pleural effusion. Examination of the pleural effusion revealed a profile compatible with empyema and chylothorax. culture of the pleural effusion yielded streptococcus agalactiae. The woman was not immunocompromised. This is the first report of infected chylothorax caused by streptococcus agalactiae in a non-immunocompromised host.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/25. Invasive streptococcal infection of the periorbita and forehead.Recent epidemiological reports suggest an increased frequency of invasive streptococcal infections linked to the appearance of a dominant group A Streptococcus serotype. Necrotizing streptococcal infections involving the skin and soft tissues of the face are uncommon. This case demonstrates the aggressive and invasive nature of these infections. The patient presented with symptoms of angioedema and was treated with corticosteroids. Her condition worsened and plastic surgery was consulted. There was extensive necrosis of the periorbital and forehead soft tissue, requiring extensive debridement to control the invasive process. Multiple reconstructive procedures were performed to close the defects and to preserve function of the facial muscles and eyelids. The literature indicates less than 50 reported cases of necrotizing streptococcal infections limited to the periorbita. This case reflects the importance of rapid diagnosis, and emphasizes the need for prompt and appropriate surgical treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/25. Fatal group A streptococcal necrotizing fasciitis and toxic shock syndrome in a patient with psoriasis and chronic renal impairment.A 78-year-old woman presented with rapid onset of skin pain which evolved into oedema, discoloration and infarction. She was diagnosed with group A beta-haemolytic streptococcus (streptococcus pyogenes) necrotizing fasciitis and streptococcal toxic shock syndrome. The patient had a past history of psoriasis and end-stage renal impairment. Despite treatment with multiple antibiotics in an intensive care unit, the skin infarction involving the upper trunk continued to expand and the patient died within 24 hours of hospital admission. Group A streptococcus and staphylococcus aureus were cultured from a tissue biopsy. Renal failure and compromised skin barrier function are known to predispose to invasive streptococcal infections, but necrotizing fasciitis has only rarely been reported in association with psoriasis. This case illustrates the fulminant nature of the infection.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/25. Group G streptococcus--a rare cause of osteomyelitis simulating bone tumour: a case report.We report a case of osteomyelitis of the proximal femur caused by Lancefield group G streptococcus in a 71-year-old otherwise healthy man. The organism has rarely been identified as the cause of osteomyelitis. The subacute nature of the symptoms and the radiological appearance of the femur in this patient mimic bone tumour. The patient was successfully treated with conservative methods, including a prolonged period of oral antibiotics. We stress the importance of histological and bacteriological evidence in avoiding misdiagnosing patients with equivocal clinical and radiological presentation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/25. Atraumatic hand infection in an infant.We report a rare case of atraumatic infection of the extensor tendon sheaths. Acute medical staff should be aware of the insidious nature of presentation of this condition, as early aggressive treatment is required to prevent tendon rupture. In this instance, an excellent functional outcome was achieved by surgical drainage and early tendon reconstruction.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/25. Septicemia and endocarditis caused by group G streptococci in a Norwegian hospital.The clinical and bacteriological features of septicemia caused by group G streptococci were analyzed in nine patients seen during a period of 28 months. Four of these patients had acute endocarditis with a high rate of serious neurological complications. The clinical response to antibiotic treatment was slow in the endocarditis patients despite sensitivity of the organism in vitro. Group G streptococcal septicemia can be a very serious condition associated with endocarditis of a destructive nature. Comparison with previous reports suggests that group G streptococcal infections are of increasing importance. The virulence of group G streptococci may be changing, resulting in more serious infections and complications. This series stresses the importance of prompt recognition of this infection and the need for aggressive management of these patients.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/25. Infectious pneumoperitoneum as an uncommon presentation of endometrial carcinoma: report of two cases.Two patients with pneumoperitoneum are reported; in both cases, the cause was severe infection of the upper genital tract. Investigation led to the finding of an underlying endometrial carcinoma. literature review of the etiology of pneumoperitoneum, nature of the usual infecting organisms, and therapeutic principles are presented. Endometrial carcinoma should be considered in the differential diagnosis of infectious pneumoperitoneum, especially where patient risk factors are present.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/25. Infections due to Lancefield group C streptococci.Our experience with group C streptococcal infection over the past 15 years demonstrates an important and emerging role for this hemolytic organism as an opportunistic and nosocomial pathogen. Significant risk factors in this predominantly male population included chronic cardiopulmonary disease, diabetes, malignancy, and alcoholism. bacteremia occurred in 74% of cases seen in our series. Nosocomial acquisition of infection was observed in 26%, and infection was frequently polymicrobial in nature with gram-negative enteric bacilli isolated most commonly along with group C streptococci. We observed a broad spectrum of infections including puerperal sepsis, pleuropulmonary infections, skin and soft-tissue infection, central nervous system infection, endocarditis, urinary tract infection, and pharyngeal infections. Several cases of bacteremia of unknown source were observed in neutropenic patients with underlying leukemia. New syndromes of infection due to group C streptococci observed in our series included intra-abdominal abscess, epidural abscess, and dialysis-associated infection. Response to therapy and outcome was related to the underlying disease. While the literature suggests that patients with group C endocarditis respond better to synergistic penicillin-aminoglycoside regimens, patient numbers are too small to draw definite conclusions. The clinical significance of antibiotic tolerant group C streptococci remains uncertain. In patients with serious group C infections including endocarditis, meningitis, septic arthritis, or bacteremia in neutropenic hosts, we advocate the initial use of cell-wall-acting agents in combination with an aminoglycoside.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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