1/35. risperidone in the treatment of choreiform movements and aggressiveness in a child with "PANDAS".The acronym 'PANDAS' (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) is used to describe neuropsychiatric symptoms putatively resulting from autoimmune responses to streptococcal infection in vulnerable children. A case of 'PANDAS' is presented to increase physician awareness of this disorder and to document effectiveness of risperidone in chorea and treatment-resistant disruptive behavior associated with this syndrome. To our knowledge, this is the first case report on risperidone in pediatric chorea, although studies on effectiveness of this agent in Tourette's disorders have been previously published.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/35. 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 = physician (Clic here for more details about this article) |
3/35. 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) |
4/35. Poststreptococcal glomerulonephritis presenting as impending airway obstruction.The presence of poststreptococcal glomerulonephritis in the pediatric patient remains a diagnostic challenge to the emergency physician. The variability of both patient presentation and laboratory parameters often obscures the diagnosis. We describe a child who presented to the emergency department with subglottic edema and the possibility of impending airway compromise. The child was admitted to the hospital under close observation, and several days later, the diagnosis of poststreptococcal glomerulonephritis was made.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/35. Varicella complicated by group A streptococcal facial cellulitis.An increase has been recently noted in the incidence of life-threatening group A beta-hemolytic streptococcal (GABHS) infections in children recovering from varicella. We report our experience with a patient who required pediatric intensive care unit admission because of a serious GABHS infection 1 week after the onset of varicella. Emergency physicians must look for this complication in patients with varicella remaining abnormally febrile and presenting unusual manifestations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/35. Successful treatment of meningitis caused by highly-penicillin-resistant streptococcus mitis in a leukemic child.In recent years, viridans streptococci have been reported with increasing frequency to cause infections in neutropenic cancer patients. streptococcus mitis, one of the species included among viridans streptococci, is the most resistant to beta-lactam antibiotics in this group. Bacterial meningitis presenting without pleocytosis in the cerebrospinal fluid (CSF) is rare, and this situation could be confusing to physicians. It is also an uncommon infectious complication in leukemic patients with neutropenia. In patients with leukopenia caused by myelosuppression after chemotherapy, bacterial meningitis must be considered a possibility when a patient develops meningeal signs, even if no pleocytosis is found in the CSF. We report on a 6-year-old boy with leukemia and neutropenia who developed sepsis and meningitis caused by S. mitis with high-level resistance to penicillin and cephalosporins (MIC of both, >2 mg/l); he was a long-term survivor receiving chronic trimethoprim-sulfamethoxazole prophylaxis. The patient was successfully treated with a combination of vancomycin, ceftriaxone, and granulocyte-colony-stimulating factor.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/35. Spontaneous bacterial peritonitis caused by streptococcus bovis: case series and review of the literature.streptococcus bovis is the rare cause of spontaneous bacterial peritonitis in decompensated cirrhosis. S. bovis bacteremia has long been known to be associated with colon cancer. We describe seven patients and review the seven previous reports of spontaneous bacterial peritonitis patients with S. bovis infection. Most of the patients had cirrhosis and presented with fever, abdominal pain, abdominal distention, and jaundice. Colonic adenomatous polyps with dysplastic change were found in 18.2% of the patients. The approach to this group of patients requires diagnostic paracentesis, blood cultures, ascitic fluid culture, and treatment with antimicrobial agents. Intravenous penicillin is still the antimicrobial agent of first choice (mean minimum inhibitory concentration for penicillin = 0.05 microg/ml). S. bovis is an infrequent cause of spontaneous bacterial peritonitis. The physician could make a case that colonoscopy is not needed because the patient is very sick and the possibility of GI pathology, especially colonic lesions, has been low. However, it may be that colonoscopy should be done if there are clinical suggestions to do so or the patient is well enough to withstand surgery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/35. Invasive group a streptococcus associated with an intrauterine device and oral sex.BACKGROUND: peritonitis due to group A Streptococcus (GAS) and toxic shock syndrome occurred in a previously healthy 45-year-old woman with an intrauterine device. The intrauterine device was believed to be the portal of entry. In addition, her husband was found to be an asymptomatic carrier of GAS in his oropharynx. GOAL: The goal was to increase physicians' awareness of oral sex as a risk factor for transmission of invasive GAS disease. STUDY DESIGN: This is a case report of the development of GAS peritonitis and toxic shock syndrome in a woman after acquisition of the organism through oral sex. RESULTS: The GAS strains isolated from the patient and her husband were identical in their M-type, T-type, and exotoxin gene pattern. CONCLUSION: Because the couple practices oral sex, it was postulated that this was the mode of transmission of the GAS.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/35. Ocular complications of the Fernand-Widal triad and its therapy.BACKGROUND: The Fernand-Widal triad (FWT) is the association of non-allergic intrinsic asthma, nasal polyposis and sensitivity to aspirin. The aim of this paper is to describe the possibility of ocular complications, which we found in 3 cases: in 1 case due to the FWT itself and in the other 2 as a result of corticosteroid treatment. methods: Three cases of the FWT with ocular complications were studied, and the pertinent literature was reviewed. RESULTS: No previous description of ocular involvement in individuals with FWT was found in the literature. In the first case, episodes of orbital cellulitis due to superinfected nasal polyposis were found as a complication produced by the disease. In the other 2 cases, corticosteroid treatment created complications: ocular hypertension in both cases and bilateral subcapsular cataracts in 1 case. CONCLUSIONS: Although not rare, the diagnosis of the FWT is often missed. This perhaps explains why no report of ocular complications has yet been published in the literature. Because of the serious clinical consequences, physicians involved in the treatment of these patients should be aware of this diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/35. Infectious crystalline keratopathy with ring opacity.A 41-year-old physician was treated for 3 months with antiviral medications, antibiotics, and steroids for presumed herpetic keratitis. When seen by us, an annular infiltrate was observed, along with crystalline-like opacities in the superficial one third of the stroma. Cultures of scrapings and of subsequent biopsies were positive for streptococcus mitis of the viridans group; histopathology demonstrated large aggregates of cocci between the stroma lamellae. Tapering of topical corticosteroids and treatment with topical penicillin resulted in resolution of the infiltrates. The clinical appearance and findings in this patient suggest that infectious crystalline keratitis can produce an annular infiltrate. Injection of the organism into rabbit corneas produced a crystalline infiltrate, but no annular opacity was observed. Corticosteroids altered the clinical and histopathologic appearance of the lesions in rabbits.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |