| patients taking multiple medications may suffer from unpredictable and complex drug-drug interactions resulting in significant morbidity and mortality. There are few reports in the literature of hypoglycemia with concurrent administration of an oral hyperglycemic agent and a fluoroquinolone antibiotic. We present a case of a diabetic patient taking glyburide who was prescribed ciprofloxacin and developed prolonged hypoglycemia, which persisted for over 24 hours. The mechanisms by which these agents interact to produce prolonged hypoglycemia are complex and probably multifactorial. patients stabilized on glyburide who are started on a fluoroquinolone should have their glucose levels monitored closely. ( info) |
| This report presents the case of a patient with a massive pyelonephritis and a urosepsis caused by streptococcus pneumoniae. This case is unusual as the focus was distant from the respiratory tract, the usual primary site of infection caused by this organism. No other primary site of infection was documented. ( info) |
203/750. Aspergillus endocarditis in a native valve after amphotericin b treatment. Systemic infection with aspergillus fumigatus is an opportunistic disease that affects mainly immunocompromised hosts and is associated with a high mortality rate. We report a case of A. fumigatus endocarditis after an episode of thrombotic thrombocytopenic purpura. diagnosis was established after sudden rupture of posterior papillary muscle of the normal native mitral valve. Soon after mitral valve replacement, Aspergillus endocarditis recurred, associated with multiple peripheral emboli, which necessitated a second operation. ( info) |
204/750. Severe ciprofloxacin-associated pseudomembranous colitis in an eight-year-old child. clostridium difficile is the principal cause of antibiotic-associated diarrhea and pseudomembranous enterocolitis in children. A case of severe pseudomembranous colitis developing in an 8-year-old child who had received oral ciprofloxacin therapy as part of an investigational protocol is presented. The safety and efficacy of fluoroquinolones in children has not yet been established. Use of these antibiotics in children outside investigational protocols ("off-label" use) as oral antipseudomonas agents is discouraged. ( info) |
205/750. Urinary tract infection caused by aerococcus viridans, a case report. BACKGROUND: aerococcus viridans organisms are gram-positive, usually airborne cocci that are widely distributed in hospital environments. These bacteria have infrequently been encountered as a human pathogen causing bacteremia, endocarditis and urinary tract infections. The clinical significance of these bacteria may be overlooked due to their fastidious growth and often confused with other strains of streptococci. CASE REPORT: We report a case of urinary tract infection with bacteremia caused by A. viridans in an 87 year-old male nursing home resident. The patient presented with a fever of 103 degrees F, dysuria, hematuria and weakness for three days. urinalysis showed large amount of blood, more than one hundred white cells/HPF and 4 bacteria. Laboratory tests revealed, white blood cell count of 2300/cu mm (neutrophils 80%, bands 7%, lymphocytes 11% and monocytes 2%), hemoglobin 15.4 gm/dL, blood urea nitrogen 23 mg/dL and creatinine 1.2 mg/dL. urine culture yielded growth of 10(5) CFU of A. viridans. The patient was treated for ten days with levofloxacin (both IV PO). CONCLUSIONS: To date, no clinical case report of this nature has been described implicating A. viridans in urinary tract infections. Increased awareness and more studies of this genus should lead to the identification of their potential role in human infections. ( info) |
206/750. Impact of prolonged treatment with trimethoprim-sulfamethoxazole on the human gut flora. The case of a mentally ill man inadvertently treated with trimethoprim-sulfamethoxazole (TMP-SMX) for 2 y is presented. Quantitative stool cultures revealed a substantially suppressed Gram-negative aerobic flora, while enterococcus spp. and anaerobes were not affected. yeasts were moderately increased. TMP-SMX represents an attractive antimicrobial for immunocompromized patients who need the integrity of their intestinal anaerobic flora for colonization resistance. ( info) |
| cytomegalovirus (CMV) is an important cause of morbidity after solid organ transplantation. We report a case of CMV infection involving the transplanted duodenum that developed after simultaneous pancreas-kidney transplantation. The patient, a 30-year-old woman with insulin-dependent diabetes undergoing hemodialysis due to chronic renal failure, received a simultaneous cadaveric pancreas-kidney transplantation. The exocrine secretion was diverted using bladder drainage. immunosuppression was maintained by a combination of tacrolimus, mycophenolate mofetil, and steroids together with OKT3 induction. Both the donor and the recipient were serologically positive for CMV IgG CMV prophylaxis consisted of a short course of parenteral gancyclovir. The patient was discharged on postoperative day 39 with normal pancreas and kidney function. She presented 2 months after transplantation with hematuria. Cystoscopic pancreas allograft biopsy specimens showed evidence of tissue invasive CMV infection in the graft duodenum and bladder. The CMV antigenemia test was positive. At 4 months after transplantation, the patient underwent surgery with the diagnosis of acute abdomen. The surgical findings consisted of a diffuse acute purulent peritonitis due to perforation of the duodenal graft. We sutured the perforation with nonreabsorbable material. The CMV antigenemia test was negative. Eight days later, the patient developed massive hematuria. At surgery, the graft was removed. The patient was discharged from the hospital with normal renal function. Pathological study of the removed graft showed the duodenal segment to have multiple wide ulcers with CMV inclusions in epithelial cells. ( info) |
208/750. aeromonas popoffii urinary tract infection. aeromonas popoffii is a recently described species isolated mainly from freshwater. An isolate of aeromonas popoffii was found to be responsible for a urinary tract infection in a 13-year-old boy suffering from spina bifida with enterocystoplasty. This is the first reported case of human infection attributed to this species. ( info) |
209/750. Prophylaxis to avert exacerbation/relapse of multiple sclerosis in affected patients undergoing surgery. Surgical observations and recommendations. To provide the neurological and neurosurgical communities with case evidence of postoperative multiple sclerosis (MS) relapse, literature review to support operative stress-induced relapse and recommendations for perioperative prophylaxis to prevent relapse in patients undergoing surgery. Two case studies are presented with recommendations based on an extensive review of the medical literature and personal experience to support perioperative prophylactic suggestions. Both patients fully recovered to preoperative functional status after treatment. We now routinely implement perioperative prophylaxis to MS patients undergoing surgery at our institution with no complications to date. Perioperative prophylaxis in patients with MS undergoing surgery can prevent relapse. It is of utmost importance that the surgical community realizes that prophylactic treatment is available and should be utilized during elective and emergent surgical situations. ( info) |
210/750. Dysfunctional elimination syndrome in three generations of one family: might it be hereditary? Dysfunctional elimination syndrome is a diagnosis gaining popularity in pediatric urologic published studies. However, its etiopathogenesis is still unclear. We report a family with 5 cases (3 urodynamically proven) of dysfunctional elimination syndrome in three generations. On the basis of the findings in this family, we revisit the hypothesis that the etiopathogenesis of dysfunctional elimination syndrome might be hereditary. We believe our observations might support the concept of the hereditary transmission of dysfunctional elimination syndrome. ( info) |