| patients with advanced cystic fibrosis typically have chronic bacterial infection of the upper and lower respiratory tracts, but rarely develop extrapulmonary sites of infection. We report a case of purulent pericarditis due to Pseudomonas aeruginosa in a patient with cystic fibrosis and no other risk factors for pericarditis. This is a previously unreported complication in cystic fibrosis prior to lung transplantation. ( info) |
2/921. Induction of a critical elevation of povidone-iodine absorption in the treatment of a burn patient: report of a case. A critical elevation of povidone-iodine absorption which occurred in a burn patient who was topically treated with 10% povidone-iodine (PI) gel is herein reported. A 65-year-old man was admitted to our hospital for deep second- and third-degree burns covering 26% of his total body surface area. The intravenous administration with lactated Ringer's solution and topical treatment with silver sulfadiazine were applied in addition to such treatments as debridement and skin grafting. However, wound infection occurred due to pseudomonas aeruginosa. Topical treatment with PI gel was effective for this condition. Persistent nodal bradycardia with hypotension, metabolic acidosis, and renal failure occurred 16 days after the start of PI gel treatment. Iodine toxicosis caused by PI gel was suspected with a serum iodine level of 20600 microg/dl (normal range 2-9 microg/dl). The PI gel treatment was therefore discontinued immediately, and hemodialysis was scheduled. However, the patient's family refused hemodialysis and he died 44 days after admission. To our knowledge, only eight patients with iodine toxicosis have been reported in burn patients treated with PI gel. ( info) |
3/921. Pacemaker-related endocarditis. Report of 7 cases and review of the literature. We report on 7 patients with pacemaker endocarditis diagnosed during the workup of long-standing fever. Persistent positive blood cultures and echocardiography led to the diagnosis in 6 patients whereas autopsy was diagnostic in another. Causative microorganisms were staphylococcus epidermidis (3), staphylococcus lugdunensis (1), pseudomonas aeruginosa (1), streptococcus bovis (1), and streptococcus mitis-streptococcus sanguis (1). pulmonary embolism was present in nearly 50% of the cases, a figure clearly higher than previously reported. In all but 1 case the initial medical approach was not successful, and thus the pacing system was finally removed. None of the cases relapsed after the removal. We have reviewed the literature regarding pacemaker endocarditis, particularly with respect to treatment. ( info) |
4/921. meningitis caused by an alkali-producing pseudomonad. The clinical and microbiological features of a case of meningitis, due to an alkali-producing pseudomonad which closely resembles pseudomonas pseudoalcaligenes, are described. A respiratory infection and a course of antibiotic therapy before admission to hospital may have been predisposing factors to opportunistic infection by this normally saprophytic organism. The problems of identifying alkali-producing pseudomonads are discussed. ( info) |
| pseudomonas aeruginosa infection can cause a wide array of skin manifestations. While some infections are mild, as are the cases with hot tub folliculitis and toe web or nail infection, others are a result of sepsis and can be fatal without prompt treatment. The classic skin finding of P. aeruginosa sepsis is ecthyma gangrenosum, but other signs such as papules, petechiae, and hemorrhagic bullae can also be seen. Suppurative panniculitis can also be caused by P. aeruginosa sepsis and clinically manifests as solitary or multiple subcutaneous nodules. Reports in the literature describe these nodules in the setting of clinical sepsis or with positive blood cultures. We report a case of localized subcutaneous nodules on the leg caused by P. aeruginosa in a patient without sepsis or positive blood cultures. The source of the infection was thought to be from a traumatic inoculation. This raises the possibility that P. aeruginosa can cause subcutaneous nodules from a localized infection, perhaps via lymphangitic spread without the manifestations of sepsis. ( info) |
6/921. pseudomonas aeruginosa endophthalmitis caused by contamination of the internal fluid pathways of a phacoemulsifier. PURPOSE: To report 4 cases of pseudomonas aeruginosa endophthalmitis caused by internal contamination of the internal pathways of a phacoemulsifier. SETTING: ophthalmology Center, Perpignan, france. methods: Four clinical cases of postoperative endophthalmitis occurred after phacoemulsification. An investigation was necessary to prove the cause of the bacteriological contamination. RESULTS: serotyping and ribotyping of the pseudomonas aeruginosa strains obtained from the vitreous samples and from the phacoemulsifier showed that all these strains were identical and that the initial site of the contamination was the phacoemulsifier. CONCLUSIONS: The profession should be cognizant of this cause of endophthalmitis, although its occurrence is rare. cataract surgeons should test samples from the collection bags of their phacoemulsifiers to ensure there is no bacteriological contamination. ( info) |
| We describe a case of rapidly progressive upper airway obstruction due to tracheal Pseudomonas abscesses in a patient with acquired immunodeficiency syndrome. The case highlights the aggressive nature of pseudomonas infections and the difficulty of eradicating this organism in patients infected with the human immunodeficiency virus. ( info) |
8/921. Subcutaneous nodules with pseudomonas septicaemia in an immunocompetent patient. Pseudomonas septicaemia presenting with subcutaneous nodules, though rare, is well described in immunocompromized populations. It is, however, very uncommon in immunocompetent patients. We describe a case of a 42-year-old woman who presented with community-acquired. pseudomonas aeruginosa septicaemia and subcutaneous nodules. No precipitating cause or immune dysfunction was found. She was successfully treated with appropriate antibiotics, respiratory and cardiovascular support in the intensive care Unit. The difficulty in eradicating the organism from the skin lesion and the need for investigating the immune function of septicaemia patients are discussed. ( info) |
9/921. A case of bacterial endophthalmitis following perforating injury caused by a cat claw. A case of bacterial endophthalmitis following a perforating ocular injury caused by a cat claw is reported. The scleral wound was sutured immediately following the injury and systemic antibiotics were administered. Despite this treatment, endophthalmitis occurred 3 days after the injury. The endophthalmitis was resolved by pars plana vitrectomy, however preretinal reproliferation and retinal detachment subsequently occurred. After reoperation the retina was reattached and the corrected visual acuity improved from 10 cm/HM to 20/200. pseudomonas aeruginosa was detected in cultured vitreous humor that was collected during surgery. This case illustrates the possibility of endophthalmitis being caused by gram negative bacillus in cases of perforating injuries caused by animal claws. Perforating ocular injuries caused by animal claws are relatively rare. Here we report a case of endophthalmitis due to pseudomonas aeruginosa that occurred after a perforating injury caused by a cat claw. The eye was treated by pars plana vitrectomy. ( info) |
10/921. A resuscitated case from asphyxia by large bronchial cast. A 62-year-old woman with bronchiectasis suffered from asphyxia due to a large bronchial cast that obstructed the bronchial tree. Immediate bronchoscopic suction of a bronchial cast of 17 cm in length through the intubated tube relieved the patients without any complications. Large bronchial casts appear to be rare in this century but it should be considered in patients with acute exacerbation of excessive sputa not only in patients with asthma or allergy but also in patients with respiratory tract infection. ( info) |