1/2142. Septic arthritis following arthroscopic meniscus repair: a cluster of three cases. Three cases of staphylococcus epidermidis septic arthritis following inside-out arthroscopic meniscus repair within a 4-day period at the same facility are described. All three patients responded to surgical debridement and 4 to 6 weeks of intravenous antibiotics. In each instance, the meniscus and repair sutures were left intact; 12- to 38-month follow-up revealed no evidence of infection or meniscal symptoms. Epidemiological investigation implicated the meniscus repair cannulas as one of the few factors common to all three cases. molecular typing of bacterial dna revealed that two of the three isolated organisms showed identical pulsed-field gel electrophoretic patterns, implying a common source of inoculation. Experimental contamination of the cannulas revealed that only sterilization involving ultrasonification, lumen washing by water jet, and steam sterilization resulted in clean and sterile cannulas. ( info) |
| Miliary tuberculosis is a rare form of tuberculosis in industrialized countries. We report on a 69-year-old woman presenting a sepsis syndrome caused by cryptic miliary tuberculosis clinically mimicking a case of cholecystitis with sepsis. The patient died of a multi-organ failure on day 6 of her hospital stay. ( info) |
3/2142. Characteristics of a strain of clostridium carnis causing septicaemia in a young infant. clostridium carnis is a species which is only rarely isolated from man or animals and is occasionally found in the soil. This paper is an account of a single isolate found in blood cultures obtained from an 8-week-old boy who was suffering from gastroenteritis. ( info) |
| We describe a patient with an atypical chronic lymphocytic leukemia (CLL) of the mixed cell type with a hypercalcemia due to parathyroid hormone-related protein production by the malignant B cells. On regard of the elevated serum calcium level without overt lytic bone lesions we found elevated serum levels of PTH-rP and demonstrated the presence of PTH-rP on the malignant lymphocytes. PTH-rP-related hypercalcemia in CLL is very rare. The role in PTH-rP in humoral hypercalcemia of malignancy is discussed. ( info) |
5/2142. Familial deficiency of the seventh component of complement associated with recurrent bacteremic infections due to Neisseria. The serum of a 29-year old woman with a recent episode of disseminated gonococcal infection and a history of meningococcal meningitis and arthritis as a child was found to lack serum hemolytic complement activity. The seventh component of complement (C7) was not detected by functional or immunochemical assays, whereas other components were normal by hemolytic and immunochemical assessment. Her fresh serum lacked complement-mediated bactericidal activity against neisseria gonorrhoeae, but the addition of fresh normal serum or purified C7 restored bactericidal activity as well as hemolytic activity. The absence of functional C7 activity could not be accounted for on the basis of an inhibitor. Opsonization and generation of chemotactic activity functioned normally. Complete absence of C7 was also found in one sibling who had the clinical syndrome of meningococcal meningitis and arthritis as a child and in this sibling's clinically well eight-year-old son. HLA histocompatibility typing of the family members did not demonstrate evidence for genetic linkage of C7 deficiency with the major histocompatibility loci. This report represents the first cases of C7 deficiency associated with infectious complications and suggests that bactericidal activity may be important in host defense against bacteremic neisseria infections. ( info) |
6/2142. Pylephlebitis associated with appendicitis. Pylephlebitis usually occurs secondary to infection in the region drained by the portal venous system. A most common antesecent focus of infection is diverticulitis and the most common blood isolate is E. coli (54%), followed by proteus mirabilis (23%). overall mortality is 32% and most of the patients who had died had severe sepsis prior to the initiation of antibiotic therapy. We describe a case of pylephlebitis which had appendicitis and consequent septic thrombosis of the portal vein and its branches, with dissemination of infection to the liver. The patient had recovered due to timely antibiotic treatment alone and resulted in complete resolution. early diagnosis and treatment are basic to a favorable clinical course. ( info) |
7/2142. Central line sepsis in a child due to a previously unidentified mycobacterium. A rapidly growing mycobacterium similar to strains in the present mycobacterium fortuitum complex (M. fortuitum, M. peregrinum, and M. fortuitum third biovariant complex [sorbitol positive and sorbitol negative]) was isolated from a surgically placed central venous catheter tip and three cultures of blood from a 2-year-old child diagnosed with metastatic hepatoblastoma. The organism's unique phenotypic profile and ribotype patterns differed from those of the type and reference strains of the M. fortuitum complex and indicate that this organism may represent a new pathogenic taxon. ( info) |
| We report a case of sepsis caused by bifidobacterium longum in a 19-year-old male who had developed high fever, jaundice, and hepatomegaly after acupuncture therapy with small gold needles. Anaerobic, non-spore-forming, gram-positive bacilli were isolated from his blood and finally identified as B. longum. He recovered completely after treatment with ticarcillin and metronidazole. To our knowledge, this is the first report of incidental sepsis caused by B. longum. ( info) |
9/2142. Pseudoaneurysm of the left ventricle after isolated pericarditis and staphylococcus aureus septicemia. Left ventricular pseudoaneurysm after isolated pericarditis as a result of Staphylococcal septicemia is very rare. A case of a very young patient is described. Diagnosis is made by echocardiography. Immediate surgical resection of the pseudoaneurysm is the therapy of choice. ( info) |
10/2142. Pericardial injury following severe sepsis from faecal peritonitis--a case report on the use of continuous cardiac output monitoring. We report on a case of a 43-year-old man who developed reversible myocardial depression and pericarditis related to severe sepsis secondary to rectosigmoid colonic perforation. The management of this patient was aided by the use of a continuous thermodilution cardiac output catheter and monitor, recently introduced in clinical practice. ( info) |