1/12. bacteremia and skin/bone infections in two patients with X-linked agammaglobulinemia caused by an unusual organism related to Flexispira/helicobacter species.Two patients with Bruton's X-linked agammaglobulinemia are described with bacteremia and skin/bone infection due to an organism which by 16S rRNA gene sequence analysis was most closely related to "Flexispira" rappini (and thus designated a Flexispira-like organism, FLO) and more distantly related to the helicobacter species. The organism required microaerobic conditions and, supplemental H(2) gas for growth and was reliably stained with acridine orange. In common with helicobacter cinaedi infections, the focus of the FLO infection was in one case in the blood vessels or lymphatics of an extremity and in the other case in the skin and adjacent bone of an extremity. In both cases, prolonged IV antibiotic therapy was necessary to clear the infection. The susceptibility of XLA patients to FLO infection appears to be related to the fact that XLA is associated with severe B cell (humoral) immunodeficiency and thus these patients have difficulty with intravascular or intralymphatic infection. These findings elucidate the nature of FLO infections in humans and point the way to their detection and treatment.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/12. Disseminated gonococcemia.A 26-year-old woman presented with a high-grade fever and chills of 2 days' duration. She complained of associated joint pain, especially in the wrists and knees. One day before admission, tender skin lesions began to develop on the fingers, and subsequently spread to the more proximal extremities. The patient recalled having a sore throat and a nonproductive cough before the onset of the fever and eruption. The past medical history was significant for gardnerella vaginitis and several urinary tract infections. The patient was taking oral contraceptive pills; her most recent menstruation was 3 weeks before admission. She reported having sexual intercourse with her boyfriend 2 weeks before admission. The patient's temperature was 40 degrees C. Dermatologic examination revealed a 6-mm, hemorrhagic pustule on an ill-defined pink base, overlying the volar aspect of the left second proximal interphalangeal joint (Fig. 1a). Scattered on the upper and lower extremities were occasional round, ill-defined pink macules with central pinpoint vesiculation (Fig. 1b). A skin biopsy of the digit revealed a dense neutrophilic infiltrate with leukocytoclasis and marked fibrin deposition in the superficial and deep dermal vessels (Fig. 2a). Gram stains demonstrated the presence of Gram-negative diplococci (Fig. 2b). Laboratory findings included leukocytosis (leukocyte count of 20 x 109/L, with 81% neutrophils). Analysis of an endocervical specimen by polymerase chain reaction was positive for neisseria gonorrhoeae and negative for chlamydia trachomatis. Throat and blood cultures grew N. gonorrhoeae. Specimen cultures obtained by skin biopsy yielded no growth. Results of serologic analysis for human immunodeficiency virus, hepatitis, syphilis, and pregnancy were negative. Beginning on admission, intravenous ceftriaxone, 2 g, was administered every 24 h for 6 days, followed by oral cefixime, 400 mg twice daily for 4 days. Oral azithromycin, 1 g, was administered to treat possible coinfection with C. trachomatis. By treatment day 4, the patient was afebrile, with the resolution of leukocytosis and symptomatic improvement of arthralgias.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/12. Acute skin and fat necrosis during sepsis in a patient with chronic renal failure and subcutaneous arterial calcification.Calcification of small subcutaneous arteries and arterioles is commonly found in patients with chronic renal failure (CRF), but the syndrome of acute ischemic necrosis of the skin and subcutaneous fat supplied by these vessels is relatively uncommon. The necrosis occurs during dialysis and after successful renal transplantation, and it is often fatal. Occlusion of the calcified arteries and associated microvessels by thrombi is reported infrequently, but it is relevant to the necrosis. However, the pathogenesis remains enigmatic. In the patient described here, who had CRF, bacteremia, and laboratory evidence of disseminated intravascular coagulation (DIC), the distribution of thrombi and necrosis was mainly that of the calcified arteries which, therefore, probably played a role in the localization of the thrombi. An increased susceptibility of the endothelium of calcified vessels to the procoagulant effects of sepsis may be a contributing factor.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
4/12. Arterial infections due to listeria monocytogenes: report of four cases and review of world literature.early diagnosis and successful antimicrobial therapy have diminished the frequency of embolomycotic aneurysms, but infected aortic and small vessel aneurysms, arteriosclerotic plaques, and prosthetic grafts are becoming more common. A broad spectrum of pathogens, including staphylococcus, salmonella, enterobacteriaceae, pseudomonas aeruginosa, and some unusual organisms, are associated with this change. We treated four patients (three with abdominal aortic aneurysms and one with a prosthetic graft) with arterial infections caused by listeria monocytogenes. Only seven other cases have previously been recorded in the world literature. Infection is suspected when a palpable or radiographically defined aneurysm is present with an otherwise obscure febrile illness. In about one-third of patients, blood cultures have yielded the pathogen. Newer imaging techniques have helped confirm the diagnosis. These infections are best managed by surgical resection in combination with long-term, appropriate antimicrobial therapy with ampicillin or sulfonamides. Unlike other adult listerial infection, except endocarditis, in arterial infection, immunosuppression and malignancy are not predisposing factors.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/12. Severe ocular involvement in disseminated intravascular coagulation complicating meningococcaemia.BACKGROUND: disseminated intravascular coagulation (DIC) is characterized by inappropriate widespread activation of coagulation leading to extensive microvascular thrombosis and haemorrhage. Ocular involvement typically manifests as fibrin-platelet clots in the choroidal vessels of the posterior pole with overlying serous retinal detachment and sparing of the retinal vessels. methods: Case report. RESULTS: An 18-year-old female with meningococcal septicaemia and DIC developed bilateral dense vitreous haemorrhage. At vitrectomy multiple areas of sub-internal limiting membrane haemorrhage were evacuated and silicone oil injected. The patient developed bilateral large macular holes with inferior tractional retinal detachment. Two years later, final visual acuity was 6/36 OD and count fingers OS. CONCLUSION: Ocular involvement in DIC can be more extensive than choroidal vascular occlusion alone. Previous reports suggest that DIC associated with sepsis (especially meningococcaemia) may present with more severe manifestations. This may be due to sub-clinical endophthalmitis or haemorrhagic ischemia. Visual prognosis can be poor.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
6/12. purpura cerebri in gram-negative septicaemia. A histological and immunohistochemical study.Two cases with brain purpura following Gram-negative septicaemia were examined morphologically and immunohistochemically. The brain lesions, including ball and ring haemorrhages, a few days old, with some microglial cells accumulated around the older foci, were restricted to the white matter. Immunohistochemically, scanty deposits of IgG, IgA and IgM mainly in the macrophages in brain, kidneys and lungs were found, whereas staining with antibodies directed against IgE and complement (C3, C4) remained negative. In the brain, immunoglobulin deposits were located mainly in the macrophages, furthermore, in and around the walls of a few intact (non-haemorrhagic) vessels; within the perivascular haemorrhagic foci no deposits could be demonstrated. The relevance of these observations to the pathogenesis of brain purpura is discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/12. Glue embolisation of a ruptured pancreaticoduodenal artery aneurysm.Embolisation of a mycotic aneurysm of the anterior pancreaticoduodenal arcade was performed in an emergency situation using a microcatheter and tissue adhesive, after unsuccessful surgical therapy. The polymerising agent occluded the outflow vessel, the aneurysm and the feeding artery successfully.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/12. Mycotic aneurysm due to non-typhi salmonella: report of 16 cases.From 1990 through 1994, we collected information on all cases of mycotic aneurysms due to non-typhi salmonella that occurred at the veterans General Hospital in Kaohsiung, taiwan. All cases of salmonella bacteremia were reviewed to find any additional cases. A total of 16 cases of salmonella mycotic aneurysms occurred. The mortality rate was 100% among the three patients treated with medical therapy alone. Nine (70%) of the 13 patients who received surgical and medical therapy survived. Ten of the 16 cases were due to salmonella choleraesuis. Diagnosis was established by computed tomography or aortography. gallium scans were of no diagnostic utility. A culture of blood from a patient with underlying atherosclerosis that is positive for invasive salmonella should prompt a search for a mycotic aneurysm. Treatment with a third-generation cephalosporin and resection of the infected vessel is usually successful.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/12. Isolated meningeal vasculopathy associated with clostridium septicum infection.A 28-year-old patient with acute lymphoblastic leukemia and neutropenia developed necrotizing enterocolitis and clostridium septicum bacteremia, followed by rhabdomyolysis, skin rash, and acute neurologic changes. Numerous cortical leptomeningeal enhancements were present on head MRI. Meningeal and brain biopsy showed segmental, full-thickness lysis of smooth muscle cells of medium-sized meningeal vessels with overall preservation of the structure of the vessel wall.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
10/12. Septic thrombosis of orbital vessels due to cutaneous nasal infection.The authors describe two cases of cutaneous nose infection that quickly spread and extended to the orbital venous complex. At first glance, the clinical presentation could be mistaken for a complicated sinusal infection; therefore, the evaluation of the sinuses, by means of physical examination and radiological investigation, was of great concern, showing that there was no important pathology in the sinuses. The CT scan and the color Doppler imaging (orbital ultrasound with Doppler) demonstrated, throughout the development of the disease, that the superior ophthalmic vein was affected in both patients and the cavernous sinus in one of them. On physical examination, chemosis of the conjunctiva, proptosis, and edema of the eyelids were prominent. patients improved only after appropriate intravenous antibiotic therapy against staphylococcus (clindamycin) and corticosteroids, making one conclude that treatment of this disease should be initiated as soon as possible in order to decrease morbidity and mortality.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
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