1/15. Infectious disease emergencies in primary care.Infectious disease emergencies can be described as infectious processes that, if not recognized and treated immediately, can lead to significant morbidity or mortality. These emergencies can present as common or benign infections, fooling the primary care provider into using more conservative treatment strategies than are required. This review discusses the pathophysiology, history and physical findings, diagnostic criteria, and treatment strategies for the following infectious disease emergencies: acute bacterial meningitis, ehrlichiosis, rocky mountain spotted fever, meningococcemia, necrotizing soft tissue infections, toxic shock syndrome, food-borne illnesses, and infective endocarditis. Because most of the discussed infectious disease emergencies require hospital care, the primary care clinician must be able to judge when a referral to a specialist or a higher-level care facility is indicated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/15. endocarditis attributable to group A beta-hemolytic streptococcus after uncomplicated varicella in a vaccinated child.Varicella is generally a benign, self-limited childhood illness; however, severe, life-threatening complications do occur. A live, attenuated vaccine exists to prevent this illness, but controversy remains concerning the need to vaccinate children for what is generally a benign, self-limited disease, although more states are currently recommending this vaccine. We report a previously healthy 3-year-old who developed varicella 6 months after vaccination with no apparent skin superinfections, who subsequently developed group A beta-hemolytic streptococcus (GABHS) bacteremia resulting in endocarditis of a normal heart valve. We are unaware of previous reports of endocarditis related to GABHS after varicella. After developing a harsh, diastolic murmur that led to an echocardiogram, aortic valve endocarditis was diagnosed. A 6-week course of intravenous penicillin g was administered. Two weeks after the initiation of therapy, the diastolic murmur was harsher, and echocardiography revealed a large vegetation on the posterior leaflet of the aortic valve, with severe aortic insufficiency and a dilated left ventricle. The patient subsequently developed congestive heart failure requiring readmission and aggressive management. One month after the initial echocardiogram, a repeat examination revealed worsening aortic regurgitation and mitral regurgitation. The patient received an additional 4 weeks of intravenous penicillin and gentamicin followed by aortic valve replacement using the Ross procedure. Our patient, the first reported case of bacteremia and endocarditis from GABHS after varicella, illustrates the need for the health care practitioner to consider both common and life-threatening complications in patients with varicella. While cellulitis, encephalitis, and septic arthritis may be readily apparent on physical examination and commonly recognized complications of varicella, the possibility of bacteremia without an obvious skin superinfection should also be entertained. The case we report is unique in that the patient had normal immune function, had been previously vaccinated, and developed a rare complication of varicella-endocarditis-in a structurally normal heart with a previously unreported pathogen. Although a child may have been vaccinated against varicella, the chance of contracting the virus still exists and parents should be informed of this risk. group A beta-hemolytic streptococcus, endocarditis, varicella, Varivax, complications of varicella.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/15. Cases from the osler medical service at Johns Hopkins University.PRESENTING FEATURES: A 29-year-old woman with a history of rheumatic heart disease and one episode of endocarditis as an adolescent was admitted to the hospital after 1 week of headache, fever, and myalgia. Her past medical history was otherwise unremarkable and did not include illicit drug use. On physical examination, she had a previously noted 3/6 holosystolic murmur at the apex, which radiated to her back; a previously noted 1/4 diastolic murmur at the right upper sternal border; diminished strength in her right upper extremity; multiple painful erythematous nodules on her fingers (Figure 1); and red streaks under her nails (Figure 2). magnetic resonance imaging of the brain demonstrated multiple lesions; the largest was in the right frontal lobe with associated hemorrhage (Figure 3).What is the diagnosis?- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/15. mitral valve endocarditis: an uncommon cause of myocardial infarction.A 39 year old woman presented with acute anterior myocardial infarction. At coronary angiography the distal left anterior descending coronary artery (LAD)was occluded despite otherwise normal coronary arteries. The LAD was successfully recanalized using PTCA. Subsequently, a transesophageal echocardiogram revealed vegetations and a significant incompetence of the mitral valve.blood cultures identified out enterococcus faecalis. Despite intra-venous antibiotic treatment guided by sensitivity testing, the patient ultimately required elective mitral valve replacement. During a prior outpatient diagnostic work-up of fever/malaise, the diagnosis of infective endocarditis was not made.This case conveys two main messages: 1) because the history and physical sings of bacterial endocarditis can be subtle or non-specific, the first step to diagnose infective endocarditis is to include it in the differential diagnosis. 2) percutaneous coronary intervention is an effective treatment of septic embolic occlusion of a major coronary artery.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/15. Victim of fashion: endocarditis after oral piercing.A case report of endocarditis after tongue piercing is presented. body piercing is a form of self-expression that is achieving greater acceptance and wider practice in modern society. Even in healthy individuals, significant health risks exist with this type of physical adornment. Despite this fact, no significant regulatory mechanisms are currently in place to guide practitioners of this craft or to protect the recipients of body piercing. Medical professionals should join the american dental association in their opposition of the practice of intraoral/perioral piercing and should call for the development of legislation protecting the recipients of such practices, particularly the population of young people in whom this type of body art is becoming increasingly prevalent.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/15. Management of valvular heart disease: an illustrative cases approach.As indicated by the 22 illustrative cases included in this monograph, a stepwise approach to the assessment of valvular heart disease provides the information necessary to make good clinical decisions. The ECG and chest x-ray add useful information to the history and physical examination. echocardiography, doppler, and color flow Doppler techniques have an important role in defining the presence and severity of valvular stenosis and regurgitation. Nuclear techniques provide useful information about global biventricular systolic function, regional wall motion, and myocardial perfusion. Exercise testing is most valuable in confirming objectively the patient's functional status and exercise tolerance. Newer imaging techniques, such as cine CT and MRI, are capable of displaying and measuring cardiac chamber size and myocardial thickness; however, visualization of the cardiac valves and demonstration of flow abnormalities are difficult, limiting the current usefulness of these techniques in patients with valvular heart disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/15. Acute severe aortic regurgitation. Pathophysiology, clinical recognition, and management.Acute severe aortic regurgitation is a relatively unfamiliar, though life-threatening, disease. We review its diverse causes, anatomic faults, and hemodynamic sequelae and set the stage for an understanding of the clinical manifestations in light of their physiologic mechanisms. Clinical information includes the natural history, physical signs (physical appearance, systemic arterial pulse, jugular venous pulse, precordial palpation, auscultation), electrocardiogram, and chest roentgenogram. Echocardiographic features are especially emphasized and the need for prompt diagnosis and surgical intervention underscored, even in the setting of active infective endocarditis.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
8/15. The clinical and echocardiographic diagnosis of infective endocarditis.We report the results of a series of 75 patients admitted to the East Birmingham Hospital between 1976 and 1984. rheumatic heart disease is now an uncommon predisposing factor. The viridans streptococci are a decreasing cause of infection while staphylococcal infections are increasing and often occur on previously normal heart valves. The presenting symptoms of the disease are usually non-specific and the classical physical signs of endocarditis are uncommon. blood culture and echocardiography are the most useful investigations in establishing the diagnosis. The diagnosis of endocarditis should be considered in all febrile patients, especially if they are ill, who have a cardiac murmur or persistent bacteraemia.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/15. incidence and clinical characteristics of "culture-negative" infective endocarditis in a pediatric population.Sixty episodes of infective endocarditis were analyzed in 56 pediatric patients over a 10-year period from 1974 to 1984. culture-negative infective endocarditis was noted on five occasions or 8.3% of all episodes. In addition to the physical findings, a combination of laboratory parameters including anemia, erythrocyte sedimentation rate, elevated rheumatoid factor, C1q activation and microhematuria supported the diagnosis. The clinical characteristics of these patients are described in detail. Pretreatment with an antimicrobial agent was only one factor associated with the failure to isolate an organism. Empiric treatment with penicillin and gentamicin and in one case nafcillin/ampicillin and gentamicin was satisfactory.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/15. haemophilus influenzae endocarditis.haemophilus influenzae endocarditis on a prosthetic valve has previously been reported only once. Routine physical and laboratory evaluation does not distinguish endocarditis from this organism from other causes of endocarditis. Our patient with prosthetic mitral valve endocarditis was successfully treated with antibiotics, but surgery was subsequently required for congestive heart failure from valve dehiscence.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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