1/217. 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.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/217. 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.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
3/217. Localised upper airway obstruction in a patient with acquired immunodeficiency syndrome.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.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
4/217. 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.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
5/217. amikacin (BBK8) in infections due to gram-negative organisms in children over the age of one month.Thirty children over the age of one month were treated with amikacin (BBK8), a new aminoglycoside derived from kanamycin A, with three intramuscular dosage schedules. Each group consisted of ten patients. The first received 7-5 mg/kg/12 hours, the second 7-5 mg/kg/24 hours and the third, 3-75 mg/kg/12 hours. The infections and the bacteria were similar in all three groups: pyelonephritis, abscesses of soft tissues, infected wounds, septicaemia, superinfected empyema, gastro-enteritis, chronic otitis media; the bacteria were E. coli, klebsiella, Pseudomonas and salmonella. A were sensitive by the Kirby-Bauer method, although two were resistant by dilution in Petri dish. Of the thirty patients, twenty four (80%) were cured. The schedule of 3-75 mg/kg/12 hours was as effective as the schedule of 7-5 mg/kg/12 hours for infections such as pyelonephritis, superficial abscesses, contaminated wounds, gastro-enteritis and sepsis. The cases with infections localized in rather unaccessible sites required double the dose and strict drainage and cleanliness. plasma levels with the administration of 3-75 mg/kg fluctuated between 8-3 and 12-6 mcg/ml; with 7-5 mg/kg they fluctuated between 8-6 and 13-1. The minimum inhibitory level (MIL) for the majority of the bacteria was 1-25 mcg/ml. No toxic reactions were observed.- - - - - - - - - - ranking = 4keywords = organ (Clic here for more details about this article) |
6/217. Painful red nodules of the legs: a manifestation of chronic infection with gram-negative organisms.skin infection secondary to gram-negative organisms is uncommon and is typically limited to persons who are immunocompromised. When these do occur, they are acute, progressive, and severe. Here we report 2 cases of painful red nodules that presented with a waxing and waning course over a long period. One case is that of a 45-year-old healthy white man who developed serratia marcescens infection in 1 leg. The other case is that of a 78-year-old man with chronic lymphocytic leukemia treated with prednisone who developed infection of the leg secondary to pseudomonas aeruginosa. In the first case, symptoms were present for 2 years before definitive diagnosis and treatment. In the second case, 4 months elapsed. Ultimately, both patients responded to antibiotic therapy and recovered. These cases illustrate an unusual presentation of chronic red painful nodules of the leg secondary to infection with gram-negative organisms and underscore the importance of culture even when infection seems unlikely.- - - - - - - - - - ranking = 6keywords = organ (Clic here for more details about this article) |
7/217. Severe complications of ulcerative colitis after high-dose prednisolone and azathioprine treatment.We report a rare case of ulcerative colitis (UC) associated with methicillin-resistant staphylococcus aureus (MRSA) and pseudomonas aeruginosa infections in multiple organs, and with compressive fracture from osteoporosis after the administration of high-dose prednisolone and azathioprine. A 25-year-old man had been treated with high-dose prednisolone for UC. He suddenly experienced severe lumbago, which prevented him from walking. Plain X-ray demonstrated compressive fractures of the thoracic and the lumbar vertebrae, which were thought to be due to osteoporosis as a side effect of the high-dose prednisolone. At this admission, in another hospital, he also had a bloody discharge from the rectum, and azathioprine was started; however, the patient's condition still did not show any improvement. The total doses of azathioprine and prednisolone he had received were 3150 mg and more than 15,000 mg, respectively. Considering the presence of the serious complications, surgical intervention was the treatment selected. culture study revealed MRSA in the feces and nasal cavity, and P. aeruginosa in the feces and urine. vancomycin hydrochloride and gentamicin were administered, and were effective, with a subsequent negative culture study. Subtotal colectomy with mucus fistula was performed. After the operation, culture studies remained negative. Major steroid side effects such as bone fracture and osteoporosis should be considered as an indication for surgery in UC patients. MRSA and P. aeruginosa are a menace, especially for UC immunosuppressed patients on steroid or immunosuppressive therapy. When these bacteria are detected, there should be prompt and adequate antimicrobial therapy against the organisms and the immunosuppressive therapy should be immediately discontinued. We conclude that surgical therapy should be considered in the earlier stage for patients with intractable UC, rather than continuing long-term administration of steroid or azathioprine, which may lead to serious complications.- - - - - - - - - - ranking = 2keywords = organ (Clic here for more details about this article) |
8/217. The treatment of Pseudomonas keratoscleritis after pterygium excision.PURPOSE: To assess the effect of intensive topical and intravenous antibiotics plus oral prednisolone and surgical debridement in Pseudomonas keratoscleritis after pterygium excision. methods: We describe three cases of P. aeruginosa-induced keratoscleritis occurring 10 days to 18 months after uncomplicated pterygium excision. Treatment included early conjunctival debridement, topical and intravenous antibiotics, and low-dosage oral prednisolone. RESULTS: All three patients responded to the combined therapy. Microorganisms were eliminated, and ulcers were healed within 8 weeks. Treatment was not extended beyond that, and infection did not recur. No evisceration was required. The patients' best corrected visual acuities are 20/200, 20/400, and 20/120, respectively. CONCLUSION: early diagnosis and prompt, intensive medical and surgical treatment may save a patient's vision and forestall evisceration.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
9/217. Community-acquired pseudomonas stutzeri vertebral osteomyelitis in a previously healthy patient: case report and review.pseudomonas stutzeri is a rare pathogen, and its recovery is often associated with colonization and contamination. We report a case that, to our knowledge, is the first of community-acquired P. stutzeri vertebral osteomyelitis in a previously healthy patient, and we review the literature regarding infections with this uncommon organism. Of the 29 previously reported cases of P. stutzeri infection cited in the literature, only two resulted in death, reflecting the relatively low degree of virulence of this organism. Predisposing risk factors for P. stutzeri infection can be categorized as follows: (1) previous surgery or procedure (implying probable nosocomial acquisition), with or without a foreign body; (2) immunocompromise (an underlying predisposition to infection by an organism with low virulence); (3) immunocompromise and a previous procedure; and (4) previous trauma or superficial infection, with or without possible nosocomial contamination. Our patient lacked any known risk factors for either pyogenic vertebral osteomyelitis or P. stutzeri infection.- - - - - - - - - - ranking = 3keywords = organ (Clic here for more details about this article) |
10/217. Severe sclerokeratitis due to pseudomonas aeruginosa in noncontact-lens wearers.PURPOSE: To review the clinical presentation, treatment and outcome in four cases of severe anterior segment infection by pseudomonas aeruginosa unrelated to contact lens wear. methods: Four cases presenting over an 18 month period were reviewed. RESULTS: The cases had variable presenting features and outcomes. Complications such as persistent infection, corneal thinning and phthisis bulbi were noted. Possible factors influencing adherence and tissue disruption are discussed. CONCLUSIONS: Suspicion of infection by P. aeruginosa and prompt isolation of the organism is needed early in the course of disease. Intensive and prolonged treatment with parenteral and topical antibiotics combined with judicious use of topical steroid gives the best chance of a favourable outcome.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
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