1/76. Novel bacterium isolated from a lung transplant patient with cystic fibrosis.The major clinical problem for patients with cystic fibrosis (CF) is progressive loss of pulmonary function, usually due to chronic bacterial infections. A patient with CF and a lung transplant was severely infected with a previously unidentified gram-negative bacterium. We isolated this organism (strain DS15158) from the patient and characterized it by phylogenetic analysis of the small-subunit rRNA and biochemically by the BIOLOG GN MicroPlate assay, fatty acid analysis, and various standard laboratory tests. No close match to any other organism could be found. Isolate DS15158 represents a new genus-level divergence within the bacterial subdivision alpha-proteobacteria on the basis of the 16S rRNA gene analysis.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/76. Graft-versus-Host disease-like syndrome in malignant thymoma.Allogenic transfusion of immunocompetent T lymphocytes into an immunodeficient recipient is necessary for the development of graft-versus-host-disease (GVHD). The gastrointestinal tract is one of the most involved organs in human GVHD, and single-cell necrosis with apoptotic change and crypt abscess are characteristic histopathologic features. The thymus is important in immune regulation, and dysregulation of the immune system can be expected once its microenvironment is disrupted. We report the case of a 38-year-old woman with malignant thymoma without transplantation or transfusion history who initially presented with myasthenia gravis and clinically developed a GVHD-like syndrome with characteristic GVHD-like colitis on colonoscopy. We propose that disruption of the thymic microenvironment caused a dysregulated immune system and development of a GVHD-like syndrome.- - - - - - - - - - ranking = 0.5keywords = organ (Clic here for more details about this article) |
3/76. Clinical features of patients with acute respiratory illness and rhinovirus in their bronchoalveolar lavages.BACKGROUND: Several reports in selected populations suggest that human rhinovirus (HRV) may be responsible for lower respiratory tract infections or pneumonia. We describe clinical features of all patients with rhinovirus cultured from their bronchoalveolar lavage (BAL) during a 10-yr period in a tertiary care center. methods: Results for viral culture of all lower respiratory specimens performed during a 10-year period at the University of virginia health Sciences Center were reviewed. A case was defined as any patient with a positive culture for HRV in a BAL specimen. A comprehensive review of the patients' medical records was performed. In one case, in situ hybridization (ISH) was performed in order to identify whether rhinoviral rna was present in bronchial biopsy specimens. RESULTS: During the 10-year study period viruses were identified in 431 lower respiratory tract specimens, and were most frequently cytomegalovirus or herpes simplex virus. Twenty patients (ages, 2.5-86 year) had a bronchoalveolar specimen culture positive for HRV. All had an abnormal chest radiograph, 60% were admitted to the intensive care unit, and 25% expired during their hospitalization. In 18 patients (90%) various severe underlying conditions were identified including solid organ transplants in seven, malignancies in four and AIDS in two. An immunosuppressive disease or condition requiring immunosuppressive therapy was present in all cases. In addition to HRV, one or more potential pathogens were identified in respiratory specimens from 14 patients (70%). Histopathological abnormalities, ranging from fibropurulent debris in alveoli to diffuse alveolar damage, were present in 6 of 13 bronchial biopsies. In two cases without any other significant pathogens than HRV, acute inflammations with fibropurulent debris in alveoli were observed. One lung transplant patient showed intermittent recovery of HRV in her respiratory specimens during a 15-week time period, but ISH did not show HRV rna in bronchial epithelial cells. CONCLUSION: Our observations suggest that HRV recovery from BALs or lower respiratory tract samples in highly immunocompromised patients is associated with severe lower respiratory tract illness. Whether HRV directly causes viral pneumonia or predispose to pulmonary injury and/or superinfection remains uncertain.- - - - - - - - - - ranking = 0.5keywords = organ (Clic here for more details about this article) |
4/76. Fite stain positivity in rhodococcus equi: yet another acid-fast organism in respiratory cytology--a case report.rhodococcus equi is an aerobic Gram-positive and acid-fast coccobacillus that may cause cavitary pneumonia in immunocompromised hosts such as hiv-infected patients. Numerous Grocott's methenamine silver (GMS)-positive organisms were initially noted on the direct smear; a minor number of acid-fast organisms were seen in the Thin-Prep slide. Since the abundant mucous material with the attached organisms seen in conventional smears may be lost in liquid-based preparations, more sensitive stains such as Fite, as well as a more diligent search for organisms, is needed. This case illustrates the importance of careful selection and evaluation of special stains in sputum specimens.- - - - - - - - - - ranking = 4keywords = organ (Clic here for more details about this article) |
5/76. Vagal neuropathy after upper respiratory infection: a viral etiology?PURPOSE: To describe a condition that occurs following an upper respiratory illness, which represents injury to various branches of the vagus nerve. patients with this condition may present with breathy dysphonia, vocal fatigue, effortful phonation, odynophonia, cough, globus, and/or dysphagia, lasting long after resolution of the acute viral illness. The patterns of symptoms and findings in this condition are consistent with the hypothesis that viral infection causes or triggers vagal dysfunction. This so-called postviral vagal neuropathy (PVVN) appears to have similarities with other postviral neuropathic disorders, such as glossopharyngeal neuralgia and Bell's palsy. MATERIALS AND methods: Five patients were identified with PVVN. Each patient's chart was reviewed, and elements of the history were recorded. RESULTS: Each of the 5 patients showed different features of PVVN. CONCLUSIONS: Respiratory infection can trigger or cause vocal fold paresis, laryngopharyngeal reflux, and neuropathic pain.- - - - - - - - - - ranking = 1.6308926526826keywords = nerve (Clic here for more details about this article) |
6/76. Symptoms associated with anthrax exposure: suspected "aborted" anthrax.anthrax is a naturally occurring organism with a low incidence of infection. There are no known cases of human-to-human transmission. bioterrorism-related anthrax in the united states has been seen in three high-risk groups: (1) postal workers, (2) politicians and their staffs, and (3) the press. It appears as though the bioterrorism-related anthrax cases of fall 2001 have been transmitted through the US postal service. The authors present a case in which a person at high risk for anthrax exposure was inadequately treated and had symptoms that do not fall into any specific category of disease. It emphasizes the need for someone who has been started on prophylaxis for anthrax to complete a full 60-day course of treatment. It also shows the effectiveness of antibiotic therapy, even in those with high exposure to weaponized anthrax. Further, we would like to suggest that there may exist a new clinical entity of "aborted anthrax infection."- - - - - - - - - - ranking = 0.5keywords = organ (Clic here for more details about this article) |
7/76. chlamydia pneumoniae respiratory infection after allogeneic stem cell transplantation.chlamydia pneumoniae is a common cause of upper and lower respiratory tract infections in immunocompetent patients; however, its role as a respiratory pathogen in immunocompromised hosts has been infrequently recognized. We describe C. pneumoniae lower respiratory tract infection in a 19-year-old male after allogeneic stem cell transplantation. The patient developed fever on day 14, and a subsequent computed tomography scan of the chest revealed a right lateral pleural-based opacity, which was then resected during thoracoscopy. diagnosis was made by culture and staining of the resected tissue with C. pneumoniae-specific monoclonal antibodies, and azithromycin was administered. To the best of our knowledge, this is the first report of C. pneumoniae respiratory infection after stem cell or marrow transplantation. C. pneumoniae often coexists with other etiologic agents of pneumonia in immunocompromised patients. Considering the infrequency of infections from this organism in this clinical setting, one must still rule out other more likely respiratory pathogens.- - - - - - - - - - ranking = 0.5keywords = organ (Clic here for more details about this article) |
8/76. Open-label, multicentre, emergency-use study of clinafloxacin (CI-960) in the treatment of patients with serious life-threatening infections.In an open-label emergency-use study, 23 patients with bacterial infections caused by multiply drug resistant pathogens were treated with clinafloxacin. Efficacy and safety were evaluated by tabulating investigators' assessments at the end of treatment, treatment discontinuations and adverse event data. Most of the patients were seriously ill and had multi-organ infections, primarily respiratory tract infections such as nosocomial pneumonia and gastrointestinal infections. Eleven patients were successfully treated, two had treatment failure and 10 were not evaluable because the patients died of their underlying disease. Considering that most of the patients had several infections caused by multiply resistant pathogens, clinafloxacin may be useful for the treatment of such life-threatening episodes.- - - - - - - - - - ranking = 0.5keywords = organ (Clic here for more details about this article) |
9/76. Acute disseminated encephalomyelitis in adults: a reappraisal of clinical, CSF, EEG, and MRI findings.OBJECTIVES: To establish an adequate definition of acute disseminated encephalomyelitis (ADEM) in adults, based on our clinical observations of a case-series. methods: Over a period of three years 10 adult patients with a para- or postinfectious disseminated (diffuse or multifocal) syndrome of the CNS fulfilling predefined strict criteria for the diagnosis of ADEM were encountered and systematically followed. RESULTS: The age ranged from 21 to 62 years, two were men. MRI was normal in 5 patients and only mildly abnormal in the remaining patients. CSF was normal in 5 patients and mildly abnormal in the remainder, EEG was abnormal in 7/8 patients. All patients survived and were followed over a period of 30 months (range: 8 to 48 months). Nine patients were left with some residual defects, consisting most often of a mild cognitive impairment. CONCLUSIONS: The EEG as an investigation of brain function can be crucial in establishing the organic nature of disease. MRI is important to exclude other diffuse or multifocal encephalopathies. However, in contrast to previous reports in the literature abnormal MRI should not be considered mandatory in adult ADEM. Difficulties in the diagnosis of ADEM are discussed and the importance of clinical and paraclinical findings for establishing the diagnosis is outlined.- - - - - - - - - - ranking = 0.5keywords = organ (Clic here for more details about this article) |
10/76. A case of lower respiratory tract infection caused by neisseria weaveri and review of the literature.neisseria weaveri (formerly CDC [Centers for disease Control and Prevention] group M-5 is part of the normal canine oral flora. Infections in humans are usually associated with dog bite wounds. Very rarely the organism has been isolated from sites other than wounds, or from deep seated infections. A 60-year-old man was admitted to our hospital because of an acute exacerbation of his bronchiectasis. Gram stain of bronchial washings and expectorated sputum showed numerous polymorphs and Gram-negative bacilli. Routine bacterial culture yielded a heavy pure growth of a Gram-negative rod-shaped organism that was strongly oxidase and catalase positive, indole negative, non-motile and did not ferment carbohydrates. The organism was identified as N. weaveri by using 16S rRNA sequencing. The patient was treated with a 3 weeks course of ofloxacin and had a good response. sputum culture after treatment yielded normal respiratory flora only. To our knowledge, this is the first reported case of lower respiratory tract infection caused by N. weaveri.- - - - - - - - - - ranking = 1.5keywords = organ (Clic here for more details about this article) |
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