1/38. Lumbar vertebral osteomyelitis with mycotic abdominal aortic aneurysm caused by highly penicillin-resistant streptococcus pneumoniae.We present a case of vertebral osteomyelitis with an adjacent abdominal aortic mycotic aneurysm caused by a highly penicillin-resistant streptococcus pneumoniae strain. The occurrence of all three phenomena in a single patient has not been previously described. This presentation offers the opportunity to reflect on the increasing incidence of S. pneumoniae as a resistant pathogen, the treatment of highly penicillin-resistant S. pneumoniae, and the etiologic agents of both vertebral osteomyelitis and mycotic aneurysm.- - - - - - - - - - ranking = 1keywords = pneumoniae (Clic here for more details about this article) |
2/38. Purulent pericarditis due to group B streptococcus and mycotic aneurysm of the ascending aorta: case report.A 61-year-old female, with a history of uterine and cervical cancer treated with radical hysterectomy and 2 years of postoperative chemotherapy, presented to the emergency department with dyspnea on exertion. Computed tomography of the chest revealed a large pericardial effusion and a sacciform aneurysm of the ascending aorta. The patient subsequently underwent emergency pericardiocentesis with drainage of approximately 330 ml of a bloody and turbid effusion. Cultures from the effusion yielded group B streptococcus. multiple organ failure and disseminated intravascular coagulation syndrome occurred in the acute phase, but gradually improved with continuous antibiotic therapy. On the 194th hospital day, in situ reconstruction of the ascending aorta was successfully performed using a synthetic graft. Although rarely reported, both purulent bacterial pericarditis and mycotic aneurysm can be life-threatening.- - - - - - - - - - ranking = 3.1790890936843keywords = streptococcus (Clic here for more details about this article) |
3/38. Mycotic pseudoaneurysm of the aorta in children.Mycotic pseudoaneurysm of the aorta is a rare disease in childhood. We report on two cases which were diagnosed in an unselected general pediatric population within an 8-month period. The first case was a 16-month-old toddler with a normal cardiac history who presented with purulent pericarditis due to group A streptococcus and subsequent pseudoaneurysm formation of the ascending aorta while convalescing from varicella infection. The second case was a 14-year-old girl with a previously undiagnosed coarctation of the aorta who developed a staphylococcus aureus aortitis in the dilated poststenotic segment with pseudoaneurysm formation and infiltration into the adjacent lung tissue. In both cases parenteral antibiotic therapy was administered over 10 and 4 days, respectively, followed by emergency surgery consisting of aneurysmectomy, coarctectomy (case 2), and in situ homograft implantation. Recovery was uneventful. In both cases early institution of a femorofemoral cardiopulmonary bypass prevented a fatal outcome despite intraoperative rupture of the pseudoaneurysm.- - - - - - - - - - ranking = 0.63581781873686keywords = streptococcus (Clic here for more details about this article) |
4/38. Intraventricular haemorrhage due to ruptured posterior inferior cerebellar artery aneurysm in tuberculous meningitis.A 9-year-old Asian boy with known miliary tuberculosis, tuberculous meningitis and hydrocephalus was successfully treated with chemotherapy and ventriculoperitoneal shunting, but re-presented 7 months later with an intraventricular haemorrhage secondary to a ruptured left posterior inferior cerebellar artery mycotic aneurysm. The aneurysm was successfully treated by craniotomy and clipping. Tuberculous mycotic intracranial aneurysms are rare, but they should be considered in patients with tuberculous meningitis, particularly when there is a rapid neurological deterioration which may represent rupture.- - - - - - - - - - ranking = 0.17239612832872keywords = meningitis (Clic here for more details about this article) |
5/38. Ruptured mycotic thoracoabdominal aortic aneurysms: a report of three cases and a systematic review.We report three cases of ruptured mycotic thoracoabdominal aortic aneurysms (TAAAS) and a review of the literature. escherichia coli and streptococcus pneumoniae (2 patients) were the responsible organisms. Surgical management consisted of wide debridement of necrotic tissue and in situ repair with a Dacron graft. Antibiotics were administered intravenously in the hospital and continued orally after discharge for at least 6 weeks, until clinical and laboratory parameters were normalized. A review of the literature showed that Gram-negative microorganisms are found in 47% of mycotic TAAAs. A trend toward increased mortality for these organisms, compared with Gram-positive microorganisms, was observed (P =.09). Lifelong antimicrobial therapy is controversial. No difference in survival or recurrence rate was found between series advocating lifelong therapy and those suggesting prolonged (6 weeks to 12 months) therapy (median follow-up period, 18 and 19 months, respectively). In situ repair with synthetic material can be successful if prompt confirmation of infection is obtained, all possibly infected tissue is resected, and antibiotic therapy based on sensitivity data is administered for a prolonged period. A short-term survival rate as high as 82% can be expected with this strategy, but data on long-term survival rates are limited. polytetrafluoroethylene-expanded grafts, homografts, and antibiotic-bonded grafts may offer advantages over Dacron grafts, but data are insufficient to draw conclusions. Careful long-term follow-up is an important element of the treatment of these patients. We suggest antibiotic treatment until biochemical parameters of inflammation (white cell count, erythrocyte sedimentation rate, or c-reactive protein) return to normal and a computerized tomography scan every 3 months for 1 year, then annually.- - - - - - - - - - ranking = 0.14285714285714keywords = pneumoniae (Clic here for more details about this article) |
6/38. Propensity of streptococcus pneumoniae for the aorta. Report of 3 cases.streptococcus pneumoniae was the unsuspected cause of a ruptured aortic aneurysm in 3 patients, as confirmed by culture of specimens obtained during surgery. A 60-y-old woman had a recently diagnosed saccular aortic aneurysm and presented with symptoms indicating a vascular catastrophe. A 66-y-old man and a 69-y-old woman were both admitted with pyrexia and abdominal pain and proper diagnosis was delayed for 4 and 15 d, respectively. All 3 patients were treated with graft insertion and antibiotic therapy for 3 months and recovered fully.- - - - - - - - - - ranking = 0.71428571428571keywords = pneumoniae (Clic here for more details about this article) |
7/38. Case report. Mycotic arteritis due to aspergillus fumigatus in a diabetic with retrobulbar aspergillosis and mycotic meningitis.A 74-year-old man with diabetes mellitus type II, retinopathy and polyneuropathy suffered from exophthalmus, ptosis and diplopia. magnetic resonance imaging and computer tomography showed a space-occupying process in the right orbital apex. An extranasal ethmoidectomy accompanied by an orbitotomia revealed the presence of septated hyphae. aspergillus fumigatus was grown from the tissue. After surgical removal of the fungal masses, therapy with amphotericin b (1 mg kg(-1) body weight) plus itraconazole (Sempera, 200 mg per day) over 6 weeks was initiated. Five months later the patient's condition deteriorated again, with vomiting, nausea and pain behind the right eye plus increasing exophthalmus. Antifungal therapy was started again with amphotericin b and 5-fluorocytosine. neutropenia did not occur. The patient became somnolent and deteriorated, a meningitis was suggested. Aspergillus antigen (titre 1:2, Pastorex) was detected in liquor. Anti-Aspergillus antibodies were not detectable. Both the right eye and retrobulbar fungal masses were eradicated by means of an exenteratio bulbi et orbitae. However, renal insufficiency and an apallic syndrome developed and the patient died. At autopsy, a mycotic aneurysm of the arteria carotis interna dextra was detected. The mycotic vasculitis of this aneurysm had caused a rupture of the blood vessel followed by a massive subarachnoidal haemorrhage. In addition, severe mycotic sphenoidal sinusitis and aspergillosis of the right orbit were seen, which had led to a bifrontal meningitis.- - - - - - - - - - ranking = 0.17239612832872keywords = meningitis (Clic here for more details about this article) |
8/38. streptococcus pneumoniae-infected aneurysm extending from a persistent lobar pneumonia: case report and review of the literature.Presented here is the case of a 63-year-old patient with a streptococcus pneumoniae-infected aneurysm extending from a persistent lobar pneumonia of the left lung into the thoracic aorta. The patient was successfully treated with surgery and high-dose penicillin, and he remained well at 6-month follow-up. A review of the English-language literature over the past 25 years revealed 22 cases of mycotic or infected aortic aneurysms due to streptococcus pneumoniae; however, none of these cases resulted in a positive outcome for the patient. The characteristics of these cases are discussed.- - - - - - - - - - ranking = 0.85714285714286keywords = pneumoniae (Clic here for more details about this article) |
9/38. Ruptured mycotic aneurysm of the iliac artery complicated by emphysematous psoas muscle abscess: report of two cases.Emphysematous psoas muscle abscess has rarely been described and has not been reported to be associated with ruptured mycotic aneurysm. We report two cases of ruptured mycotic iliac arterial aneurysm complicated by emphysematous abscess of the left psoas muscle. Case 1 occurred in a 70-year-old man and Case 2 in a 63-year-old woman. Both patients presented with fever for several weeks. Clinical clues leading to the diagnosis included a palpable abdominal mass with (Case 2) or without (Case 1) pulsation, blurring of the psoas muscle shadow with abnormal gas distribution on the plain abdominal film (Case 1), and peripheral vascular insufficiency and salmonella bacteremia (Case 2). Ruptured mycotic aneurysm of the left iliac artery complicated with left psoas muscle abscess was clearly demonstrated by abdominal computerized tomography scan and intravenous digital subtraction angiography in both cases. Causative agents, multi-drug resistant acinetobacter baumannii and klebsiella pneumoniae, unusual pathogens for mycotic arterial aneurysm, were cultured from debrided tissue in Case 1, and this finding led to the speculation that the infection was hospital-acquired. The favorable outcome in Case 2 resulted from early vascular surgery and a prolonged course of effective antimicrobial therapy.- - - - - - - - - - ranking = 0.14285714285714keywords = pneumoniae (Clic here for more details about this article) |
10/38. streptococcus pneumoniae mycotic aortic aneurysm after allogeneic bone marrow transplantation.BACKGROUND: streptococcus pneumoniae (SP) is a common cause of community-acquired pneumonia and accounts for up to 30% of all cases of pneumonia. patients with chronic graft-versus-host-disease (GvHD) after allogeneic bone marrow transplantation (BMT) have a high susceptibility to SP infections. So far, mycotic aneurysm resulting from SP has not been reported after BMT. methods: We report on a patient with extensive, chronic GvHD who developed low back pain 22 months after allogeneic BMT. RESULTS: Computed tomography of the abdomen displayed mycotic, saccular aneurysmatic enlargement of the infrarenal aorta, with leakage of contrast medium into the aneurysm. The aneurysm was resected, and the defect was closed with an autologous patch from the internal iliac artery. Bacteriologic samples from the abscess grew SP. The patient recovered uneventfully. CONCLUSIONS: This observation confirms the importance of pneumococcal prophylaxis after BMT and suggests that an aggressive diagnostic approach should always be considered in patients with chronic GvHD, even if they present with nonspecific symptoms.- - - - - - - - - - ranking = 0.71428571428571keywords = pneumoniae (Clic here for more details about this article) |
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