1/28. Central line sepsis in a child due to a previously unidentified mycobacterium.A rapidly growing mycobacterium similar to strains in the present mycobacterium fortuitum complex (M. fortuitum, M. peregrinum, and M. fortuitum third biovariant complex [sorbitol positive and sorbitol negative]) was isolated from a surgically placed central venous catheter tip and three cultures of blood from a 2-year-old child diagnosed with metastatic hepatoblastoma. The organism's unique phenotypic profile and ribotype patterns differed from those of the type and reference strains of the M. fortuitum complex and indicate that this organism may represent a new pathogenic taxon.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/28. Asplenia as a cause of sudden unexpected death in childhood.Sudden unexpected death in childhood is rare. The commonest causes of such deaths are a result of fulminating infections of the respiratory or nervous systems. Other causes include unsuspected congenital abnormalities of the heart, acute metabolic disorders, and rarities such as internal hemorrhages and pulmonary thrombosis. Recognition of children with congenital asplenia who are otherwise normal but have an increased susceptibility to overwhelming sepsis is extremely difficult. We reviewed 1763 autopsy files from our institution over 5 years (1990-1995), of which 293 were classified as pediatric cases. The vast majority of the cases were stillbirths and deaths within the first year of life as a result of complex congenital anomalies. Four cases of asplenia were identified in our entire series, 3 of which were of the congenital syndromal variety and 1 of which was a case of isolated sporadic congenital asplenia. All 4 cases of asplenia were analyzed in detail with respect to autopsy findings and cause of death. Severe complex cardiac malformations were present in the congenital syndromal asplenia patients; these other malformations contributed significantly to their death. In this report, we discuss in detail the autopsy findings in a previously healthy 4-year-old girl who presented with a brief 8-hour history of being unwell and died within 4 hours of admission into the hospital. She had sporadic, isolated congenital asplenia complicated by high-grade type 6B pneumococcemia and acute bilateral adrenal hemorrhage (waterhouse-friderichsen syndrome). Previously healthy children who clinically deteriorate very rapidly should have a blood smear done as part of their clinical workup. The detection of Howell-Jolly bodies on a peripheral blood smear can be an indicator of asplenia, and this diagnosis can be confirmed by medical imaging of the abdomen. Such steps may aid in the aggressive management of isolated congenital asplenia and thereby avert untimely death.- - - - - - - - - - ranking = 0.66666666666667keywords = complex (Clic here for more details about this article) |
3/28. weissella confusa (basonym: Lactobacillus confusus) bacteremia: a case report.Infection with Lactobacillus is rare, and only a handful of species have been identified as being clinically significant: lactobacillus casei, lactobacillus rhamnosus, and lactobacillus leichmannii. The literature contains one case report of bacteremia caused by weissella confusa (basonym: Lactobacillus confusus), but the clinical significance of the infection was unclear. We describe a case of W. confusa bacteremia in a 46-year-old man with a history of abdominal aortic dissection and repair. This procedure was complicated by gut ischemia, which necessitated massive small bowel resection. He subsequently developed short-bowel syndrome, which required him to have total parenteral nutrition. He later developed an enterococcus faecalis aortic valve endocarditis that required a coronary artery bypass graft and aortic root replacement with homograft and 6 weeks of intravenous ampicillin and gentamicin. Three months prior to his most recent admission, he was diagnosed with klebsiella pneumoniae bacteremia and candidemia. At the present admission, he had fever (T(max), 39.5 degrees C) and chills of 2 days' duration and was admitted to the intensive care unit because of hemodynamic instability. blood cultures grew K. pneumoniae and W. confusa in four of four blood culture bottles (both aerobe and anaerobe bottles). Imaging studies failed to find any foci of infection. A transesophageal echocardiogram revealed no vegetations. A culture of the patient's Hickman catheter tip was negative. The patient was treated with piperacillin-tazobactam and gentamicin. His condition improved, and he was discharged home, where he completed 4 weeks of piperacillin-tazobactam therapy. Lactobacillemia seldom results in mortality; however, it may be a marker of a serious underlying disease. It is usually seen in patients who have a complex medical history or in patients who receive multiple antibiotics. Lactobacillus spp. are generally associated with polymicrobial infections, and when isolated from the blood, they need to be considered possible pathogens. The presence of a vancomycin-resistant, gram-positive coccobacilli on a blood culture should alert clinicians to the possibility of bacteremia caused by W. confusa or other small gram-positive rods.- - - - - - - - - - ranking = 0.33333333333333keywords = complex (Clic here for more details about this article) |
4/28. Two cases of long lasting bacteremia due to mycobacterium avium complex despite new macrolides-containing regimens in patients with acquired immunodeficiency syndrome.The prognosis of mycobacterium avium complex (MAC) infection has been improved by new macrolides-containing regimens and the use of highly active antiretroviral therapy (HAART) in the treatment of acquired immunodeficiency syndrome (AIDS). We report on two AIDS cases with long lasting bacteremia due to MAC under this regimen. Both patients experienced problems due to side effects from the anti-MAC regimen and from an immune-reconstitution syndrome related to HAART. MAC infection persisted despite treatment, however, no anti-MAC drug-resistant isolates emerged throughout the clinical course in either case. These cases demonstrate that therapy for disseminated MAC infection is sometimes difficult even with HAART and macrolides-containing regimens.- - - - - - - - - - ranking = 1.6666666666667keywords = complex (Clic here for more details about this article) |
5/28. Vasculitis associated with septicemia: case report and review of the literature.We report an unusual case in which infectious endocarditis presented systemic vasculitis and glomerulonephritis as the initial manifestation of the disease. The patient was a 16-year-old girl with congenital cyanotic heart disease who presented with skin purpura, proteinuria, and hematuria. She had hypergammaglobulinemia, cryoglobulinemia, and positive circulating immune complexes. Renal biopsy revealed crescentic glomerulonephritis. Her serum C3 level, which was initially normal, became decreased, and prednisolone and azathioprine were administered with a tentative diagnosis of systemic lupus erythematosus (SLE). Soon after, she developed fever and renal failure. blood culture grew streptococcus pyogenes, and the diagnosis of infectious endocarditis was made. Eight cases of systemic vasculitis and glomerulonephritis associated with infectious endocarditis have been described in the literature. Infectious endocarditis should be included in the differential diagnosis of systemic vasculitis and glomerulonephritis.- - - - - - - - - - ranking = 0.33333333333333keywords = complex (Clic here for more details about this article) |
6/28. Non-valvular isolated pulmonary artery vegetations.BACKGROUND: One of the serious potential complications of complex congenital heart defect (CHD) is bacterial endocarditis. Right sided endocarditis accounts for 5-10% of all cases of infective endocarditis, with the tricuspid valve more frequently affected than the pulmonary valve. pulmonary artery involvement in bacterial endocarditis is very rare, but when it exists it is almost always associated with endocarditis of the pulmonary valve: isolated pulmonary artery vegetations have not previously been reported before. CASE REPORT: A 6-year-old boy with atrial septal defect (ASD), ventricular septal defect (VSD), coarctation of the aorta (CA), persistent ductus arteriosus (PDA) and pulmonary hypertension, who had been operated for closure of PDA, correction of CA and pulmonary artery banding, was readmitted with bacterial endocarditis. In surgery, the VSD was closed with a Dacron patch using interrupted pledget buttressed sutures, and the ASD was closed using primary sutures. After debanding, while pulmonary arteriotomy was performed for patch angioplasty, we observed that the entire pulmonary artery trunk, right and left pulmonary artery branches, were filled with a solid mass, which was successfully treated by surgical excision. CONCLUSIONS: With ongoing improvements in diagnostic tools, especially in echocardiography, antibiotic therapy and surgery, CHD can now be treated successfully in early infancy or childhood.- - - - - - - - - - ranking = 0.33333333333333keywords = complex (Clic here for more details about this article) |
7/28. sepsis, multiple organ failure, and death due to Pandoraea pnomenusa infection after lung transplantation.A 30-year-old man died with Pandoraea pnomenusa sepsis after lung transplantation. Pandoraea species are gram-negative rods, closely related to, and commonly misidentified as, burkholderia cepacia complex or ralstonia species. Heretofore considered soil bacteria and colonizers that infect patients with chronic lung diseases, Pandoraea species can produce severe infections.- - - - - - - - - - ranking = 0.33333333333333keywords = complex (Clic here for more details about this article) |
8/28. Fatal intracranial hemorrhage after double valve replacement in infective endocarditis.endocarditis is a life-threatening disease, although it is relatively uncommon. The complications of infective endocarditis may involve any organ system. Cardiac and extracardiac complications including neurologic, vascular and renal diseases are common and are usually caused by either embolization of vegetation or immune complexes. This case report presents a 31-year-old male with combined mitro-aortic valves defect and infective endocarditis on mitral valve. The replacement of mitral and aortic valves prosthesis were performed. During postoperative period low output heart failure, renal failure and respiratory failure developed. 25 days after the first operation the reoperation was performed because of mitral prosthesis insufficiency and thrombus just under the valve. On 31st day after the first operation patient died because of subdural hematoma and acute cerebral oedema and encephalomalatia.- - - - - - - - - - ranking = 0.33333333333333keywords = complex (Clic here for more details about this article) |
9/28. Meningococcal septicaemia in a C6-deficient patient and effects of plasma transfusion on lipopolysaccharide release.patients whose blood is deficient in the terminal component of complement have an increased susceptibility to meningococcal infection. However, mortality from meningococcal infection is lower in these patients than in immunocompetent subjects. We studied a C6-deficient patient with meningococcal sepsis who received fresh frozen plasma (FFP). The patient's initial plasma endotoxin, C6, and terminal-complement-complex concentrations were low, but rose sharply after treatment with FFP. Samples of the patient's serum taken shortly after admission did not cause endotoxin release from escherichia coli J5 in vitro, but endotoxin-releasing activity was restored in serum samples taken after infusion of FFP. It is possible that C6-deficient patients have reduced mortality from meningococcal infection because their serum cannot cause acute release of endotoxin from the invading organism and extensive tissue damage is thus avoided.- - - - - - - - - - ranking = 0.33333333333333keywords = complex (Clic here for more details about this article) |
10/28. sepsis in a renal transplant recipient due to Citrobacter braakii.cellulitis is usually caused by organisms such as beta-hemolytic streptococci and staphylococcus aureus. Citrobacter are gram-negative bacilli that can cause opportunistic infections in immunocompromised hosts. They are rarely implicated in skin or soft tissue infections. The genus Citrobacter has been respeciated according to genetic relatedness. Citrobacter braakii refers to the genomospecies 6 of the citrobacter freundii complex. There are no detailed studies of infections caused by the newly formed specific genetic species. We report a case of C. braakii infection in a renal transplant patient receiving immunosuppressive therapy. The patient's lower extremity cellulitis did not respond to conventional antibiotic therapy. blood cultures grew C. braakii. Sensitivity studies and treatment with appropriate antibiotics resulted in prompt recovery. Immunosuppressive therapy in renal transplant recipients predisposes to infection by unusual pathogens, and this should be suspected when lack of a clinical response to conventional antibiotics is observed. We believe this is the first reported case of C. braakii cellulitis and bacteremia in a renal transplant recipient.- - - - - - - - - - ranking = 0.33333333333333keywords = complex (Clic here for more details about this article) |
| | Next -> |