1/15. streptococcus pneumoniae spinal infection in Nottingham, United Kingdom: not a rare event.Pneumonia and meningitis are the most frequent manifestations of streptococcus pneumoniae infection. Spinal infection is considered to be a rarity. Between 1985 and 1997, 8 patients with spinal infection (vertebral osteomyelitis, 3; spinal epidural abscess, 1; both, 4) due to S. pneumoniae were seen at University Hospital (Nottingham, U.K.). Predisposing factors for pneumococcal infection were documented for five patients and included diabetes mellitus, alcoholism, and corticosteroid therapy. One patient presented with concomitant meningitis and endocarditis. Clinical features of note were prolonged symptoms and a lack of febrile response. S. pneumoniae was isolated from the blood of five patients. magnetic resonance imaging was used to localize the spinal infection in five patients. Two cases were managed medically. Three patients died after a protracted illness. A literature search revealed 20 other cases of spinal infections due to S. pneumoniae. The salient features of the cases are summarized.- - - - - - - - - - ranking = 1keywords = meningitis, pneumoniae (Clic here for more details about this article) |
2/15. Spinal epidural abscess due to streptococcus pneumoniae in an hiv-infected adult.Spinal epidural abscess (SEA) due to streptococcus pneumoniae is rare and has never been reported in an hiv-infected patient, despite the higher risk of invasive disease in this group. We describe here the first case of pneumococcal epidural abscess, presenting with fever and back pain in a 60-year-old man infected with hiv. blood cultures were positive for S. pneumoniae and magnetic resonance imaging (MRI) confirmed the suspicion of diskitis and SEA at the L4-S1 level. The patient was successfully treated with iv ceftriaxone without surgical intervention. The clinical characteristics of this case are compared with existing literature on pneumococcal SEA.- - - - - - - - - - ranking = 0.52182276822492keywords = pneumoniae (Clic here for more details about this article) |
3/15. Group a streptococcus spinal epidural abscess during varicella.Multiple complications of varicella have been described. Musculoskeletal complications (osteomyelitis, septic arthritis, and necrotizing fasciitis) as well as neurologic complications (ataxia, encephalitis, and transverse myelitis) are well-known. We describe the cases of 2 children, ages 18 months and 5 years, who were admitted recently to 2 pediatric hospitals in Montreal with a resolving varicella, abdominal and lumbar pain, and a refusal to walk and in whom a diagnosis of epidural abscess caused by group A streptococcus (GAS) was established. No previous case of epidural abscess caused by GAS in the context of varicella has been reported. Epidural abscesses are rare in pediatrics and are caused mainly by hematogenous spread of staphylococcus aureus. The diagnosis in pediatrics is challenging because it is rare and does not present as classically as in adults. The prognosis is related to the presence of neurologic deficits before surgery and to the rapidity with which the diagnosis and the intervention are made. These cases highlight a new clinical association in children of epidural abscess caused by GAS and varicella. An early clinical diagnosis requires a high index of suspicion when back or abdominal pain with or without neurologic signs and symptoms occurs during or soon after varicella.- - - - - - - - - - ranking = 0.64083042106597keywords = streptococcus (Clic here for more details about this article) |
4/15. uropathogenic escherichia coli as agents of diverse non-urinary tract extraintestinal infections.Escherichia coli isolates from 3 consecutively encountered patients with serious, invasive, non-urinary tract extraintestinal infections (pneumonia, deep surgical wound infection, and vertebral osteomyelitis with associated epidural/psoas/iliacus abscesses) were characterized, using molecular methods, as to extended virulence genotype and phylogenetic background. All 3 isolates exhibited virulence genotypes and genomic profiles characteristic of specific familiar virulent clones of extraintestinal pathogenic E. coli (ExPEC), which traditionally have been regarded primarily as uropathogenic or as associated with meningitis. These included E. coli O1/O2:K1:H7, E. coli O18:K1:H7, and a recently described E. coli O11/O17/O77:K52:H18 clonal group (clonal group A). These findings demonstrate the extraintestinal pathogenic versatility of ExPEC clones, which supports the use of an inclusive designation for such strains and suggests the possibility of cross-syndrome protective interventions. They also provide novel evidence that multidrug-resistant epidemic clonal group A can cause extraintestinal infections other than uncomplicated urinary tract infections and can cause them in hosts other than young women.- - - - - - - - - - ranking = 0.15211815451672keywords = meningitis (Clic here for more details about this article) |
5/15. Macrolide-resistant pneumococcal endocarditis and epidural abscess that develop during erythromycin therapy.Suppurative complications of streptococcus pneumoniae infections have become uncommon in the antibiotic era. We report a case of pneumococcal bacteremia and pneumonia complicated with epidural abscess and endocarditis in which macrolide resistance (the MLS(B) phenotype) emerged during erythromycin therapy. Genetic determinants known to mediate the most common mechanisms of macrolide resistance (methylation of the 23S rRNA and antibiotic efflux) were not detected by polymerase chain reaction or dna hybridization. sequence analysis of the dna encoding the 23S rRNA of the macrolide-resistant isolate from the patient demonstrated the replacement of adenine by thymine at position 2058 (A2058T) in 2 of 4 alleles. Clinicians should be alert to the possibility of the emergence of resistance during macrolide therapy for community-acquired pneumonia, particularly if suppurative complications of pneumococcal infection are suspected.- - - - - - - - - - ranking = 0.08697046137082keywords = pneumoniae (Clic here for more details about this article) |
6/15. natural history of sigmoid sinus thrombosis.To demonstrate the evolution of sigmoid sinus thrombosis, we performed a prospective observational study on a 6-year-old girl who presented with mastoiditis, epidural abscess, and occipital osteomyelitis from multiple drug-resistant streptococcus pneumoniae. She underwent mastoidectomy and partial occipital craniectomy. This procedure produced a window in the occipital bone that allowed serial ultrasonography of the sigmoid sinus during medical treatment. Computed tomography was performed, followed by weekly Doppler ultrasonography used to monitor resolution of sigmoid sinus thrombosis. The natural history of a treated episode of sigmoid sinus thrombosis was illustrated. Venous occlusion resolved over a 4- to 6-week period without surgical drainage or venous anticoagulants. Collateral flow, reversal of normal venous flow, and ultimate return to normal venous transport characterized the period of resolution. We conclude that an occluded sigmoid sinus from mastoiditis can naturally recanalize. Aberrant venous flow can be demonstrated during the period of resolution. This case supports a conservative approach to management of the occluded sinus and suggests that 4 to 6 weeks of antibiotic therapy after removal of perisinus infection is sufficient for cure.- - - - - - - - - - ranking = 0.08697046137082keywords = pneumoniae (Clic here for more details about this article) |
7/15. Atypical presentation of spontaneous discitis: case report.BACKGROUND: Spontaneous discitis is primarily a pediatric illness. adult patients usually present at an average age of 69 years with a history of diabetes or with a systemic infection. The lumbar spine is the most frequent site of infection (54%), and the cervical is the least at 10%. The causative organisms are most commonly staphylococcus aureus and beta-hemolytic streptococcus species. Intravenous antibiotics are the mainstays of treatment, and surgical intervention is usually not required. CASE PRESENTATION: A single case observation with an unusual presentation from the statistically typical criterion of discitis is described. CONCLUSIONS: Atypical discitis needs to be considered in the differential diagnoses in the middle-aged and healthy population.- - - - - - - - - - ranking = 0.12816608421319keywords = streptococcus (Clic here for more details about this article) |
8/15. Epidural intracranial abscess as a complication of frontal sinusitis: case report and review of the literature.Two cases of epidural abscess as a complication of frontal sinusitis are presented. The diagnoses were suspected on the basis of history and were confirmed by magnetic resonance imaging and computed tomography. Both patients were treated successfully by means of surgery and intravenous antibiotics. One patient developed meningitis in the postoperative course and was treated by changing the antibiotic regimen. However, further follow-up in the outpatient clinic by physical examinations and brain computed tomography scans showed no longterm neurologic complications in either case. Intracranial suppuration, including epidural abscesses, can complicate acute and chronic frontal sinusitis. These complications are diagnosed by maintaining a high index of suspicion and using the appropriate neuroimaging studies without delay.- - - - - - - - - - ranking = 0.15211815451672keywords = meningitis (Clic here for more details about this article) |
9/15. epidural abscess and meningitis after epidural corticosteroid injection.epidural abscess with and without associated meningitis after epidural corticosteroid injections for radicular back pain is a rarely reported complication. We report the occurrence of an epidural abscess and meningitis in a 70-year-old man after 2 epidural corticosteroid injections for treatment of acute radicular lumbar back pain. At the time of diagnosis, cerebrospinal fluid cultures grew staphylococcus aureus, and the patient was treated with intravenous antibiotics. Possible predisposing factors for the development of an epidural abscess and meningitis in this patient include a 2-year history of neutropenia and an accidental dural puncture that occurred during performance of the first epidural injection. A literature search identified 11 reported cases of epidural abscess, 2 of epidural abscess and meningitis, and 1 of meningitis attributed to epidural corticosteroid injections. Eight of the 14 reported patients were immunocompromised, and 8 (67%) of the 12 in whom cultures of blood, cerebrospinal fluid, or epidural pus were performed had results positive for S. aureus. antibiotic prophylaxis for S. aureus should be considered for immunocompromised patients undergoing epidural corticosteroid injections.- - - - - - - - - - ranking = 1.3690633906505keywords = meningitis (Clic here for more details about this article) |
10/15. Transoral approach to drain streptococcus pneumoniae spinal epidural abscess in an hiv-infected adult.Spinal epidural abscess due to streptococcus pneumoniae is extremely rare in adults. It typically occurs in the thoracic, lumbar or lumbosacral epidural spaces, and less frequently in the cervical epidural space. The principal causative microbial agent is staphylococcus aureus, representing 70% of cases, while 1.6% of cases are caused by S. pneumoniae. We report the first case of an hiv-infected patient with a cervical spinal epidural abscess. The patient was a 43-year-old male with pneumococcal bacteremia and a metatarsal abscess. He reported cervical pain with muscle spasm during cephalic flexion and extension, fever and a painful tumefaction on the second metatarsal of the left foot. MRI confirmed that the retropharyngeal abscess extended to the cervical spinal epidural space. Antibiotic therapy with cefotaxime plus vancomycin was initiated and a transoral surgical approach was used to achieve retropharyngeal and local debridement of the metatarsal abscess. blood and pus cultures were positive for S. pneumoniae. After 4 months of follow-up the patient remained asymptomatic, without clinical or MRI evidence of recurrence.- - - - - - - - - - ranking = 4.4072954292546keywords = streptococcus pneumoniae, streptococcus, pneumoniae (Clic here for more details about this article) |
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