1/76. Bacterial complications of strongyloidiasis: streptococcus bovis meningitis.We report the case of a 64-year-old veteran who had streptococcus bovis meningitis as a result of a long latent strongyloides infection that became acute when he was treated with prednisone. We reviewed 38 reported cases of serious bacterial infections associated with strongyloidiasis. patients most frequently had nonspecific gastrointestinal symptoms. Of these 38 patients, 21 (55%) had meningitis, and 28 (73%) had bacteremia that was polymicrobial in 3 cases (8%). Other sites of infection included lung, bone marrow, ascites, mitral valve, and lymph node. Most infections were due to enteric gram-negative bacteria. There is one previously reported case of S bovis meningitis. Thirty-four of the patients (89%) were immunosuppressed; 21 of these (55%) were taking pharmacologic doses of adrenal corticosteroids. Thirty-three of the 38 (87%) patients died. patients with enteric bacterial infection without an obvious cause should be tested for the presence of strongyloidiasis.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
2/76. Bivalve polymicrobial infective endocarditis.Polymicrobial infective endocarditis is uncommon, particularly vancomycin-resistant endocarditis and fugal endocarditis. The incidence of these infections is likely to. increase with advances in mediCAl technology and widespread use of central venous catheters. We report a case of bivalve endocarditis in which four organisms were identified, including vancomycin-resistant Enteroocausfaecium and Torulopsis glabrata.- - - - - - - - - - ranking = 5keywords = valve (Clic here for more details about this article) |
3/76. osteomyelitis and possible endocarditis secondary to lactococcus garvieae: a first case report.Although osteomyelitis is commonly caused by staphylococcal infection, the first case of a lumbar osteomyelitis secondary to lactococcus garvieae is reported. The case was complicated by possible endocarditis of an aortic valve prosthesis.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
4/76. Prosthetic biologic valve endocarditis caused by a vancomycin-resistant (vanA) enterococcus faecalis: case report.We recently observed (February 1999) a 68-year old patient with endocarditis on a prosthetic biologic valve caused by a vancomycin-resistant enterococcus faecalis. Broth dilution tests showed susceptibility to ampicillin (MIC=0.5 microg/ml), no high resistance to aminoglycosides (MIC for gentamicin <500 microg/ml) and resistance to vancomycin (MIC >256 microg/ml) and teicoplanin (MIC >16 microg/ml). A PCR assay detected vanA gene in this strain. A transthoracic echocardiogram did not show valvular vegetations. A possible endocarditis was diagnosed and the patient received ampicillin for 8 weeks and gentamicin for 6 weeks. The patient remained afebrile after a 4-month follow-up when he underwent surgical replacement of the dysfunctional bioprosthetic valve. mitral valve was sterile on culture, but histology confirmed the diagnosis of previous endocarditis. This is the third case of endocarditis caused by vancomycin-resistant E. faecalis reported to date.- - - - - - - - - - ranking = 7keywords = valve (Clic here for more details about this article) |
5/76. 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 = 1keywords = valve (Clic here for more details about this article) |
6/76. propionibacterium acnes endocarditis in a native valve complicated by intraventricular abscess: a case report and review.propionibacterium acnes is a constituent of the normal skin flora. It has been described as causing infection on prosthetic valves but very rarely on native valves. We describe a case of aggressive P. acnes endocarditis in a healthy 36-y-old man which infected a native aortic valve and was complicated by an aortic root abscess and review the literature.- - - - - - - - - - ranking = 7keywords = valve (Clic here for more details about this article) |
7/76. Partial mitral valve replacement for acute endocarditis.We present a case of acute endocarditis involving the posteromedial commissure and both leaflets of the mitral valve, including a vegetation on and perforation of the anterior leaflet, in a young man with active Crohn's disease. Repair was performed using glutaraldehyde-treated bovine pericardium. Competence of the valve was achieved with no recurrence of endocarditis. This case demonstrates that extensive destruction of both leaflets of the mitral valve does not prohibit repair.- - - - - - - - - - ranking = 7keywords = valve (Clic here for more details about this article) |
8/76. Clinical experience with linezolid in the treatment of resistant gram-positive infections.This study presents our clinical experience with linezolid in 19 patients with serious resistant gram-positive infections enrolled as part of the compassionate study. In this prospective, non-randomized, noncomparative study, 19 patients were enrolled as part of the National Compassionate Study Protocol conducted by Pharmacia-Upjohn. At the time of this writing, these patients had not been published in the literature. All of the patients had to have documented evidence of serious gram-positive infections in normally sterile sites and should have been unable to tolerate available antimicrobial therapy or be unresponsive to available drugs. Clinical characteristics, laboratory values, and pharmacokinetic and pharmacodynamic parameters were obtained. patients were followed both short-term and long-term after completion of therapy. Nineteen patients were enrolled: 13 females and 6 males. The average age was 63 years. The average length of therapy with linezolid was 22 days. methicillin-resistant staphylococcus aureus (MRSA) was treated in eight patients, methicillin-resistant staphylococcus epidermidis (MRSE) in two patients, vancomycin-resistant enterococcus faecium (VREF) in eight patients, and coagulase-negative Staphylococcus in two patients. Co-infecting organisms include Enterococcus species colonization in six patients, pseudomonas species in one patient, serratia marcenens in one patient, and candida albicans in one patient. Sterile sites that were infected included bone and joint (wounds and septic joints) in six patients, gastrointestinal system (hepatobiliary, liver abscess, Crohn's) in five patients, genitourinary (kidney and urine) in two patients, blood in five patients, respiratory in one patient, and aortic valve in 1 patient. Linezolid was given at 600 mg IV every 12 hours with a mean length of therapy of 22 days. Surgical drainage was used in combination with linezolid in 11 of the patients. Seventy nine percent of these patients achieved clinical and microbiologic cure, and none of the deaths reported in this series were related to the drug. Adverse events included skin rash in one patient, mild bone marrow suppression in two patients, and mild elevation in liver function tests in two patients. No life-threatening adverse events were noted. It appears that linezolid, along with surgical intervention (when necessary), appears to be an effective treatment option for resistant gram-positive infections. Long-term studies evaluating the possible resistance rates are necessary.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
9/76. Intraoperative acute type A dissection caused by an intra-aortic filter (EMBOL-X) in a patient undergoing mitral valve re-replacement for acute endocarditis.We report on the case of a 60-year-old male patient who underwent mitral valve re-replacement for acute mechanical valve endocarditis. When an intra-aortic filter (EMBOL-X Inc, Mountain View, CA) was inserted through the arterial cannula in order to prevent embolization from a floating thrombus attached to the mitral valve prosthesis, our patient developed acute type A aortic dissection. This, to our knowledge, is the first report on this kind of complication using intra-aortic filter systems. Here we discuss a potential mechanism that might have led to the event of acute type A dissection in our case. Furthermore we point out strategies that might help to prevent this life-threatening complication in the future.- - - - - - - - - - ranking = 7keywords = valve (Clic here for more details about this article) |
10/76. propionibacterium acnes endophthalmitis in Ahmed glaucoma valve.PURPOSE: To report a case of propionibacterium acnes endophthalmitis in a patient with an Ahmed glaucoma valve. CASE REPORT: A nine-year-old boy with bilateral congenital glaucoma, with an Ahmed glaucoma valve implanted in the left eye, had recurrent conjunctival dehiscence and endophthalmitis. RESULTS: Vitreous cultures demonstrated the presence of propionibacterium acnes. CONCLUSIONS: This is the first reported case of propionibacterium acnes endophthalmitis in an Ahmed glaucoma valve and the second one in a glaucoma drainage device. We strongly recommend using a patch graft to prevent and treat tube exposure. Conjunctival grafts may be useful to close the conjunctiva when there is marked scarring to prevent patch exposure and melting or extrusion.- - - - - - - - - - ranking = 7keywords = valve (Clic here for more details about this article) |
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