1/154. Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-Intermediate Staphylococcus aureus Working Group.BACKGROUND: Since the emergence of methicillin-resistant staphylococcus aureus, the glycopeptide vancomycin has been the only uniformly effective treatment for staphylococcal infections. In 1997, two infections due to S. aureus with reduced susceptibility to vancomycin were identified in the united states. methods: We investigated the two patients with infections due to S. aureus with intermediate resistance to glycopeptides, as defined by a minimal inhibitory concentration of vancomycin of 8 to 16 microg per milliliter. To assess the carriage and transmission of these strains of S. aureus, we cultured samples from the patients and their contacts and evaluated the isolates. RESULTS: The first patient was a 59-year-old man in michigan with diabetes mellitus and chronic renal failure. peritonitis due to S. aureus with intermediate resistance to glycopeptides developed after 18 weeks of vancomycin treatment for recurrent methicillin-resistant S. aureus peritonitis associated with dialysis. The removal of the peritoneal catheter plus treatment with rifampin and trimethoprim-sulfamethoxazole eradicated the infection. The second patient was a 66-year-old man with diabetes in new jersey. A bloodstream infection due to S. aureus with intermediate resistance to glycopeptides developed after 18 weeks of vancomycin treatment for recurrent methicillin-resistant S. aureus bacteremia. This infection was eradicated with vancomycin, gentamicin, and rifampin. Both patients died. The glycopeptide-intermediate S. aureus isolates differed by two bands on pulsed-field gel electrophoresis. On electron microscopy, the isolates from the infected patients had thicker extracellular matrixes than control methicillin-resistant S. aureus isolates. No carriage was documented among 177 contacts of the two patients. CONCLUSIONS: The emergence of S. aureus with intermediate resistance to glycopeptides emphasizes the importance of the prudent use of antibiotics, the laboratory capacity to identify resistant strains, and the use of infection-control precautions to prevent transmission.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
2/154. peritoneal dialysis-associated peritonitis caused by Propionibacteria species.There are an increasing number of reports about unusual causes of peritonitis in peritoneal dialysis (PD) patients. The Propionibacteria species is a microorganism that is a normal skin flora. Under the presence of certain risk factors, it may produce serious infections. patients at risk of having Propionibacteria sp infections have malignancy, diabetes mellitus, foreign bodies, or immunodeficiency. We describe a PD-associated peritonitis in a 51-year-old woman that was caused by Propionibacteria sp. This patient's risk factors for developing Propionibacteria sp peritonitis include a history of crest syndrome, malignancy of the breast, and recent catheter surgery. To our knowledge, this is the first case of a PD-associated peritonitis caused by Propionibacteria sp reported in the literature.- - - - - - - - - - ranking = 0.82472525430229keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
3/154. Successful living related simultaneous pancreas-kidney transplant between identical twins.Simultaneous pancreas-kidney transplant from living donors has been recently proposed as an effective therapeutic option in selected uremic patients with type I diabetes. We report the first simultaneous pancreas-kidney transplant performed between identical twins. Posttransplant, the recipient has been maintained on low dose cyclosporine to avoid recurrent auto-immune insulitis. At the 1-year follow-up, both donor and recipient are well with normal renal function and excellent glucose control. Simultaneous pancreas-kidney transplant between identical twins can be performed successfully using cyclosporine to prevent recurrent auto-immune insulitis.- - - - - - - - - - ranking = 0.17527474569771keywords = diabetes (Clic here for more details about this article) |
4/154. Successful obstetric outcome after simultaneous pancreas and kidney transplantation.A 34-year-old woman became pregnant two years after having a simultaneous pancreas and kidney (SPK) transplantation, necessitated by type 1 diabetes and end-stage renal disease. The pregnancy was uneventful until 30 weeks' gestation, when she developed pancreatitis and a worsening of mild hypertension. A healthy 1700 g boy was delivered by caesarean section at 34 weeks' gestation. This is the first report of a successful pregnancy after SPK transplantation in australia.- - - - - - - - - - ranking = 0.17527474569771keywords = diabetes (Clic here for more details about this article) |
5/154. Improvement of glycemic control by CAPD with intraperitoneal insulin in a child with IDDM and ESRD.Use of intraperitoneal insulin in diabetic end-stage renal disease (ESRD) patients receiving continuous ambulatory peritoneal dialysis (CAPD) is known to result in improved glycemic control. This route of insulin administration, although standard in adult diabetic CAPD patients, has not previously been reported in children. A 12-year old boy with ESRD from renal dysplasia who also had insulin-dependent diabetes mellitus (IDDM) was treated with CAPD and intraperitoneal insulin prior to renal transplantation. Diabetes and renal dysplasia were both diagnosed at 11 weeks of age. When he reached end-stage he was initially started on hemodialysis via a central line but was switched to CAPD because of recurrent line sepsis. His IDDM had been poorly controlled up to that time. CAPD was performed using 4 exchanges per day of 1.5% dialysate with a fixed dose of insulin added to each bag and with adjustments made based on blood glucose. His glycemic control markedly improved, with a fall in his glycosylated hemoglobin from 13.6% to 6%. CAPD was continued for 7 months until a living-related renal transplant was performed. Two episodes of peritonitis occurred while the patient received CAPD (1 episode/3.5 patient-months). We conclude that the use of intraperitoneal insulin in children with IDDM and ESRD leads to improved glycemic control. The rate of peritonitis, however, may be increased in these children.- - - - - - - - - - ranking = 0.8390315862916keywords = diabetes mellitus, diabetes, mellitus, insulin-dependent (Clic here for more details about this article) |
6/154. Subcutaneous nodules attributed to nocardiosis in a renal transplant recipient on tacrolimus therapy.We report a renal transplant patient who suffered from disseminated nocardiosis after empirical tacrolimus rescue therapy for chronic allograft rejection. The nocardiosis presented initially as only mildly tender subcutaneous calf nodules without any other signs of inflammation nor constitutional upset, which later spread to the lung and brain causing bronchopneumonia and brain abscesses. The risk factors for nocardial infection in our patient include the use of potent immunosuppressive agents such as tacrolimus, poorly controlled diabetes mellitus and kidney dysfunction. She responded well to combination antibiotic therapy comprising parenteral meropenem, cefotaxime and oral minocycline. We conclude that in transplant recipients, especially those receiving newer and more potent immunosuppressive agents like tacrolimus, nocardial infection can present as apparently 'cold' subcutaneous nodules without any systemic upset. An associated brain lesion should be excluded even in patients without neurological symptoms.- - - - - - - - - - ranking = 0.82472525430229keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
7/154. Ulceration of the urethral meatus after simultaneous pancreas-kidney transplantation.A 39-year-old male developed painful ulceration of the glans penis following simultaneous pancreas and kidney transplantation for end-stage renal failure complicating insulin-dependent diabetes mellitus. Infection was excluded. Diversion of the pancreatic secretions away from the urinary bladder into the bowel resulted in healing.- - - - - - - - - - ranking = 0.8390315862916keywords = diabetes mellitus, diabetes, mellitus, insulin-dependent (Clic here for more details about this article) |
8/154. Prevention of intraocular pressure elevations during hemodialysis.intraocular pressure (IOP) may rise during hemodialysis sessions in predisposed patients because of a rapid drop in osmolality at the blood compartment. A patient with diabetes had painful ocular episodes during hemodialysis that were associated with an IOP increase. We modified the dialysis parameters to prevent a rapid decrease in osmolality by creating conductivity and ultrafiltration profiles and adding a colloid solution at the beginning of the procedure. After instituting these changes, the patient became asymptomatic and did not have variations in IOP during the dialysis sessions.- - - - - - - - - - ranking = 0.17527474569771keywords = diabetes (Clic here for more details about this article) |
9/154. Evidence of recurrent type I diabetes following HLA-mismatched pancreas transplantation.Type 1 diabetes mellitus is considered as an autoimmune disease against beta cells. Diabetes recurrence after pancreas transplantation is well known in HLA-identical twins while it is rarely reported in recipients of cadaveric pancreatic grafts. In the present case report, diabetes recurrence occurred in a recipient who underwent cadaveric combined pancreas kidney transplantation. Seven years after transplantation the patient exhibited progressive hyperglycemia needing insulin therapy while the renal graft was well functioning. The diagnosis of recurrent disease was obtained on the histological features such as selective loss of beta cells without clear signs of insulitis and on the presence of markers (GAD 65 and IA-2) for humoral autoimmunity. It is intriguing that, at the time of recurrence of type 1 diabetes, the patient had stopped steroids and azathioprine, while only cyclosporine was maintained as immunosuppressive treatment. Our case report underlines the relevance of studying the humoral autoimmune response directed to islet autoantigens in cadaveric pancreas allograft recipients. Furthermore, it suggests that an efficient immunosuppressive treatment after transplantation may be able to reduce the autoimmune response against the pancreatic allograft.- - - - - - - - - - ranking = 1.8763737284886keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
10/154. Typical features of calciphylaxis in a patient with end-stage renal failure, diabetes mellitus and oral anticoagulation.We report a multimorbid patient with end-stage renal failure showing a large necrosis and livedo racemosa on the right thigh. histology revealed medial calcification of the small arteries typical of calciphylaxis. We found the typical features of the disease with different risk factors like elevated calcium-phosphate product, diabetes mellitus and oral anticoagulation. On account of the location of the skin lesions, a bad prognosis was expected. In spite of therapeutical measures with lowering of the calcium and phosphate levels, the patient died 1 month after the diagnosis had been made.- - - - - - - - - - ranking = 4.1236262715114keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
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