1/12. 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 = 1keywords = medium (Clic here for more details about this article) |
2/12. Acute otitis media and facial nerve paralysis in adults.OBJECTIVE: The pathophysiology and treatment of facial nerve paralysis associated with acute otitis media are still under debate. The objective of this study was to review treatment strategies and extent of recovery in adult patients with the aim of defining a standard treatment protocol for this rare pathologic condition. STUDY DESIGN: Retrospective chart review. SETTING: University hospital, tertiary referral center. patients: Between 1993 and 2000, 11 patients were admitted for facial nerve paralysis secondary to acute otitis media. There were six women and five men without a history of chronic middle ear disease, who ranged in age from 21 to 71 years. Facial palsy was graded with the House-Brackmann scale: four patients had Grade III palsy, six had Grade IV palsy, and one patient had Grade V palsy. Bacteriologic examination of middle ear fluid was performed in four patients streptococcus pneumoniae was observed in one patient, and the remaining three cultures were negative. INTERVENTIONS: All patients were treated with parenteral ampicillin-sulbactam or a third-generation cephalosporin in conjunction with oral or intravenous corticosteroids, except in a single patient with diabetes mellitus who received antibiotics alone. Myringotomy alone or with ventilation tube application was performed in eight patients. A simple mastoidectomy without facial nerve decompression was used in a patient with sudden impairment to Grade VI paralysis and worsening otitis after an initial improvement. RESULTS: Normal facial function returned in all patients, independently of the grade of the paralysis, the treatment strategy, or the outcome of the middle ear disease. The time of recovery varied from 2 weeks to 3 months, except for one patient who underwent mastoidectomy and in whom normal function returned in 10 months. CONCLUSIONS: The treatment of facial nerve paralysis secondary to otitis media should be as conservative as possible, using antibiotics and corticosteroids. Myringotomy and a ventilation tube should be added when spontaneous perforation of the tympanic membrane is not present. Mastoidectomy should be performed only when it is necessary to treat otitis media. facial nerve decompression should not be necessary.- - - - - - - - - - ranking = 128.3273132986keywords = otitis (Clic here for more details about this article) |
3/12. Clinical consequences of Thorotrast in a long-term survivor.Thorotrast, a colloidal suspension of 252Th dioxide, was widely used as a radiographic contrast medium for more than 25 y after its clinical practice introduction in 1930. Its excellence as a contrast medium was ultimately eclipsed by its long-term associated morbidities, and its use essentially ended by 1954. This case history presents the clinical events in the last 10 y of life in a patient injected with Thorotrast in 1953. This patient developed three previously described Thorotrast-associated morbidities: pneumococcus sepsis due to functional asplenia and reticuloendothelial system blockade, an enlarging Thorotrastoma (inflammatory mass) at the injection site, and a fatal blood dyscrasia. In addition, she developed three clinical syndromes where a Thorotrast association may exist. She suffered from severe spinal column osteoarthritis and vertebral collapse. An abnormal bone-density measurement implies the presence of radiodense radioactive thorium or its degradation products as potentially responsible. She had evidence of chronic immune system disregulation with immunoglobulin excess, auto antibodies, and cell-mediated immunity deficiency. This condition is similar to that found in patients infected with human immunodeficiency virus and may suggest a shared etiology in reticuloendothelial system damage. Lastly, she developed dense bilateral cataracts. This case history illustrates the temporal relationship of a variety of symptoms. Discussion is directed at review of previous data and support for new associations.- - - - - - - - - - ranking = 2keywords = medium (Clic here for more details about this article) |
4/12. Failure of a 5-day course of intramuscular ceftriaxone to eradicate streptococcus pneumoniae from the middle ear.A 10-kg 9-month-old infant with recurrent, unresponsive otitis media presented with bilateral acute otitis media caused by streptococcus pneumoniae type 19A, resistant to all oral agents and intermediately susceptible to ceftriaxone. Treatment with myringotomies and intramuscular ceftriaxone, 50 mg/kg/d for 5 days, was unsuccessful. The patient responded to pressure equalization tubes and local ciprofloxacin with dexamethasone drops.- - - - - - - - - - ranking = 28.517180733023keywords = otitis (Clic here for more details about this article) |
5/12. streptococcus pneumoniae acute suppurative parotitis in a patient with Sjogren's syndrome.A case of suppurative parotitis due to streptococcus pneumoniae is reported in a patient with sjogren's syndrome. The rarity of this condition is noted by a review of the literature.- - - - - - - - - - ranking = 71.292951832557keywords = otitis (Clic here for more details about this article) |
6/12. Combined IgG2, IgG4 and iga deficiency: low C1q concentrations and the presence of excess C1r and C1s in an adult patient with recurrent pneumococcal infections.The complement (C) profile was investigated in an adult patient with combined IgG2, IgG4 and iga deficiency and recurrent pneumococcal infections. The analysis revealed no gross impairment of the classic and alternative pathways of C activation. However, the concentrations of circulating C1q were persistently decreased, and the sera contained an excess of C1r-C1s complexes, resembling the C1 aberrations previously found in children with recurrent acute otitis media. The concentrations of C4 in the patient were persistently low. This could be ascribed to partial C4 deficiency with lack of C4A variants. The patient's IgG and IgM antibody responses to pneumococcal capsular polysaccharides and to other bacterial carbohydrate antigens were very poor. Interestingly, pneumococcal C-polysaccharide (CPS) could be detected in serum obtained during infection-free periods. Since CPS has been shown to bind C1q without causing C1 activation, the possibility was considered that the C1 aberrations in serum were due to circulating CPS. After administration of intramuscular gammaglobulin to the patient, the serum C1q levels were observed to return to normal.- - - - - - - - - - ranking = 14.258590366511keywords = otitis (Clic here for more details about this article) |
7/12. C2 deficiency, moderately low IgG2 concentrations and lack of the G2m(23) allotype marker in a child with repeated bacterial infections.C2 deficiency was demonstrated in an 11-year-old boy with a past history of recurrent purulent otitis media, pneumonia, H. influenzae meningitis and S. pneumoniae septicaemia. The major histocompatibility complex haplotypes present, A10, B18, DR2, BF*S, C2*QO, C4*A4, C4*B2 and A28, B18, DR2, BF*S, C2*Q0, C4*A4, C4*B2, were in accord with previous observations in C2 deficiency. The concentrations of C1q, C5, factor B and factor D were in the low normal range and the hemolytic activity of the alternative pathway was slightly decreased. In addition, the patient showed moderately low IgG2 concentrations and lacked the IgG2 subclass marker G2m(23). The findings indicate that the patient's susceptibility to bacterial infections may be due to C2 deficiency in combination with the presence of an IgG allotype associated with impaired antibody responses to carbohydrate antigens.- - - - - - - - - - ranking = 14.258590366511keywords = otitis (Clic here for more details about this article) |
8/12. Necrotizing ("malignant") external otitis histopathologic processes.The histologic findings in a serially sectioned temporal bone, from a patient who succumbed to brain abscess secondary to necrotizing ("malignant") external otitis, are described. The mechanism of invasion of the ear canal appears to be due to local bone necrosis. This in turn extends to the submucosal vasculature of the pneumatic spaces. The infective process extends submucosally, establishing one or several sites of bone destruction. The lumen of the pneumatic space is not involved. In this process, the periphery of the fibrous inflammatory tissue formation is the site of active bone destruction. In pneumococcal petrositis, the peripheral fibrous elements are protective. The process in malignant external otitis may extend directly to adjacent central nervous system structures inoculating the structure with pseudomonas. Development of pseudomonas brain abscesses can be slow, allowing for new bone closure of the site from which the infection spreads as demonstrated in this specimen. Therefore, apparent local control of the disease can be established while a central infective process progresses.- - - - - - - - - - ranking = 85.551542199068keywords = otitis (Clic here for more details about this article) |
9/12. Pneumococcal parotitis and cervical lymph node abscesses in an hiv-infected patient.The case of a 33-year-old patient with rapid onset of bilateral parotid gland and lymph node abscesses is described. The patient was positive for human immunodeficiency virus 1 and presented with a history of interstitial lymphocytic pneumonia and pneumococcal meningitis prior to admission. The patient received cotrimoxazole as primary prophylaxis against pneumocystis carinii pneumonia. Fine needle aspiration from the abscesses yielded streptococcus pneumoniae. penicillin g treatment in combination with surgical drainage of the lesions led to healing with minimal residual lymph node enlargement. No relapse was noted until 12 months after presentation.- - - - - - - - - - ranking = 57.034361466045keywords = otitis (Clic here for more details about this article) |
10/12. Pyogenic brain abscess caused by streptococcus pneumoniae: case report and review.While streptococcus pneumoniae is the most common cause of bacterial meningitis in adults, cases of pneumococcal brain abscess have rarely been reported. We describe a case of otogenic brain abscess caused by S. pneumoniae that developed in a patient who was receiving ciprofloxacin for the empirical treatment of otitis media. We also review 23 additional cases of pyogenic brain abscess caused by S. pneumoniae that have previously been reported. The development of a pneumococcal brain abscess was associated with a contiguous intracranial focus of infection in 50% of cases. The majority of patients presented with headache (81%) and focal neurological deficits (86%). However, the classic triad of headache, fever, and focal neurological deficits was present in only 24% of patients. The mortality rate for patients with brain abscess caused by S. pneumoniae was 35%; persistent neurological deficits were documented in 40% of patients who survived.- - - - - - - - - - ranking = 14.258590366511keywords = otitis (Clic here for more details about this article) |
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