1/39. 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 = tract (Clic here for more details about this article) |
2/39. Gemifloxacin: survival of the fittest.The incidence of penicillin resistance in pneumococci is increasing in the USA, having risen from <5% before 1989 to >35% in 1997. There has also been a shift in the ratio of intermediate to high-level resistance from 3 or 4:1 to 2 or 1:1. Multidrug resistance and resistance to macrolides and fluoroquinolones in pneumococci is also a matter of concern. The implications for empirical treatment of respiratory tract infections are considerable. The potential of quinolones with activity against respiratory pathogens including pneumococci must be preserved by careful antimicrobial prescribing.- - - - - - - - - - ranking = 1338.9119698444keywords = respiratory tract infection, respiratory tract, tract infection, tract (Clic here for more details about this article) |
3/39. Pneumococcal purulent genual arthritis after allogeneic bone marrow transplantation.A 21-year-old male patient with non-Hodgkin's lymphoma (diffuse large T-cell type, clinical stage IV) received allogeneic bone marrow transplantation (BMT) from a partially HLA-mismatched unrelated donor in July 1998 and achieved complete remission. Thereafter, he suffered from chronic graft-versus-host disease (GVHD) and was continuously administered immunosuppressive drugs for a long time. Two years after the BMT, he complained of severe pain in the right knee, which was swollen, and was diagnosed as having pneumococcal purulent genual arthritis. He underwent arthroscopic synovectomy and was administered systemic and intra-articular antibiotics, leading to a gradual improvement. Streptococcal infections are often seen in patients in the late phase after allogeneic BMT because of immunodeficiency associated with chronic GVHD and hyposplenism. Most streptococcal infections are respiratory tract infections and septicemia, and there have been very few reports on cases of purulent genual arthritis. Administration of prophylactic antibiotics and control of chronic GVHD, which is a risk factor of pneumococcal infection, seem to be important to prevent purulent genual arthritis.- - - - - - - - - - ranking = 1338.9119698444keywords = respiratory tract infection, respiratory tract, tract infection, tract (Clic here for more details about this article) |
4/39. Heart and brain: a case of focal myocytolysis in severe pneumococcal meningoencephalitis with review of the contemporary literature.We report electrocardiographic changes mimicking myocardial ischaemia in a 73-year-old man with fatal pneumococcal meningoencephalitis, present the autopsy-confirmed histological picture of extensive focal myocytolysis (contraction band necrosis) without myocardial infarction or myocarditis, and review the contemporary literature. Potentially reversible, probably non-ischaemic myocardial dysfunction may occur in association with acute noncardiac illnesses, such as brain injuries. Biochemical and morphological abnormalities in acutely failing hearts from head-injured organ donors point to specific pathophysiological mechanisms, which are different from heart failure from other causes. sepsis-related factors may add to the myocardial dysfunction in patients with brain injury from meningoencephalitis.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
5/39. Postcataract surgery endophthalmitis in a patient with a functioning Jones tube.dacryocystorhinostomy with Jones tube placement has proven to be an effective method for correcting upper-system lacrimal drainage obstruction. The present case report illustrates the potential risk of bacterial contamination of the operative field during subsequent cataract surgery by retrograde passage of airway secretions. Temporary occlusion of the Jones tube by a silicone plug can eliminate this potential source of endophthalmitis. In addition, temporary occlusion of the Jones tube in the office can be used to determine the effectiveness of lacrimal drainage through a reconstructed canalicular system.- - - - - - - - - - ranking = 0.039909416900174keywords = upper (Clic here for more details about this article) |
6/39. Pneumococcal bacteremia with retropharyngeal soft-tissue inflammation and acute epiglottitis.Pneumococcal bacteremia secondary to acute epiglottitis is relatively rare, and all previously reported cases occurred in immunocompromised patients. We report a case of pneumococcal bacteremia associated with acute epiglottitis and retropharyngeal soft-tissue inflammation with upper airway narrowing that occurred in an otherwise healthy patient. In light of our unique finding, we recommend that pneumococcal bacteremia be suspected in an otherwise healthy patient who has systemic manifestations associated with acute epiglottitis.- - - - - - - - - - ranking = 0.039909416900174keywords = upper (Clic here for more details about this article) |
7/39. Coexistent yellow nail syndrome and selective antibody deficiency.BACKGROUND: yellow nail syndrome (YNS) is a rare, often underdiagnosed condition of unknown origin. The clinical features of the syndrome include yellow nails, chronic sinusitis, bronchiectasis, pleural effusion, and lymphoedema. Despite the frequent occurrence of upper and lower respiratory tract infections in patients with YNS, comprehensive analysis of their humoral immunity has not been previously reported. OBJECTIVE: To present the case of a patient with YNS whose recurrent upper and lower respiratory tract infections may have been caused by an underlying selective antibody deficiency that manifests as impaired IgG antibody response to polysaccharide antigens. methods: The patient underwent cultures of purulent sputum for streptococcus pneumoniae and haemophilus influenzae, bronchial washings for H. influenzae, and nail scrapings for fungi. Her serum levels of IgG, IgA, IgM, IgG subclasses, and serum titers of IgG antitetanus toxoid, anti-H. influenzae, and anti-S. pneumoniae antibodies were measured. RESULTS: Cultures of purulent sputum were positive on multiple occasions for S. pneumoniae and H. influenzae and bronchial washings were positive for H. influenzae. Nail scrapings were consistently negative for fungi. She had no reductions in serum levels of IgG, IgA, IgM, or IgG subclasses and had normal serum titers of IgG antitetanus toxoid antibodies. However, she demonstrated impaired IgG antibody responses following immunization with Pneumovax and an H. influenza B vaccine. CONCLUSIONS: This case report describes the first comprehensive analysis of humoral immune function in a patient with YNS. The finding of a selective antibody deficiency in our patient provides a potential explanation for the occurrence of respiratory infections in YNS. Accordingly, we recommend that functional antibody determinations and quantitative serum immunoglobulins be evaluated in patients diagnosed as having this unusual, enigmatic syndrome.- - - - - - - - - - ranking = 2677.9037585226keywords = respiratory tract infection, respiratory tract, tract infection, tract, upper (Clic here for more details about this article) |
8/39. Bilateral endogenous bacterial endophthalmitis: a report of four cases.PURPOSE: To present and discuss four cases of bilateral endogenous endophthalmitis. methods: An observational study of four patients aged 55-80 years, seen within a 2-year period. All had diagnostic and therapeutic vitrectomy. The antibiotic therapy was guided by analyses of cultures of blood and vitreous. RESULTS: blood cultures demonstrated streptococcus pneumoniae in two patients and staphylococcus aureus and morganella morganii, each in one patient. The findings corresponded with culture findings from vitreous material in two patients. The primary foci for the metastatic spread of infection were endocarditis, discitis and a subdural abscess of the lumbar spine, urinary tract infection, and infection of a recent hip alloplasty, respectively, in the four patients. Five eyes became blind, whereas three eyes recovered to visual acuity of 0.25-0.67. CONCLUSIONS: Endogenous bacterial endophthalmitis usually leads to total loss of vision. The disease is acute and the time span for intervention limited. We believe that an active therapeutic approach including intravitreal antibiotics and vitreoretinal surgery saved three eyes from blindness.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
9/39. Post-operative meningitis caused by drug-resistant streptococcus pneumoniae: two case reports.We report 2 patients with post-operative meningitis caused by drug-resistant streptococcus pneumoniae (DRSP), following correction of frontoethmoidal encephalomeningocele in 1 patient and adenotonsillectomy in the other. Both patients responded well to vancomycin plus cefotaxime. DRSP may be colonized in the upper respiratory tract and causes serious infections after surgical operation.- - - - - - - - - - ranking = 114.37233667204keywords = respiratory tract, tract, upper (Clic here for more details about this article) |
10/39. pyelonephritis and urosepsis caused by streptococcus pneumoniae.This report presents the case of a patient with a massive pyelonephritis and a urosepsis caused by streptococcus pneumoniae. This case is unusual as the focus was distant from the respiratory tract, the usual primary site of infection caused by this organism. No other primary site of infection was documented.- - - - - - - - - - ranking = 114.33242725514keywords = respiratory tract, tract (Clic here for more details about this article) |
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