1/13. Severe thrombocytopenia associated with alatrofloxacin.OBJECTIVE: To report the development of severe thrombocytopenia during alatrofloxacin therapy. CASE SUMMARY: A 54-year-old Native American woman was admitted for pneumonia after completing a 10-day course of loracarbef 200 mg po bid. On admission, the woman was hypoxic (PO2 56 mm Hg) and had a platelet count of 408 x 10(3)/mm3. Alatrofloxacin 300 mg iv piggyback qd was initiated in the emergency department. The patient's condition gradually improved during the next three days. While preparing for discharge on hospital day 4, the patient developed epistaxis that lasted approximately three hours. Laboratory testing revealed a platelet count of 7 x 10(3)/mm3; stable red blood cell count, hemoglobin, and hematocrit values; and a normal white blood cell count. Alatrofloxacin therapy was discontinued and azithromycin was initiated on hospital day 4. methylprednisolone 125 mg iv piggyback every 12 hours was initiated on hospital day 5. The platelet count fell to 2 x 10(3)/mm3 on hospital day 5 and then began to rise, reaching 60 x 10(3)/mm3 when the patient was discharged on hospital day 8. DISCUSSION: Numerous infectious, disease-related, environmental, and pharmacologic factors may cause thrombocytopenia. Drug-induced thrombocytopenia usually develops during the first two weeks of therapy and resolves within one week of drug discontinuation. thrombocytopenia occurred in <1% of more than 7000 patients receiving alatrofloxacin or trovafloxacin during clinical trials. CONCLUSIONS: The time course of this patient's development of and recovery from thrombocytopenia suggests that it was induced by alatrofloxacin. Clinicians should monitor patients receiving alatrofloxacin or trovafloxacin for signs and symptoms of bleeding and thrombocytopenia.- - - - - - - - - - ranking = 1keywords = white blood cell, white blood, blood cell, white (Clic here for more details about this article) |
2/13. Community-acquired pneumonia: a case study.Community-acquired pneumonia (CAP) is an infectious disease commonly seen in the primary care environment. CAP is ranked as the sixth leading cause of death in the united states. It affects more than 10 million individuals per year and accounts for 500,000-1,000,000 hospital admissions. Precise diagnosis of CAP continues to be complex. Despite enormous advances in serologic analysis and antimicrobial development, at least 50% of causative pathogens are not identified. This article presents a case report of a white female in her seventies diagnosed with CAP and emphasizes the need for early detection, immunization, and prompt interventions to reduce morbidity and mortality rates. This case brings to light the dilemma practitioners can face when treating high-risk populations on an outpatient basis.- - - - - - - - - - ranking = 0.0091546362026247keywords = white (Clic here for more details about this article) |
3/13. The evolution of lemierre syndrome: report of 2 cases and review of the literature.lemierre syndrome (postanginal septicemia) is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. A high degree of clinical suspicion is necessary for diagnosis. fusobacterium necrophorum is the usual etiologic agent. The disease progresses in several steps. The first stage is the primary infection, which is usually a pharyngitis (87.1% of cases). This is followed by local invasion of the lateral pharyngeal space and IJV septic thrombophlebitis (documented in 71.5% of cases), and finally, the occurrence of metastatic complications (present in 90% of cases at the time of diagnosis). A sore throat is the most common symptom during the primary infection (82.5% of cases). During invasion of the lateral pharyngeal space and IJV septic thrombophlebitis, a swollen and/or tender neck is the most common finding (52.2% of patients) and should be considered a red flag in patients with current or recent pharyngitis. The most common site of metastatic infection is the lungs (79.8% of cases). In contrast to the preantibiotic era, cavitating pneumonia and septic arthritis are now uncommon. Most patients (82.5%) had fever at some stage during the course of the disease. Gastrointestinal complaints such as abdominal pain, nausea, and vomiting were common (49.5% of cases). An elevated white blood cell count occurred in 75.2% of cases. hyperbilirubinemia with slight elevation of liver enzyme levels occurred in one-third of patients, but frank jaundice was uncommon, in contrast to its high frequency reported in the preantibiotic era. We conclude that, most likely as a consequence of widespread antibiotic use for pharyngeal infections, the typical course of the disease has changed since Lemierre's original description. The typical triad in our series was: pharyngitis, a tender/swollen neck, and noncavitating pulmonary infiltrates. The previous classical description of severe sepsis with cavitating pneumonia and septic arthritis was not commonly seen in our review. mortality was low in our series (6.4%), but significant morbidity occurred, which was likely preventable by early diagnosis and treatment. The pathophysiology, natural history, diagnostic methods for internal jugular vein thrombosis, and management are discussed.- - - - - - - - - - ranking = 0.93885598739221keywords = white blood cell, white blood, blood cell, white (Clic here for more details about this article) |
4/13. Rapid imipenem/cilastatin desensitization for multidrug-resistant Acinetobacter pneumonia.OBJECTIVE: To report a successful case of rapid imipenem desensitization in a critically ill patient with multidrug-resistant acinetobacter baumannii ventilator-associated pnemonia (VAP). CASE SUMMARY: A 40-year-old white man who had a lengthy stay in the intensive care unit (ICU) following a motorcycle accident developed VAP caused by A. baumannii. treatment with imipenem was necessary due to the bacteria's resistance to all other antibiotics. However, this patient was diagnosed with an allergy to imipenem following exposure earlier in his hospitalization in addition to a positive penicillin skin test. Thus, we attempted rapid desensitization to imipenem using a continuous infusion protocol. The patient was desensitized within 4 hours and was successfully treated for 21 days with a continuous infusion of imipenem combined with daily amikacin. He experienced no adverse reaction during the desensitization process or the remainder of his treatment course. DISCUSSION: The protocol used in this case was modified from a previously reported case, and differed in the speed of desensitization and total daily dose. We assumed that a more gradual escalation of the dose in our modified protocol would prevent the occurrence of adverse events, thereby resulting in more rapid desensitization. Rapid desensitization was necessary in this patient due to the presence of a life-threatening infection. The lower total daily dose of imipenem was in response to impaired renal function. CONCLUSIONS: Therapeutic options for multidrug-resistant pneumonia in the ICU are significantly limited in the presence of imipenem allergy. An option of last resort is to desensitize the patient using a rapid administration protocol. Our modified rapid imipenem desensitization protocol was successful and allowed for effective treatment of life-threatening pneumonia.- - - - - - - - - - ranking = 0.0091546362026247keywords = white (Clic here for more details about this article) |
5/13. Clinical features of q fever pneumonia.The aim of the study was to assess the clinical features of q fever pneumonia in japan. Four cases of q fever pneumonia (a female aged 21 and males aged 53, 74 and 87 years) who were diagnosed using the PanBio ELISA test kit, were assessed and their clinical features are described. The frequency of q fever pneumonia among our cases of community-acquired pneumonia was 1.4% (4/284). A 21-year-old female had a typical case of the disease with (i) a history of owning a cat, (ii) onset with fever and dry cough, (iii) multiple soft infiltrative shadows on CXR, (iv) a normal white blood cell count, and (v) good response to clarithromycin. The pneumonias in the other three cases were considered mixed infections with bacteria such as streptococcus pneumoniae and haemophilus influenzae. Their clinical features included the following: (i) an elderly person with an underlying disease, (ii) onset with fever and purulent sputum, (iii) coarse crackles on auscultation, (iv) infiltrative shadows and pleural effusion on CXR, (v) increased white blood cells with elevated BUN and hyponatraemia, and (vi) modest responses to combined therapy with carbapenem and minocycline. Our observations suggest that two types of pneumonia caused by coxiella burnetti exist; one with the usual features of atypical pneumonia, and the other presenting with the clinical features of bacterial pneumonia in the elderly due to mixed bacterial infection.- - - - - - - - - - ranking = 1.8777119747844keywords = white blood cell, white blood, blood cell, white (Clic here for more details about this article) |
6/13. Pertussis pneumonia, hypoxemia, hyperleukocytosis, and pulmonary hypertension: improvement in oxygenation after a double volume exchange transfusion.A 3-month-old infant of 33 weeks' gestation was hospitalized with pneumonia caused by bordetella pertussis. respiratory insufficiency worsened, and on hospital day 3, there was severe pulmonary dysfunction (arterial oxygen pressure/fraction of inspired oxygen ratio: 120), extreme leukocytosis (white blood cell count 104,000/mm3), and severe pulmonary hypertension as assessed by 2-dimensional echocardiogram. A double volume exchange transfusion was performed to reduce the leukocyte mass. Oxygenation began to improve during the exchange and continued to improve over the ensuing 31 hours (arterial oxygen pressure/fraction of inspired oxygen ratio: 280). The white blood cell count fell dramatically after the exchange, and the rate of rise was slower after exchange therapy compared with preexchange.- - - - - - - - - - ranking = 1.8777119747844keywords = white blood cell, white blood, blood cell, white (Clic here for more details about this article) |
7/13. rhodococcus equi pneumonia in a renal transplant patient: a case report and review of literature.Immunocompromised patients are susceptible to many pathogens, including those that are predominantly problems in veterinary medicine. We report a case of a 42-yr-old white male who presented 19 months post-cadaveric renal transplant (for IgA nephropathy) with a 5 d history of nausea, vomiting, abdominal cramping and diarrhea. Admission chest X-ray revealed a suspicious mass lesion in the left lower lobe. Computed tomography (CT) guided biopsy of the lesion showed a large zone of CD68 ve histiocytes in a non-caseating granuloma. Gram stain revealed multiple gram-positive rods within the histiocytes, which were eventually identified as R. equi. After 4 months of therapy with fluoroquinolones (Avelox) and azithromycin a repeat CT showed complete resolution of the lesion. We reviewed the literature with special focus on the clinical features, challenges in diagnosis, and treatment of this rare infection (especially in the transplant patients who are also on immunosuppressive therapy).- - - - - - - - - - ranking = 0.0091546362026247keywords = white (Clic here for more details about this article) |
8/13. Newly diagnosed chronic granulomatous disease in a 53-year-old woman with crohn disease.BACKGROUND: Chronic granulomatous disease (CGD) is characterized by defective bactericidal activity of white blood cells, specifically, a defect in superoxide production. patients experience infections, predominantly caused by catalase-positive bacteria and fungal organisms, that may be severe and life-threatening. Most cases of CGD are diagnosed in children; however, it may rarely go undiagnosed until adulthood in individuals with unexplained infections and granulomatous inflammation. OBJECTIVE: To describe an adult with crohn disease and recurrent infections who was newly diagnosed as having CGD. methods: A 53-year-old woman with a history of liver abscesses and crohn disease presented with burkholderia cepacia pneumonia and required a right middle lobe resection. nitroblue tetrazolium test results confirmed the diagnosis of CGD, and Western blot analysis revealed the absence of the 47-phagocyte oxidase protein. Levels of Crohn-associated specific antibodies to saccharomyces cerevisiae and escherichia coli outer membrane porin C were elevated. RESULTS: The patient, newly diagnosed as having CGD, was given intravenous trimethoprim-sulfamethoxazole, after which she improved clinically and was discharged from the hospital in stable condition to receive daily oral trimethoprim-sulfamethoxazole treatment. CONCLUSIONS: The concomitant occurrence of crohn disease and CGD, both characterized by granulomatous inflammation, is noteworthy. This case study demonstrates that CGD should be considered in adults with recurrent infections, especially those caused by catalase-positive organisms, such as B cepacia.- - - - - - - - - - ranking = 0.93885598739221keywords = white blood cell, white blood, blood cell, white (Clic here for more details about this article) |
9/13. Diagnosis of legionella pneumophila infection by polymerase chain reaction.We examined the application of the polymerase chain reaction (PCR) for the diagnosis of legionellosis. Eight intratracheal aspirates were collected from a patient with pneumonia caused by legionella pneumophila serogroup 2, and serial 10-fold dilutions of the samples were obtained. Two samples were positive for L. pneumophila by the direct fluorescent antibody (DFA) method down to a 10(-2) concentration, and one was positive down to a 10(-4) concentration. PCR was positive for all eight samples, and the sensitivity was greater than that of the DFA method. Only one of the eight samples yielded organisms in culture: the L. pneumophila serogroup 2 strain was isolated on buffered charcoal yeast extract alpha agar as an atypical white, papillate colony.- - - - - - - - - - ranking = 0.0091546362026247keywords = white (Clic here for more details about this article) |
10/13. M. Kansasii pulmonary disease in idiopathic CD4 T-lymphocytopenia.Cases of patients with markedly depressed CD4 T-lymphocyte counts, with or without opportunistic infections, in the absence of any evidence of human immunodeficiency virus (hiv) have been described in recent years. In 1992, the definition of "idiopathic CD4 T-lymphocytopenia" was formulated by the Centers for Disease Control and Prevention (CDC) of Atlanta (USA). The present case illustrates the occurrence of an unexplained mycobacterium kansasii pneumonia in a white hiv-negative subject with a persistent depletion of CD4 t-lymphocytes and suppression of cell-mediated immunity. To our knowledge, this is the first observation of idiopathic CD4 T-lymphocytopenia with pulmonary mycobacteriosis due to mycobacterium kansasii, and the sixth case of this kind of immunodeficiency described in italy.- - - - - - - - - - ranking = 0.0091546362026247keywords = white (Clic here for more details about this article) |
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