1/201. Septicaemia and endomyocarditis caused by aerococcus urinae.aerococcus urinae, an uncommon urinary tract pathogen, was recently shown to cause septicaemia and endocarditis in a few patients in denmark and the netherlands. In austria this is the first report of a fatal course of endomyocarditis by aerococcus urinae, associated with multiple septic infarcts.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
2/201. Purpura as a cutaneous association of sickle cell disease.A common chronic feature of sickle cell disease is the presence of painful, punched-out leg ulcers. Other cutaneous findings in patients with homozygous sickle cell disease have not been described in the literature. We present a case of a 50-year-old black woman with sickle cell disease who was admitted for acute onset of arm and hip pain. After admission she deteriorated clinically, with multiorgan failure and mental status changes. Examination of the skin revealed erythematous papules and plaques with scaly centers and purpura on the upper trunk. The clinical differential diagnosis was vasculitis versus sepsis. Skin biopsy of two representative lesions was performed. hematoxylin- and eosin-stained sections showed a superficial perivascular mixed inflammatory infiltrate with numerous eosinophils and extravasated erythrocytes, some of which exhibited bizarre morphology of sickled red blood cells. These findings indicated that the patient's cutaneous lesions, possibly multifactorial in origin, could be a component of her sickle cell crisis. This case is presented as an unusual one in which evaluation of erythrocyte morphology contributed to patient management and to emphasize the importance of examining erythrocyte morphology as a part of the histologic evaluation of stained tissue.- - - - - - - - - - ranking = 0.037867056245435keywords = upper (Clic here for more details about this article) |
3/201. Marked histiocytosis in the portal tract in a patient with reactive hemophagocytic syndrome: An autopsy case.We report an autopsy case of reactive hemophagocytic syndrome with peculiar liver histology. A 71-year-old female was diagnosed as having acute myelogenous leukemia and treated with chemotherapy. During her course, methicillin-resistant staphylococcus aureus (MRSA) was noted in blood culture and she was diagnosed as having MRSA sepsis. She died of respiratory failure 5 months after the onset of leukemia and 10 days after the MRSA sepsis. Ante-mortem liver function tests were within normal ranges. At autopsy, myeloblastic leukemia cells positive for CD13 were present in the bone marrow and, to a much lesser extent, in the spleen and liver. Numerous histiocytes of a bland appearance with erythrophagocytosis were noted in the bone marrow and spleen. The histiocytes were positive for CD68, but negative for S-100 and lysozymes. In the liver, many histiocytes of bland appearance with erythrophagocytosis and CD68 positivity were present in the portal tracts with no Kupffer cell hyperplasia. There were no hepatocellular degeneration, fatty changes or sinusoidal dilations. We consider that this histiocytosis was associated with MRSA infection and diagnosed this as infection-associated hemophagocytic syndrome. In previously reported cases, hemophagocytosis in hyperplastic kupffer cells was the main liver change of reactive hemophagocytic syndrome. The present case suggests that marked histiocytosis in portal tracts only may be a main feature of liver changes in reactive hemophagocytic syndrome and that such cases may not show abnormal liver function tests.- - - - - - - - - - ranking = 6keywords = tract (Clic here for more details about this article) |
4/201. Biliary sepsis as a cause of appearance of endoluminal Tc-99m HMPAO-labeled leukocytes: a case report.A case is presented that shows the abnormal early appearance of Tc-99m HMPAO-labeled leukocytes within the small bowel lumen as a result of septic cholangitis. It is essential to perform early images with Tc-99m HMPAO-labeled leukocytes to differentiate between the appearance of abnormal uptake in the bowel and normal physiologic excretion, which occurs later in the renal and biliary tracts. Endoluminal radiolabeled leukocytes have been described in several clinical settings unrelated to bowel disease, such as swallowed activity from sinus or pulmonary infection, and it is important to differentiate this from primary gastrointestinal disease. To our knowledge, acute pyogenic cholangitis has not been shown previously as a cause of these appearances and should be included in the differential diagnosis for the early appearance of mobile radiolabeled leukocytes in the lumen of the gastrointestinal tract.- - - - - - - - - - ranking = 2keywords = tract (Clic here for more details about this article) |
5/201. Spontaneous corneal perforation and endophthalmitis in pseudomonas aeruginosa infection in a ventilated patient: a case report.We report a case of Pseudomonas keratitis and endophthalmitis after inoculation from the respiratory tract in a mechanically ventilated patient. In these (semi)comatose and more vulnerable patients, colonisation of the upper respiratory tract by Pseudomonas occurs frequently, and this can lead to inoculation of the eyes. Emphasis lies on careful prevention of ocular inoculation and aggressive therapy as soon as keratitis is noticed.- - - - - - - - - - ranking = 60.015498366835keywords = upper respiratory tract, respiratory tract, tract, upper (Clic here for more details about this article) |
6/201. Isolation of moraxella canis from an ulcerated metastatic lymph node.moraxella canis was isolated in large numbers from an ulcerated supraclavicular lymph node of a terminal patient, who died a few days later. Although the patient presented with septic symptoms and with a heavy growth of gram-negative diplococci in the lymph node, blood cultures remained negative. M. canis is an upper-airway commensal from dogs and cats and is considered nonpathogenic for humans, although this is the third reported human isolate of this species.- - - - - - - - - - ranking = 0.037867056245435keywords = upper (Clic here for more details about this article) |
7/201. rhabdomyolysis and aggravation of arthritis in a rheumatoid arthritis patient as a result of sepsis due to staphylococcus aureus infection of a rheumatoid nodule; a catastrophic outcome.A 63-year-old man with rheumatoid arthritis presented with rhabdomyolysis and intractable arthritis of acute onset. He was diagnosed to have sepsis due to staphylococcus aureus infection through of an ulcerated rheumatoid nodule. staphylococcus aureus isolated from pus in the ulcerated rheumatoid nodule and a blood sample obtained from the heart post-mortem produced the toxic shock syndrome toxin-1 (TSST-1). The TSST-1 and/or unmethylated CpG motifs in the oligonucleotides present in a bacterium, staphylococcus aureus in this case, might be implicated in the induction of rhabdomyolysis and intractable arthritis.- - - - - - - - - - ranking = 2keywords = tract (Clic here for more details about this article) |
8/201. Therapeutic approaches to anergy in surgical patients. Surgery and levamisole.skin tests (ST) in 1332 patients are associated with increased morbidity from sepsis. patients with normal skin tests had a 7% major sepsis rate and 2% mortality rate. Thirty-six per cent of anergic (A) patients and 21% of relatively anergic (RA) patients died; 52% of A patients and 34% of RA patients had sepsis. These data include all patients studied and represent their worst skin test. Two studies were done. The first was a retrospective evaluation of effect of surgery upon 49 anergic patients with biliary tract disease, colon cancer, bowel obstruction, hypovolemia and visceral abscesses. The patients did not receive total parenteral nutrition (TPN). The data show that surgery without TPN can reverse the anergic state and did so in 84% of patients reported. The second study was a prospective, double-blind, randomized trial of the effect of levamisole on skin tests, neutrophil chemotaxis (CTX), sepsis and mortality iin 39 preoperative anergic patients. Major sepsis was significantly increased in placebo group (p less than 0.05). mortality, minor sepsis, restoration of skin tests and chemotaxis were somewhat better in levamisole patients but not statistically so. These studies show that in addition to TPN, surgery and immunorestorative drugs are viable approaches to the management of selected anergic patients.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
9/201. The protective effect of brachial plexus palsy in purpura fulminans.Acute infectious purpura fulminans is reported in a 16-month-old male with a history of posttraumatic asplenia and complete left brachial plexus palsy. This patient developed peripheral necrosis of both lower extremities and the right upper extremity, whereas the left upper extremity was completely spared from ischemia and tissue damage. amputation of four digits on the right hand and debridement of both lower extremities were required. This patient demonstrated the protective effect of a traumatic sympathectomy, which suggests the requirement of an intact sympathetic reflex in the development of purpura fulminans.- - - - - - - - - - ranking = 0.075734112490869keywords = upper (Clic here for more details about this article) |
10/201. Group A streptococcal sepsis and ovarian vein thrombosis after an uncomplicated vaginal delivery.BACKGROUND: Group A streptococcal puerperal sepsis is an uncommon peripartum infection that can quickly progress to a fulminant, multisystemic infection and life-threatening toxin-mediated shock. This infection can be asymptomatic during a short hospital stay after a routine delivery. Early treatment with antibiotics might not alter the course of tissue destruction caused by the exotoxin A. methods: literature searches were performed using the key words "puerperal infections," "streptococcal infections," "septic sacroiliitis," "postpartum septic arthritis," and "postpartum ovarian vein thrombosis." After patient consent was obtained, a report was prepared documenting the disease course, diagnosis, and treatment of a case of puerperal sepsis with multiple serious complications. RESULTS AND CONCLUSION: Puerperal sepsis occurs when streptococci colonizing the genital tract or acquired nosocomially invade the endometrium, adjacent structures, lymphatics, and bloodstream. A lack of symptoms early in the course of infection is common; later, minor somatic complaints can quickly progress to septic shock as effects of the exotoxin A are manifest. women who complain of fever, pelvic pain, or unexplained systemic symptoms in the early postpartum period should have a detailed history and physical examination. All sites of suspected infection should be cultured. If sepsis is suspected, diagnostic imaging includes chest radiographs, contrast-enhanced computed tomographic scans, or magnetic resonance imaging to rule out ovarian vein thrombosis, pelvic abscess, or sacroiliac septic arthritis. Broad-spectrum antibiotic coverage must be initiated immediately after collection of cultures. clindamycin plus a beta-lactam antibiotic is preferred for streptococcal toxic shock syndrome.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
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