1/74. Infectious disease emergencies in primary care.Infectious disease emergencies can be described as infectious processes that, if not recognized and treated immediately, can lead to significant morbidity or mortality. These emergencies can present as common or benign infections, fooling the primary care provider into using more conservative treatment strategies than are required. This review discusses the pathophysiology, history and physical findings, diagnostic criteria, and treatment strategies for the following infectious disease emergencies: acute bacterial meningitis, ehrlichiosis, rocky mountain spotted fever, meningococcemia, necrotizing soft tissue infections, toxic shock syndrome, food-borne illnesses, and infective endocarditis. Because most of the discussed infectious disease emergencies require hospital care, the primary care clinician must be able to judge when a referral to a specialist or a higher-level care facility is indicated.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
2/74. Febrile lady with acute renal failure and desquamating erythema.A 63-year-old woman developed acute renal failure and streptococcal toxic shock syndrome caused by streptococcus group G. Initially, an erythema resembling vasculitis was misleading. The subsequent clinical course, however, was typical for streptococcal toxic shock syndrome and met the criteria put forward by The Working Group on Severe streptococcal infections. In patients infected with streptococcus group G, toxic shock syndrome is rare. The streptococcus group G strains isolated from this patient did not produce pyrogenic exotoxins. Instead they produced an M-like protein related to group C and G streptococci that do not act as superantigens.- - - - - - - - - - ranking = 258.37406501718keywords = streptococcus (Clic here for more details about this article) |
3/74. Toxic-shock-like-syndrome due to streptococcus pneumoniae sinusitis.We describe a patient with streptococcus pneumoniae sinusitis associated with a severe sepsis syndrome and desquamative rash whose clinical illness strongly resembled toxic-shock syndrome. Assay of convalescent serum for antibodies to toxic-shock syndrome toxin 1 was negative. This case suggests the possibility of an additional bacterial pathogen associated with toxic-shock syndrome.- - - - - - - - - - ranking = 12.306418861999keywords = pneumoniae (Clic here for more details about this article) |
4/74. Severe invasive group A beta-hemolytic streptococcus infection complicating pharyngitis: a case report and discussion.Group A beta-hemolytic streptococcus (GABHS) has long been recognized as a deadly pathogen with manifestations ranging from impetigo to necrotizing fasciitis. bacteremia from streptococcal pharyngitis is a rare complication. We report a patient presenting with septic shock and diabetic ketoacidosis from streptococcal pharyngitis. The pathophysiology, classification, and treatment of invasive group A streptococcal infection is discussed.- - - - - - - - - - ranking = 430.6234416953keywords = streptococcus (Clic here for more details about this article) |
5/74. Toxic shock-like syndrome caused by T serotype B3264 streptococcus.A 45-year-old woman was transferred from a local hospital to our hospital because of shock-like manifestations in addition to septic polyarthritis and necrotizing cellulitis of the left leg. Since streptococcus pyogenes was isolated from the blood culture examined one day before admission, the diagnosis of streptococcal toxic shock-like syndrome (TSLS) was made. Antibiotic treatment together with supportive care started at the time of admission, resulting in clinical improvement, although poststreptococcal acute glomerulonephritis occurred during the period. TSLS is a life-threatening disease, but early recognition of the disease and prompt initiation of appropriate treatment may lead to successful outcome.- - - - - - - - - - ranking = 344.49875335624keywords = streptococcus (Clic here for more details about this article) |
6/74. Primary peritonitis due to group A streptococcus.Primary peritonitis is a rare condition occurring, by definition, in patients without underlying causes, such as perforated viscus, pre-existing ascites, or nephrosis. We report a case of primary peritonitis and shock due to group A beta-hemolytic streptococcus, a rare etiology. A review of the world's literature shows a predilection for women to have this condition. The entry site is obscure in most cases. Asymptomatic genital tract colonization may be a portal of entry in some women. shock or toxic shock syndrome often accompany the abdominal findings. laparotomy to exclude a perforated viscus may be unavoidable. Despite the significant morbidity, expeditious and appropriate antibiotic therapy is curative.- - - - - - - - - - ranking = 430.6234416953keywords = streptococcus (Clic here for more details about this article) |
7/74. Streptococcal toxic shock syndrome in two patients infected by a colonized surgeon.The incidence of severe invasive infections caused by streptococcus pyogenes, a group A streptococcus (GAS), has increased in the past 10 years. Most cases occur outside of the hospital setting. We report on two patients with nosocomial streptococcal toxic shock syndrome (StrepTSS). In patient 1 the syndrome was associated with the development of necrotizing fasciitis following inguinal hernia repair. Patient 2 suffered from StrepTSS shortly after receiving a tetanus vaccine in her left deltoid. Epidemiologic investigations of these cases, which were noted within 48 hours of each other, showed that the same surgeon performed the vaccination on patient 2 after assisting a colleague during the hernia repair procedure on patient 1. He was found to be a nasal carrier of GAS. All GAS isolates from the patients and the surgeon were indistinguishable by pulsed field gel electrophoresis. PCR analysis demonstrated the presence of streptococcal pyogenic exotoxins A and F. All strains were of the T-1 serotype and possessed the gene for M-protein 1. This report demonstrates that a virulent strain of GAS may be spread by asymptomatically colonized medical personnel via the air route.- - - - - - - - - - ranking = 86.12468833906keywords = streptococcus (Clic here for more details about this article) |
8/74. Necrotizing fasciitis secondary to group A streptococcus. morbidity and mortality still high.OBJECTIVE: To update physicians on Group A streptococcal necrotizing fasciitis, including current methods of diagnosis and treatment. QUALITY OF EVIDENCE: Current literature (1990-1998) was searched via medline using the MeSH headings necrotizing fasciitis, toxic shock syndrome, and Streptococcus. Articles were selected based on clinical relevance and design. Most were case reports, case series, or population-based surveys. There were no randomized controlled trials. MAIN MESSAGE: The hallmark of clinical diagnosis of necrotizing fasciitis is pain out of proportion to physical findings. Suspicion of underlying soft tissue infection should prompt urgent surgical examination. Therapy consists of definitive excisional surgical debridement in conjunction with high-dose intravenous penicillin g and clindamicin. risk factors for mortality include advanced age, underlying illness, hypotension, and bacteremia. CONCLUSION: Necrotizing soft tissue infections due to Group A streptococcus might be increasing in frequency and aggression. overall mortality remains high (20% to 34% in larger series). Clinical diagnosis requires a high level of suspicion and should prompt urgent surgical referral.- - - - - - - - - - ranking = 430.6234416953keywords = streptococcus (Clic here for more details about this article) |
9/74. Invasive group A streptococcus infection of the scrotum and streptococcal toxic shock syndrome.We report a case of invasive group A streptococcus infection of the scrotum that presented as epididymoorchitis and rapidly progressed to streptococcal toxic shock syndrome. The presentation, pathophysiology, and management of invasive group A streptococcus and streptococcal toxic shock syndrome are reviewed. Rapid recognition is necessary to avoid the significant morbidity and mortality associated with these invasive infections.- - - - - - - - - - ranking = 516.74813003436keywords = streptococcus (Clic here for more details about this article) |
10/74. Necrotizing fasciitis and toxic shock-like syndrome caused by group B streptococcus.A recent increase in reports of necrotizing fasciitis resulting from group B streptococcus has alerted physicians to a possible concomitant increase of toxic shock-like syndrome. We report the second case of group B streptococcus causing necrotizing fasciitis and toxic shock-like syndrome. A black woman, aged 52 years, with newly diagnosed diabetes mellitus had necrotizing fasciitis type II of the left groin. hypotension, elevated bilirubin and liver enzymes, and adult respiratory distress syndrome rapidly developed. Because group B streptococcus was isolated from a normally sterile site, the patient's condition met the criteria for toxic shock-like syndrome. Extensive surgical debridement, hyperbaric oxygen therapy, and intravenous antibiotic therapy (including clindamycin) were required for complete recovery. The antitoxin effects of hyperbaric oxygen therapy and clindamycin should be further investigated for the treatment of such patients.- - - - - - - - - - ranking = 602.87281837342keywords = streptococcus (Clic here for more details about this article) |
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