1/11. Use of differential reinforcement to treat medical non-compliance in a paediatric patient with leukocyte adhesion deficiency.Leukocyte Adhesion Deficiency (LAD) is a rare immuno-deficiency disorder which results in chronic infections, such as gingivitis, necrotic skin infections and gastrointestinal ulcers. This case describes an 18-year-old male who was non-compliant during an inpatient hospitalization with several aspects of his complex medical regimen, particularly his wound care, physical therapy and use of his crutches. The patient's dressing change protocol was task analysed in order to create a structured, predictable routine by having the subject complete small, discrete steps. A differential reinforcement programme was implemented to provide the patient with tangible reinforcement for general compliance with his treatment, including compliance with dressing changes and physical therapy. Over a 1-month period, the subject's overall compliance with his medical regimen achieved an average of approximately 87%. His compliance with physical therapy and dressing changes both improved to 87 and 80%, respectively, by the end of his hospitalization. During the last week of his hospitalization, the use of his crutches was task analysed and included in his reinforcement programme using a changing criterion design. His average use of his crutches also improved to 80%.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/11. A papular eruption associated with human T cell lymphotropic virus type III disease.The clinical spectrum of human T cell lymphotropic virus type III (HTLV-III) disease is associated with myriad cutaneous findings, commonly of infectious origin. A clinically characteristic, yet histologically nonspecific, papular eruption was observed in seven of thirty-five patients followed up for HTLV-III disease (acquired immunodeficiency syndrome and the related complex). Noncoalescing 2- to 5-mm skin-colored papules of the head, neck, and upper trunk typify the lesions. Histologically, a chronic perivascular infiltrate of mononuclear cells was regularly present. The eruption was often, but not always, pruritic. The clinical course was chronic. Many patients had persistent lesions for more than 9 months; however, the number of papules tended to wax and wane with time. Although the cause of this eruption is unknown, it is sufficiently distinct and frequent to be recognized by clinicians as a cutaneous sign of human retrovirus infection.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
3/11. Infections due to Lancefield group G streptococci.The group G streptococcus has surfaced in the past 10 to 15 years as an important opportunistic and nosocomial pathogen. Although more precise organism recognition accounts for a portion of these cases, there can be little doubt that the group G streptococcus has become a more prevalent pathogen. Commercial kits, utilizing staphylococcal coagglutination or latex agglutination, are now available, affording all clinical laboratories the opportunity to identify this organism easily. Published reviews encompassing the experiences of a single institution or even several institutions affiliated with a single medical center, particularly as they were influenced by referral patterns, did not reflect the broad scope of infections that we discovered by extending our survey into the community, beyond the medical center complex and its immediate affiliated hospitals. Although malignancy is the single most obvious background factor, alcoholism and diabetes are also important host determinants of infection. Skin and soft-tissue infections (and surface sources of infection) are equally important among patients with or without the element of malignancy. Polymicrobial infection, including polymicrobial bacteremia, is an important feature, with S. aureus infections accounting for most of these cases, relating to the skin and soft tissue sources of infections so commonly seen. We saw a panorama of problems including endocarditis, septic arthritis, pleuropulmonary infections, bone and joint infections, puerperal sepsis and neonatal infection, peritonitis and ophthalmitis; we also saw a significant number of patients with bacteremia and no apparent primary source of infection. Response to antibiotic therapy was dictated by the nature of the underlying diseases, and individuals without a background of malignant disease did well, particularly those with skin and soft-tissue infections. While the literature suggests that patients with endocarditis and septic arthritis due to this organism respond poorly to antibiotic therapy, implying that such failures relate to in vitro antibiotic phenomena, we preferred to examine the problem from the viewpoint of the host(s) involved. Subacute endocarditis and acute endocarditis due to the group G streptococcus may be clinically separable, and thus require separate therapeutic approaches. In patients with septic arthritis, prosthetic devices, prior joint disease and immunosuppressive diseases and therapy often adversely influence the response to antibiotic therapy.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
4/11. Acute generalized pustular bacterid and immune complexes.The case is described of a 39-year-old man with acute generalized pustular bacterid and high Clq-binding activity in the sera during the active stage. histamine-induced vascular changes studied by immunofluorescence microscopy revealed a perivascular deposition of IgM and C3. These findings support the view that leukocytoclastic vasculitis underlying the subcorneal pustules is mediated by immune complex deposition.- - - - - - - - - - ranking = 5keywords = complex (Clic here for more details about this article) |
5/11. Primary granulomatous dermatitis caused by Rhodochrous. Evidence for a pathogenic role in humans.bacteria belonging to the Rhodochrous complex are of uncertain taxonomic status. Currently excluded from the genus Mycobacterium, these organisms are more closely allied to nocardia. Organisms of the Rhodochrous complex have only rarely been implicated as human pathogens. An 81-year-old man had a plaquelike cutaneous granuloma from which Rhodochrous was both cultured and demonstrated in tissue section. A pathogenic role for Rhodochrous causing a primary cutaneous infection is suggested. Specific antimicrobial treatment with doxycycline hydrochloride was successful and there has been no recurrence of the infection after three years.- - - - - - - - - - ranking = 2keywords = complex (Clic here for more details about this article) |
6/11. Primary inoculation complex of skin by Mycobacterium chelonei.We report a patient with a primary inoculation complex of the skin caused by Mycobacterium chelonei, a facultative pathogen that belongs to group IV of Runyon's classification of atypical mycobacteria. This organism is seldom responsible for disease in humans, although cutaneous, pulmonary, heart, bone, and disseminated infections have been reported. An unusual cutaneous manifestation of this organism is presented with a review of the literature.- - - - - - - - - - ranking = 5keywords = complex (Clic here for more details about this article) |
7/11. ethambutol-induced toxic epidermal necrolysis.Toxic epidermal necrolysis (TEN) is a severe cutaneous reaction that most commonly is related to drug exposure and that clinically can be confused with other bullous dermatoses, particularly staphylococcal scalded skin syndrome (SSSS) and erythema multiforme major (the stevens-johnson syndrome). We report the first case, to our knowledge, of TEN associated with ethambutol hydrochloride administration. Toxic epidermal necrolysis can be partially differentiated from other bullous dermatoses by history and clinical presentation. Microbiological results (eg, the isolation of staphylococcus aureus in SSSS) and immunological studies (eg, the demonstration of immune complexes in the stevens-johnson syndrome) may aid in differentiation, but ultimately the diagnosis depends on histopathological examination of involved skin.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
8/11. A clinical and bacteriologic evaluation of cefamandole therapy in serious skin and skin structure infections.The results of this study suggest that the enhanced in vitro spectrum of cefamandole may be clinically advantageous, particularly when complex mixtures of aerobic and aerobic-anaerobic bacteria are present in the lesions of serious skin and skin structure infections. The reported incidence of satisfactory clinical and bacteriologic responses appears to justify the use of cefamandole as a single agent for the treatment of these infections.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
9/11. mycobacterium avium complex infection limited to the skin in a patient with systemic lupus erythematosus.We describe a case of Mycobacterium avium infection of the skin in a 51-year-old woman with systemic lupus erythematosus. Two lesions were treated with a combination of oral tetracycline or minocycline and hyperthermia using a portable warmer. One subsequently healed, leaving an atrophic scar, but the other lesion persisted, and was eventually excised.- - - - - - - - - - ranking = 4keywords = complex (Clic here for more details about this article) |
10/11. Papulonecrotic tuberculid secondary to disseminated mycobacterium avium complex.BACKGROUND. Papulonecrotic tuberculid is a rarely reported cutaneous reaction to the mycobacterium bacillus. It is most often encountered in association with tuberculosis. The clinical and histologic picture of the entity is a distinctive one, but the etiology of the disease process is uncertain. Therapy directed against the causative organism is dramatically successful. methods. A 35-year-old white man with AIDS was referred to the dermatology clinic for evaluation of a widespread skin eruption. The skin lesions were biopsied for histopathology and culture. From the cutaneous cultures mycobacterium avium complex (MAC) organisms were grown. RESULTS. We report the first case of papulonecrotic tuberculid manifestation in an AIDS patient with disseminated MAC. Unusual features seen in this case include the predominance of pruritic eschars rather than asymptomatic papules and the confirmation by special stains of mycobacterium organisms within the skin biopsy. Papulonecrotic tuberculid has not been previously associated with either MAC or AIDS. CONCLUSIONS. Papulonecrotic tuberculid should be a diagnostic consideration in immunocompromised patients with MAC whose clinical and histologic features are compatible with this rare entity.- - - - - - - - - - ranking = 5keywords = complex (Clic here for more details about this article) |
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