1/11. Does primary Streptococcus viridans pneumonia exist?In 4 adult black patients admitted to an urban general hospital with community-acquired pneumonia, Streptococcus viridans alone was isolated from blood culture (first subculture), in the absence of any other positive microbiological finding. sputum examination by Gram staining and culture in 3 cases was reported as negative. echocardiography was performed in 3 cases and was normal, without evidence of endocarditis. The clinical course of illness in the 4 patients is described. The chest radiograph showed a segmental or subsegmental consolidation in all cases; this appeared 'mass-like' in 2 patients. viridans streptococci may be a more important, if still uncommon, cause of community-acquired pneumonia than previously suspected. The organism should be considered as a possible cause of chest infection, particularly in patients with appropriately positive blood cultures and no other positive microbiological finding.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
2/11. Childhood panhypopituitarism presenting as child abuse: a case report and review of the literature.Childhood panhypopituitarism may be acquired or congenital. Children with panhypopituitarism can present clinically with diabetes, growth failure, decreased bone density, and morbid obesity. In the forensic setting without the proper history, it can be misdiagnosed as child abuse or neglect. We report a case of a 3-year-old black girl who was admitted to the emergency room with apnea and subsequently died. While at the emergency department, it was discovered that the child had a fractured left hip and was severely growth retarded for age. The coroner wanted to rule out child abuse and/or neglect and requested an autopsy based on the physical findings identified by hospital staff. Significant findings at autopsy included small for age (15th percentile for age), hypoplastic brain/pituitary gland/adrenal gland/thyroid gland, abnormally formed skull with an occipital protuberance, a fractured left hip with decreased bone density, and central adiposity. Subsequent to the autopsy, it was discovered that at 6 weeks of age the child suffered from group B streptococci meningitis that resulted in panhypopituitarism. The panhypopituitarism then resulted in seizure activity, diabetes insipidus, and growth retardation. The authors hope this case report and review of the literature will assist investigators, pathologists, and clinicians in making a distinction between neglect or inflicted injury of child abuse and panhypopituitarism that can present with similar signs and symptoms.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
3/11. Anterior segment necrosis associated with endogenous endophthalmitis secondary to group C streptococcal septicemia.Anterior segment necrosis following ocular infections and endophthalmitis secondary to group C streptococcal infection are both rare. We report a case of unilateral anterior segment necrosis associated with bilateral metastatic group C streptococcal endophthalmitis in a 68-year-old black man with multiple systemic disorders complicated by culture-confirmed group C streptococcal septicemia and endocarditis. Pathological examination of the left eye at autopsy demonstrated necrosis of the anterior segment involving the cornea, iris, lens and ciliary body. The right eye showed signs of mild residual inflammation. To our knowledge anterior segment necrosis has not previously been described in association with group C streptococcal endophthalmitis.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
4/11. Tubo-ovarian abscess caused by streptococcus pneumoniae.A 46-year-old black woman underwent exploratory surgery for evaluation of a tender mass in her abdomen. During the exploratory surgery bilateral tubo-ovarian abscesses ruptured. Specimens from both tubes and from the wall of the abscesses contained bacteria seen on the Brown-Hopps tissue gram stain. The bacteria were gram-positive, lancet-shaped diplococci characteristic of streptococcus pneumoniae. Immunoperoxidase stains confirmed the identification of the organism as S pneumoniae.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
5/11. osteomyelitis of the distal phalanges in three children with severe atopic dermatitis.Three children with severe, secondarily infected atopic dermatitis since infancy developed osteomyelitis of the distal phalanges of the hands. The insidious onset of one or more distal subungual black macules was followed by edema, erythema, and pain in the involved fingers. No child had an elevated erythrocyte sedimentation rate or fever, but all had roentgenographic or scintigraphic evidence of bony destruction. In two children, Staphylococcus aureus grew from skin surface cultures; S aureus also grew from nail bed and osseous cultures of the distal phalanges; Streptococcus viridans grew from one child's nail bed. All children had prolonged hospitalizations. In two children, laboratory evaluation of immunologic function disclosed normal findings. We postulate that intense scratching of infected skin coupled with minor trauma to the fingertips created distal subungual microabscesses that spread contiguously to the underlying bone.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
6/11. Pseudofolliculitis barbae with keloids.Pseudofolliculitis barbae is a common cutaneous infection occurring in the bearded area of the face of black men. The infection is caused by ingrown hairs that produce an inflammatory foreign body reaction characterized by papules and pustules at the point of hair penetration that may result in permanent scarring, usually in grooved patterns, and occasionally in keloids. The purpose of this article is to describe the successful treatment of a patient with pseudofolliculitis with keloids that was based on the pathophysiology of the disease and the biology of wound repair.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
7/11. confusion of a poststreptococcal syndrome complicated by uveitis with mucocutaneous lymph node syndrome.This article describes the case of a 13-year-old black male who fulfilled the diagnostic criteria for mucocutaneous lymph node syndrome (MLNS), but developed severe posterior uveitis. Because severe posterior uveitis is not reported in MLNS, the patient's diagnostic evaluation was repeated and a markedly elevated antistreptolysin O titer detected. Since severe posterior uveitis is known to complicate streptococcal infection, we concluded this was the more likely etiology of the child's illness. This was an important differentiation, because prednisone therapy was felt to be indicated for the uveitis but is contraindicated in MLNS. This case also highlights the importance of careful and sometimes repeated diagnostic evaluation before the description of a previously unreported manifestation of a disease for which no single diagnostic test exists. If the diagnostic workup had not been repeated, this child would have been reported as having severe posterior uveitis complicating MLNS.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
8/11. Rapidly progressive glomerulonephritis in black children. A report of 4 cases.Rapidly progressive glomerulonephritis in children in rare, and we have therefore described 4 cases in Black children. All had evidence of a preceding streptococcal infection and there were crescents in more than 80% of the glomeruli seen on histological examination. The dominant clinical features were oliguria or anuria in a setting of nephritis or nephrotic syndrome, with a relentless progression to chronic renal failure and death. Quadruple therapy with cyclophosphamide, steroids, heparin and dipyridamole in 3 of the patients was of no lasting benefit and was attended by severe complications. Guidelines to the monitoring of children with post-streptococcal glomerulonephritis for the early detection of this uncommon complication are given.- - - - - - - - - - ranking = 4keywords = black (Clic here for more details about this article) |
9/11. Fatal craniocervical necrotizing fasciitis in an immunocompetent patient: a case report and literature review.BACKGROUND. Craniocervical necrotizing fasciitis (CCNF) is a rapidly progressive, severe bacterial infection of the superficial fascial planes of the head and neck. Group A beta-hemolytic Streptococcus, staphylococcus aureus, and obligate anaerobic bacteria are common pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CCNF. Recently the lay press has referred to necrotizing fasciitis in several articles about "flesh eating" bacteria, which have resulted in several deaths. methods. We report the first case of a fatality in an otherwise immunocompetent patient. The patient was a 66-year-old black man with no identifiable source of infection and no history or evidence of immunocompromising disorders. RESULTS. Despite aggressive surgical debridement and broad-spectrum antibiotic coverage, he died 30 hours after admission from multisystem organ failure secondary to overwhelming sepsis. CONCLUSION. Treatment consists of early recognition of CCNF combined with aggressive surgical debridement and drainage of the involved necrotic fascia and tissue along with broad-spectrum intravenous antibiotic coverage. Although 11 other fatal cases of CCNF have been previously reported, all had an underlying medical problem which created an immunocompromised state, usually diabetes mellitus or chronic alcoholism. We present a case report and literature review along with a discussion of the related anatomy.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
10/11. A case of subacute necrotizing fasciitis.We report a 48-year-old woman who developed necrotizing groin fasciitis with insidious onset. Before she visited us, she had been unsuccessfully treated with several kinds of antibiotics by other doctors for one month, because of a small ulcer covered by blackish necrotic tissue. She was referred to us because of high fever, an ulcer on the left labium majus, and a cellulitis-like lesion with severe pain on the lower abdomen. methicillin-resistant staphylococcus aureus (MRSA), streptococcus intermedius, and bacteroides uniformis were isolated from the wound. After aggressive debridement on the eighth day after admission of the whole indurated area and the fascia of the underlying muscle, healthy granulation tissue covered the defect, and the wound was finally closed with a skin graft Long-term administration of antibiotics along with insufficient and delayed surgical treatment were considered to have caused the full development of this disease.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
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