Cases reported "Bacterial Infections"

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1/11. Infections in pregnant women: the need to assess and possibly treat the fetus and the sexual partner as well.

    Assessing and treating pregnant women in the emergency department for complaints unrelated to pregnancy are complex processes at best. Obtaining a consultation from an obstetrician is always prudent, even if it is simply by telephone. Careful attention to laboratory and other diagnostic test results is imperative, and communication with the patient's primary care physician and/or obstetrician is a must. Assessment of fetal well-being should be documented, and implications for the fetus of all treatments and/or omitted treatments should be considered. With infections in pregnant women, remember to think about implications for the baby and the woman's sexual partner; both may need to be assessed and treated.
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2/11. Gas-containing otogenic brain abscess.

    BACKGROUND: Gas-containing brain abscesses are very rare. Two mechanisms may be responsible for the presence of intracavitary gas: bacterial fermentation or penetration through an abnormal communication between the exterior and the intracranium. The need to search for this potential communication is considered an indication for open surgery. We report the case of a surgically treated gas-containing brain abscess originating from an undiagnosed chronic otitis media. CASE DESCRIPTION: A 54-year-old man developed acute neurologic deterioration, becoming comatose within 24 hours. A contrast-enhanced computed tomography (CT) scan disclosed a gas-containing cystic mass in the right temporal lobe. Urgent surgical decompression revealed the presence of an abscess, which was excised. During the same surgery, we performed a radical mastoidectomy, removing a previously undiagnosed attic cholesteatoma. Neither procedure revealed a discontinuity of the floor of the middle cranial fossa. Cultures grew a mixed flora. Antibiotics were administered for 6 weeks. The patient made a complete neurologic recovery. CONCLUSION: This report demonstrates that otogenic brain abscesses may contain gas due to fermentation of nonclostridial bacteria.
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3/11. Regression of lung lesions in Hodgkin's disease by antibiotics: case report and hypothesis on the etiology of Hodgkin's disease.

    In this article, we propose that the pathogenesis of Hodgkin's disease is similar to the one of crown gall tumors in plants. Here a natural exchange of genetic material from (oncogenic plasmids) to plant cells induces malignant tumors in dicotyledons. The "crown gall" hypothesis for Hodgkin's disease would explain the clinical observations of a bacterial infection the behavior as a malignant tumor. The clinical consequence of this hypothesis is that antibiotic treatments of very early Hodgkin's disease may be successful before the genetic exchange between prokaryotic and eukaryotic cells has taken place. This "crown gall" hypothesis is testable (1) by looking for bacterial dna sequences in Reed-Sternberg and Hodgkin's cells, and (2) by antibiotic treatments of Hodgkin's patients. In this communication we show a regression of Hodgkin's disease in the lung by prolonged treatment with ciprofloxacin and clarithromycin.
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4/11. An unusual case infection following spinal surgery.

    A case of extensive subcutaneous inflammation infection four months after a spinal operation is presented. The patient had had an extensive laminectomy and foraminotomy for lumbar canal stenosis and protruded discs at L3/L4 and L4/L5 levels. Four months postoperatively, bilateral gluteal abscesses developed and were treated by surgical evacuation. Three months after the evacuation of the abscesses, extensive inflammation and purulent infiltration of the laminectomy wound together with recurrence of the gluteal abscesses were noticed. In spite of reevacuation of the abscesses the inflammation persisted. A syringography disclosed communication of the gluteal abscesses with the laminectomy wound. Eventually this complication was treated by surgical reexploration of the laminectomy wound, during which it was found that the inflammation, although longstanding, did not spread to the intervertebral spaces.
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5/11. Mixed bacterial meningitis.

    Two recent cases of mixed bacterial meningitis at the kansas City veterans Administration Medical Center were studied. A review of the literature suggests that 1% of all cases of meningitis are caused by more than one bacterial species. Before 1950 such cases occurred predominantly in children and were caused by combinations of bacteria commonly associated with meningitis. Since 1950 a largely adult population has been affected by mixed bacterial meningitis, with a higher incidence of gram-negative bacillary organisms cultured from the cerebrospinal fluid. Common predisposing factors in this older group of patients include infection at contiguous foci, tumors in close proximity to the central nervous system, or fistulous communications with the central nervous system. mortality was 26% for cases occurring before 1950 and 63% for those occurring after 1950. Failure to recognize one of the organisms present in the cerebrospinal fluid may result in the initiation of inadequate therapy in as many as 67% of cases. Empiric broad-spectrum antimicrobial therapy is indicated in symptomatic patients predisposed to mixed bacterial meningitis until culture results become available.
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6/11. Supracallosal interhemispheric arachnoid cyst: resolution after intracystic hemorrhage and infection.

    A case of a large, symptomatic, supracallosal interhemispheric arachnoid cyst is presented. Positive contrast-enhanced computed tomographic (CT) cystography after stereotactic puncture and aspiration demonstrated lack of communication between the cyst and the subarachnoid space or ventricular system. A cystoperitoneal shunt was successful in relieving the patient's symptoms for 5 years. A delayed shunt infection after gynecologic surgery necessitated removal of the shunt, and was complicated by asymptomatic intracystic hemorrhage. Thereafter, serial CT and magnetic resonance imaging scans showed eventual disappearance of the cyst.
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7/11. ureaplasma urealyticum septic arthritis in hypogammaglobulinemia.

    We describe a hypogammaglobulinemic man with erosive oligoarticular septic arthritis due to ureaplasma urealyticum. His clinical course was complicated by a subcutaneous abscess. Multiple synovial cultures were negative until finally cultures specific for mycoplasmas were performed. Serologic diagnosis cannot be relied upon in hypogammaglobulinemic patients because they do not mount a perceptible antibody response. This underscores the importance of a high clinical suspicion of mycoplasmas as etiologic agents of septic arthritis in this population and early communication with the microbiology laboratory so that appropriate cultures for mycoplasmas can be performed and joint destruction minimized.
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8/11. Purulent umbilical drainage from infection of left umbilical artery associated with open umbilicoperitoneal communication.

    This is a case report of a 20-day-old girl with persistent umbilical drainage due to infection of the left umbilical artery that ruptured at the base of the umbilicus and formed an open umbilicoperitoneal communication.
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9/11. Pancreatic abscess due to infected hydatid disease.

    A 35-year-old man sought treatment for acute epigastric pain, mild jaundice, and high fever. The patient was alcoholic and had been treated for a week in another hospital, at which time the clinical findings and indirect laboratory test indicated an attack of acute pancreatitis. At admission to the surgical intensive care unit of Aretaieon Hospital, the patient was in a septic condition; a computed tomographic scan of the upper abdomen revealed an abscess at the head of the pancreas. Surgical exploration showed an infected hydatid cyst at the head of the pancreas and pancreatic edema. The cyst was evacuated and drained, which resulted in formation of an external pancreatic fistula. Fistulography showed a communication of the residual cavity with the main pancreatic duct. The patient was begun on a regimen of somatostatin infusion, and the fistula closed within 3 days. The patient was discharged on the sixteenth postoperative day and has remained in good health for a year.
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10/11. Cerebral abscess associated with an intrauterine contraceptive device.

    The present communication is the first report of a metastatic brain abscess occurring as a complication of severe intrauterine device (IUD)-related pelvic inflammatory disease (PID). The diagnostic and therapeutic problems are discussed, and a suggestion is made for the reporting of all IUD-associated infections to a central agency.
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