Cases reported "Bacteroides Infections"

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1/54. Multiple organ dysfunction syndrome induced by whole-body hyperthermia and polychemotherapy in a patient with disseminated leiomyosarcoma of the uterus.

    OBJECTIVE: Whole-body hyperthermia (WBH) in combination with chemotherapy is a relatively new promising treatment modality for patients with cancer. The objective of this report is to present the development of an acute systemic inflammatory response syndrome (SIRS) with multiple organ dysfunction syndrome (MODS) following WBH in combination with chemotherapy. Although WBH can also induce cytokine production, MODS has not been described before in association with WBH. DESIGN: Case report. The patient was treated with WBH (core temperature 41.8 degrees C using a radiant heat device (Aquatherm) ) in combination with polychemotherapy (ifosfamide, carboplatin and etoposide (ICE) ) in the context of a clinical trial for metastatic sarcomas. SETTING: Department of medical oncology and intensive care unit of a university hospital. PATIENT: A 58-year-old Caucasian woman treated for disseminated leiomyosarcoma of the uterus, who developed SIRS with brain dysfunction, hypotension, respiratory failure and renal dysfunction following WBH/ICE. INTERVENTIONS: She was successfully treated in the intensive care unit by mechanical ventilation, inotropics and antibiotics. MEASUREMENTS AND RESULTS: There was a remarkable recovery within 2 days: she regained full conciousness, could be extubated, inotropic support was stopped and creatinine levels returned to pre-treatment levels. All cultures remained sterile. After almost complete recovery, 5 days later a second episode of fever during neutropenia occurred and, despite antibiotic treatment, she died of Bacteroides distasonis sepsis. CONCLUSION: WBH should be added as a new cause to the already known list of physical-chemical insults which can result in MODS.
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2/54. bacteroides fragilis bacteremia and infected aortic aneurysm presenting as fever of unknown origin: diagnostic delay without routine anaerobic blood cultures.

    We report the case of a 71-year-old male with bacteroides fragilis bactermia and infected aortic aneurysm that went undiagnosed, in part, because routine anaerobic blood cultures were not obtained. bacteremia caused by anaerobes has been reported to be declining, and recommendations to discontinue routine anaerobic blood cultures have been implemented in some hospitals. To our knowledge, this is the first report of an anaerobic bacteremia and infection that had a delay in diagnosis due to this change in blood-culturing protocol. The potential impact of deleting anaerobic blood cultures from routine protocols is discussed.
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3/54. eikenella corrodens: a clinical problem.

    E corrodens occurs as a significant clinical infection more frequently than suspected or cultured at the present time. It is essential that the dentist or physician work closely with the laboratory clinician in order to use proper techniques for its isolation. Inconsistencies between in vitro disk sensitivity and clinical drug response are noted. Because of clinical response, the clinician must carefully follow the patient's daily progress to recognize antibiotic treatment failure so that combination therapy or appropriate incision and drainage procedures may be initiated.
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4/54. Stent graft infection after abdominal aortic aneurysm repair: a case report.

    A 77-year-old man had clinical and radiologic signs of graft infection develop 1 year after stent grafting for abdominal aortic aneurysm. Blood cultures grew bacteroides fragilis, and cultures of the aneurysm sac grew enterococcus. The patient's condition was successfully managed with staged extraanatomic revascularization followed by graft excision. Although stent graft infection to date is extremely rare, some aspects peculiar to the placement of these devices potentially could increase their susceptibility to infection. Recognition and standard techniques in management can lead to successful outcome.
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5/54. bacteroides fragilis bacteremia associated with portal vein and superior mesentery vein thrombosis secondary to antithrombin iii and protein c deficiency: a case report.

    Hypercoagulability is one of the causes of portal vein and superior mesentery vein thrombosis. We report a case of bacteroides fragilis bacteremia associated with portal vein and superior mesentery vein thrombosis secondary to antithrombin iii and protein c deficiency. The patient presented with high fever for more than 3 weeks. Abdominal sonography revealed a liver cyst of 1.7 cm in diameter over segment 4 and a renal stone of 0.7 cm in size over the lower portion of the right kidney but no evidence of hydronephrosis. Elevation of liver enzymes was also noted. Intermittent fever was noted despite treatment with ceftriaxone and doxycycline. On Day 15 of hospitalization, blood culture revealed B. fragilis, which prompted further investigation of the source of intraabdominal and pelvic infection. Abdominal computed tomography revealed portal vein and superior mesentery vein thrombosis. Endoscopic studies of the gastrointestinal tract showed no tumor or diverticulum. Study of coagulation factors disclosed deficiency of antithrombin iii and protein C. Clinicians should remain aware of the need to promptly search for a portal or mesentery vein thrombosis in cases of Bacteroides bacteremia of unknown origin.
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6/54. Tension pneumopericardium caused by positive pressure ventilation complicating anaerobic pneumonia.

    A 22-year-old man was admitted with pneumonia. He was immediately intubated and positive pressure ventilation was initiated. Blood and sputum cultures showed bacteroides fragilis and corynebacterium sp., which were treated with metronidazole and clindamycin. Three weeks later his blood pressure suddenly dropped with an elevation of the central venous pressure. Chest X-ray revealed a pneumopericardium. A parasternal mediastinotomy with partial pericardiectomy was immediately performed. On opening the pericardium his blood pressure normalised. The patient gradually recovered and six weeks after admission he was extubated. Two weeks later he was discharged. A pneumopericardium without previous thorax trauma is very rare and early recognition is imperative because a tension pneumopericardium with cardiac tamponade may develop, as happened in this case. A tension pneumopericardium has to be treated with immediate pericardiocentesis followed by partial pericardiectomy to avoid recurrence.
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7/54. Treatment of portal vein septic thrombosis by infusion of antibiotics and an antifungal agent into portal vein and superior mesenteric artery: a case report.

    A 44-year-old man was hospitalized because of right-sided abdominal pain and fever. On admission, he presented spike fever, jaundice, and renal failure. Abdominal ultrasonography and computed tomography showed extensive thrombus in the portal vein. Anaerobic bacteria were identified in arterial and portal blood cultures. Based on these findings, septic thrombosis of the portal vein was diagnosed. Intraportal infusion of antibiotics, urokinase and an antifungal agent, followed by infusion of antimicrobials, urokinase, and heparin into the superior mesenteric artery resulted in marked improvement of symptoms and signs. diverticulitis of the ascending colon was later found to be the underlying disease. In the follow-up, there were no signs of recurrent disease.
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8/54. Treatment of Bacteroides endocarditis with carbenicillin.

    A heroin addict developed acute bacterial endocarditis with streptococcus viridans and Bacteroides melaninogenicus. Although blood cultures became negative during penicillin g and clindamycin therapy there was little clinical response. Prompt clinical improvement was achieved with intravenous carbenicillin in a dose of 40 g daily. in vitro testing supported the superiority of carbenicillin therapy in this patient.
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9/54. First isolation of Bacteroides thetaiotaomicron from a patient with a cholesteatoma and experiencing meningitis.

    A 45-year-old man with a cholesteatoma experienced purulent meningitis. Microbial analysis of cerebrospinal fluid yielded in pure culture a gram-negative bacillus. Phenotypic methods were suggestive of a Bacteroides distasonis or either a Bacteroides thetaiotaomicron or Bacteroides ovatus infection. The isolate was identified by 16S rRNA gene sequence analysis as B. thetaiotaomicron. This is the first case of B. thetaiotaomicron meningitis in pure culture.
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10/54. Dysgonomonas capnocytophagoides bacteraemia in a neutropenic patient treated for acute myeloid leukaemia.

    Dysgonomonas capnocytophagoides, formerly known as CDC group DF-3, is an opportunistic pathogen associated with diarrhoea and very rarely bacteraemia. We report a case of D. capnocytophagoides found in blood cultures from a severely neutropenic patient treated for acute myeloid leukaemia. The isolate was found resistant to penicillin, cephalosporins, meropenem, aminoglycosides and ciprofloxacin, and susceptible to ampicillin, tetracycline, chloramphenicol, clindamycin and trimethoprim-sulphamethoxazole. It was identified using conventional phenotypic testing but remained unidentified by the automated identification system (Vitek-2) as this system did not contain DF-3 or D. capnocytophagoides in its database.
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