Cases reported "Gonorrhea"

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1/48. Disseminated gonococcemia.

    A 26-year-old woman presented with a high-grade fever and chills of 2 days' duration. She complained of associated joint pain, especially in the wrists and knees. One day before admission, tender skin lesions began to develop on the fingers, and subsequently spread to the more proximal extremities. The patient recalled having a sore throat and a nonproductive cough before the onset of the fever and eruption. The past medical history was significant for gardnerella vaginitis and several urinary tract infections. The patient was taking oral contraceptive pills; her most recent menstruation was 3 weeks before admission. She reported having sexual intercourse with her boyfriend 2 weeks before admission. The patient's temperature was 40 degrees C. Dermatologic examination revealed a 6-mm, hemorrhagic pustule on an ill-defined pink base, overlying the volar aspect of the left second proximal interphalangeal joint (Fig. 1a). Scattered on the upper and lower extremities were occasional round, ill-defined pink macules with central pinpoint vesiculation (Fig. 1b). A skin biopsy of the digit revealed a dense neutrophilic infiltrate with leukocytoclasis and marked fibrin deposition in the superficial and deep dermal vessels (Fig. 2a). Gram stains demonstrated the presence of Gram-negative diplococci (Fig. 2b). Laboratory findings included leukocytosis (leukocyte count of 20 x 109/L, with 81% neutrophils). Analysis of an endocervical specimen by polymerase chain reaction was positive for neisseria gonorrhoeae and negative for chlamydia trachomatis. Throat and blood cultures grew N. gonorrhoeae. Specimen cultures obtained by skin biopsy yielded no growth. Results of serologic analysis for human immunodeficiency virus, hepatitis, syphilis, and pregnancy were negative. Beginning on admission, intravenous ceftriaxone, 2 g, was administered every 24 h for 6 days, followed by oral cefixime, 400 mg twice daily for 4 days. Oral azithromycin, 1 g, was administered to treat possible coinfection with C. trachomatis. By treatment day 4, the patient was afebrile, with the resolution of leukocytosis and symptomatic improvement of arthralgias.
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2/48. A case of asymptomatic gonorrhoea in a male using illegal steroids.

    Acute gonococcal urethritis is usually a symptomatic infection in males. Most men will present within one or two weeks after an exposure with symptoms of urethral discharge and dysuria. early diagnosis is possible in genitourinary medicine clinics with typical signs and symptoms along with microscopy awaiting confirmation by culture and sensitivities. We report a case of gonorrhoea in which we believe the symptoms were masked due to regular use of steroids in a body builder.
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3/48. Gonococcemia associated with adult respiratory distress syndrome.

    We report a case of gonococcemia that was associated with adult respiratory distress syndrome (ARDS). To our knowledge, this is only the third reported case of ARDS associated with gonococcemia. This is the first reported case of ARDS associated with gonococcemia that was documented by positive results of blood cultures and measurements of wedge pressure obtained by a catheter in the pulmonary artery. We also believe that this is the first reported patient who required mechanical ventilation under positive end-expiratory pressure. This patient made a full recovery. Gonococcemia associated with ARDS continues to occur rarely in patients despite the prevalence of disseminated gonococcal infection. The reason for the infrequent occurrence of ARDS with disseminated gonococcal infection remains uncertain.
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4/48. Complications of coexisting chlamydial and gonococcal infections.

    physicians need to take every opportunity to educate their patients regarding the pathogenesis of sexually transmitted diseases and the risks of acquiring them. If the current epidemic of these diseases is to be curtailed, concurrent infections must be detected and treated according to the guidelines of the Centers for Disease Control. In addition, cultures should be obtained and appropriate treatment administered to sexual partners of patients treated for gonorrhea, acute urethral syndrome, mucopurulent cervicitis, pelvic inflammatory disease, nongonococcal urethritis, and epididymitis. Finally, screening should be done in patient groups at high risk for chlamydial infection.
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5/48. Chronic meningococcal disease.

    Chronic meningococcal septicaemia is an unusual and infrequently recognised presentation of disease caused by neisseria meningitidis. Clinical features are immunologically mediated and include fever, rash and arthritis, which may mimic cutaneous vasculitis or reactive gonococcal arthritis. Diagnosis is difficult to confirm as blood cultures commonly do not grow the organism despite weeks of symptoms. culture of the organism from the nasopharynx may provide supportive evidence for diagnosis. Chronic meningococcaemia should be considered in the differential diagnosis of a cutaneous vasculitis. In the clinical setting of an undiagnosed fever with vasculitic rash and joint symptoms an empirical trial of intravenously administered penicillin should be considered before steroid therapy as a rapid response may simplify the diagnostic dilemma.
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6/48. Increased risk of neisserial infections in systemic lupus erythematosus.

    survival in systemic lupus erythamatosus (SLE) continues to improve because of better ancillary care, earlier diagnosis, and earlier treatment. However, infection remains a leading cause of morbidity and mortality in this disease. Although corticosteroids and immunosuppresives increase the risk of opportunistic infection, the SLE patient is still most at risk from common bacterial pathogens. As the prototypic immune-complex disease, patients with active SLE have low circulating complement as well as a reticuloendothelial system (RES) saturated with immune complexes. It seems intuitive that SLE patients should be most at risk for organisms dependent for their removal on the RES or complement for opsonization or bacteriolysis. The current series presents four patients with SLE and disseminated neisseria infection and brings to 14 the number of patients in the literature with disseminated neisserial infection. They are typically young, female, with renal disease, and either congenital or acquired hypocomplementemia, and may present with all features of a lupus flare. Surprisingly, they are not all on corticosteroids or immunosuppressives and have some features that are unusual for non-SLE patients with these infections. There seems to be an over-representation of Nisseria meningitidis (despite potential reporting bias), and there ironically may be better tolerance with fewer fulminant complications in patients who have complement deficiencies. The best approach for the physician treating SLE is to immunize all SLE patients with available bacterial vaccines to N meningitidis and streptococcus pneumonia, have a low threshold of suspicion for the diagnosis of disseminated neisserial or other encapsulated bacterial infection in the SLE patient who is sick, and to treat empirically with third generation cephalosporins after appropriate cultures.
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7/48. Gonococcal endocarditis: report of a case and review of the literature.

    Gonococcal endocarditis may appear in the extremes of cardiogenic and septic shock. These patients must be quickly stabilized and evaluated by echocardiography and cardiac catheterization where possible. Urgent surgical intervention for valve replacement may be necessary before complete stabilization of the patient's cardiac hemodynamics status is accomplished. Although the aortic valve is most commonly involved with gonococcal endocarditis, the mitral valve is involved as well and may present as a true emergency situation. Right-sided valve infections may be treated by a more conservative medical means if the patient does not deteriorate into a hemodynamic instability. Deterioration of the patient requires immediate intervention with catheterization and surgery in the absence of positive blood cultures to confirm the diagnosis of gonococcal endocarditis. Once the need for emergency surgical valve replacement has been determined the rules of complete debridement of all infected tissues, insertion of sutures into healthy annular tissue, and selection of an appropriate mechanical valve apply. Long-term antibiotic therapy is included in post-operative management.
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8/48. Gonococcal arthritis caused by auxotype P in a man with hiv infection.

    The development of gonococcal arthritis is reported in a man with hiv infection and CDC Stage IVC2 disease. The diagnosis of disseminated neisseria gonorrhoeae was facilitated by microbiological examination of a joint aspirate. The auxotype identified by culture was moderately resistant to penicillin, a characteristic which is highly unusual for an organism causing disseminated gonococcal infection. This case serves as an example of the role of hiv infection in the modification of host response to common pathogens and the need for clinicians to modify their management of disseminated gonococcal infection especially in immunosuppressed persons.
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9/48. Gonococcal pericarditis with tamponade in a patient with systemic lupus erythematosus.

    pericarditis is one of the most frequent manifestations of systemic lupus erythematosus; however, purulent pericarditis and tamponade are rare. We describe a patient with systemic lupus erythematosus and culture-proven gonococcal arthritis who developed purulent pericarditis with intracellular gram-negative diplococci. Evidence of tamponade was seen on echocardiography. There has not been a reported case of neisseria gonorrhoeae in pericardial fluid or tissue since the introduction of antibiotics.
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10/48. neisseria gonorrhoeae dissemination and gonococcal meningitis.

    Disseminated infection is a serious complication in approximately 2 percent of primary gonococcal infections. Meningeal infection is very rare; only 23 cases have been reported since 1922. We report a sexually active teenager with an acute febrile illness. From her cerebrospinal fluid cultures, neisseria gonorrhoeae was identified. She recovered completely after treatment with ceftriaxone and penicillin. Possible explanations for gonococcal dissemination include unique strains of the organism as well as particular complement deficiencies of the host. Aggressive efforts by physicians to prevent, identify, and treat primary gonococcal diseases should continue because this will reduce the frequency of serious complications.
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