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1/533. Enterococcus avium endocarditis in an infant with tetralogy of fallot.

    We report a case of infective endocarditis secondary to Enterococcus avium in a 1-year-old infant with tetralogy of fallot and a Blalock-Taussig shunt. To our knowledge, this is the first case of E. avium endocarditis to be reported. ( info)

2/533. Systemic lupus erythematosus complicated by necrotizing fasciitis.

    A case of necrotizing fasciitis (NF) is described in a 46-year-old woman with recent onset systemic lupus erythematosus (SLE). Deep-tissue infections are more common in SLE patients on high-dose corticosteroids, but, to our knowledge, this is the second case described in association with SLE. Although NF may initially be difficult to diagnose, the presence of marked systemic symptoms out of proportion to the local findings should suggest the correct diagnosis. NF diagnostic criteria, treatment and prognosis are discussed. ( info)

3/533. Intra-operative ultrasound-guided drainage of parotid abscess.

    parotitis complicated by parotid abscess remains a potentially life-threatening problem. Conventional surgical treatment involves incising the parotid parenchyma in the direction of the facial nerve until the abscess is located and evacuated. Intra-operative ultrasound greatly assists in localizing the abscess and in ensuring its complete drainage. Expeditious and exact localization of the abscess reduces operative time. Equally importantly, ultrasound-assisted drainage reduces surgical dissection and the potential for facial nerve damage. ( info)

4/533. endocarditis due to aerococcus urinae: diagnostic tests, fatty acid composition and killing kinetics.

    Two cases of aerococcus urinae endocarditis are reported. The organism is not included in any database of commercial identification systems at this time. Formation of tetrades and positive reactions for leucine arylamidase and beta-glucuronidase pointed strongly to A. urinae. The cellular fatty acid pattern was similar to that of aerococcus viridans, with predominantly C16:0, C18:1 omega 9c and C18:0; the presence of C18:1 omega 7t differentiated our isolates from A. viridans and can support the diagnosis of A. urinae. Furthermore, susceptibility to penicillin but resistance to cotrimoxazole represents a pattern opposite to that of A. viridans. Minimal inhibition concentrations of gentamicin and netilmicin were < or = 64 mg/l but those of tobramycin were > or = 256 mg/l. Penicillin combined with either gentamicin or netilmicin showed distinct synergy in killing kinetics. These combinations seem to be the appropriate regimen to treat A. urinae endocarditis. ( info)

5/533. Propionibacterium as a cause of postneurosurgical infection in patients with dural allografts: report of three cases.

    OBJECTIVE AND IMPORTANCE: Although propionibacterium acnes is a common inhabitant of human skin, it is an uncommon pathogen in postoperative infections. We report three cases of postoperative wound infection/osteomyelitis caused by P. acnes. CLINICAL PRESENTATION: Three patients underwent craniotomy for a supratentorial meningioma and had a dural allograft at the time of closure. The patients presented several weeks after surgery with clinical evidence of a wound infection. INTERVENTION: All patients were diagnosed with P. acnes infection and treated for this pathogen with appropriate antibiotics. The bone flap was removed in two patients. After antibiotic therapy, all patients demonstrated no further evidence of infection. CONCLUSION: To our knowledge, this is the first published report of P. acnes infection in patients with a dural substitute. The source of infection cannot be confidently ascertained; however, two patients had strains of P. acnes from one brand of graft, which were indistinguishable by pulsed field gel electrophoresis typing. ( info)

6/533. Localized pericarditis with calcifications mimicking a pericardial tumor.

    A 62-year-old man was admitted with increasing palpitations. radiography of the chest demonstrated a calcified mass. magnetic resonance imaging revealed compression of the right ventricle by a tumor. At the time of cardiac catheterization, the coronary arteries were found not to supply blood flow of the mass, and no dip-and-plateau pattern was seen in the right ventricular pressure measurements. At the time of surgery, the mass was found to be a focal calcified thickening of the pericardium containing only pus. The thickening resembled an oval pericardial tumor. Microbiologic examination of the pus revealed propionibacterium acnes. ( info)

7/533. Recurrent enterococcal endophthalmitis following cataract surgery: a case report.

    Recurrent post-cataract endophthalmitis is a well-recognized postoperative complication that has been attributed to various organisms and different mechanisms. To our knowledge, there is no case of recurrent postoperative endophthalmitis reported where the organism was found to be sequestered in the posterior capsule, escaping total eradication and thus producing the recurrence. The following is a case report of such recurrent postoperative endophthalmitis caused by enterococcus faecalis sequestered in the posterior capsule. ( info)

8/533. Destructive knee joint infection caused by peptostreptococcus micros: importance of early microbiological diagnosis.

    peptostreptococcus micros is a commensal of the oral cavity and the genitourinary tract that rarely causes serious infections. A case of a destructive knee joint infection with rapid progress caused by P. micros is presented. The significance of the microbiological findings was initially not acknowledged, which contributed to a nonsuccessful clinical outcome. ( info)

9/533. Bacterial complications of strongyloidiasis: streptococcus bovis meningitis.

    We report the case of a 64-year-old veteran who had streptococcus bovis meningitis as a result of a long latent strongyloides infection that became acute when he was treated with prednisone. We reviewed 38 reported cases of serious bacterial infections associated with strongyloidiasis. patients most frequently had nonspecific gastrointestinal symptoms. Of these 38 patients, 21 (55%) had meningitis, and 28 (73%) had bacteremia that was polymicrobial in 3 cases (8%). Other sites of infection included lung, bone marrow, ascites, mitral valve, and lymph node. Most infections were due to enteric gram-negative bacteria. There is one previously reported case of S bovis meningitis. Thirty-four of the patients (89%) were immunosuppressed; 21 of these (55%) were taking pharmacologic doses of adrenal corticosteroids. Thirty-three of the 38 (87%) patients died. patients with enteric bacterial infection without an obvious cause should be tested for the presence of strongyloidiasis. ( info)

10/533. Septicaemia and endomyocarditis caused by aerococcus urinae.

    aerococcus urinae, an uncommon urinary tract pathogen, was recently shown to cause septicaemia and endocarditis in a few patients in denmark and the netherlands. In austria this is the first report of a fatal course of endomyocarditis by aerococcus urinae, associated with multiple septic infarcts. ( info)
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