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1/4. Human pythiosis, brazil.

    pythiosis, caused by pythium insidiosum, occurs in humans and animals and is acquired from aquatic environments that harbor the emerging pathogen. diagnosis is difficult because clinical and histopathologic features are not pathognomonic. We report the first human case of pythiosis from brazil, diagnosed by using culture and rDNA sequencing.
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keywords = animal
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2/4. Parenteral fluoroquinolones in children with life-threatening infections.

    The new fluoroquinolones have not been tested in children despite their wide spectrum of in vitro activity and efficacy, because of an observed damage to cartilage in young animals. However, in some cases they may be life-saving. We present three pediatric patients with life threatening infections in whom the fluoroquinolones were used when other antibiotics failed: A seven-year-old boy with meningitis due to multiresistant acinetobacter calcoaceticus, a three-year-old boy with Job's syndrome with line sepsis due to staphylococcus epidermidis and a four month-old boy with agammaglobulinemia with mixed infection due to escherichia coli, pseudomonas aeruginosa, and Acinetobacter spp. All three children were cured of their infections.
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3/4. Exchange of amino acids by muscle and liver in sepsis.

    The amino acid "central fractional clearance rate" (CFCR), the ratio of the rate of amino acid entry into the extracellular pool to the size of the pool, is a measure of amino acid uptake and clearance by liver and other visceral tissues. In nine normal postabsorptive persons, the mean CFCR was 5%, compared with 21% in 31 seriously infected patients. For comparative purposes, biopsy specimens of liver and muscle were obtained for incubation. In infected patients, the rate of hepatic incorporation of tyrosine into protein was three times that in noninfected patients and correlated well with the CFCR. There was no significant difference in hepatic tyrosine oxidation. In muscle from infected patients, net protein degradation was six times that in noninfected patients. Incubated tissues from rats behaved similarly. Thus, accelerated transfer of amino acid from muscle to viscera for protein synthesis occurs in humans with sepsis, as it does in animals. The CFCR demonstrated the importance to survival of visceral amino acid uptake; it was 35% in surviving patients, and only 19% in those who died.
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keywords = animal
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4/4. Successful medical therapy for deeply invasive facial infection due to pythium insidiosum in a child.

    pythiosis occurs in animals and humans who encounter aquatic habitats that harbor pythium insidiosum. drug therapy for deeply invasive infections with this organism has been ineffective in humans and animals; patients have been cured only by radical surgical debridement. A 2-year-old boy developed periorbital cellulitis unresponsive to antibiotic and antifungal therapy. The cellulitis extended to the nasopharynx, compromising the airway and necessitating a gastrostomy for feeding. P. insidiosum was isolated from surgical biopsy specimens of the affected tissue. On the basis of in vitro susceptibility studies of the isolate, the patient was treated with a combination of terbinafine and itraconazole. The infection resolved over a period of a few months. The patient remained well 1.5 years after completing a 1-year course of therapy. Cure of deep P. insidiosum infection is feasible with drug therapy.
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