Cases reported "Infection"

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1/10. Distal deep venous thrombosis in a hemophilia a patient with inhibitor and severe infectious disease, 18 days after recombinant activated factor VII transfusion.

    We describe a 38 year old hemophilia a patient with a factor viii inhibitor who was admitted to our hematology Department in January 2001 with a seriously infected and bleeding perianal ulcer. To treat infection and bleeding the patient received broad spectrum antibiotics and recombinant activated factor VII (rFVIIa) (Novoseven(R)) for about 1 month (see detailed time of administration and dosing schedule of rFVIIa further in text). Eighteen days after his last rVIIa infusion the patient developed an ultrasound proven right calf vein thrombosis. In the whole period of admission, preceding the thrombotic event the patient biologically showed a picture of severe systemic inflammatory disease as indicated by persistent increased levels of D-dimer and fibrinogen (table). It is an interesting point of discussion whether the calf thrombosis was provoked as a consequence of rFVIIa infusion (with symptoms 18 days after the last infusion) or as a consequence of long-standing immobilization and severe inflammatory disease immobilization and severe infection are conditions well known for promoting venous thromboembolic disease.
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keywords = infectious disease
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2/10. 5: Hospital-in-the-home treatment of infectious diseases.

    1. A growing range of infections can be safely and effectively treated with parenteral antimicrobial therapy at home, including cellulitis, pyelonephritis, pneumonia, endocarditis, osteomyelitis, septic arthritis and deep abscesses. 2. patients may be admitted to HITH directly from the emergency department or after a period of in-hospital care; they must be thoroughly assessed for suitability, including clinical stability and social circumstances, and both patient and carer consent must be obtained. 3. patients should be medically reviewed weekly at the hospital to monitor progress of therapy and check for possible complications, including adverse drug reactions. 4. Antibiotic selection should be based on appropriate prescribing principles rather than purely dosing convenience. 5. Innovative dosing regimens, including once-daily aminoglycosides, continuous-infusion beta-lactams (eg, flucloxacillin), once- or twice-daily cephalosporins (eg, cephazolin) and oral fluoroquinolones (eg, ciprofloxacin) provide effective therapy for a wide range of infections that would have previously required in-hospital care. 6. Appropriate use of HITH leads to improved patient and carer satisfaction, efficient in-hospital bed use and possibly some financial efficiencies. Not all patients receiving intravenous antibiotics need to be in hospital
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keywords = infectious disease
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3/10. Case of multiple myeloma mimicking an infectious disease with fever, intrahepatic cholestasis, renal failure, and pulmonary insufficiency.

    We describe a case of multiple myeloma (MM) presenting with high fever, inflammatory chemistry abnormalities, simultaneous acute renal failure, cholestatic hepatitis, and acute lung failure. The extremely aggressive course and pulmonary involvement in the form of pulmonary alveolar proteinosis (PAP) are discussed, stressing the unusual nature of the findings and the variable picture of MM.
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keywords = infectious disease
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4/10. Venous thromboembolic risk and prevention in acute medical illness.

    We describe a case in which an elderly woman is hospitalised for acute medical illness and ask how this patient's risk of venous thromboembolism should be assessed and managed. venous thromboembolism was previously regarded as a surgical problem, but occurs at least as frequently among medical patients. The risk of venous thromboembolism varies, but recent studies have provided detailed data on the risk in patients with acute medical illness, in particular those patients with acute heart failure, respiratory failure and acute infectious disease. As the evidence has accumulated, specific guidelines recommend provision of thromboprophylaxis to patients at risk. An approach to venous thromboembolic risk assessment and prevention in acutely ill medical patients is presented.
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keywords = infectious disease
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5/10. Pathophysiology and current management of necrotizing enterocolitis.

    Necrotizing enterocolitis continues to be a common and life-threatening gastrointestinal emergency in the low birth weight infant. Prematurity, ischemia, enteral feeding, and infectious disease have been identified as common risk factors, however the exact cause of NEC other than prematurity is yet to be identified. Good assessment skills by the nurse are imperative, because clinical signs of NEC can be both subtle and catastrophic. Frequent radiographs are essential for the diagnosis of NEC and ongoing assessment of neonates diagnosed with NEC. Radiographs including an abdominal flat plate examination and a left lateral decubitus film to evaluate for free air should be obtained every 6-8 hours in the neonates with Stages II and III NEC.
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keywords = infectious disease
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6/10. Spurious serologic test results in patients receiving infusions of intravenous immune gammaglobulin.

    Intravenous immune gammaglobulin (IVIgG) has a definite role in the modern armamentarium of therapies for immunocompromised patients. Intravenous IgG is manufactured from the plasma of a large number of donors and contains antibodies against numerous infectious agents. patients who receive infusions of IVIgG may test false-positive for a variety of viral, bacterial, and other infectious diseases when serologic determinations are performed on their blood samples. It is important that laboratories performing serologic testing be aware that patients have been infused with IVIgG, so that spurious laboratory results can be identified. Serologic testing on implicated lots of IVIgG and on the patient's pretreatment sample may aid in correctly identifying a spurious serologic result due to therapy with IVIgG.
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7/10. diabetic foot amputations. Part I: Digital.

    Foot lesions in diabetic patients with sensory deficiencies are ignored or not noted by the patients, therefore, leading to major infections of the soft tissue and/or bone. This can be quite devastating with subsequent loss of limb and life-threatening if the extent of the problem is not recognized and prompt treatment initiated. If an amputation is necessary, it should be performed at the lowest level possible. Part I of this series of articles, concerning diabetic foot amputations, will review the pathogenesis, indications, objective vascular criteria, basic surgical principles and complications of diabetic foot amputations. case reports with various digital amputation procedures and their postoperative care will also be presented in detail. A team approach should be used in the treatment of diabetic foot disorders. The podiatrist, along with admitting internist, leads a team of other specialists including: radiologist, vascular surgeon, infectious disease physicians and plastic surgeon, depending on the progression of foot pathology.
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keywords = infectious disease
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8/10. Cellular elements in the urine in health and in acute infectious diseases, especially with respect to the presence of haematuria. A study with application of millipore procedure and Papanicolaou staining.

    The excretion of cellular per litre of urine amounted in healthy persons to, in round figures, one million epithelial cells (2.5 cells per visual field) in both sexes, one million leukocytes in males, one million erythrocytes in females and 0.5 million in males. The maximal excretion was calculated to be 5-6 million per litre. In acute infections the number of epithelial cells and leukocytes in the urine rose to more than the double. Pathological microscopic haematuria, judged by exceeding of the maximal value for normal excretion during the acute phase (24 or more erythrocytes per visual field), occurred in no case of mycoplasma infection, in about 4% of measles, mononucleosis, serous meningitis and hepatitis cases, in about 8% of mumps and streptococcal infections, and in more than 20% of influenza A2 cases. Statistical significance or probable significant existed between influenza and other diseases. The haematuria was unrelated either to the general degenerative or to the specific inclusion-provocative reaction within the renal and urinary tract epithelium. The cause is sought in an involvement of glomeruli with increased diapedesis. The special position of influenza may be explained by the marked haemorrhagic reactions produced by this infection. In one case persistent haematuria combined with increased content of inclusion-bearing cells occurred after influenza. Immunoglobulin deposition in glomerular mesangium may perhaps be one explanation of this haematuria.
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keywords = infectious disease
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9/10. fever, jaundice, and histiocytic erythrophagocytosis: fulminant infection or malignancy?

    Some of the problems which we see on the infectious disease consultation service can be quite frustrating. This is one such case. A middle-aged man presented to our medical service with fever and dyspnea. His fulminant downhill course was characterized by anemia, jaundice, hypercalcemia, pulmonary abnormalities, and a lack of responsiveness to conventional antimicrobial therapy. At autopsy, malignant-appearing histiocytes were present in several organs including spleen, lymph nodes, and lung. Histopathological examination of tissues obtained at autopsy confirmed the presence of phagocytized erythrocytes within such histiocytes. This case aptly illustrates the hazy dividing line which sometimes exists between infectious and/or malignant processes which are, at present, still of undetermined etiology.
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keywords = infectious disease
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10/10. head and neck manifestations of uncommon infectious diseases.

    Certain uncommon systemic infections may be present with head and neck manifestations either initially or during the course of the disease. A high index of suspicion is required on the part of the otolaryngologist with the subsequent procedures leading to the appropriate diagnosis. The manifestations of infectious diseases such as erysipelas, histoplasmosis, rabies, tetanus, botulism, and cysticercosis must be understood by the head and neck specialist. For successful management, many of the infections require prompt identification and initiation of therapy. Airway maintenance, ventilatory support, and medical chemotherapy may be required.
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keywords = infectious disease
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