1/39. Concha bullosa pyocele--undiagnosed for 3 years.We report a rare case of post-traumatic concha bullosa pyocele in a diabetic teenager that has gone undiagnosed for 3 years. The clinical findings, radiological features and management are discussed. The literature is reviewed.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
2/39. Bilateral emphysematous pyelonephritis with perirenal abscess cured by conservative therapy.Emphysematous pyelonephritis is a rare life-threatening infection of the renal parenchyma. It usually affects unilateral kidney and occurs mostly in diabetic patients. It is characterized by the presence of gas within the renal parenchyma and requires prompt diagnosis and early aggressive therapy. Bilateral emphysematous pyelonephritis is even more rare and is associated with high mortality. We describe a case of a 62-year-old diabetic woman who presented with nonketotic hyperosmolar coma and bilateral emphysematous pyelonephritis caused by klebsiella pneumoniae. Diagnosis of bilateral emphysematous pyelonephritis was confirmed by an abdominal computed tomographic scan and microbiologic studies. Our patient was successfully treated using percutaneous catheter drainage and long-term antibiotic therapy.- - - - - - - - - - ranking = 2keywords = diabetic (Clic here for more details about this article) |
3/39. Pyogenic liver abscesses due to klebsiella pneumoniae in a diabetic patient.Pyogenic liver abscess due to klebsiella pneumoniae is a rare clinical entity. It has emerged as an important infection complication in diabetics and its incidence in diabetics without intraabdominal or biliary tract infections is increasing. We present herein a case of multiple pyogenic liver abscesses due to K. pneumoniae in a diabetic patient and discuss clinical course, treatment and possible reasons for association between K. pneumoniae liver abscess and diabetes.- - - - - - - - - - ranking = 7keywords = diabetic (Clic here for more details about this article) |
4/39. liver abscess caused by klebsiella pneumoniae in siblings.klebsiella pneumoniae has been emerging as the leading cause of liver abscess in diabetic patients. Results of molecular typing of K. pneumoniae isolates from two siblings with liver abscess, their family members, and the environment suggest a possibility of cross infection of liver abscess by the fecal-oral route within diabetic patients.- - - - - - - - - - ranking = 2keywords = diabetic (Clic here for more details about this article) |
5/39. Endogenous Klebsiella endophthalmitis.PURPOSE: To report 4 cases of endogenous Klebsiella endophthalmitis. This disease is a rare but devastating complication of Klebsiella sepsis. Familiarity with its varied clinical presentations would aid in early diagnosis and institution of appropriate therapy. methods: We report 5 eyes of 4 patients with endogenous Klebsiella endophthalmitis from December 1995 to September 1996 and review the literature regarding previously successfully treated cases. RESULTS: The mean age of the patients was 67.5 years (range 37-85 years). One patient had bilateral involvement. At presentation, 3 eyes had a visual acuity of no perception of light (NPL) and the 1 patient with bilateral involvement had an acuity of counting fingers in one eye and 20/40 in the other. The primary source of sepsis was the pulmonary system in 2 patients, the hepatobiliary system in 1 patient and the urinary tract in 1 patient. One patient had coexisting diabetes mellitus. Two patients had a pupillary hypopyon. Local and systemic treatment with an aminoglycoside and cephalosporin was initiated. Despite treatment, 2 eyes remained NPL. One eye developed a globe perforation and was eviscerated. The patient with bilateral involvement was treated within 8 h and recovered fully with a final visual acuity of 20/20 in both eyes. CONCLUSION: It is important to have a high index of suspicion in patients with septicaemia presenting with intraocular inflammation, especially in diabetics with suppurative liver disease, urinary tract infection or pulmonary infection. As the visual prognosis for patients with Klebsiella endophthalmitis is generally poor, early diagnosis and treatment with intravenous and intravitreal antibiotics may improve the visual outcome.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
6/39. Septic metastatic endophthalmitis complicating klebsiella pneumoniae liver abscess in a non-diabetic Chinese man.Septic metastatic endophthalmitis is a rare but serious disease. endophthalmitis arising from klebsiella pneumoniae liver abscess has been reported with diabetes mellitus as a major associated condition, but is rarely seen in patients without diabetes. A non-diabetic patient with liver abscess complained of right eye discomfort and floaters 3 days after admission. Both blood and liver aspirate cultured klebsiella pneumoniae. The patient was treated initially with systemic and subconjunctival antibiotics followed by intravitreal antibiotics with successful visual salvation. Previous reports from the literature showed poor visual outcome despite treatment and delayed recognition was often the cause. Clinicians should be alert to endophthalmitis whenever a patient with Klebsiella pneumoniae liver abscess complains of ocular symptoms. Urgent ophthalmological assessment should be sought.- - - - - - - - - - ranking = 5keywords = diabetic (Clic here for more details about this article) |
7/39. klebsiella pneumoniae psoas abscess: predominance in diabetic patients and grave prognosis in gas-forming cases.Seven cases of psoas abscess caused by klebsiella pneumoniae were observed at the National Cheng Kung University Hospital within a period of 4.5 years. These cases constituted 25% of a total 28 episodes of non-tuberculous psoas abscess, ranking second to those caused by staphylococcus aureus (8 cases). Eight cases of psoas abscess caused by K. pneumoniae were identified from medline, and 5 of which were reported from taiwan. Of these 8 cases, 1 neonatal case was excluded, and the remaining 7 adult cases were combined with the 7 cases in this series for analysis. The mean age was 53.8 years, and diabetes mellitus was the most common underlying disease. fever and pain on the flank and back area were the common findings. The interval between the onset of symptoms and diagnosis ranged from 1 to 60 days. The most common sites of concurrent infection were the urinary tract (6 cases; 43%) and bone (3 cases; 21%). All patients received percutaneous or surgical drainage in addition to antibiotic treatment. Gas formation was present in 5 of the 12 patients recorded, and 4 of them died during hospitalization. Only 1 patient had a metastatic infection with osteomyelitis of the left radius and right humerus; he had experienced 5 episodes of recurrent K. pneumoniae infections in different sites. We concluded that K. pneumoniae should be considered as an important endemic pathogen of psoas abscess in diabetics in taiwan. The high mortality rate in the gas-forming cases should also be highlighted. Early recognition, empiric antimicrobial coverage for K. pneumoniae, and aggressive drainage or debridement are indicated in these patients.- - - - - - - - - - ranking = 5keywords = diabetic (Clic here for more details about this article) |
8/39. Two cases of pyomyositis caused by klebsiella pneumoniae and review of the literature.Two patients with diabetes mellitus developed klebsiella pneumoniae pyomyositis involving multiple muscles and other metastatic foci associated with bacteraemia. The cases are presented here, and the 22 cases of gram-negative pyomyositis reported previously in the literature are reviewed. As gram-positive cocci cause 99% of pyomyositis, it is postulated that the pathogenesis of pyomyositis may be associated with the ability of the bacteria to adhere to muscles by various cell surface adhesins that are not present in gram-negative bacilli. It is also postulated that a high serum glucose concentration may facilitate the growth and formation of the klebsiella pneumoniae capsule, hence increasing its virulence and causing serious disseminated klebsiella infections in diabetic patients.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
9/39. Primary liver abscess caused by one clone of klebsiella pneumoniae with two colonial morphotypes and resistotypes.Two diabetic patients with primary liver abscess, who initially responded unsatisfactorily to intravenous ceftriaxone or cefoxitin treatment and had abscess drainage, were found to be infected with a single clone of klebsiella pneumoniae with two different colonial morphotypes and resistotypes. Primary liver abscess caused by second-generation cephalosporin-resistant K. pneumoniae strains may be an emerging problem in taiwan.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
10/39. Acute fulminant hepatic infection causing fatal "emphysematous hepatitis": case report.We describe a case of fatal fulminant hepatic infection with gas replacement of the hepatic parenchyma and no evidence of a liquified abscess in a diabetic patient: a case of "emphysematous hepatitis," the hepatic equivalent of emphysematous pyelonephritis. Computed tomography and clinical findings are described.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
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