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1/4. vibrio vulnificus septicemia in a patient with the hemochromatosis HFE C282Y mutation.

    vibrio vulnificus is an extremely invasive gram-negative bacillus found in marine waters that causes overwhelming bacteremia and shock that is associated with high mortality. Impaired iron metabolism has been implicated in the susceptibility to V vulnificus bacterial infections. We report a case of fatal V vulnificus sepsis in a 56-year-old man who died within 1 to 3 days after consuming raw seafood. At autopsy, he was found to have micronodular cirrhosis and iron overload. Postmortem genetic analysis revealed the presence of the hemochromatosis gene (HFE) C282Y mutation. To our knowledge, this is this first documented fatal case of V vulnificus infection in a patient proven to carry the HFE C282Y mutation. Because this patient was heterozygous for the major hereditary hemochromatosis mutation and was not previously diagnosed with clinical iron overload, the spectrum of clinical susceptibilities to V vulnificus infection may include carriers of the C282Y mutation.
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ranking = 1
keywords = bacillus
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2/4. Dermatologic manifestations and update of cat scratch disease.

    Cat scratch disease is a relatively common cause of chronic (three weeks or longer) lymphadenopathy, with 80% of cases occurring in children and adolescents. This self-limited infection caused by a small, gram-negative, pleomorphic bacillus has been identified in ocular granuloma, skin inoculation lesions, and lymph node specimens. Dermatologic manifestations observed prospectively in 908 patients included primary cat scratch inoculation papules, pustules or rarely, vesicles. Occasionally, enanthematous mucous membrane (oral, ocular) primary inoculation lesions were observed. About 5% of patients have generalized macular, maculopapular, morbilliform, and rarely petechial, usually nonpruritic exanthem. Rarely, erythema nodosum or multiforme and ecchymoses with petechial rashes are seen. Thrombocytopenic purpura is extremely uncommon. Unusual manifestations such as the oculoglandular syndrome of Parinaud, encephalopathy, or severe systemic disease occur in about 10% of patients. Management consists of symptomatic treatment and occasional aspiration of a suppurative node. The disease usually resolves spontaneously in two to four months.
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ranking = 1
keywords = bacillus
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3/4. Disseminated actinomycosis.

    A case of pulmonary actinomycosis with dissemination to skin, subcutaneous tissue, and bone is described. The cutaneous lesions were characterized by tender swellings and fluctuant nodules and were the presenting manifestation of the disease. Typical sulfur granules were present in the skin and pleural biopsies. actinomyces israelii and its synergistic bacteria actinobacillus actinomycetemcomitans were cultured from skin and pleura. Clinical improvement, with resolution of lung and disseminated skin lesions, was prompt with parenteral penicillin therapy.
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ranking = 1
keywords = bacillus
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4/4. Disseminated bacillus Calmette-Guerin infection in an hiv-infected child: a case with cutaneous lesions.

    A boy born to a mother with unknown hiv infection was immunized with BCG in his first month of life. Seven months later axillary adenopathy developed. At the age of 10 months, 2 months after hiv infection had been diagnosed, papular skin lesions appeared all over his body. mycobacterium bovis, BCG strain, was cultured from a lymph node and blood. Ziehl-Neelsen stain of a skin biopsy specimen showed histiocytes loaded with numerous acid-fast bacilli. The patient died 10 days later, before the infection was confirmed. This is the first reported case of disseminated BCG infection in an hiv-infected child presenting with cutaneous lesions.
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ranking = 4
keywords = bacillus
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