Cases reported "Stomatitis"

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1/9. Oral staphylococcal mucositis: A new clinical entity in orofacial granulomatosis and Crohn's disease.

    OBJECTIVE: Orofacial granulomatosis and the oral manifestations of Crohn's disease comprise many clinical features, of which stomatitis is one. The purpose of this study was to establish a role for staphylococcus aureus in mucositis affecting some patients with orofacial granulomatosis or oral Crohn's disease. STUDY DESIGN: Four patients (2 with orofacial granulomatosis and 2 with oral Crohn's disease), from a total of 450 patients examined over 10 years, had stomatitis involving the entire oral mucosa, from which S aureus was cultured by the oral rinse technique. These patients were treated with flucloxacillin or erythromycin. RESULTS: A heavy growth of S aureus was isolated from the mouth of each patient. All 4 patients responded to treatment with flucloxacillin or erythromycin. CONCLUSIONS: S aureus is a potential cause of panstomatitis in patients with orofacial granulomatosis or Crohn's disease. This infection responds rapidly to antimicrobial treatment.
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2/9. herpes zoster of the maxillary branch of the trigeminus nerve. Virological and serological studies.

    A 70-year-old male had erythematous and vesiculous lesions in the area of the right maxillary branch of the trigeminus nerve and was clinically diagnosed as having herpes zoster; virological and serological investigations of this case were carried out. Consequently, an electron microscopic observation revealed a great number of virus particles of herpes type in the vesiculous lesion and in baby hamster kidney BHK21/WI-21 cells, cultured after inoculating the fluid from the vesicle formed on the patient's upper lip or from serum harvested during the viremia. When BHK21/WI-21 cells infected with this virus were tested for antigenicity by an indirect immunofluorescent staining technique, they showed a positive staining to antivaricella-zoster virus. When serum of this patient was assayed fof the antibody level against varicella-zoster virus by the complement fixation test at various time intervals during the therapeutic period, this antibody titer on recovery period showed a threefold increase in comparison to that at onset. From these findings, this infectious disease was precisely diagnosed as herpes zoster.
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3/9. Successful treatment of invasive stomatitis due to exophiala dermatitidis in a patient with acute myeloid leukemia.

    BACKGROUND: Although the most common orofacial fungal infection in immunocompromised patients is candidosis, infections caused by virulent molds, such as aspergillus spp. and Furarium spp. are being recognized with increasing frequency. We report a case of oral exophiala infection in a 39-year-old woman with acute myeloid leukemia. methods: Clinical records of the patient were reviewed and the following additional information was collected: histological and microbiological evidence; identification of the causative organism; in vitro antifungal susceptibility. RESULTS: The patient developed a necrotic ulcer surrounded by a violaceous rim in the gingiva during neutropenia. exophiala dermatitidis was identified as the causative organism by histopathological examination and culture, and finally confirmed by sequencing of the ribosomal dna internal transcribed space domain. in vitro, amphotericin b was found to show strong activity against the exophiala isolate while itraconazole showed less activity. The patient was successfully treated with parenteral amphotericin b and oral itraconazole in combination with surgical removal of the fungi focus. CONCLUSION: Local excision with adequate antifungal agents can be used to treat immunocompromised patients with exophiala stomatitis, based on early diagnosis.
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4/9. moraxella osloensis blood and catheter infections during anticancer chemotherapy: clinical and microbiologic studies of 10 cases.

    moraxella osloensis, a gram-negative bacterium that is saprophytic on skin and mucosa, rarely causes infections. Moreover, infections in patients with cancer have not been reported. We describe 10 cases of M. osloensis blood or catheter infections that occurred during anticancer chemotherapy with or without preexisting neutropenia. The organism was identified definitively by sequencing analysis of the 16S ribosomal rna gene. fever (up to 39.7 degrees C) with substantial neutrophilia characterized these infections. The infections were monomicrobic for 3 patients and polymicrobic for 7 patients. Nine patients acquired the infection through central venous catheter colonization. The likely sources of the organism were sinusitis (3 cases), bronchitis (1 case), presumed subclinical mucositis from anticancer therapy (4 cases), and cutaneous graft-vs-host disease (2 cases). The infections resolved, without catheter removal, after antibiotic therapy with cell wall-active agents, to which all strains were shown to be susceptible. The M. osloensis strains exhibited significant morphologic variations on gram stain, and sheep blood agar was the preferred culture medium for 9 strains.
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5/9. Uvulitis in three children: etiology and respiratory distress.

    Uvulitis is an uncommonly reported disorder with the potential for significant morbidity. We describe three cases of uvulitis seen within a six month period in our emergency department. In two cases with respiratory distress, but without epiglottitis, haemophilus influenzae was isolated from throat or blood cultures. The third case was associated with group A streptococcus tonsillitis and no respiratory compromise. Atypical presentations of upper airway infection with H. influenzae may be increasingly common.
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6/9. Neonatal herpes simplex infection possibly acquired via maternal breast milk.

    A newborn infant with disseminated herpes simplex virus type 1 (HSV-1) infection was determined serologically to have acquired the infection postnatally; his mother was found to have HSV-1 in her breast milk but had no history of genital lesions and negative viral cultures of cervix, vagina, and throat. We suggest that HSV-infected maternal breast milk may be a source of this infection for susceptible infants.
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7/9. aerococcus bacteremia associated with granulocytopenia.

    Two cases of bacteremic infection due to aerococci in granulocytopenic patients with acute leukemia and oral mucositis are described. Strains isolated from blood cultures of both patients were resistant to the antibiotics given orally for prophylaxis. One patient died in septic shock; surveillance cultures from oral washings in the other repeatedly showed high concentrations of aerococci. Aerococci were also isolated from surveillance cultures taken from 5 of 17 other patients with acute leukemia; however, their viable counts were lower than in the surviving patient.
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8/9. Cutaneous form of bovine papular stomatitis in man.

    A cutaneous form of bovine papular stomatitis (BPS) infection was diagnosed in eight persons at the School of veterinary medicine at Auburn University, Auburn, Ala. The initial outbreak occurred in five persons who were involved in the care of a bull that required manual placement of an oral feeding tube. Confirmation of diagnosis was based on clinical findings, cytopathological effects in tissue culture, and isolation of typical paravaccinia virus particles in tissue culture. Transmission studies were performed successfully in three normal calves using tissue culture prepared from human biopsy material. In man, the cutaneous form of BPS infection shows gross lesions similar to the cutaneous form of contagious ecthyma ("orf") or pseudocowpox ("milkers' nodules") infection. Because BPS in cattle occurs most often without evidence of readily observable lesions, unlike contagious ecthyma in sheep or pseudocowpox in cattle, the transmission of BPS to man in the cutaneous form could occur without apparent source. The mild clinical manifestations make the condition relatively minor; however, the occasional case may have more severe lesions.
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9/9. trichosporon beigelii causing oral mucositis and fungemia: report of one case.

    A 23-month-old boy, a victim of acute myelomonocytic leukemia (AML), was admitted for chemotherapy. On the eighth hospital day, he started a one-week course of chemotherapy with agents of epirubicin and cytosine arabinoside. Unfortunately, persistent neutropenia, deteriorating diarrhea and intermittently spiking fever developed from the sixteenth hospital day. Initially, ceftazidime and amikacin were empirically utilized. blood culture yielded klebsiella pneumoniae and the fever subsided for one day. Unfortunately, oral mucositis and catheter-induced phlebitis developed subsequently. Subsequently, oral nystatin and intravenous oxacillin were added. The results of cultures from both blood and oral mucosal tissue yielded a fungus. trichosporon beigelii. We changed from an oral antifungal agent to intravenous amphotericin b on the twenty-fourth hospital day. He presented signs of septic shock with disseminated intravascular coagulopathy and expired on the twenty-fifth hospital day after failure to respond to aggressive resuscitation. We report this case to emphasize that in cytotoxic chemotherapy-induced granulocytopenic AML patients who have compromised immune systems, and who may manifest some signs or symptoms of infection, and at the same time poorly respond to interventional antibiotic treatment, the possibility of T. beigelii infection can not be neglected.
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