Cases reported "Streptococcal Infections"

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21/1614. Treatment of skin and soft tissue infections with cefadroxil, a new oral cephalosporin.

    Oral cefadroxil in doses of 0-6-1-8 g per day given on twice or three times daily schedules was effective in the treatment of thirty-six patients with infections such as abscesses, carbuncles, cellulitis, furunculosis and impetigo. staphylococcus aureus strains and beta-haemolytic streptococci, alone or in combination, were cultured from lesions before treatment. in vitro studies with test discs showed that all the organisms were sensitive to cefadroxil, but twenty-three of twenty-nine S aureus strains and one of the seven streptococci strains were resistant to penicillin g. Pre- and post-treatment laboratory tests of renal, hepatic and haematopoietic functions produced no evidence of drug toxicity. The cefadroxil dosage effective in this study is lower than that recommended for currently available oral cephalosporins, which must be given on a four times daily schedule.
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22/1614. anaphylaxis in labor secondary to prophylaxis against group B Streptococcus. A case report.

    BACKGROUND: Two strategies have been recommended by the Centers for disease Control and Prevention and approved by the American College of obstetrics and gynecology to help prevent group B streptococcal disease in the newborn. Both involve using penicillin in labor. However, the potential for allergic and even anaphylactic reactions to penicillin exists. CASE: A patient was treated for risk factors for group B Streptococcus in labor and suffered a serious anaphylactic reaction to penicillin; it resulted in an emergency cesarean section. Although the patient and infant were eventually discharged, the patient developed disseminated intravascular coagulation and suffered acute tubular necrosis that required dialysis. CONCLUSION: Prophylaxis against group B streptococcal sepsis is of proven benefit, but the possible harm to the mother and fetus from treatment with penicillin must be recognized.
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23/1614. Spinal anaesthesia and meningitis in former preterm infants: cause-effect?

    meningitis associated with spinal anaesthesia is a rare but well-known complication. We report on a case of fatal bacterial meningitis following spinal anaesthesia in a former preterm infant. The aetiology of this meningitis could not be established. Former preterm infants represent a high-risk population because of their susceptibility to group B streptococcal meningitis at this age as documented in a second case. Therefore we discuss whether meningitis was consequential or coincidental with spinal anaesthesia and could have been prevented by more comprehensive preoperative laboratory screening or prophylactic antibiotics.
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24/1614. Acute bronchopulmonary infection due to Streptococcus milleri in a child with cystic fibrosis.

    An 8 year old girl with cystic fibrosis had severe respiratory disease associated with chronic pseudomonas aeruginosa bronchopulmonary infection. Despite regular courses of intravenous antipseudomonal antibiotics, she continued to deteriorate over 18 months with persistent productive cough, worsening respiratory function, and increasing oxygen dependence. During her 11th admission Streptococcus milleri was isolated from sputum cultures in addition to P aeruginosa. She failed to respond to antipseudomonal antibiotics but improved dramatically with the addition of intravenous benzylpenicillin. Although S milleri is considered a normal mouth commensal and its isolation from sputum of cystic fibrosis patients is of uncertain significance, it was associated with clinically significant infection in this child. S milleri was eradicated with antibiotic treatment and clinical improvement has been maintained.
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25/1614. Bacterial endophthalmitis after suture removal.

    We present 3 cases of endophthalmitis following suture removal after cataract surgery. In all cases, prophylactic antibiotics had been used. Treatment included vitreous tap and intravitreal antibiotic injection, with only 1 of the 3 patients regaining good visual acuity. Because povidone-iodine 5% is more effective at decreasing conjunctival bacterial counts than topical antibiotics, we recommend this method of conjunctival preparation before suture removal.
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26/1614. Severe prosthetic valve-related endocarditis following dental scaling: a case report.

    There is a well-known correlation between surgical dental procedures and the risk of bacterial endocarditis in patients with prosthetic cardiac valves. A 43-year-old patient with prosthetic aortic and mitral valves, which already have been removed twice because of endocarditis, suffered from a prosthetic valve-related endocarditis following dental scaling, which was performed without any antibiotic prophylaxis. Invasive medical procedures in patients with prosthetic heart valves may lead to endocarditis. antibiotic prophylaxis is recommended even for dental procedures considered to be "harmless," such as dental scaling.
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27/1614. Acute bacterial meningitis secondary to gamma hemolytic streptococcus. Case report and review of the literature.

    Gamma hemolytic streptococcal meningitis in a 17-year-old boy resulted in a severe purulent reaction and death. review of the literature shows only one other case of a gamma hemolytic streptococcus as the cause of bacterial meningitis in the absence of endocarditis.
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28/1614. Group G streptococcus sacroilitis with sepsis in a 15-y-old adolescent.

    Group G streptococci cause invasive infections of different tissues. Most infected patients have underlying diseases and are of adult age. Invasive group G streptococcal infections rarely occur in childhood and adolescence. A 15-y-old boy with a beta-haemolytic group G streptococcus sacroiliitis, sepsis and secondary pulmonary manifestations resembling an acute respiratory distress syndrome is described.
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29/1614. Bronchopleural fistula complicating group A beta-haemolytic streptococcal pneumonia. Use of a Fogarty embolectomy catheter for selective bronchial blockade.

    A 36-year-old woman developed severe group A Streptococcal pneumonia, complicated by a bronchopleural fistula, ARDS and multi-organ failure. We describe the use of selective middle lobe bronchus blockade, with a Fogarty embolectomy catheter, to localise and control the air leak. This allowed effective mechanical ventilation and oxygenation on intensive care and during right middle lobectomy. The patient made a prolonged, but full recovery.
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30/1614. Recurrent meningitis in the pediatric patient--the otolaryngologist's role.

    OBJECTIVE: To assess the etiology of recurrent meningitis in the pediatric patient. DESIGN: Retrospective case series and literature review. SETTING: Tertiary-care pediatric hospital. patients: Children (< 17-years-old) with recurrent meningitis, treated at texas Children's Hospital (TCH) between 1984 and 1995. RESULTS: A review of 463 cases of bacterial meningitis over an 11 year period revealed six children aged 3 months to 15 years with the diagnosis of recurrent meningitis. The patient's age, number of episodes of meningitis, diagnostic investigations performed and etiologies of recurrent meningitis were recorded. Fifteen episodes of meningitis were identified in these six patients; streptococcus pneumoniae represented the bacteriology in 73% of the cases. Two patients were diagnosed with temporal bone abnormalities, two children with immunological deficiencies and no underlying etiology for the recurrent meningitis was identified in the remaining two patients. In this series, one-third of patients had an otolaryngologic etiology for their recurrent meningitis. These six patients, along with a review of the recent literature, will highlight the need for otolaryngological assessment and the importance of considering immunological investigations when managing recurrent meningitis in the pediatric patient. CONCLUSION: We propose that children with recurrent meningitis of unknown etiology undergo: (1) an audiological evaluation; (2) a CT scan of the temporal bones, skull base and paranasal sinuses; and (3) an immunological evaluation.
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