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Blank M, Collas O, Hirji H. A young man with shortness of breath. BMJ 2021; 373:n1313. [PMID: 34112652 DOI: 10.1136/bmj.n1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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2
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Tambunan D, Rana M. Increasing ear pain and headache. J Fam Pract 2020; 69:464-470. [PMID: 33176347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Visits to the family physician, a specialist, and the ED prompted us to look beyond the initial diagnosis of acute otitis media.
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Affiliation(s)
| | - Mandeep Rana
- Department of Pediatrics, Division of Pediatric Neurology and Sleep Medicine, Boston University School of Medicine, Boston Medical Center, MA, USA.
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Abstract
RATIONALE Sternoclavicular joint septic arthritis is an unusual disease in healthy adults, and Staphylococcus aureus is the most common causative pathogen. The current treatment of choice is surgery with sternoclavicular joint resection and pectoralis flap closure, especially when the disease is complicated by osteomyelitis and abscess. PATIENT CONCERNS Here, we report a 76-year-old woman without risk factors who visited our hospital for pain and redness, swelling on the left anterior chest wall. DIAGNOSIS Magnetic resonance imaging showed infectious arthritis in the left SCJ, with multiple abscess pockets at the subcutaneous layer of anterior chest wall communicating with the joint cavity. Streptococcus agalactiae was isolated from blood culture. INTERVENTION She was treated with 6 weeks of antibiotic therapy. OUTCOMES After antibiotic treatment, she was successfully treated without recurrence. LESSONS Besides surgery, medical treatment should also be considered for sternoclavicular joint septic arthritis, depending on patient status and the causative pathogen. Physicians should be aware of this rare disease to facilitate its prompt diagnosis and management.
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Patail H, Patail H, Ahmad S. A Man in His 30s Presenting With Shortness of Breath and Productive Cough After a Recent Pneumonia. Chest 2020; 157:e91-e93. [PMID: 32145823 DOI: 10.1016/j.chest.2019.06.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/12/2019] [Accepted: 06/12/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Haris Patail
- School of Medicine, St. George's University, St. George's, Grenada
| | - Hassan Patail
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Sahar Ahmad
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Hospital, Stony Brook, NY.
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Ayala OD, Doster RS, Manning SD, O’Brien CM, Aronoff DM, Gaddy JA, Mahadevan-Jansen A. Raman microspectroscopy differentiates perinatal pathogens on ex vivo infected human fetal membrane tissues. J Biophotonics 2019; 12:e201800449. [PMID: 31162821 PMCID: PMC6902120 DOI: 10.1002/jbio.201800449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/28/2019] [Accepted: 06/02/2019] [Indexed: 06/01/2023]
Abstract
Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is a major cause of chorioamnionitis and neonatal sepsis. This study evaluates Raman spectroscopy (RS) to identify spectral characteristics of infection and differentiate GBS from Escherichia coli and Staphylococcus aureus during ex vivo infection of human fetal membrane tissues. Unique spectral features were identified from colonies grown on agar and infected fetal membrane tissues. Multinomial logistic regression analysis accurately identified GBS infected tissues with 100.0% sensitivity and 88.9% specificity. Together, these findings support further investigation into the use of RS as an emerging microbiologic diagnostic tool and intrapartum screening test for GBS carriage.
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Affiliation(s)
- Oscar D. Ayala
- Biophotonics Center, Vanderbilt University, Nashville, TN 37232, U.S.A
- Department of Biomedical Engineering, Vanderbilt University, Nashville TN 37232, U.S.A
| | - Ryan S. Doster
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232, U.S.A
| | - Shannon D. Manning
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, U.S.A
| | - Christine M. O’Brien
- Biophotonics Center, Vanderbilt University, Nashville, TN 37232, U.S.A
- Department of Biomedical Engineering, Vanderbilt University, Nashville TN 37232, U.S.A
| | - David M. Aronoff
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232, U.S.A
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, U.S.A
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232, U.S.A
| | - Jennifer A. Gaddy
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232, U.S.A
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, U.S.A
- Tennessee Valley Healthcare Systems, Department of Veterans Affairs, Nashville, Tennessee, U.S.A
| | - Anita Mahadevan-Jansen
- Biophotonics Center, Vanderbilt University, Nashville, TN 37232, U.S.A
- Department of Biomedical Engineering, Vanderbilt University, Nashville TN 37232, U.S.A
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Kralik SF, Kukreja MK, Paldino MJ, Desai NK, Vallejo JG. Comparison of CSF and MRI Findings among Neonates and Infants with E coli or Group B Streptococcal Meningitis. AJNR Am J Neuroradiol 2019; 40:1413-1417. [PMID: 31320464 DOI: 10.3174/ajnr.a6134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/17/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Group B Streptococcus and Escherichia coli (E coli) are the 2 most common causes of bacterial meningitis in neonates. The purpose of this study was to determine whether CSF and/or MR imaging findings differ between infants with group B streptococcal or E coli meningitis. MATERIALS AND METHODS A retrospective review was performed among neonates (younger than 28 days) and infants (younger than 120 days) with proved group B streptococcal (n = 57) or E coli meningitis (n = 50). A CSF or blood culture positive for Streptococcus or E coli and an elevated CSF white blood cell count were used as the criterion standard. Independent, blinded review of brain MRIs obtained within 21 days of presentation were performed by 2 board-certified neuroradiologists. CSF laboratory values and MR imaging findings were compared between the groups. RESULTS There was no statistically significant difference between the mean age at presentation for patients with group B streptococcal (40 days; range, 2-111 days) versus patients with E coli meningitis (31 days; range, 12-115 days) (P = .18). There was no statistically significant difference in the CSF white blood cell count, glucose, or protein. There was a significant difference between group B streptococcal and E coli meningitis in the frequency of hydrocephalus (0% versus 22%, P = .001) and infarct (40% versus 14%; P = .038), respectively. There was no statistically significant difference in leptomeningeal enhancement, cerebritis, ventriculitis, abscess/granuloma, subdural effusion, extra-axial purulent material, intraventricular purulent material, hemorrhage, and sinus thrombosis. CONCLUSIONS Although neonates and infants with group B streptococcal or E coli meningitis had similar age and CSF laboratory values, patients with group B streptococcal meningitis more frequently demonstrated infarcts, while those with E coli meningitis more frequently had early onset of hydrocephalus.
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Affiliation(s)
- S F Kralik
- From the Department of Radiology (S.F.K., M.K.K., M.J.P., N.K.D.), Texas Children's Hospital, Houston, Texas
- Indiana University Riley Children's Hospital (S.F.K.), Indianapolis, Indiana
| | - M K Kukreja
- From the Department of Radiology (S.F.K., M.K.K., M.J.P., N.K.D.), Texas Children's Hospital, Houston, Texas
| | - M J Paldino
- From the Department of Radiology (S.F.K., M.K.K., M.J.P., N.K.D.), Texas Children's Hospital, Houston, Texas
| | - N K Desai
- From the Department of Radiology (S.F.K., M.K.K., M.J.P., N.K.D.), Texas Children's Hospital, Houston, Texas
| | - J G Vallejo
- Department of Pediatrics (J.G.V.), Baylor College of Medicine, Houston, Texas
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Maeda S, Tahara N, Takase F, Bekki M, Tahara A, Honda A, Igata S, Sugiyama Y, Nakamura T, Sun J, Kurata S, Fujimoto K, Abe T, Fukumoto Y. Diagnostic performance of FDG-PET/CTA in native mitral valve endocarditis. J Nucl Cardiol 2019; 26:681-683. [PMID: 29872968 DOI: 10.1007/s12350-018-1321-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Shoko Maeda
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Nobuhiro Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Fumitake Takase
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Munehisa Bekki
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Atsuko Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Sachiyo Igata
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Yoichi Sugiyama
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Tomohisa Nakamura
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Jiahui Sun
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Seiji Kurata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
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Abstract
A 53-year-old Japanese man experienced fever/neck pain, and neck magnetic resonance imaging revealed a spinal epidural abscess. The following day, he developed a palpable mass with evident inflammatory signs in the right sternoclavicular joint (SCJ) with severe pain. Ultrasound revealed synovitis with remarkable power Doppler signals in the right SCJ. Blood cultures yielded Streptococcus agalactiae growth. After 12 days, ultrasound showed right distal clavicle bone erosion. His symptoms improved with long-term parenteral antibiotic treatment, but the right SCJ joint destruction progressed for several months. We diagnosed him with sternoclavicular septic arthritis complicated with a spinal epidural abscess and bacteremia.
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Affiliation(s)
- Shin-Ya Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yushiro Edo
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Abstract
OBJECTIVE We explored the relationship between pediatric infective endocarditis and stroke. PATIENTS AND METHODS All children encountered with infective endocarditis from January 2002 to December 2015 were included as our sample, and their medical records were comprehensively reviewed. RESULTS Sixty children with infective endocarditis were identified, including 30 boys and 30 girls aged eight months to 18 years (mean ± SD: 10.3 ± 5.6), and om 43 (71.6%) of these individuals had congenital heart disease. Left-sided endocarditis occurred in 25 patients (41.7%), and vegetations were found in 58 individuals (96.6%). The most often encountered microorganisms were Streptococcus viridans and Staphylococcus aureus, which were identified in five and four patients, respectively. Postendocarditis stroke occurred in nine patients, including five with cerebral infarction, two with intracerebral hemorrhage, and one with subarachnoid hemorrhage. The remaining child experienced cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage simultaneously. The incidence of stroke in children with left-sided endocarditis was significantly higher than that of which in those who had right-sided endocarditis (32% versus 2.8%, P < 0.01). The most common manifestation of stroke was hemiparesis (55.5%). Two girls died of stroke, and the mortality rate in the patients who had stroke was significantly higher than that in those without stroke (22.2 % versus 3.9 %, P < 0.05). CONCLUSIONS Our data indicate that stroke is common among children with infective endocarditis, especially in those with left-sided endocarditis, and major stroke may increase their risk of death. Congenital heart disease is the main underlying disease in children with infective endocarditis in China.
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Affiliation(s)
- Gui-Fang Cao
- Department of Neurology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
| | - Qi Bi
- Department of Neurology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
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Abstract
In 2017, endocarditis caused by Streptococcus equi subspecies zooepidemicus was diagnosed in a man in the Netherlands who had daily contact with horses. Whole-genome sequencing of isolates from the man and his horses confirmed the same clone, indicating horse-to-human transmission. Systematic reporting of all zoonotic cases would help with risk assessment.
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Martel A. Septic thrombosis of cavernous sinus extended to the ipsilateral internal jugular vein and transversal sinus with favorable outcome: Clinical and radiological features of a Lemierre syndrome. Orbit 2018; 37:94-96. [PMID: 29040036 DOI: 10.1080/01676830.2017.1383458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An 86-year-old patient was hospitalized for fever and left acute orbital syndrome (red eye with moderate visual impairment, chemosis, ophthalmoplegia without proptosis, or any fundus involvement). CT scan showed superior ophthalmic vein and cavernous sinus enlargement complicating ipsilateral sphenoidal sinusitis. Magnetic resonance imaging (MRI) demonstrated the left cavernous sinus thrombosis extended to the ipsilateral jugular vein and transversal sinus (Lemierre syndrome). Intravenous broad-spectrum antibiotics and curative anticoagulation were prescribed. Blood cultures allowed the identification of Streptococcus intermedius and Staphylococcus warneri species. Evolution was favorable and the patient was discharged 3 weeks after. Antibiotics and anticoagulation were carried out for a total duration of 4 and 12 weeks, respectively. Lemierre syndrome is a potentially life-threatening emergency rarely encountered; thus, ophthalmologists should be cognizant of clinical and radiological features. Broad-spectrum antibiotics are the mainstay of treatment. Curative anticoagulation may be added if no blood coagulation disorder nor bleeding on neuroimaging has been identified.
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Affiliation(s)
- Arnaud Martel
- a Department of Ophthalmology , University Hospital of Nice , Nice , France
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Abstract
Acute dacryoadenitis with abscess formation has been rarely described. We describe four cases that resolved with incision and drainage. This includes a retrospective case series of four patients with radiologically confirmed lacrimal gland abscesses and a review of the reported cases in the literature. Computed tomography showed characteristic rim enhancing collections with central attenuation in all four cases. All patients presented with ptosis, upper eyelid erythema, and severe pain similar to scleritis. Injection of the conjunctiva and sclera was present in two patients, and a third patient presented with expression of purulent discharge onto the ocular surface upon palpation of the lacrimal gland. All patients were treated with intravenous antibiotics and underwent incision and drainage with subsequent improvement. All were monitored for 24 to 48 hours and discharged on oral antibiotics. There were no complications or recurrences. Lacrimal gland abscess formation is a rare complication of dacryoadenitis, and in our experience these patients respond well to incision and drainage in combination with systemic antibiotics.
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Affiliation(s)
- Brian Savoie
- a Department of Ophthalmology , Hofstra Northwell School of Medicine , Great Neck , New York , USA
| | - Rand Rodgers
- b Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Matthew Gorski
- a Department of Ophthalmology , Hofstra Northwell School of Medicine , Great Neck , New York , USA
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Kurnicka K, Nowakowski P, Pruszczyk P. A rare case of isolated streptococcal pulmonary valve endocarditis diagnosed with repeated echocardiography. Pol Arch Intern Med 2017; 127:794-795. [PMID: 29148522 DOI: 10.20452/pamw.4152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Capo J, Helman SN, de Serres LM, Chinnaduraic S. Retropharyngeal abscess as a result of hyaluronic acid injection pharyngoplasty: A first of its kind. Am J Otolaryngol 2017; 38:718-719. [PMID: 28793960 DOI: 10.1016/j.amjoto.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Joseph Capo
- Department of Otolaryngology/Head and Neck Surgery, New York Eye and Ear Infirmary- Mount Sinai Health System, 310 E. 14th St., 6th Floor, New York, NY 10003, United States.
| | - Samuel N Helman
- Department of Otolaryngology/Head and Neck Surgery, New York Eye and Ear Infirmary- Mount Sinai Health System, 310 E. 14th St., 6th Floor, New York, NY 10003, United States.
| | - Lianne M de Serres
- Department of Otolaryngology/Head and Neck Surgery, Westchester Medical Center, - ENT Faculty Practice 100 Woods Rd. Valhalla, NY 10595, United States
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Shimozono K, Hayashi Y, Nishinaka T, Kobayashi S. [An adult case of group A streptococcus meningitis associated with steroid-responsive meningoencephalitis]. Rinsho Shinkeigaku 2017; 57:499-503. [PMID: 28804111 DOI: 10.5692/clinicalneurol.cn-001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A previously healthy 80-year-old woman presented to our service in a comatose state. On examination the patient had fever and neck stiffness. Laboratory investigation showed polymorphonuclear pleocytosis in cerebro-spinal fluid (CSF). These findings prompted us to a diagnosis of bacterial or viral meningitis and combination therapy consisting of ceftriaxone, vancomycin and acyclovir was started immediately. Two days later, culture of blood yielded Streptococcus pyogenes (group A streptococcus; GAS). The antibiotic therapy was converted to intravenous ampicillin for 14 days. Fever resolved quickly, however, somnolence persisted. Fluid attenuated inversion recovery image of the brain, taken on the day 29, showed focal hyperintense lesions on the right subcortical area in the temporal and parietal lobes. Three times repeated intravenous steroid pulse therapy (methylprednisolone 1,000 mg/day, 3 days) resulted in complete improvement of her consciousness disturbance. We considered the present case to be a steroid-responsive meningoencephalitis caused by GAS infection.
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Azharuddin M, Prudence D, Shukla PS, Mathur A. Rapid developing empyema by group F beta Streptococcus anginosus group. BMJ Case Rep 2017; 2017:bcr-2017-219617. [PMID: 28705799 PMCID: PMC5534869 DOI: 10.1136/bcr-2017-219617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 11/04/2022] Open
Abstract
A 43-year-old male had progressive pleuritic left-sided chest tightness with shortness of breath. He had dental caries and tenderness on palpation of the left lateral chest. Complete blood count showed leucocytosis. CT scan of the chest with pulmonary emboli protocol showed multiple pulmonary nodules and nodular pleural thickening at left posterior lateral pleura. Forty-eight hours post CTPE scan, CT scan of the chest, abdomen and pelvis displayed right lower lobe consolidation and left-sided pleural effusion with superimposed compressive atelectasis. Ceftaroline intravenous was initiated, with CT-guided pigtail chest tube insertion. Pleural fluid later grew group F beta-haemolytic Streptococcus anginosus Patient improved significantly and was discharged 11 days later with intravenous ertapenem. Patients with group F beta-haemolytic streptococci should be managed aggressively with early and accurate diagnosis, antibiotics, drainage and possible surgery.
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Affiliation(s)
- Muhammad Azharuddin
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Dy Prudence
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Prem Shanker Shukla
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Ajay Mathur
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
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Cedielq G, Guillen Marzo M, de Castro Aritmendiz R, Toro Gil J, Bardají A. Satellite Atrial Septal Vegetations Secondary to Mitral Valve Endocarditis. J Heart Valve Dis 2017; 26:224-225. [PMID: 28820555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Infective endocarditis is a challenging clinical problem with a high rate of mortality. Early recognition of this disease, and especially its complications, remain a critical task for the cardiologist. In this scenario, atrial endocarditis is a rare and sometimes unrecognized complication of mitral valve endocarditis. Herein is reported a clinical case that shows how a satellite vegetation in the atrial septum can be produced in a patient with mitral regurgitation secondary to mitral valve endocarditis. Video 1: Transthoracic echocardiography showing the presence of vegetation in the posterior mitral leaflet, severe secondary mitral regurgitation, and satellite vegetation in the atrial septum.
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Affiliation(s)
- Germán Cedielq
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain. Electronic correspondence:
| | | | | | - Jairo Toro Gil
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain
| | - Alfredo Bardají
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain
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Muşetescu AE, Florea M, ForŢofoiu MC, Bumbea AM, Tudorancea AD, Criveanu C, GofiŢă CE, Ciurea PL, Ştefănescu A, Dinescu ŞC, Mogoantă CA. Streptococcal tonsillitis related reactive arthritis - clinical, ultrasound imaging and immunohistochemical study. Rom J Morphol Embryol 2017; 58:801-807. [PMID: 29250657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In clinical practice and literature studies, the most common condition associated to streptococcal tonsillitis used to be acute rheumatic fever (ARF). Several publications in the late years report a more frequent and distinctive entity from ARF following β-hemolytic group A streptococcus infection in patients with post-infectious arthritis, that do not fulfill the modified Jones criteria, the so-called post-streptococcal reactive arthritis (PSRA). A distinctive pattern of clinical framing and biological profile in patients with PSRA following streptococcal tonsillitis is described, with a non-migratory, additive, recent onset (7-10 days) arthritis that affects small and large joints as well, with a bimodal peak of incidence at 8-14 and 21-37 years of age, with variate response to non-steroidal anti-inflammatory drugs and has a tendency for recurrence and persistence. Sacroiliitis, although rare, is described in human leukocyte antigen (HLA)-B27 positive PSRA patients. The main objective of the current study was to evaluate various immunohistochemical patterns of streptococcal tonsillitis in patients with PSRA and find possible correlations with the clinical, biological and ultrasound profile.
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Affiliation(s)
- Anca Emanuela Muşetescu
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania;
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Tamborrini G, Gut C, Schaefer DJ, Lardinois D. [Not Available]. Praxis (Bern 1994) 2017; 106:387-389. [PMID: 28357905 DOI: 10.1024/1661-8157/a002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | | | - Dirk Johannes Schaefer
- 3 Plastische, Rekonstruktive, Ästhetische und Handchirugie, Universitätsspital Basel, Universität Basel
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Upapan P. Mycotic Aneurysm of the Abdominal Aorta due to Group B Streptococcus (GBS) Infection: A Case Report and Review of the Literature. J Med Assoc Thai 2016; 99 Suppl 8:S253-S259. [PMID: 29906058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We present a case report of an extremely rare infected abdominal aortic aneurysm (AAA) caused by group B streptococcus (GBS). A 66 years old, afebrile male patient with hypertension and history of chronic smoking presented with mild abdominal pain and discomfort. Physical examination revealed a pulsatile mass of 5 cm in diameter located at the periumbilical region. A computed tomography (CT) scan of the whole abdomen exhibited an outpouching lesion with intramural hematoma located at the infrarenal abdominal aorta, sized 5.1x3.7 cm in diameter, suggesting an abdominal aortic aneurysm. A transthoracic echocardiography demonstrated normal endocardium without vegetation. Surgical abdominal aortic aneurysm repair (aneurysmorrhaphy) was successfully done and intravenous amoxicillin/clavulanic acid was given. Tissue culture obtained from the aneurysm sac and para-aortic lymph nodes revealed group B streptococcus infection. Intravenous amoxicillin/clavulanic acid was continued for 14 days, and was transitioned to oral amoxicillin 3 grams/day. Currently, the patient has been followed-up for 20 months with neither recurrent infection nor post-operative complication. This is the first case report of infected abdominal aortic aneurysm due to GBS in Thailand.
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Tomsic A, Li WWL, van Paridon M, Bindraban NR, de Mol BAJM. Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm. Tex Heart Inst J 2016; 43:345-9. [PMID: 27547149 DOI: 10.14503/thij-15-5322] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature.
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MESH Headings
- Adult
- Aged
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/therapy
- Aneurysm, Ruptured/diagnostic imaging
- Aneurysm, Ruptured/microbiology
- Aneurysm, Ruptured/therapy
- Anti-Bacterial Agents/administration & dosage
- Aortic Valve/diagnostic imaging
- Aortic Valve/microbiology
- Aortic Valve/surgery
- Drug Administration Schedule
- Echocardiography, Transesophageal
- Endocarditis, Bacterial/diagnostic imaging
- Endocarditis, Bacterial/microbiology
- Endocarditis, Bacterial/therapy
- Female
- Heart Aneurysm/diagnostic imaging
- Heart Aneurysm/microbiology
- Heart Aneurysm/therapy
- Heart Valve Diseases/diagnostic imaging
- Heart Valve Diseases/microbiology
- Heart Valve Diseases/therapy
- Heart Valve Prosthesis Implantation
- Humans
- Male
- Middle Aged
- Mitral Valve/diagnostic imaging
- Mitral Valve/microbiology
- Mitral Valve/surgery
- Mitral Valve Insufficiency/diagnostic imaging
- Mitral Valve Insufficiency/microbiology
- Mitral Valve Insufficiency/surgery
- Streptococcal Infections/diagnostic imaging
- Streptococcal Infections/microbiology
- Streptococcal Infections/therapy
- Streptococcus gordonii/drug effects
- Streptococcus gordonii/isolation & purification
- Treatment Outcome
- Young Adult
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23
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Blanco Amil CL, Vidal Rey J, López Arquillo I, Pérez Rodríguez MT, Encisa de Sá JM. Mycotic Abdominal Aortic Aneurysm Secondary to Septic Embolism of a Thoracic Aorta Graft Infection. Ann Vasc Surg 2016; 33:227.e13-20. [PMID: 26965799 DOI: 10.1016/j.avsg.2015.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 11/19/2015] [Accepted: 11/21/2015] [Indexed: 11/19/2022]
Abstract
Mycotic aneurysms account for 1% of abdominal aortic aneurysms. There are very few cases published that describe the formation of mycotic aneurysms after septic embolism due to graft infection. We present the first case to our knowledge to be described in the literature of a mycotic aneurysm caused by septic embolism derived from a thoracic aorta graft infection, treated with conventional surgery leading to a successful outcome and evolution.
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Affiliation(s)
- Carla Lorena Blanco Amil
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain.
| | - Jorge Vidal Rey
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - Irene López Arquillo
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | - José Manuel Encisa de Sá
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
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Feder OI, Gruson KI. Glenohumeral Joint Sepsis Caused by Streptococcus mitis: A Case Report. Am J Orthop (Belle Mead NJ) 2016; 45:E343-E346. [PMID: 27737290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Septic arthritis of the shoulder girdle remains relatively uncommon, with Staphylococcus aureus and β-hemolytic streptococci the typical offending organisms in adult patients. Rare cases of Streptococcus viridans, an oral bacterium with low virulence, have been reported in the setting of septic arthritis, mostly involving the knee joint or the sternoclavicular joint. In this article, we report a case of Streptococcus mitis infection of the glenohumeral joint that likely resulted from hematogenous spread after oral trauma in a patient with poor underlying dentition. Prompt diagnosis followed by arthroscopic irrigation and débridement of the glenohumeral joint resulted in a satisfactory clinical outcome.
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Affiliation(s)
| | - Konrad I Gruson
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, NY.
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25
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Boussir H, Ghalem A, Ismaili N, El Ouafi N. Endocardite infectieuse sur communication interventriculaire: intérêt de l’échocardiographie? de l’antibioprophylaxie ? Pan Afr Med J 2016; 25:154. [PMID: 28292116 PMCID: PMC5326043 DOI: 10.11604/pamj.2016.25.154.10673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/17/2016] [Indexed: 11/23/2022] Open
Abstract
L’endocardite infectieuse peut survenir sur un cœur sain ou pathologique. Parmi les cardiopathies à risque, on trouve les cardiopathies congénitales dont la CIV est la plus fréquente. Nous rapportons le cas d’une endocardite infectieuse à streptocoque oral, survenue sur une CIV non connue jusqu’à maintenant, chez un patient de 17 ans, se présentant sous forme de fièvre prolongée associée à une éruption cutanée. L’examen de la sphère ORL révéla par ailleurs des angines pseudomembraneuses avec un mauvais état buccodentaire. Les EI sur CIV sont les plus fréquentes des EI sur cardiopathie congénitale. Leur présentation clinique peut être atypique d’où le rôle primordial de l’échocardiographie. La prévention dans ces cas passe par une hygiène bucco-dentaire et cutanée optimale et non par une antibioprophylaxie.
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Affiliation(s)
- Hanane Boussir
- Service de Cardiologie, Centre Hospitalier universitaire Mohammed VI, Oujda, Maroc
| | - Amine Ghalem
- Service de Cardiologie, Centre Hospitalier universitaire Mohammed VI, Oujda, Maroc
| | - Nabila Ismaili
- Service de Cardiologie, Centre Hospitalier universitaire Mohammed VI, Oujda, Maroc
| | - Noha El Ouafi
- Service de Cardiologie, Centre Hospitalier universitaire Mohammed VI, Oujda, Maroc
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26
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Lin CH, Tsai HW, Hwang JI, Tsan YT, Hu SY. Brachial artery mycotic aneurysm and splenic infarction associated with infective endocarditis. QJM 2015; 108:981-2. [PMID: 26186921 PMCID: PMC4658470 DOI: 10.1093/qjmed/hcv127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- C-H Lin
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - H-W Tsai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan and Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - J-I Hwang
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, School of Medicine and School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Y-T Tsan
- Department of Emergency Medicine and Department of Medical Research, Center for Translation Medicine, Taichung Veterans General Hospital, Taichung, Taiwan and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - S-Y Hu
- Department of Emergency Medicine and Department of Medical Research, Center for Translation Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, School of Medicine and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan and Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan.
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27
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Pritchett CV, Zacharek MA. Raeder syndrome: Paratrigeminal oculosympathetic syndrome presenting as a manifestation of chronic sinusitis. Ear Nose Throat J 2015; 94:E22-E25. [PMID: 26670762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Raeder syndrome (paratrigeminal oculosympathetic syndrome) is a rare clinical entity characterized by ipsilateral trigeminal sensory deficits, ptosis, and miosis, with an absence of anhidrosis secondary to interruption of the postganglionic oculosympathetic pathway. Going back to its original description, this constellation of physical examination findings has historically been associated with intracranial pathology involving the middle cranial fossa. Understanding this pathway is important in distinguishing Raeder syndrome from Horner syndrome, as the presentation of the former is now recognized to accompany a number of other disease entities in the head and neck region. We present an unusual case of Raeder syndrome associated with bacterial sinusitis, and we discuss its management and review the literature.
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Affiliation(s)
- Cedric V Pritchett
- Division of Laryngology, Rhinology, and General Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, 1904 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5312, USA
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28
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Lasoff D, Wardi G. An Unusual Case of Dysphagia. J Emerg Med 2015; 49:335-7. [PMID: 26116338 DOI: 10.1016/j.jemermed.2015.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/16/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel Lasoff
- Department of Emergency Medicine, University of California, San Diego, California
| | - Gabriel Wardi
- Department of Emergency Medicine, University of California, San Diego, California
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29
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Thielberg AK, Cleeman L, Klausen C. [Bacterial sacroiliitis caused by group B streptococci]. Ugeskr Laeger 2014; 176:V11120653. [PMID: 25497658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 12-year-old girl was admitted to the paediatric department due to a short history of severe pain in the right hip, inability to walk and fever, 39 °C. She had had no previous trauma or ongoing infection elsewhere. Examination showed a septic girl with pain of the right sacroiliac joint. Laboratory findings showed a marginally raised white blood cell count and C-reactive protein. A magnetic resonance imaging was performed and showed effusion of the right sacroiliac joint without root compression. Three days later blood cultures showed group B streptococci and the patient received intravenous antibiotic treatment for two weeks and continued with oral antibiotics for four weeks.
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30
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Cachovan G, Blessmann M, Schön G, Rother U, Heiland M, Stürenburg E, Platzer U, Sobottka I. Radiography-based score indicative for the pathogenicity of bacteria in odontogenic infections. Acta Odontol Scand 2014; 72:530-6. [PMID: 24444257 DOI: 10.3109/00016357.2013.876553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To develop a new radiography-based score to assess the potential of bacteria to cause odontogenic infections derived from the occurrence of bacteria at small or large radiographical lesions. MATERIALS AND METHODS The patients analyzed were a sub-population from a large randomized clinical trial comparing moxifloxacin and clindamycin in the treatment of inflammatory infiltrates and odontogenic abscesses. Routine radiographs were used to analyze the area of the periapical radiolucent lesions. Lesions were stratified by their radiographically measured area as large (>9 mm(2)) or small (≤9 mm(2)). A risk ratio was calculated for each species from the frequency of their occurrence in large vs in small lesions. RESULTS Fifty-one patients, 19 with abscesses and 32 with infiltrates, were evaluated. Overall, the radiographical lesion areas ranged from 0.4-46.2 mm(2) (median = 9 mm(2)). An increased risk (risk ratio >1) to occur at large abscess lesions was observed for Prevotella (P.) oralis, P. buccae, P. oris, P. intermedia, Fusobacterium nucleatum and Streptococcus (Strep.) anginosus group. An increased risk to occur at large infiltrate lesions was found for Strep. salivarius, Strep. parasanguis, Strep. anginosus group, Capnocytophaga spp., Neisseria (N.) sicca, Neisseria spp., Staphylococcus (Staph.) aureus, P. intermedia, P. buccae, Prevotella spp. and P. melaninogenica. CONCLUSIONS The radiography-based score suggests that certain Prevotella spp., F. nucleatum and Strep. anginosus groups play a crucial role in the pathogenesis of odontogenic abscesses, and that various streptococci, Neisseria spp., Capnocytophaga spp., Staph. aureus and Prevotella spp. are involved in the pathogenesis of odontogenic infiltrates.
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Affiliation(s)
- Georg Cachovan
- Center for Oral and Dental Medicine, Department of Restorative and Preventive Dentistry
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31
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Martikainen MH, Hohenthal U, Pirilä L, Kemppainen J. Constant high adrenal FDG uptake in PET/CT associated with mitochondrial disease. J Inherit Metab Dis 2014; 37:863-4. [PMID: 24554338 DOI: 10.1007/s10545-014-9685-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/17/2014] [Accepted: 01/27/2014] [Indexed: 11/25/2022]
Abstract
We describe a patient with the m.3243A>G mitochondrial DNA mutation who developed sepsis caused by Streptococcus constellatus. In the acute phase of illness, abnormally high uptake of (18)F-FDG was observed in both adrenal glands that appeared anatomically normal. In repeated imaging six months later the adrenal uptake had diminished but remained clearly elevated. We did not observe high adrenal FDG uptake as in the patient described here among 30 patients with Staphylococcus aureus sepsis that were investigated with identical imaging protocol. In sepsis, oxygen consumption and metabolic rate are increased compared to normal metabolism. The observed high adrenal FDG uptake during sepsis in this patient probably reflects the acute metabolic stress induced by the infection. Interestingly, in repeated imaging six months later, the adrenal SUVs had diminished but were still abnormally high: this suggests constant high levels of metabolic stress associated with the mitochondrial disorder.
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Affiliation(s)
- Mika H Martikainen
- Division of Clinical Neurosciences, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland,
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32
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Zarrif H, Navarro-Navarro R, Bolaños-Rivero M, Pisos-Álamo E. [Spondylodiscitis by Streptococcus dysgalactiae subsp. equisimilis (group G)]. Rev Esp Quimioter 2014; 27:130-131. [PMID: 24940896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Hanan Zarrif
- Hanan Zarrif, Servicio de Microbiología, Hospital Universitario Insular de Gran Canaria, Avda. Marítima del Sur, s/n. 35016. - Las Palmas de Gran Canaria, Spain.
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Kharwar RB, Mohanty A, Sharma A, Narain VS, Sethi R. Ruptured anterior mitral leaflet aneurysm in aortic valve infective endocarditis--evaluation by three-dimensional echocardiography. Echocardiography 2014; 31:E72-6. [PMID: 24749164 DOI: 10.1111/echo.12449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Ruptured aneurysm of the anterior mitral leaflet is a rare but a devastating complication secondary to aortic valve infective endocarditis. We report a case of 30-year-old male with native aortic valve endocarditis who was referred to us for evaluation of worsening of heart failure after an initial period of responsiveness to antibiotics. Detailed evaluation with two-dimensional and three-dimensional transthoracic echocardiography revealed ruptured anterior mitral leaflet aneurysm with severe eccentric mitral regurgitation along with a large vegetation on the aortic valve. The patient underwent successful surgical closure of the defect along with aortic valve replacement.
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34
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Iyer S, Collum J, Babores M. Descending necrotizing mediastinitis: a conservative approach. Ear Nose Throat J 2014; 93:E11-E14. [PMID: 24652563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Descending necrotizing mediastinitis (DNM) is a now-rare complication of dental and pharyngeal infections. Reports in the literature have emphasized the need for early, aggressive surgical intervention. We present a case of DNM with bilateral empyemas that arose secondary to a perforated pharyngeal abscess. The patient was successfully managed conservatively with intravenous antibiotics and intercostal drainage. We conclude that conservative management with antibiotics and image-guided percutaneous pleural drainage may be initially appropriate for the stable patient.
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Affiliation(s)
- Sriram Iyer
- Department of Respiratory Medicine, Macclesfield District General Hospital, East Cheshire NHS Trust, Victoria Rd., Macclesfield, Cheshire SK10 3BL, UK.
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35
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Pachirat O, Prathani S, Lulitanond V, Watt G. Echocardiographic features in Streptococcus agalactiae endocarditis: four cases report. J Med Assoc Thai 2014; 97:118-122. [PMID: 24701739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Streptococcus agalactiae endocarditis is uncommon compared to other types of streptococcal endocarditis. The aim of this study was to describe the echocardiographic features of S. agalactiae endocarditis. MATERIAL AND METHOD Between January 2010 and December 2012, 150 patients diagnosed with infective endocarditis by the modified Duke criteria treated at Srinagarind Hospital and Queen Sirikit Heart Center, Khon Kaen University were included. The transthoracic echocardiography (TTE) was performed on every patient. RESULTS Four patients with S. agalactiae endocarditis were identified. The TTE features included one patient with a huge, highly mobile vegetation at the mitral position and patient presented with acute embolic stroke. Two patients with highly mobile vegetations at the aortic position and destroyed aortic cusps, both patients presented with congestive heart failure. One patient with vegetation at mechanical valve, mitral position and patient presented with congestive heart failure. All four patients underwent a combined medical and surgical therapy A correlation between the echocardiographic features and surgical findings in all but two patients, fewer abscesses were found by surgery. CONCLUSION In the setting of acute endocarditis, the detection of large vegetation and severely destroyed valve by echocardiography is an argument in favor of S. agalactiae endocarditis and may warrant early surgical intervention.
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Shah SQ, Khan MR. Synthesis of (99m)Tc labeled temafloxacin complex and biodistribution in male Wistar rats artificially infected with Streptococci pneumonia. ADV CLIN EXP MED 2013; 22:319-325. [PMID: 23828672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Radiotracers techniques are offering a unique way to diagnosis deep tissue infection in its early stages. The radiotracers including radio-antibiotics have shown promising results in the early diagnosis of infection and its discrimination from infectious foci but wide ranges of microorganisms still poses threats. OBJECTIVES Synthesis of Technetium-99m ((99m)Tc)-temafloxacin (TMC) complex for the localization of in vivo Streptococci pneumoniae infection in the early stages. MATERIAL AND METHODS The (99m)Tc-TMC complex was prepared by adding 50 µg of stannous chloride (SnCl2) with 37 MBq (0.5 mL) of sodium pertechnetate (Na(99m)TcO4-) at a pH of 5.2. Then 1 mg of the TMC was added to the mixture followed by incubation at room temperature for 10 min. The same procedure was repeated by changing the amount of the SnCl2 from 50 to 250 µg along with the TMC from 2 to 5 mg and Na(99m)TcO4- from 74 to 185 MBq. In higher concentrations of cysteine the stability of the (99m)Tc-TMC complex was evaluated. In vitro Streptococci pneumoniae uptake was investigated to validate the accuracy and preciseness of the (99m)Tc-TMC complex. In vivo uptake of the (99m)Tc-TMC complex was evaluated in ten (10) normal male Wistar rats (MWR) (140-160 g) divided into two groups (I and II). RESULTS Maximum stability of 98.00 ± 0.34% at 30 min after reconstitution was observed by mixing 2.5 mg of TMC, 100 µg of SnCl2 with 74 MBq of the Na(99m)TcO4-. The stability of the complex remained 90% up to 4 hours. In serum the complex showed stability up to 16 hours. A saturated in vitro binding was noted with live Streptococci pneumoniae. In the infected region (left thigh) of the MWR, almost five times higher uptake was observed as compared to the inflamed and normal muscles. CONCLUSIONS The above results confirm the suitability of the (99m)Tc-TMC complex as a potential Streptococci pneumoniae infection localizing agent.
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Nagai T, Hamabe A, Arakawa J, Konishi T, Hisadome H, Yoshida M, Tabata H, Ito T, Mitsumaru A, Tanaka Y, Uehata A. Mitral valve aneurysm. Ultraschall Med 2013; 34:69-70. [PMID: 23229413 DOI: 10.1055/s-0032-1330324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- T Nagai
- Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan.
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Sugibayashi S, Miyasaka Y, Suwa Y, Hirayama Y, Okura H, Maeba H, Tsujimoto S, Shiojima I, Takahashi H. [Recent trends in the clinical characteristics of infective endocarditis: a survey of 54 consecutive cases from 2006 to 2010]. Rinsho Byori 2012; 60:1121-1125. [PMID: 23427692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND It has been reported that the clinical characteristics of infective endocarditis are changing during the course of the decades. However, most of the available data are obtained in the early 2000s or earlier. We therefore evaluated the more recent clinical spectrum of infective endocarditis. METHODS Fifty-four consecutive patients diagnosed as infective endocarditis based on the Duke criteria at our hospital from January 2006 to December 2010 were evaluated. RESULTS Of 54 cases, 31 (57%) were male and 23 (43%) were female, with mean age of 57 +/- 17 years. Twenty-three (43%) patients were older than 65 years. The number of patients with diabetes mellitus or undergoing chronic hemodialysis, or cancer were 9 (17%), 5 (9%), and 5 (9%), respectively. In 25 patients (46%), endocarditis occurred without any underlying cardiac disease. The frequencies of streptococcal endocarditis and staphylococcal endocarditis were almost identical [18 (33%) vs. 17 (32%)]. Methicillin resistant staphylococcus aureus was found in 6 patients (11%). CONCLUSIONS A survey of patients with infective endocarditis from 2006 to 2010 revealed a trend towards increased staphylococcal endocarditis in compromised patients without prior cardiac disorders.
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Affiliation(s)
- Sachiyo Sugibayashi
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata 573-1191, Japan
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Vos FJ, Kullberg BJ, Sturm PD, Krabbe PFM, van Dijk APJ, Wanten GJA, Oyen WJG, Bleeker-Rovers CP. Metastatic infectious disease and clinical outcome in Staphylococcus aureus and Streptococcus species bacteremia. Medicine (Baltimore) 2012; 91:86-94. [PMID: 22391470 DOI: 10.1097/md.0b013e31824d7ed2] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Early detection of metastatic infection in patients with Gram-positive bacteremia is important as morbidity and mortality are higher in the presence of these foci, probably due to incomplete eradication of clinically silent foci during initial treatment. We performed a prospective study in 115 patients with Staphylococcus aureus or Streptococcus species bacteremia with at least 1 risk factor for the development of metastatic foci, such as community acquisition, treatment delay, persistently positive blood cultures for >48 hours, and persistent fever >72 hours after initiation of treatment. An intensive search for metastatic infectious foci was performed including ¹⁸F-fluorodeoxyglucose-positron emission tomography in combination with low-dose computed tomography scanning for optimizing anatomical correlation (FDG-PET/CT) and echocardiography in the first 2 weeks of admission. Metastatic infectious foci were detected in 84 of 115 (73%) patients. Endocarditis (22 cases), endovascular infections (19 cases), pulmonary abscesses (16 cases), and spondylodiscitis (11 cases) were diagnosed most frequently. The incidence of metastatic infection was similar in patients with Streptococcus species and patients with S. aureus bacteremia. Signs and symptoms guiding the attending physician in the diagnostic workup were present in only a minority of cases (41%). An unknown portal of entry, treatment delay >48 hours, and the presence of foreign body material were significant risk factors for developing metastatic foci. Mean C-reactive protein levels on admission were significantly higher in patients with metastatic infectious foci (74 vs. 160 mg/L). FDG-PET/CT was the first technique to localize metastatic infectious foci in 35 of 115 (30%) patients. As only a minority of foci were accompanied by guiding signs or symptoms, the number of foci revealed by symptom-guided CT, ultrasound, and magnetic resonance imaging remained low. Mortality tended to be lower in patients without complicated infection compared to those with metastatic foci (16% vs. 25%, respectively). Five of 31 patients (16%) without proven metastatic foci died. In retrospect, 3 of these 5 patients likely had metastatic foci that could not be diagnosed while alive. In patients with Gram-positive bacteremia and a high risk of developing complicated infection, a structured protocol including echocardiography and FDG-PET/CT aimed at detecting metastatic infectious foci can contribute to improved outcome.
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Affiliation(s)
- Fidel J Vos
- From the Departments of Medicine (FJV, BJK, CPBR), Nuclear Medicine (FJV, WJGO), Microbiology (PDS), Cardiology (APJvD), Gastroenterology (GJAW), Radboud University Nijmegen Medical Center, Nijmegen; Nijmegen Institute for Infection, Inflammation and Immunity (N4i) (FJV, BJK, PDS, WJGO, CPBR), Radboud University Nijmegen, and Department of Epidemiology (PFMK), Unit Health Technology Assessment, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Zubaidah NH, Azim MIM, Osama MH, Harunarashid H, Das S. An unique case of thoracic endovascular aortic repair (TEVAR) graft infection with Streptococcus viridans. Clin Ter 2012; 163:27-29. [PMID: 22362230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The incidence of infection following TEVAR is low. To the best of our knowledge, this is the first case report of post thoracic endovascular aortic repair (TEVAR) with Streptococcus viridans graft infection. A 54-year-old male underwent TEVAR for dissecting thoracic aneurysm with spinal ischaemia. He had an eventful recovery with prolonged period of stay in intensive care unit. Three months later, he presented with persistent chest discomfort and fever. Computed tomography (CT) of the thorax revealed evidence of graft infection and the blood culture grew Streptococcus viridans. The rarity of TEVAR graft infection due to Streptococcus viridans and its management are being discussed.
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Affiliation(s)
- N H Zubaidah
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Cho JJW, Anand V, Rudmik L, Lysack JT, Dort JC. Impact of newer generation multidetector computed tomography on the diagnosis of abscesses in the head and neck. J Otolaryngol Head Neck Surg 2011; 40:337-342. [PMID: 21777553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To understand how newer generation multidetector computed tomographic (NGCT) scanner technology (≥ 16 slices) has affected the imaging characteristics of head and neck abscesses. DESIGN Retrospective chart review. SETTING Tertiary referral centre. METHODS Forty-eight patients with a head and neck abscess who underwent a soft tissue neck computed tomographic (CT) scan were identified from September 1, 2001, to December 1, 2008. The degree of rim enhancement, delta (Δ), was graded using mean Hounsfield units (HU) from five peripheral points and five central points from a representative CT slice. The difference was then calculated and compared between older generation computed tomography (OGCT; < 16 slices) and newer generation multidetector computed tomography (NGCT; ≥ 16 slices) using the Student t-test. A p value < .05 was considered significant. RESULTS Forty-eight patients met our inclusion criteria. Of these, 20 were scanned with OGCT and 28 were scanned with NGCT. The mean peripheral point values were OGCT = 78 HU (95% CI 71-86 HU), NGCT = 74 HU (95% CI 68-80 HU); p = .3. The mean central point values were OGCT = 24 HU (95% CI 21-28 HU), NGCT = 26 HU (95% CI 21-31 HU), p = 0.7. The mean delta values (mean peripheral HU--mean central HU) were OGCT = 52 HU (95% CI 43-61 HU), NGCT = 46 HU (95% CI 41-52 HU), p = .2. CONCLUSION There is no significant difference between OGCT and NGCT in the amount of rim enhancement seen on CT scans of head and neck abscesses.
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Affiliation(s)
- John J W Cho
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, AB
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Casal RF, Jimenez CA, Mehran RJ, Eapen GA, Ost D, Sarkiss M, Morice RC. Infected mediastinal bronchogenic cyst successfully treated by endobronchial ultrasound-guided fine-needle aspiration. Ann Thorac Surg 2010; 90:e52-3. [PMID: 20868780 DOI: 10.1016/j.athoracsur.2010.06.062] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 05/26/2010] [Accepted: 06/10/2010] [Indexed: 11/19/2022]
Abstract
Bronchogenic cysts are one of the most common bronchopulmonary congenital malformations found in adults. Most authors agree that symptomatic or infected cysts should be surgically removed. We report our experience in which we treated an infected mediastinal bronchogenic cyst with a combination of antibiotics and drainage by endobronchial ultrasound-guided fine-needle aspiration, with resolution of symptoms and no evidence of recurrence after an 18-month follow-up.
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Affiliation(s)
- Roberto F Casal
- Department of Pulmonary and Critical Care Medicine, Baylor College of Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Mandac I, Prkacin I, Matovinović MS, Sustercić D. Septic arthritis due to Streptococcus sanguis. Coll Antropol 2010; 34:661-664. [PMID: 20698149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Septic arthritis may represent a direct invasion of joint space by various microorganisms, including bacteria, viruses and fungi. Although any infectious agent may cause bacterial arthritis, bacterial pathogens are the most significant because of their rapidly destructive nature. We present a case of septic arthritis in a 56-year old male patient due to Streptococcus viridans which is member of the viridans group streptococci. Patient was admitted to Our Hospital presented as fever of unknown origin, losing more than 30 kg of body weight during couple of months, and anemia of chronic disease as paraneoplastic process. He had long history of arterial hypertension and stroke. There was swelling and pain of the right sternoclavicular joint and precordial systolic murmur in physical status. A large diagnostic panel has been made, computerized tomography (CT) of right sternoclavicular joint showed widening of periarticular soft tissue and loss of clavicular corticalis. Cytologic analysis of synovial fluid showed more than 90% of polymorphonuclear leukocytes. There were no crystals on microscopic examination and Gram stain of fluid was negative. Blood cultures were positive for S. sanguis and there was a consideration about possible periodontal disease. Stomatologic examination verified periapical ostitis and extraction of potential cause of infection has been done. Therapy with benzilpenicilline was followed by the gradual improvement of clinical and laboratory parameters. Although viridans group streptococci and Streptococcus sanguis in particular are rare causes of septic arthritis in native joints, they should be considered in the differential diagnosis of periodontal disease.
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Affiliation(s)
- Inga Mandac
- "Merkur, University Hospital, Zagreb, Croatia.
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Badeli H, Mircharkhchian M, Pirooz A. Prolonged sterile dysuria as a first presentation of pyocolpos. Iran J Kidney Dis 2010; 4:82-84. [PMID: 20081311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Pyocolpos is a rare clinical finding in vaginal atresia, especially in childhood. We present a child with pyocolpos and a long history of severe sterile dysuria before she was admitted to hospital with fever, urinary tract infection, and abdominal mass.
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Affiliation(s)
- Hamidreza Badeli
- Department of Pediatric Nephrology, Guilan University of Medical Sciences, Rasht, Iran.
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Horino T, Takao T, Terada Y. A case of post-streptococcal reactive arthritis in which lesions were detected with [18F]-fluorodeoxyglucose positron emission tomography-CT imaging and magnetic resonance imaging. Mod Rheumatol 2009; 20:287-90. [PMID: 20039186 DOI: 10.1007/s10165-009-0264-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 11/27/2009] [Indexed: 11/27/2022]
Abstract
A 55-year-old man with lumbago and polyarthralgia was admitted to our hospital. Laboratory data showed elevated levels of anti-streptolysin O and C-reactive protein. Throat swab culture revealed beta-hemolytic streptococcal infection. Magnetic resonance imaging detected effusion of the lumbar bone and the left hip joint. Positron emission tomography-computed tomography (PET-CT) demonstrated increased fluorodeoxyglucose activity in the bilateral shoulder and hip joints and the interspinal ligament between L2 and L3. He was diagnosed as having post-streptococcal reactive arthritis (PSReA) and treated with amoxicillin hydrate. Polyarthralgia improved and did not relapse. To our knowledge, no results of PET-CT have previously been reported in patients with PSReA. We propose that PET-CT might be a useful tool for diagnosing PSReA.
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Affiliation(s)
- Taro Horino
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kohasu, Okoh-cho, Nankoku, Kochi 783-8505, Japan.
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Brivet FG, Smadja C, Hilbert U, Vons C, Jacobs F, Gordji-Therani H, Musset D. Usefulness of abdominal CT scan in severe peritoneal sepsis linked to primary peritonitis. ACTA ACUST UNITED AC 2009; 37:76-8. [PMID: 15764196 DOI: 10.1080/00365540410024899] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report 2 cases of primary group A streptococcal peritonitis in which emergency abdominal CT scan ruled out a hollow viscus perforation, or necrosis, avoiding unnecessary laparotomy. These cases highlight the usefulness of abdominal CT scan and suggest that blind surgical exploration has no advantages.
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Affiliation(s)
- François Gilles Brivet
- Medical Intensive Care Unit, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris and Université Paris XI, France.
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Abstract
In patients with aortic valve endocarditis, lesion of the mitral valve leaflets caused by jet strike or vegetation touch (kissing) is a well-described complication. We present a case of infectious aortic ulcer caused by aortic valve vegetation kissing. A 72-year-old woman who underwent operation for Streptococcus viridans aortic valve endocarditis presented with a "kissing ulcer" in the aortic wall disclosed by intraoperative transesophageal echocardiography. The aortic valve was replaced by a bileaflet prosthesis, and the ulcer was closed with a small patch of autologous pericardium after thorough inspection. Transesophageal echocardiography performed before discharge showed a good surgical result without signs of infection recurrence. To the best of our knowledge, this is the first report of aortic wall involvement by the mechanism described.
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Affiliation(s)
- Raquel Garcia
- Center of Thoracic Surgery, S. João Hospital, Oporto, Portugal
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Abstract
A patient developed fever, chills, and shortness of breath after an elective first trimester dilation and curettage. Blood cultures grew Group B streptococcus, and a transesophageal echocardiogram revealed a 2 x 2 cm vegetation on the tricuspid valve and global left ventricular hypokinesis. A 6-week course of parenteral antibiotics and vasodilator therapy resulted in resolution of the valvular vegetation as well as of the left ventricular dysfunction.
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Affiliation(s)
- S Kangavari
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Saxena P, Shehatha J, Downie S, Newman MAJ, Konstantinov IE. Translocation of prosthetic aortic valve in advanced prosthetic valve endocarditis. Tex Heart Inst J 2009; 36:604-606. [PMID: 20069091 PMCID: PMC2801941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Advanced prosthetic valve endocarditis is often associated with substantial destruction of the tissues adjacent to the prosthesis. Removal of the infected prosthesis and débridement of the infected tissues make implantation of a new prosthesis challenging. Herein, we discuss successful surgical aortic valve translocation in a 50-year-old man who had advanced acute prosthetic valve endocarditis with destruction of the aortic annulus. One year after being discharged from the hospital, the patient was asymptomatic with good exercise tolerance.
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Affiliation(s)
- Pankaj Saxena
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital & School of Surgery, University of Western Australia, Perth, WA 6009, Australia
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Abstract
Necrotizsing fasciitis is a rapidly developing, fatal bacterial infection of deep subcutaneous tissues. It may occur at any site in the body. We describe a case of necrotizing fasciitis in the breast that was diagnosed on the basis of sonographic findings. Sonographic examination revealed fluid collection in deep tissues with bright echoes likely to represent gas microbubbles. The diagnosis of necrotizing fasciitis was subsequently confirmed on surgical exploration.
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