RESUMEN
We review biliary tract and gallbladder candidiasis and define patient demographics, risk factors, prognostic factors, and treatment strategies for this infection. This is a 3-year retrospective review of our experience with this disease and a review of the English-language literature. Thirty-one cases of biliary tract and gallbladder candidiasis, including nine in our series, have been examined. The same risk factors that predispose patients to other forms of candidal infection are implicated here. No mortality was found with uncomplicated candidal cholecystitis in nonneutropenic patients treated with cholecystectomy alone. Patients with associated extrabiliary tract candidiasis or candidemia had worse outcomes and required both surgical intervention and antifungal therapy. When risk factors exist for the development of biliary tract or gallbladder candidiasis, the physician should be alert to this possibility. There is no need for antifungal therapy in cases of isolated candidiasis of the gallbladder in nonneutropenic patients.
Asunto(s)
Enfermedades de las Vías Biliares , Candidiasis , Enfermedades de la Vesícula Biliar , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Recurrent aseptic meningitis as a manifestation of systemic lupus erythematosus (SLE) has most often been reported as an adverse reaction to the use of nonsteroidal antiinflammatory drugs. We present a case of recurrent aseptic meningitis and transverse myelitis as the initial manifestation of SLE.
Asunto(s)
Lupus Eritematoso Sistémico/diagnóstico , Meningitis Aséptica/diagnóstico , Meningitis/diagnóstico , Mielitis Transversa/diagnóstico , Mielitis/diagnóstico , Adulto , Líquido Cefalorraquídeo/citología , Diagnóstico Diferencial , Humanos , Masculino , Meningitis Aséptica/patología , RecurrenciaRESUMEN
Prosthetic joint infection caused by Streptococcus pneumoniae is a rare condition. An 86-year-old woman with a S. pneumoniae-infected total knee arthroplasty was successfully treated by a combined medical-surgical approach.
Asunto(s)
Artritis Infecciosa/etiología , Prótesis de la Rodilla , Infecciones Neumocócicas , Anciano , Artritis Infecciosa/terapia , Terapia Combinada , Desbridamiento , Femenino , Humanos , Penicilinas/uso terapéutico , Infecciones Neumocócicas/terapia , Streptococcus pneumoniaeRESUMEN
We have reported a case of Streptococcus pneumoniae endocarditis involving the aortic valve of a 61-year-old alcoholic man. Antibiotic therapy with vancomycin sterilized the blood and valve, but aortic valve replacement was required for progressive congestive heart failure resulting from a ruptured valve leaflet.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Endocarditis Bacteriana/tratamiento farmacológico , Prótesis Valvulares Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus pneumoniae/aislamiento & purificación , Vancomicina/uso terapéuticoRESUMEN
Trichinella encephalitis remains a rare but life-threatening illness. Although well known to clinicians of another era, this disease currently may represent a diagnostic dilemma because of its infrequent occurrence and varied presentations. This report of trichinella encephalitis, presenting as quadriplegia, demonstrates that technological advances such as CAT scan, angiogram, and EEG are of no diagnostic assistance and add nothing to traditional diagnostic modalities, i.e., eosinophilia, sedimentation rate, and muscle biopsy. In some cases of trichinosis encephalitis where hypersensitivity reaction and/or vasculitis is believed to be the inciting factor, cortical steroids may have a role in treatment.
Asunto(s)
Encefalitis/diagnóstico , Triquinelosis/diagnóstico , Biopsia , Sedimentación Sanguínea , Eosinofilia , Femenino , Humanos , Persona de Mediana Edad , Músculos/parasitologíaRESUMEN
All infections occurring in a busy pediatric intensive care unit (PICU) from 1982 to 1984 were characterized by site, bacteriology, acquisition status, and outcome. Standard Centers for Disease Control criteria were employed. Nine hundred sixty-five patients were admitted to the PICU. Mortality was 3.4%. Two hundred twenty-one infections occurred in 180 patients. Infection rates were 23% and 6% for total and PICU-acquired infections, respectively. Infections of the central nervous system (n = 56), lower respiratory tract (n = 53), and genitourinary tract (n = 46) made up 70% of all infections. Haemophilus influenzae (n = 39) was the most commonly isolated pathogen. Staphylococcus aureus (20%) and Klebsiella-Enterobacter-Serratia (18.3%) were most commonly noted in PICU-acquired infections. Twenty infected patients (11.1%) died in the PICU. Lower respiratory tract infections (20.5%) were associated with the highest mortality. Both PICU-acquired and community-acquired infections were associated with similar mortalities. Infected patients in a PICU have a mortality approximately 300% higher than that seen in the overall PICU population. The data presented document the importance of infection and provide information against which similar units can gauge their infection status for quality-assurance purposes.
Asunto(s)
Infecciones Bacterianas/epidemiología , Infección Hospitalaria/epidemiología , Unidades de Cuidados Intensivos , Pediatría , Infecciones Bacterianas/mortalidad , Niño , Preescolar , Infección Hospitalaria/mortalidad , Infecciones por Haemophilus/epidemiología , Hospitales con más de 500 Camas , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Massachusetts , Estudios Prospectivos , Infecciones del Sistema Respiratorio/epidemiologíaRESUMEN
Mixed bacterial pneumonia caused by organisms other than anaerobes has been infrequently reported. We describe six cases and review the literature. Two patients had co-infection with S pneumoniae and L pneumophila. Two were infected with S pneumoniae and K pneumoniae and the others simultaneously harbored M tuberculosis and N asteroides. The first two sets of patients had bacteria isolated from usually sterile sites (blood and lung), while the latter harbored repeatedly isolated organisms not usually felt to be part of the normal respiratory flora. Mixed infection may help explain the substantial mortality still seen from pneumonia. This is especially true if Legionella, mycobacteria, or Nocardia species are encountered where routine smears and cultures may not aid in the diagnosis. Poor clinical response to specific antibacterial therapy in pneumonia should trigger further investigation for other potential pathogens.
Asunto(s)
Infecciones Bacterianas/microbiología , Enfermedades Transmisibles/microbiología , Neumonía/microbiología , Adulto , Anciano , Bacterias Aerobias , Femenino , Humanos , Klebsiella pneumoniae , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis , Nocardia asteroides , Streptococcus pneumoniaeRESUMEN
Optimal empiric therapy for the infected patient in the intensive care unit (ICU) is based on many considerations, including acquisition of illness, severity, and host factors, such as organ dysfunction. In addition, the type of ICU may also play a role in helping decide appropriate empiric therapy. Complete clinical examination and the results of initial Gram's stain provide the most important therapeutic guidelines. Descriptions of the types of infections seen in various ICUs, including medical/surgical, pediatric, coronary care, and neonatal, are presented. Recommendations based on clinical experiences regarding effective therapeutic agents and combinations are provided.