RESUMEN
Prosthetic joint infection with Mycobacterium tuberculosis usually involves the hips or knees and can result from either local reactivation, or less often from hematogenous spread. Predisposing conditions include rheumatoid arthritis, chronic steroid use and pulmonary diseases. The most common symptom at presentation is pain, and the most common physical finding is joint swelling and/or a draining sinus tract. The sedimentation rate is helpful when elevated but is nonspecific, and initial skin testing is only helpful when positive. The diagnosis depends on culture and histologic examination of tissue. Removal of the joint combined with oral antituberculous treatment is necessary when the infection is discovered greater than six weeks post joint replacement. Early diagnosis leads to decreased morbidity. Tuberculous infection of prosthetic joints is a rare disease and its diagnosis depends on a high degree of clinical suspicion.
Asunto(s)
Articulación de la Rodilla , Prótesis de la Rodilla/efectos adversos , Mycobacterium tuberculosis/aislamiento & purificación , Infecciones Relacionadas con Prótesis/microbiología , Tuberculosis Osteoarticular/microbiología , Anciano , Antituberculosos/uso terapéutico , Remoción de Dispositivos , Femenino , Humanos , Prótesis de la Rodilla/microbiología , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/cirugía , Tuberculosis Osteoarticular/tratamiento farmacológico , Tuberculosis Osteoarticular/cirugíaRESUMEN
Central nervous system (CNS) infection with Morganella morganii is very rare. We describe a 38-year-old female patient with frontal brain abscess caused by M morganii who was unsuccessfully treated. We also review all reported cases of Morganella CNS infections with an emphasis on treatment modalities and outcomes. Aggressive surgical management and appropriate antimicrobial therapy can lead to cure, but the mortality rate for these infections remains high.
Asunto(s)
Infecciones del Sistema Nervioso Central/diagnóstico , Infecciones por Enterobacteriaceae/diagnóstico , Morganella morganii/patogenicidad , Adulto , Anciano , Antibacterianos/clasificación , Antibacterianos/uso terapéutico , Infecciones del Sistema Nervioso Central/diagnóstico por imagen , Infecciones del Sistema Nervioso Central/tratamiento farmacológico , Infecciones del Sistema Nervioso Central/microbiología , Infecciones por Enterobacteriaceae/diagnóstico por imagen , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/microbiología , Resultado Fatal , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Morganella morganii/efectos de los fármacos , Tomografía Computarizada por Rayos XRESUMEN
Nonmenstrual toxic shock syndrome (TSS) due to Staphylococcus aureus can lead to significant morbidity and mortality. While drotrecogin alfa (DA) has been employed in patients with Methicillin-resistant Staphylococcus aureus (MRSA) severe sepsis and septic shock, its utility in TSS remains unclear. The authors report a case of severe sepsis in the setting of MRSA-associated TSS that responded to treatment with DA. This case illustrates a potential role for DA in the treatment of toxic shock syndromes and emphasizes the importance of aggressive diagnostic and therapeutic modalities in approaching these conditions.