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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe 3 cases of fatal but clinically unsuspected anerobic bacteremia amongst hematopoietic stem cell transplant (HSCT) recipients treated empirically for fever and neutropenia with third or fourth generation cephalosporins. All patients had diarrhea but none had classical findings of neutropenic enterocolitis. HSCT recipients with fever, neutropenia and gastrointestinal tract symptoms such as abdominal pain or diarrhea or with septic shock despite broad spectrum antibiotics should receive an antimicrobial agent with anerobic activity.
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PMID:Fatal anerobic bacteremia after hematopoietic stem cell transplant. 1506 Dec 11

This retrospective study was conducted in order to determine the clinical and microbiologic features of infection with Salmonella enterica serotype Choleraesuis. Between March 1999 and December 2002, 55 patients with 66 isolates were enrolled for analysis. The ratio of males to females was 2.2:1. Most patients were older than 60 years (56%) and had underlying diseases (78%), such as diabetes mellitus, malignancy, and peptic ulcer. Fever (85%) was the most common clinical manifestation, followed by abdominal pain/fullness (31%). The gastrointestinal manifestations, including nausea/vomiting or diarrhea, accounted for only 13% and 11% of patients, respectively. S. enterica serotype Choleraesuis was extremely invasive, with a high predilection to cause bacteremia (78% of the isolates were from blood). Various types of metastatic focal infections were found, including infected arterial aneurysm, osteomyelitis, septic arthritis, urinary tract infection and wound infection. The crude mortality rate was 18% (10 deaths in 55 cases). Nearly all isolates were susceptible to the third-generation cephalosporins. A higher resistance rate to commonly used antimicrobial agents was found with ampicillin (85%, 56/66), trimethoprim-sulfamethoxazole (81%, 40/49), chloramphenicol (96%, 47/49), and ciprofloxacin (49%, 30/61). In view of the emergence of fluoroquinolone resistance, the third-generation cephalosporins appear to be the best choice for treatment of invasive infections caused by this organism.
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PMID:Salmonella enterica serotype Choleraesuis infection in a medical center in northern Taiwan. 1518 91

Streptococcus agalactiae typically induces serious infections in pregnant women and newborns. Nonpregnant adult patients can also be infected and mortality rate exceeds 40%. CAPD peritonitis is very rarely induced by S. agalactiae. Seven cases have been described previously and all had a very severe course, which included bacteremia, septic shock and death. A 27-year-old male with end-stage renal disease due to membranoprolipherative glomerulonephritis type I, who was on CAPD for 17 months, was admitted with the clinical and laboratory picture of CAPD peritonitis. Severe abdominal pain, shaking chills and fever 38.5 microC were also observed at presentation. Streptococcus agalactiae was isolated from the peritoneal fluid and blood culture was sterile. Under treatment with ceftazidime and tobramycin (i.p.) and vancomycin (i.v.) cultures became negative after 48 hours, abdominal symptoms resolved after 12 days and WBC count in the dialysate normalized after 14 days. As a possible source of infection the patient's partner was shown to be a vaginal carrier of a clone of S. agalactiae identical to that isolated in the peritoneal fluid. S. agalactiae is a rare cause of CAPD peritonitis with potentially very serious consequences. Anal or genital tract colonization is, in general, the source of contamination with S. agalactiae. The microbiological findings in the case presented here suggest that colonization of the patient or of his close environment may be important in the pathogenesis of S. agalactiae-induced CAPD peritonitis.
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PMID:Group B Streptococcus (Streptococcus agalactiae) peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). 1557 Nov 87

We describe a case of bacteremia due to Clostridium difficile, which was successfully treated by intravenous vancomycin. A 69-year-old woman was admitted to our hospital because of third degree burn injuries. She was treated with cefazolin for two weeks followed with flomoxef for one week before the operation (debridement and grafting of skin). On the third postoperative day high fever (temperature 40 degrees C), abdominal pain and severe watery diarrhea developed. Antibiotic-associated colitis with bacteremia was diagnosed presumptively, flomoxef was stopped, and oral and intravenous therapy with vancomycin was started. A blood culture taken before the administration of vancomycin yielded C. difficile accompanied with Enterococcus faecalis and Enetrococcus casseliflavus. A stool culture taken on the next day yielded C. difficile, and a stool latex agglutination test was also positive. The patient improved slowly. Parenteral vancomycin was discontinued after two weeks. One week later, the patient developed pneumonia, and imipenem/cilastatin was added. Soon after addition of the agent, she developed recurrent diarrhea despite continual oral vancomycin therapy. The fecal samples obtained at this time were positive for C. difficile by culture and positive for toxins A & B. She was satisfactorily treated with oral vancomycin for a total of four weeks. After the following two weeks, however, recurrence of diarrhea developed again, which rapidly decreased with oral vancomycin for seven days. The patient did well thereafter and was discharged. All three C. difficile isolates from blood and fecal specimens were positive for toxins A & B, and identified the same PCR ribotyping pattern.
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PMID:[Bacteremia due to Clostridium difficile]. 1567 79

We describe a case of Clostridium intestinale bacteremia in a previously healthy adolescent female presenting with fever and abdominal pain. The bacterium was definitively identified via 16S rRNA gene sequencing. This is the first report, in the world literature, of human infection caused by this microorganism.
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PMID:Bacteremia caused by Clostridium intestinale. 1581 49

Transient bacteremia during and after endoscopic procedures is a well-documented phenomenon. Streptococcus viridans peritonitis is frequently associated with peritoneal dialysis, and the infection is probably attributable to hematogenous spread, dental procedures, or transluminal contamination with oral flora. To our knowledge, no reports exist of peritonitis occurring after gastroscopy in peritoneal dialysis patients. Here, we report the case of a 69-year-old male patient receiving automated peritoneal dialysis who required emergency gastroscopy and sclerotherapy plus heat-probe coagulation to control active bleeding from a duodenal ulcer The next day, this patient developed nausea and abdominal pain. The diagnosis of peritonitis was made based on a cloudy peritoneal effluent and a leukocyte count of 11,500 cells/microL with 98% neutrophils. S. viridans was identified in the peritoneal fluid culture. The patient received ceftazidime for 14 days, followed by clarithromycin for 7 days, and he recovered successfully. Patients receiving peritoneal dialysis who undergo esophagogastroduodenal endoscopy are at risk to develop peritonitis, and so antibiotic prophylaxis is desirable.
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PMID:Streptococcus viridans-associated peritonitis after gastroscopy. 1668 85

Neutropenic enterocolitis or typhlitis (from the Greek word typhlon, meaning cecum) is a clinical syndrome that occurs in the setting of disease or chemotherapy-induced neutropenia. The disease is characterized by an inflammatory process involving colon and/or small bowel, and it can result in ischemia, necrosis, bacteremia, hemorrhage, and perforation. The classic clinical features include fever and abdominal pain. The diagnosis is supported by the findings of bowel wall thickening on ultrasonography or CT imaging. The management of neutropenic enterocolitis is controversial. Neither prospective nor high-quality retrospective studies concerning medical or surgical therapies are available. Most authors will recommend initial conservative management with bowel rest, intravenous fluids, total parenteral nutrition, broad-spectrum antibiotics and normalization of neutrophil counts. Surgical intervention is recommended in the setting of obstruction, perforation, persistent gastrointestinal bleeding despite correction of thrombocytopenia and coagulopathy, and clinical deterioration.
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PMID:Neutropenic enterocolitis: current issues in diagnosis and management. 1732 48

We report a case of a 57-year-old female patient who presented with fever, abdominal pain, and bacteremia. A CT scan demonstrated sigmoid diverticulitis and air within the inferior mesenteric vein. The patient underwent exploratory laparotomy and sigmoid colectomy. She was discharged without complications. Septic thrombophlebitis of the inferior mesenteric vein is a rare complication of diverticulitis. It may manifest as bacteremia not responding to intravenous antibiotics. CT scan findings are diagnostic, and include evidence of intraluminal gas within the inferior mesenteric vein. As with any case of complicated diverticulitis, the treatment is surgical resection of the involved colon.
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PMID:Mesenteric venous thrombophlebitis--septic thrombophlebitis of the inferior mesenteric vein: an unusual manifestation of diverticulitis. 1743 39

Spontaneous remissions of acute myeloid leukemia (AML) have been reported in association with infection. Here, we report a case of spontaneous remission of AML in a 47-year-old Saudi Arabian male patient who presented with a few weeks history of recurrent abdominal pain, vomiting and fever. He was diagnosed with acute monocytic leukemia (AML, FAB M5b) and a perforated bowel. He also had Clostridium septicum bacteremia and thus chemotherapy was deferred. He received supportive therapy and intravenous antibiotics. Six weeks later, he achieved spontaneous and complete remission lasting for about 4 months. The remission and relapse were documented by bone marrow examination. Similarly, previous reports of spontaneous remission of AML were short lived and were followed by relapse and progression.
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PMID:Spontaneous remission of acute monocytic leukemia after infection with Clostridium septicum. 1782 21

Salmonellosis is a worldwide health problem; Salmonella infections are the second leading cause of bacterial foodborne illness in the United States. Approximately 95% of cases of human salmonellosis are associated with the consumption of contaminated products such as meat, poultry, eggs, milk, seafood, and fresh produce. Salmonella can cause a number of different disease syndromes including gastroenteritis, bacteremia, and typhoid fever, with the most common being gastroenteritis, which is often characterized by abdominal pain, nausea, vomiting, diarrhea, and headache. Typically the disease is self-limiting; however, with more severe manifestations such as bacteremia, antimicrobial therapy is often administered to treat the infection. Currently, there are over 2,500 identified serotypes of Salmonella. A smaller number of these serotypes are significantly associated with animal and human disease including Typhimurium, Enteritidis, Newport, Heidelberg, and Montevideo. Increasingly, isolates from these serotypes are being detected that demonstrate resistance to multiple antimicrobial agents, including third-generation cephalosporins, which are recommended for the treatment of severe infections. Many of the genes that encode resistance are located on transmissible elements such as plasmids that allow for potential transfer of resistance among strains. Plasmids are also known to harbor virulence factors that contribute to Salmonella pathogenicity. Several serotypes of medical importance, including Typhimurium, Enteritidis, Newport, Dublin, and Choleraesuis, are known to harbor virulence plasmids containing genes that code for fimbriae, serum resistance, and other factors. Additionally, many Salmonella contain pathogenicity islands scattered throughout their genomes that encode factors essential for bacterial adhesion, invasion, and infection. Salmonella have evolved several virulence and antimicrobial resistance mechanisms that allow for continued challenges to our public health infrastructure.
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PMID:Food animal-associated Salmonella challenges: pathogenicity and antimicrobial resistance. 1787 85


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