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

Micrococcus strains which are the normal flora members of skin, mucosa and oropharynx, may lead to infections associated with intravenous catheter, chronic ambulatory peritoneal dialysis, venticular shunt and prosthetic valve. In this paper, a case of peritonitis due to Kocuria rosea of Micrococcea family, in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD), was presented. Fiftysix years old female patient was admitted to the hospital by complaints of abdominal pain, nausea and fever. The patient was undergoing CAPD due to chronic renal failure for one and a half year and turbidity was detected in the peritoneal fluid during dialysis. Examination of the peritoneal fluid revealed 1800 cells/mm3, with no evidence of bacteria in Gram and Ziehl-Neelsen stained smears. No bacterial growth was detected in conventional culture media, however, bacteria was isolated from the peritoneal fluid culture on second day by Bactec (Becton Dickinson, USA) automated blood culture system. By means of API identification system (bioMerieux, USA), the causative agent was identified as Kocuria rosea. The patient was successfully treated with intraperitoneal teicoplanin (4 x 40 mg) for 14 days. In conclusion, in patients undergoing CAPD, rare pathogens should be considered in case of peritonitis and peritoneal fluid samples should be inoculated into automated culture systems.
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PMID:[Peritonitis due to Kocuria rosea in a continuous ambulatory peritoneal dialysis case]. 1962 23

Haemophilus influenzae is a rarely reported cause of peritonitis in chronic ambulatory peritoneal dialysis (CAPD) patients. In this report, a peritonitis case due to H. influenzae in a 32-years-old female patient with end-stage renal failure receiving CAPD for 7 years, has been reported. The patient was admitted to our clinic with the complaints of nausea, vomiting, abdominal pain, and cloudy dialysate. She had diffuse abdominal tenderness, however, other systems and peritoneal catheter exit site were found to be normal in physical examination. White blood cell (WBC) count in peritoneal fluid was 1.500/mm3 with 90% neutrophils. Gram stain of the peritoneal fluid yielded moderate number of polymorphonuclear leucocytes but no microorganism. Empirical antibiotic therapy with vancomycin and amikacin was initiated intraperitoneally. Peritoneal fluid and blood cultures were performed using BacT/ALERT (bioMerieux, NC, USA) blood culture system. Although no growth was detected in the blood sample at the end of the 5 days, growth was observed in the peritoneal sample within 48 hours. Gram staining of the positive bottle revealed gram-negative coccobacilli. At the end of an overnight incubation period, the colonies, which grew on chocolate agar, were identified as H. influenzae by using API NH system (bioMerieux, NC, USA). The isolate was found to be beta-lactamase-negative. The antibiotic regimen was switched to cephazoline 2 g/day intraperitoneally. The patient rapidly recovered and the WBC count of the peritoneal effluent decreased to 70/mm3. The therapy was continued for 21 days and she was discharged. The peritoneal catheter was not removed. During 7 months after the therapy, peritonitis did not recur. In conclusion, H. influenzae should be kept in mind as a cause of peritonitis in CAPD patients even though it is an unusual agent and the infection may be successfully treated with intraperitoneal antibiotics without removal of peritoneal dialysis catheter.
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PMID:[A rare cause of peritoneal dialysis-related peritonitis: Haemophilus influenzae]. 1979 24

Aerococcus viridans is a gram-positive, catalase and oxidase negative, microaerophylic and non-motile coccus which is rarely associated with human infections such as endocarditis, meningitis, artritis and bacteremia. We report a case of bacteremia due to A. viridans in a 61-years-old man with malignant gall bladder neoplasm. The patient underwent a surgical operation and on the 5th day of operation he had severe abdominal pain, vomiting, high fever and discharge from operation site. He was transferred to intensive care unit and blood cultures were obtained. Piperacillin-tazobactam was initiated as empirical therapy. Blood cultures performed in Bactec system (Becton Dickinson, USA) yielded catalase negative, gram-positive cocci in tetrads. The isolate was pyrrolidonyl aminopeptidase (PYR) positive and produced alfa-hemolysis on sheep blood agar. These cocci were identified as A. viridans by Vitek 2 Compact System (BioMerieux, France) and identification was confirmed by using mini API System (BioMerieux, France). Antibiotic susceptibility testing performed with Kirby-Bauer disk diffusion method revealed that the isolate was susceptible to trimethoprim-sulfamethoxazole, tigecycline and vancomycin and resistant to penicillin, ampicillin, piperacillin-tazobactam, ceftriaxone, erythromycin, clindamycin and amikacin. The patient was successfully treated with vancomycin (2 x 1 g/day) and completely recovered without complication. In conclusion, A. viridans should be suspected as an opportunistic pathogen in immunocompromised patients and these patients should be treated according to the antibiotic susceptibility test results.
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PMID:[Post-operative bacteremia caused by multidrug-resistant Aerococcus viridans in a patient with gall bladder cancer]. 2045 8

AbdCT for the evaluation of AAP in the ED in the US may be excessive and is potentially (although rarely) misleading and harmful. A selective policy of 'AbdUS first' combined with an observation unit and/or surgeon evaluation prior to AbdCT is preferred to a 'routine AbdCT' policy. Repeated AbdCTs for abdominal pain are not recommended because of cumulative radiation exposure. Standardized and complete history and physical examination, such as that originally designed for computer-aided diagnosis of AAP, along with select laboratory testing and higher utilization of AbdUS lessens the necessity of AbdCT. 'Routine AbdCT' is particularly not necessary for the evaluation of suspected appendicitis. 'Routine AbdCT' lowers the negative appendectomy rate but at the expense of exposure to radiation. Right lower quadrant US and selective use of observation prior to AbdCT for suspected appendicitis, particularly in children, adolescents, and young adults, are warranted. MRI should substitute for AbdCT for the evaluation of suspected appendicitis during pregnancy.
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PMID:The utility of CT scan for the diagnostic evaluation of acute abdominal pain. 3082 70

Porphyrias, particularly acute intermittent porphyria (AIP), are rare disorders which could be associated with systemic lupus erythematosus (SLE). Although the association with AIP has been known since 1952, only 11 cases have been published to date. It is widely known that precipitating causes such as infections, hormonal changes, sunlight exposure, stress and drugs could provoke an AIP crisis. Hydroxychloroquine (HCQ) is usually used in lupus patients, but rarely appears to trigger AIP crises even in SLE patients. The case of a 51-year-old man in whom AIP onset was probably due to hydroxychloroquine use during SLE management is presented. SLE onset was accompanied by fever, pleural, lung and joint involvement with a characteristic SLE autoantibody panel. Although prednisone was given, the joint symptoms did not subside. HCQ was then started; however, some days later the patient suffered anxiety, vomiting and severe abdominal pain refractory to pain-relief drugs and liver function had worsened. No cutaneous lesions were observed. The patient suffered similar episodes accompanied by paralytic ileus and dark-coloured urine, the sediment of which showed no abnormalities. In addition, no myoglobinuria was found. This finding raised the suspicion of AIP and urine tests revealed elevated values of delta-aminolevulinic acid and porphobilinogen. Hydroxychloroquine was preventively suspended and the patient improved notably within a few days. In the following months, the patient suffered no relapse and the prednisone dose could be lowered. Finally, a review of the literature on this topic highlighted the exceptional nature of an API/ SLE association particularly in men. Interestingly, porphyria may present first followed by SLE, or vice versa. The latency period between drug administration and disease onset varies from days to 2 years. Both chloroquine and HCQ may induce PAI in SLE patients. Clinicians should be alerted to a possible association with AIP when a patient with SLE recently put on HCQ presents acute onset of abdominal and/or neurological symptoms and dark urine. Appropriate tests and prompt HCQ cessation are mandatory.
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PMID:Systemic lupus erythematosus and hydroxychloroquine-related acute intermittent porphyria. 3186 45