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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present an analysis of the neurologic manifestations of Staphylococcus aureus infections in 43 patients. Half of the infections whose source could be identified were nosocomial. The spectrum of neurological sequelae included meningitis, solitary and multiple intracerebral and epidural abscesses, cerebral ischemia and hemorrhage, acute encephalopathies, subdural empyemas, spinal abscesses, and radicular compression syndromes. In the majority of patients the course was severe and protracted and relapses were frequent. Mortality was high (28%), even with early diagnosis and treatment; diabetes mellitus, alcohol abuse, and chronic renal failure were unfavorable prognostic factors. In patients with abscess formation early surgical drainage improved the outcome. However, often treatment was complicated by sequestration at inaccessible foci and secondary dissemination. Combined antibiotic therapy with flucloxacillin and chloramphenicol may be the most successful antibiotic regimen.
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PMID:Neurologic manifestations of Staphylococcus aureus infections. Analysis of 43 patients. 752 54

A rare case of a patient with non-insulin-dependent diabetes mellitus (NIDDM) with small cell lung cancer, initially diagnosed as pyogenic vertebral osteomyelitis, was reported. A 40-year-old male patient was diagnosed with NIDDM about 3 years earlier, but he did not receive any treatment. Then, a two-month history of high fever, persistent cough and back pain developed. Chest X-ray film showed a lung infiltrate with a small cavity in the upper portion of the left lung. Computed tomography and magnetic resonance imaging of the chest revealed a tumor mass shadow with osteoclasia along the bodies of the 6th and 7th thoracic vertebral bone. Staphylococcus aureus infection was confirmed by arterial blood culture. Administration of antibiotics resulted in the disappearance of the left lung infiltrate and a slight reduction of the tumor mass in the thoracic vertebral bone, suggesting pyogenic vertebral osteomyelitis as an unusual complication of NIDDM. However, as the tumor mass still remained, needle biopsy for the mass lesion was performed, resulting in the diagnosis of metastasis of small cell carcinoma from the left lung. Gene aberration in this lung disease has been reported recently, and its correlation with NIDDM which may also be induced by genetic abnormality is an interesting question that remains to be resolved.
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PMID:[A rare case of a diabetic patient with small cell lung cancer, initially diagnosed as pyogenic vertebral osteomyelitis]. 775 Jun 28

Staphylococcus aureus infections may occur with greater frequency among patients with diabetes mellitus. This article reviews the available literature as it pertains to diabetes and S. aureus in three categories: colonization/carriage, bacteremia with or without metastatic complications, and dialysis-related infections. The clinical entity of pyomyositis is also discussed.
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PMID:Staphylococcus aureus infections in diabetic patients. 776 12

Pyomyositis is an uncommon infection in temperate climates, usually resulting from Staphylococcus aureus infection of skeletal muscle. In this report, the authors describe a patient with untreated Type 2 diabetes mellitus who suffered nonpenetrating blunt trauma to his left anterior thigh, and S. aureus pyomyositis and secondary osteomyelitis of his proximal tibia and patella subsequently developed as a result of delayed diagnosis and treatment. Patients with diabetes mellitus are at increased risk for the development of pyomyositis because of more frequent S. aureus colonization of skin, nasal mucosa, and oropharynx; a delay in definitive treatment can lead to significant morbidity in these patients. Computed tomography or magnetic resonance imaging may be helpful in the diagnosis of pyomyositis. An anemia of chronic disease may result from this disorder, which resolves with treatment.
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PMID:Case report: diabetes mellitus as a predisposing factor in the development of pyomyositis. 794 86

The aim of the present study was to elucidate the effect of diabetes and metabolic control on the presentation, sources, pathogens and outcome of common infections. Of 515 patients admitted to three departments of internal medicine because of a suspected acute infection, 132 (26%) had diabetes mellitus. Osteomyelitis was diagnosed in 3% of the diabetic patients and in 1% of patients without diabetes, and infection of the extremities in 7% and 0%, respectively (p = 0.003). Klebsiella sp. caused 24% of urinary tract infections in diabetic patients, versus 13% in patients without diabetes (p = 0.1). The percentage of Staphylococcus aureus infections in diabetic patients was 10% versus 5% in non-diabetic patients (p = 0.06). The gross mortality rate in the diabetic patients was 10%, and in patients without diabetes, 12%. In patients without fatal underlying disorders, mortality in the diabetic patients was 10% (2% in patients with glycosylated haemoglobin (GHb) lower than median, and 17% in patients with GHb higher than median) and in the non-diabetic patients 4% (p = 0.04). Five factors were independently and significantly related to mortality in diabetic patients: acute respiratory distress (very large odds-ratio [OR]), coma (OR 3.8, 95% confidence interval [CI] 1.0-14.3), GHb above the median (OR 3.3, 95% CI 1.8-6.2), the interaction between GHb and absence of a severe underlying disorder (OR 12.0, 95% CI 2.9-50.7) and duration of diabetes (OR of 1.072 for 1-year increment, and 1.42 for a 5-year increment). Choice of empiric antibiotic treatment in diabetic patients with suspected bacterial infection should take into account the preponderance of Klebsiella sp. and Staphylococcus aureus infections. The present results favour an association between poor glycaemic control and a fatal outcome of infectious diseases in diabetic patients.
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PMID:Influence of diabetes mellitus and glycaemic control on the characteristics and outcome of common infections. 873 28

The objective of this study was to create a 5-year survivorship model to identify key clinical features of cystic fibrosis. Such a model could help researchers and clinicians to evaluate therapies, improve the design of prospective studies, monitor practice patterns, counsel individual patients, and determine the best candidates for lung transplantation. The authors used information from the Cystic Fibrosis Foundation Patient Registry (CFFPR), which has collected longitudinal data on approximately 90% of cystic fibrosis patients diagnosed in the United States since 1986. They developed multivariate logistic regression models by using data on 5,820 patients randomly selected from 11,630 in the CFFPR in 1993. Models were tested for goodness of fit and were validated for the remaining 5,810 patients for 1993. The validated 5-year survivorship model included age, forced expiratory volume in 1 second as a percentage of predicted normal, gender, weight-for-age z score, pancreatic sufficiency, diabetes mellitus, Staphylococcus aureus infection, Burkerholderia cepacia infection, and annual number of acute pulmonary exacerbations. The model provides insights into the complex nature of cystic fibrosis and supplies a rigorous tool for clinical practice and research.
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PMID:Predictive 5-year survivorship model of cystic fibrosis. 1120 52

PURPOSE: Arthroscopic surgery for septic coxarthritis has not become a well-established technique despite its minimally invasive nature. The authors performed arthroscopic surgery and intraoperative high-volume irrigation on 4 adult patients with septic coxarthritis. This minimally invasive procedure was successful in treating these patients, and there was no recurrence of arthritis or other complications. The purpose of this article is to introduce this 3-directional-approach method of arthroscopic surgery for septic coxarthritis. Type of Study: Case study of arthroscopic surgery for septic arthritis of the hip joint in 4 adults. METHODS: There were 3 women and 1 man with an average age of 58 years. The length of time from onset of symptoms to surgery averaged 36 days. One patient had diabetes; another had subarachnoid hemorrhage and was being treated with steroidal drugs. The etiologic agent was found to be Staphylococcus aureus infection in 2 patients, Serratia sp. in 1 patient, and group-B Streptococcus in 1 patient. Three-directional-approach arthroscopic surgery and intraoperative high-volume irrigation were performed using 20 to 25 L of physiologic saline on the 4 patients. Continuous postoperative intra-articular irrigation was not performed. RESULTS: Inflammatory reactions subsided within 4 weeks of surgery in 3 of the 4 patients and within 6 weeks in the other patient. At the time of the final examination, the postoperative follow-up period ranged from 1 to 6 years and none of the patients had ankylosis of the hip joint. CONCLUSIONS: Three-directional-approach arthroscopic surgery in combination with intraoperative large-volume irrigation is an effective technique for treating septic arthritis of the hip joint because the joint can be preserved and it is less invasive than other open arthrotomy techniques.
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PMID:Arthroscopic surgery for septic arthritis of the hip joint in 4 adults. 1123 51

The case of a 42 year old female patient is described, who presented with abscesses in the lung, the left kidney, the perspiratory glands of the axillae and endophthalmitis as well. Staphylococcus aureus could be isolated from sputum, urine, bronchoalveolar lavage and excisates of the abscesses in the right axilla. After long-term antibiotic and antimycotic treatment, restitutio ad integrum could be achieved. Since the further course excluded underlying malignancy, the septic course of Staphylococcus aureus infection must be regarded as an effect of immunosuppression in long-standing and untreated diabetes mellitus.
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PMID:[Abscesses, endophthalmitis and retinopathy as "initial manifestations" of type 2 diabetes]. 1193 53

Recurrence is a common complication of Staphylococcus aureus infections. A shorter duration of antibiotic treatment for a S. aureus infection has been previously suggested as a possible risk factor for recurrence. We conducted a retrospective cohort study of patients with S. aureus infection complicated by bacteremia who survived their initial treatment (N = 397) at the VA Maryland Health Care System from 1995 to 2004 to determine if 2 weeks or less of antibiotic therapy is significantly associated with a higher rate of recurrence. Recurrence was defined as recurrence of infection because of S. aureus with the same susceptibility to methicillin within 1 year of treatment of the initial bacteremia. Seventeen percent of patients who survived their initial infection had a recurrence of infection. Mean duration of antibiotic therapy in those who recurred was longer than in those who did not recur (21 versus 18 days, P = .18). No evidence was found to support an association between a duration of therapy of 14 days or less and an increased risk for recurrence (RR, 0.68; 95% CI, 0.44-1.04). However, being HIV infected (OR, 4.59; 95% CI, 1.61-13.10), having diabetes (OR, 2.02; 95% CI, 1.13-3.61) and having an infection due to a methicillin-resistant S. aureus (MRSA) (OR, 2.11; 95% CI, 1.17-3.80) were independent risk factors for recurrence. In conclusion, 2 weeks or less of antibiotic therapy was not associated with an increased risk for recurrence. However, patients with diabetes or HIV infection and patients with MRSA infections are at an increased risk for recurrence and should be followed more closely.
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PMID:Risk factors for recurrence in patients with Staphylococcus aureus infections complicated by bacteremia. 1663 40

Formation of carotid artery pseudoaneurysm is uncommon after intensive treatment for head and neck cancer. We encountered a case of postoperative formation of pseudoaneurysm at the left carotid bifurcation in a diabetic man. The risk factors for carotid artery pseudoaneurysm in the patient included diabetes mellitus, previous radiotherapy to the neck, neck dissection, and postoperative Staphylococcus aureus infection secondary to accidental pharyngocutaneous fistula. We successfully obliterated this pseudoaneurysm using a Smart stent and detachable coils without neurological deficits. The possibility of vascular injury after treatment for head and neck cancer must be considered, especially in patients with risk factors for it due to previous treatment.
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PMID:Carotid artery pseudoaneurysm as a rare sequela of surgery for laryngeal cancer. 1669 10


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