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Although hyperthermia is a component of many endocrine diseases, it is uncommon for fever to be the presenting manifestation of hormonal disorders. During a four year period we encountered six patients, hospitalized principally because of fever, who were found to have endocrine causes for the fever. In all, the admitting diagnosis was infection; three were suspected of having tuberculosis, two of gram-negative bacteremia and one of endocarditis. Except for asymptomatic bacteriuria in one patient (who remained febrile despite appropriate antibiotic therapy) infection was ruled out in all cases, and fever was attributed to "masked" thyrotoxicosis, triiodothyronine (T3) toxicosis, subacute thyroiditis, primary adrenal insufficiency, secondary adrenal insufficiency and pheochromocytoma. In a seventh patient, extreme pyrexia developed in the setting of the thyroid storm. The importance of hormonal mechanisms in thermoregulation is discussed.
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PMID:Hormonal hyperthermia: endocrinologic causes of fever. 21 48

Patients with bacteriuria are at risk for local and distant infectious complications at the time of urologic procedures. The American Heart Association recommends that penicillin and streptomycin be given prophylactically to patients with rheumatic or congenital heart disease without reference to the presence or absence of bacteriuria. A patient with unrecognized calcification of the mitral annulus who underwent cystoscopy for evaluation of urinary retention is reported. Although bacteriuria was present preoperatively antibiotics were not given. Subsequently, Serratia marcescens and possibly Proteus morgani mitral valve infection developed and the patient died. Calcification of the mitral valve annulus and an extensive urinary tract infection were identified at autopsy. This case suggests that calcification of the mitral annulus may be an endocarditis risk factor. The spectrum of prophylactic antibiotic coverage given at the time of urologic procedures to patients with congenital or aquired heart disease, including calcification of the mitral annulus, should include whatever organisms are present in the urine.
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PMID:Gram-negative endocarditis following cystoscopy. 34 Jul 13

The relationship between Staphylococcus aureus bacteremia and bacteriuria was studied over a five year period in three hospitals. In a Veterans Administration Hospital, 59 patients with Staph, aureus bacteremia had a urine culture within 48 hours of a positive blood culture. In 16 of 59 (27 per cent), greater than 10(5) Staph. aureus was recovered from the urine in pure culture. Six of these patients had apparent primary staphylococcal urinary tract infection. Clinical and laboratory parameters in the patients with staphylococcal bacteremia and bacteriuria were compared with those in 31 patients with staphylococcal bacteremia and sterile urine cultures. The two groups differed only in the more frequent occurrence of pyuria and proteinuria in the bacteriuric patients. In two other hospitals, staphylococcal bacteriuria occurred in 7 per cent of patients with Staph. aureus bacteremia and in 13 per cent of cases of staphylococcal endocarditis. Review of autopsy records for 33 patients who died within one month of their bacteremia failed to show a correlation between bacteriuria and the presence of renal abscess. Staphylococcal bacteriuria is a frequent and unexplained concomitant of Staph. aureus bactremia.
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PMID:The association between Staphylococcus aureus bacteremia and bacteriuria. 68 15

In an effort to ascertain important epidemiologic and prognostic risk factors, we analyzed 33 cases of Staphylococcus aureus meningitis occurring over an 8-year period (1976 to 1984). Staphylococcus aureus caused 6% of all bacterial meningitis at our University Hospital. Fifty percent of cases were pediatric and included 7 newborn infants, of whom 71% were either premature or had low birth weight. Major underlying diseases were: central nervous system (CNS) disorders (55%), endocarditis (21%, predominantly intravenous drug abusers), other sites of infection (27%), and prematurity (24%). Fifty-seven percent of patients were bacteremic and 41% of those had concomitant bacteriuria. Hypoglycorrhachia was present in 27% of cases, positive cerebrospinal fluid (CSF) Gram stain in 20%, disseminated intravascular coagulation (DIC) in 19%, and methicillin-resistant organisms in 18%. Cerebrospinal fluid cultures remained positive for a protracted period (mean, 6.7 days) regardless of the presence or absence of a CNS shunt. Overall mortality was 21%. Favorable outcomes were associated with the eventual presence of sterile CSF (15.4% vs. 100% mortality) and the removal of foreign bodies (10% vs. 67% mortality). Mortality was also associated (p less than 0.5) with the presence of diabetes mellitus, age greater than 60, obtundation or coma on presentation, bacteremia, or DIC. Cure correlated (p less than .05) with CNS shunt-associated infections, age less than 1, normal neurologic examinations on presentation, or the absence of DIC or bacteremia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Staphylococcus aureus meningitis: a broad-based epidemiologic study. 382 85

Utilization of rapid microbiologic methods could improve both the quality of patient care and help to reduce patient health care costs through more efficient patient management. Medically urgent situations such as meningitis, endocarditis, bacteremia, some soft tissue infections, ocular infections, and pneumonia in immunocompromised hosts are obvious areas for application of rapid methods. However, efficient management of outpatient infections such as group A streptococcal pharyngitis, bacteriuria, diarrhea, and sexually transmitted diseases could also benefit from rapid test results. Rapid methods for detection of slow growing or unculturable microorganisms represent a promising area for development of new test methodologies. Realization of the potential of various rapid microbiology tests, however, requires that several difficult questions be addressed. Acceptable test rapidity and accuracy must be established by concensus of microbiologists and clinicians. Moreover, new approaches to reduce total test turn-around time and novel means to facilitate physician use of rapid test results must be sought in the immediate future.
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PMID:Rapid methods in clinical microbiology. Clinical situations in which rapid methods may best be applied. 390 30

Enterococci are frequently encountered in urinary, biliary, and gastrointestinal tract infections and are increasingly being recognized in nosocomial bacteriuria and bacteremia. Undoubtedly, however, the most serious of all enterococcal infections is endocarditis. At present, enterococci are the third most common cause of infective endocarditis (after streptococci and Staphylococcus aureus), and the incidence of the disease is likely to grow as the population ages and increasing numbers of persons are placed at risk by degenerative valve disease and by predisposition to enterococcal infections through portals such as the genitourinary tract. The case presented here exemplifies many features of enterococcal endocarditis. It also illustrates the therapeutic issues and dilemmas faced in managing this disorder. Although a transesophageal approach (Figure 1) has increased the sensitivity of echocardiography for detecting valvular abnormalities in infective endocarditis, diagnosis continues to rely on blood cultures--which raises the question of how long antimicrobial therapy should be delayed for collection of blood samples. Since enterococcal isolates are often resistant to antibiotics, therapy is based on synergistic drug combinations.
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PMID:Diagnosis and treatment of enterococcal endocarditis. 834 Apr 32

A randomized open prospective study with antibodies was conducted on 398 cases of TURP to compare the efficacy of either 250 mg of ciprofloxacin twice daily (CF) or 500 mg/160mg of sulfadiazine-trimethroprim twice daily (ST) in the prevention of urinary and other infection complications. The medication was started on the evening preceding the operation and continued up to the day following the removal of an indwelling catheter. The preoperative risk factors were similar in both groups. The groups did not differ in terms of the duration of the operation, the volume of irrigation fluid or the weight of the resected chips. The incidence of immediate complications was 26% in the CF group and 20% in the ST group. All the complications were minor. There were three serious late complications, one intertervertebral discitis and one coxitis in the CF group and one endocarditis in the ST group. The patient with endocarditis died. One the removal of the indwelling catheter on the third postoperative day, bacteriuria was detected in 3% of the patients in the CF group and in 9% in the ST group. The difference was statistically significant (p < 0.05). One month after TURP, bacteriuria was detected in 7% in both study groups. It is concluded that ciprofloxacin may be more effective to preventing immediate urinary tract infections after TURP than a combination of sulfadiazine and trimethoprim. There were three serious late complications. As late as one month after TURP, bacteriuria was still diagnosed in about 7% of all patients, which is post-TURP monitoring of urinary values is important.
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PMID:Prospective randomized open study between ciprofloxacin and a combination of sulfadiazine and trimethoprim in antibiotic prophylaxis in connection with transurethral prostatectomy. 872 63

Urinary tract instrumentation is a significant cause of septicaemia. Review of the literature suggests that selective use of antimicrobials would reduce the risk of septicaemia as this varies between patients and with procedures. Antimicrobial prophylaxis is indicated for patients at high risk of endocarditis, or who are neutropenic. For patients without these risk factors, it is indicated for open, transurethral, or certain forms of laser prostatectomy or trans-rectal prostate biopsy. For cystoscopy, antimicrobials are indicated for patients with preoperative bacteriuria or a preoperative indwelling catheter. Single dose aminoglycosides or oral fluoroquinolones are the agents of choice with the exception of the prevention of endocarditis, where combinations active against streptococci are recommended. For other instrumentations, the risk of antimicrobial toxicity probably outweighs the benefits and a risk-reduction strategy is recommended. Further studies are required to provide definitive answers in many of these areas.
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PMID:Do antimicrobials have a role in preventing septicaemia following instrumentation of the urinary tract? 1086 Jun 85

Intrarenal abscesses remain a significant cause of morbidity and mortality as well as a diagnostic dilemma because a plethora of microorganisms can cause this condition. A definitive diagnosis is made by demonstrating the organisms from the aspirate and the success or failure of therapy depends upon the antimicrobial sensitivity pattern. Enteric fever is a multisystem disorder caused by invasive strains of salmonella. Salmonellosis continues to be a major public health problem, especially in developing countries. Classic enteric fever is caused by S. typhi and usually less severe enteric fevers are caused by S. paratyphi A, B, or C. However, at times S. paratyphi is capable of causing serious and often life-threatening infections like infective endocarditis, pericarditis, empyma, sino-venous thrombosis, osteomyelitis, meningitis, bone marrow infiltration, hepatitis and pancreatitis. There are anecdotal case reports in world literature of abscesses being caused by this organism. Renal involvement like bacteriuria, nephrotic syndrome and acute renal failure have been reported due to S. parayphi A. S. paratyphi A has never been implicated in renal abscess, we report one such case that was managed successfully with medical therapy.
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PMID:Isolation of Salmonella paratyphi A from renal abscess. 1913 4

Bacterial endocarditis is rare in children. We report the case of streptococcal B endocarditis in a newborn whose mother had asymptomatic bacteriuria during pregnancy. This report emphasizes the importance of maternal intrapartum antibiotic therapy when there is a major risk of neonatal infection and underlines the diagnostic value of echocardiography in case of prolonged fever.
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PMID:[Maternal group B streptococcal bacteriuria and neonatal infective endocarditis: a case report]. 2152 95


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