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Query: UMLS:C0014118 (endocarditis)
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Human infections due to fungi belonging to the genus Acremonium occur uncommonly, but unlike infections due to other filamentous fungi, usually affect immunocompetent individuals. Mycetoma, which usually develops following trauma, is the most common infection caused by Acremonium spp. Other sites of infection include the eye (generally following abrogation of ocular defenses), colonizing disease of the lung and gastrointestinal tract, as well as locally invasive infections such as osteomyelitis, sinusitis, arthritis, and peritonitis. Pneumonia and disseminated infections including meningitis, endocarditis, and cerebritis rarely have been reported. Optimal treatment of acremonium infections is not well defined both because infections due to these organisms are rare, and because many reports antedate effective antifungal therapy. In addition, susceptibility testing of filamentous fungi is poorly standardized, and in vitro sensitivity may not correlate with clinical response. Based on anecdotal reports, treatment of most invasive acremonium infections requires a combination of surgical intervention, when possible, and a regimen of amphotericin B. Some azoles also display inhibitory activity. Until more details are available regarding susceptibility of these organisms to antifungal agents, amphotericin B is recommended as initial therapy with the addition of either ketoconazole or fluconazole in infections of a life-threatening nature.
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PMID:Infection due to the fungus Acremonium (cephalosporium). 195 81

The antibiotic carry-over effect occurs when antibiotic transferred onto the agar plate with the subcultured aliquot is sufficient to inhibit the growth of viable bacteria, and results in a falsely low MBC. This phenomenon was eliminated by widely streaking the transferred aliquot over at least one half of a 100 mm agar plate or by centrifugation and resuspension of the organisms in non-antibiotic-containing media prior to plating. Both methods require more effort than the current method of MBC determination, but can be performed in clinical laboratories and are thus highly recommended in the testing of organisms from endocarditis and meningitis patients.
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PMID:Evaluation of two methods for overcoming the antibiotic carry-over effect. 200 76

Although resistance to Listeria monocytogenes infection requires intact T cell-mediated immunity, only 20 patients with human immunodeficiency virus (HIV) infection and listeriosis (including one patient described herein) have been reported to date. Listeriosis developed before AIDS in five cases. Syndromes included meningitis in nine cases, bacteremia in nine, brain abscess in one, and endocarditis in one. Eighteen patients were treated with ampicillin, penicillin, or amoxicillin with or without aminoglycosides. Clinical and microbiologic responses were obtained in one patient with bacteremia treated with vancomycin and in one patient with meningitis treated with trimethoprim-sulfamethoxazole. Three of the nine patients with meningitis died, as did the patient with brain abscess. All nine patients with bacteremia and the patient with endocarditis survived. No case of relapse was documented. L. monocytogenes, although uncommon, should be considered in the differential diagnosis of febrile illness, meningitis, and brain abscess in patients with HIV infection.
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PMID:Listeriosis in patients infected with human immunodeficiency virus. 201 9

Eighty-eight cases of group C streptococcal bacteremia were reviewed retrospectively. Most patients had underlying diseases (72.7%), predominantly cardiovascular disease (20.5%) or malignancy (20.5%). The infection originated most often from the upper respiratory tract (20.5%), the gastrointestinal tract (18.2%), or the skin (17.1%). Prior exposure to animals or animal products was reported in 23.9% of cases. The most common clinical manifestations of group C streptococcal bacteremia were endocarditis (27.3%), primary bacteremia (22.7%), and meningitis (10.2%). Of streptococcal isolates, 61.4% were not speciated, 19.3% were Streptococcus equisimilis, 17.1% were Streptococcus zooepidemicus, and two (2.3%) were Streptococcus equi. The isolates were sensitive to most antibiotics, and most patients were treated with beta-lactam agents. Mortality was high (25.0%), especially among older patients and patients with endocarditis, meningitis, and disseminated infection. Group C streptococcal bacteremia does not differ from bloodstream infection caused by other beta-hemolytic streptococci with regard to clinical presentation, treatment, or outcome.
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PMID:Group C streptococcal bacteremia: analysis of 88 cases. 196 83

Acute disseminated staphylococcal disease may develop in previously healthy children below the age of 15 years. It progresses rapidly and may cause death in a significant number. The diagnostic criteria are infection in 2 or more anatomical sites and isolation of a coagulase-positive Staphylococcus aureus from the blood or from a site of infection. We present an 11.5-year-old boy with disseminated staphylococcal disease with evidence of cellulitis, osteomyelitis and endocarditis. He developed intracranial hemorrhage as a complication and survived, but with mild residual hemiparesis. Nervous system involvement, such as meningitis and brain abscess, have been described in this particularly severe disease. This is the only known report of intracranial hemorrhage as a complication of the disease.
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PMID:[Intracranial hemorrhage complicating acute disseminated staphylococcal disease in a child]. 207 64

Decisions on treatment times with antibiotics are often arbitrary and based on empirical decisions or clinical trials which are too small to exclude even considerable differences between two study groups. Single-dose treatment of uncomplicated cystitis in women has been advocated by many but a careful analysis of available information clearly shows that a single-dose has so far always been inferior to 3-day or greater than 5-day treatment. With trimethoprim-sulphonamide combinations, no further efficacy is gained by increasing the treatment time in uncomplicated cystitis above three days while frequency of side effects increases drastically with extended treatment. In contrast, treatment with beta-lactams, for less than five days seems to result in unacceptable failure rates. In pyelonephritis there are few studies of the efficacy of antibiotic treatment for less than ten days. A comparison of two and six weeks' treatment showed no advantages with the extended time. There has also been a tendency towards reduced treatment times in upper respiratory tract infections such as streptococcal pharyngotonsillitis. However, two studies comparing 10-day treatment to 7-day and 5-day treatments, respectively, have clearly shown that the shorter treatment times give much higher rates of both clinical and bacteriological relapse. In more severe infections such as meningitis, no studies comparing treatment times have been carried out. It seems possible to use treatment for five days or less in meningococcal meningitis while other pathogens should be treated for ten days or longer. In endocarditis, the treatment time must vary with causative pathogens and can only rarely be shorter than four weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Efficacy and safety of antibiotic treatment in relation to treatment time. 209 14

Although listeriosis is an uncommon infection in patients with human immunodeficiency virus (HIV) infection, the frequency of listeriosis in New York City has increased because of the increase in the number of HIV-infected patients. The medical records of 30 patients admitted to three medical centers in New York City from 1981 to 1988 with infections due to Listeria monocytogenes were reviewed. Six patients had AIDS, one was seropositive and asymptomatic, and four had risk factors for HIV infection. While the annual number of cases of listeriosis in patients without risk factors for HIV infection was constant, 9 of the 11 patients with AIDS or with risk factors for HIV infection presented with listeriosis between 1985 and 1988, the last half of the survey period. These patients were male homosexuals or intravenous drug abusers, and all but one were black or Hispanic. Manifestations of listeriosis in patients with AIDS or with risk factors for HIV infection included bacteremia without apparent source in seven, meningitis in three, and endocarditis in one, syndromes that were similar to those in patients without risk factors for HIV infection. Ten of 11 patients were treated with penicillin or ampicillin, and 7 were also given an aminoglycoside. All patients responded well to therapy and no relapses were observed. Physicians should include antibiotics effective against L. monocytogenes when treating AIDS patients with meningitis of unknown origin and consider the diagnosis of listeriosis in patients with sepsis of unknown origin.
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PMID:Listeriosis in patients with HIV infection: clinical manifestations and response to therapy. 210 31

Branhamella catarrhalis was formerly regarded as a common, essentially harmless inhabitant of the pharynx. This misapprehension was caused, in part, by confusion with another pharyngeal resident, Neisseria cinerea. The two organisms can now be differentiated by the positive reactions of B. catarrhalis in tests for nitrate reduction and hydrolysis of tributyrin and DNase. B. catarrhalis is currently recognized as the third most frequent cause of acute otitis media and acute sinusitis in young children. It often causes acute exacerbations of chronic bronchopulmonary disease in older or immunocompromised adults and is incriminated occasionally in meningitis, endocarditis, bacteremia, conjunctivitis, keratitis, and urogenital infections. Virulence-associated factors, such as pili, capsules, outer membrane vesicles, iron acquisition proteins, histamine-synthesizing ability, resistance to the bactericidal action of normal human serum, and binding to the C1q complement component, have been identified in some strains. beta-Lactamase producing strains, first detected in 1976, have risen to approximately 75% worldwide. Thus far, however, practically all American strains of B. catarrhalis remain susceptible to alternative antibiotics. A possible selective advantage of recent isolates is their reportedly heightened tendency for adherence to oropharyngeal cells from patients with chronic bronchopulmonary disease.
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PMID:Branhamella catarrhalis: an organism gaining respect as a pathogen. 212 28

Histopathologic studies and isolation of virus and bacteria in culture were carried out for 71 children less than 5 years of age with fatal pneumonia. A potential microbial etiology was identified for 61 children (86%): bacteria for 19 (27%), virus for 16 (23%), and virus plus bacteria for 26 (37%). Staphylococcus was the most prevalent pathogen, alone or in combination with other organisms, followed by Pseudomonas aeruginosa. Viral infection may predispose to bacterial infection in some children. A correlation of clinical course, results of cultures, and morphologic changes revealed cofactors that may have contributed to a fatal outcome. Lung abscess, pericarditis, myocarditis, endocarditis, and meningitis were associated with bacterial infection. Many patients in this study had severe bronchopneumonia, with a high prevalence of complications such as abscess (62%), atelectasis (40%), pericarditis (28%), and empyema (7%). Such complications added to multiple infections, measles, and malnutrition contributed to the fatal outcome in these children.
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PMID:Etiology of infection and morphologic changes in the lungs of Filipino children who die of pneumonia. 212 58

Streptococcus pneumoniae was isolated from 43 children and 143 adults in a ten year period from 1977 through 1986. There was a high incidence in the males, in the extremes of ages and in the Indian and Others racial groups. The overall mortality rate was 29.5% with a higher rate associated in those with chronic obstructive lung disease, smoking, malignancy and alcoholism, 0.5% of the isolates were resistant to penicillin (of intermediate resistance only) and 16% resistant to tetracycline. Common serotypes isolated were types 1, 4, 14, 3 and 6B, all of which are covered by the pneumococcal vaccine. In children, the common serotypes associated with primary bacteraemia were types 14 and 20; with pneumonia, types 6B, 14, 19A and with meningitis, types 6B, 19F and 19A. In adults, the common serotypes associated with primary bacteraemia were types 20, 11A and 1; with pneumonia, types 3, 4, 7F, 14; with meningitis, types 1, 13, 34 and with endocarditis, type 13. Characteristics of pneumococcal infection, the organism's antibiogram and the serotype distribution are discussed in relation to the work of other investigators.
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PMID:Epidemiology of pneumococcal infection in Singapore (1977-1986). 213 Jul 39


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