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 6,116 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of Candida albicans arthritis involving a knee and cuneiform bone is presented. As with other forms of candidiasis, multiple antibiotic treatment and hyperalimentation predisposed to the infection. Fourteen previously published cases are reviewed. The knee is the most common site of infection and there is a high frequency of associated osteomyelitis. Treatment with both amphotericin and 5-fluorocytosine seems to be effective. The case presented was treated successfully with a small dose of amphotericin followed by five and one-half months of 5-fluorocytosine.
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PMID:Arthritis and osteomyelitis due to Candida albicans: a case report. 33 87

Candida albicans arthritis is uncommon. Although occasional instances of meningitis, osteomyelitis, endocarditis, pneumonia, and extensive visceral involvement due to Candida species have been reported, only 7 documented cases of arthritis caused by Candida albicans are found in the literature. The present case was an infant with a gastroschisis defect of the abdominal wall, who required multiple surgical procedures, prolonged antibiotic therapy, and parental intravenous hyperalimentation. Following a blood stream infection with Candida albicans, septic arthritis of the left knee developed. Treatment with intravenous Amphotericin-B over a 6-week period was successful in eridicating the infection. The child is completely well 9 months after discharge from the hospital. Factors which may predispose patients to infection by Candida albicans include prolonged antibiotic therapy. corticosteroids, generalized debilitation, malnutrition, parental hyperalimentation, and immunosuppressive therapy. Amphotericin-B therapy may be associated with considerable toxicity including azotemia, hepatic dysfunction, and hematologic abnormalities. The therapeutic regimen of Amphotericin-B is effective but a 6-week course of antifungal therapy may be necessary to eradicate septic arthritis of Candida albicans. Surgical drainage is probably indicated only for recent infections.
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PMID:Candida arthritis. A case report and review of the literature. 80 14

A case of Torulopsis glabrata osteomyelitis of the thoracic spine producing spinal cord compression and myelopathy is reported. The patient displayed several of the predisposing factors to T. glabrata infection, including diabetes mellitus, a history of abdominal surgery, and intravenous catheterization with hyperalimentation. The patient was successfully managed with surgical decompression, debridement, and curettage of the affected bone, postoperative immobilization, and systemic amphotericin B therapy. Her pain was relieved, spinal cord function recovered, and the vertebrae healed uneventfully. T. glabrata osteomyelitis is a rare and unpredictably progressive infection. This case demonstrates that it requires prompt therapy and close observation.
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PMID:Torulopsis glabrata vertebral osteomyelitis. 152 Sep 98

This report describes a severe case of perifolliculitis capitis with the rare complication of skull osteomyelitis, a combination not previously reported. The patient demonstrated the typical features of perifolliculitis capitis, namely, rubbery, hard, elevated nodules involving almost the entire scalp with multiple deep-seated abscesses. Bone was exposed in two areas and the diagnosis of skull osteomyelitis was confirmed by skull x-ray films and bone biopsy specimens, which grew Staphylococcus aureus. The patient was treated with enteral hyperalimentation, intravenous antibiotics, and multiple debridements of the scalp, including the involved periosteum and outer cortex of the exposed bone, followed by reconstruction with split-thickness skin grafts. A complete eradication of the disease with closure of all open wounds and clearance of osteomyelitis of the skull was achieved.
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PMID:Severe perifolliculitis capitis with osteomyelitis. 359 11

Four neonates presented with leg-length discrepancy in the first and second year of life, secondary to physeal growth arrest. All four had stormy postnatal periods, requiring indwelling arterial and/or hyperalimentation catheters. One had documented osteomyelitis. In the last three cases, the growth disturbance may have been secondary to aseptic emboli to the bones from the indwelling catheters. In two cases, there was evidence of other nonseptic embolic phenomena.
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PMID:Acquired bone dysplasia secondary to catheter-related complications in the neonate. 394 98

10 patients with serious infections caused by Staphylococcus epidermidis (8 cases of endocarditis in non-prosthetic valves, 1 was complicated by osteomyelitis, 1 case of osteomyelitis, and 1 case of septicemia) are described. Clinical and microbiologic features were evaluated including antibiotic sensitivity and synergy studies, phage typing and biotyping. Endocarditis tended to affect the elderly population and the clinical manifestations were quite similar to those caused by Streptococcus viridans. Both patients with osteomyelitis had involvement of the cervical spine with excellent response to antibiotic therapy. The only patient with septicemia acquired via hyperalimentation had delayed clearance of the bacteremia but ultimately responded to intravenous antibiotics. Rifampicin was the most effective of all antibiotics tested. All isolates were sensitive to penicillinase-resistant penicillins and cephalosporins and over half were sensitive to penicillin. Full synergistic activity was demonstrated with cephalothin and nafcillin in combination with rifampicin, and rifampicin-vancomycin was partially synergistic against the majority of the strains. Five of 8 available isolates were non-phage typeable and no definite pattern was established for various types of infections. Four of the 8 isolates were classified as biotype SIIa, 2 biotype SIIc and 2 biotype SVh.
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PMID:Clinical and microbiologic aspects of serious infections caused by Staphylococcus epidermidis. 636 77

Salmonellosis in older children and adults is usually a self-limited disease, but the risk of complications in infants is not well-defined. We performed a retrospective review of 52 patients. 90 days of age or less, seen at the St. Louis Children's Hospital between 1975 and 1981 with stool cultures positive for salmonella. Sixteen were 30 days old or less (neonates), 21 were 31- 60 days of age, and 15 were 61-90 days old. Among patients in whom blood cultures were done initially, bacteremia was most frequent in neonates: 5/11 (45%), compared to 2/18 (11%) in older infants. All seven infants presenting with bacteremia received 10 or more days of antibiotic therapy: yet complications (osteomyelitis, fatal meningitis or chronic diarrhea) developed in three of five neonates and one of two older infants. Complications also developed in seven of 22 patients who initially had negative blood cultures, including two infants in whom sepsis later developed and two infants who required intravenous hyperalimentation because of chronic diarrhea and malnutrition. The group of 23 patients who did not have blood cultures all did well. Salmonellosis is not necessarily a self-limited infection in young infants. Even in the absence of bacteremia, clinicans would appear to be justified in using antimicrobial therapy in infants 3 months of age or les with salmonella gastroenteritis, particularly neonates of older infants with symptoms of dysentery or failure to thrive.
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PMID:Salmonella gastroenteritis in the first three months of life. A review of management and complications. 714 Jan 21

Candida albicans arthritis in the pediatric patient is rarely reported. In each instance, the patient has had one of the factors that predispose to fungal sepsis: broad spectrum antibiotic therapy, hyperalimentation, prematurity, abdominal surgery, corticosteroid or immunosuppressive therapy, malnutrition, maternal vaginal candidiasis, or lymphoproliferative disorders. To avoid the potentially fatal consequences of delayed treatment, early recognition of the disease is imperative. The patient usually refuses to use the affected joint and plain radiography shows a joint effusion with soft tissue swelling. Osteomyelitis develops in approximately half of the cases. Arthrocentesis with fungal cultures is the best method to make the diagnosis. Treatment is primarily chemotherapeutic and the drug of choice is the membrane inhibitor amphotericin B given intravenously. The antimetabolite 5-fluorocytosine is a second-line drug to be used if resistance develops. All cases before the present one involved the knee joint initially. The case presented involved the left hip and was successfully treated with intravenous amphotericin B.
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PMID:Pediatric Candida albicans arthritis: case report of hip involvement with a review of the literature. 714 47

Several chelates are available for leukocyte labeling. Studies indicate that cells labeled with any of the chelates have a sensitivity for infection of 90% to 95% when imaged at 24 hours postinjection. The sensitivity of 111In-labeled leukocytes at earlier imaging times is more controversial. There has been concern about the utility of labeled leukocytes in musculoskeletal infection. Recent leukocyte studies show a high sensitivity for infected prostheses, even though these infections are often walled off and do not cause systemic symptoms. However, leukocytes frequently miss osteomyelitis of the spine for reasons that are not known. Although some investigators do not recommend the use of 111In-labeled leukocytes in chronic infections, we have found a high sensitivity for infections that are 2 or more weeks old. Autopsy studies from the preantibiotic era indicate that bacterial infections with common organisms have high levels of neutrophil infiltration for months. Labeled lymphocytes from mixed-cell preparations also may play a role in detecting these inflammatory sites. Questions have been raised about the effect of antibiotic therapy on leukocyte sensitivity. Antibiotics do not appear to have a significant effect on scan sensitivity. By reducing the number of bacteria at an inflammatory site, antibiotics reduce the amount of chemotactic inhibitors. In addition, some antibiotics have been shown to directly stimulate leukocyte chemotaxis. Other factors that can theoretically reduce leukocyte function, including hemodialysis, hyperalimentation, hyperglycemia, and steroids, do not appear to reduce labeled leukocyte sensitivity for infection. The specificity of leukocyte uptake is reduced in the gastrointestinal tract and lungs. In these sites, uptake correlates with infection or the true cause of the patients' fever in only 10% to 50% of cases.
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PMID:Indium-111-labeled leukocytes for the detection of infection: current status. 802 76

Postoperative bronchial stump failure is a life-threatening complication, and several surgical approaches and procedures have been developed to close the stump. In this report, we describe a case of left mainstem bronchial stump diastasis after pneumonectomy for lung cancer, in which the bronchial stump was re-closed using a contralateral approach with video-assisted thoracic surgery, with good success. The left main bronchus was closed with an automatic stapler device, but the stump reopened and left pyothorax developed postoperatively. Emergent intratracheal intubation and ventilation was required due to rapid progression of right pyothorax. Under strict nutritional management by IV hyperalimentation, administration of antibiotics to which the organisms were sensitive, and drainage, the patient recovered from pneumonia. However, thoracic air leak increased daily, and reoperation for bronchial diastasis was performed. Using this approach, the left main bronchus near the carina was easily exposed extrapleurally, with only the azygos vein being incised. Video-assisted contralateral treatment was effective in avoiding sternal osteomyelitis due to a transpericardial approach via median sternotomy in the case of mainstem bronchial stump failure, only after left pneumonectomy.
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PMID:Video-assisted contralateral treatment for bronchial stump diastasis after left pneumonectomy. 1071 20


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