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Query: UMLS:C0085593 (chills)
 4,268 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Salmonella arteritis developed in three patients with subsequent arterial rupture and pseudoaneurysm formation. They had a one- to two-week history of chills and fever, and blood cultures were positive for salmonella. Pulsatile, tender abdominal masses developed in two patients with aortic infection while they were hospitalized. The third patient's femoral artery infection presented as a painful swelling behind the knee. Arteriography demonstrated large vessel rupture with pseudoaneurysm formation and allowed a planned operation in each case. The infected aortic aneurysms were totally excised, the aortic stump oversewn, and the retroperitoneum drained through the flank. Axillobifemoral grafts were constructed to bypass the infection area. Antibiotics effective against salmonella (ampicillin sodium, amoxicillin trihydrate, or chloramphenicol) were given for six weeks postoperatively. Allthree patients are alive without evidence of furhter infection. Recognition that microbial arteritis may be a complication of salmonella infections, particularly when Salmonella choleraesuis and Salmonella typhimurium are cultured, will lead to earlier detection of vascular lesions.
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PMID:Salmonella arteritis: a precursor of aortic rupture and pseudoaneurysm formation. 70 37

We have evaluated three patients with Haemophilus parainfluenzae endocarditis. Two of the three had underlying heart disease. All presented with fever, chills and malaise of less than two weeks' duration. Mitral valve involvement led to congestive heart failure in two of three cases. Treatment proved difficult, despite normally adequate dosages of antibiotics to which the pathogens were sensitive in vitro (ampicillin, 12-20 gm/dag; gentamicin, 3-5 mg/kg/day). Two patients were cured; one died. There was a suggestion of an inverse correlation between vegetation mass and favorable clinical response. Review of the English literature disclosed 22 documented cases of H parainfluenzae endocarditis, including 12 in the antibiotic era.
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PMID:Bacterial endocarditis due to Haemophilus parainfluenzae. 83 83

Presented is the first case report of intraperitoneal Neisseria gonorrhoea infection after tubal ligation. The patient, a 34-year-old women who underwent bilateral tubal ligation 10 years prior to presentation, complained of right lower quadrant pain, fever, chills, anorexia, and constipation. Prior to sterilization, she had been treated at least 3 times for pelvic inflammatory disease (PID). Laparotomy revealed 200 mL of free pus in the abdominal cavity, induration of the proximal stump of the right fallopian tube, and a tuboperitoneal fistula. the intraperitoneal culture was positive for N gonorrhoea and pathology demonstrated acute salpingitis. Treatment with ampicillin, gentamicin, and clindamycin eliminated the infection, although uterine and adnexal tenderness persisted at the 6-week follow-up. Falk's postulate that cornual resection prevents reinfection with PID of the upper genital tract apparently cannot be extended to isthmic interruption of the lower and upper tracts. Since this case demonstrates that there can be ascending gonococcal infection in women with prior tubal sterilization, PID should be part of the differential diagnosis of all sterilized women who present with acute pelvic pain.
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PMID:Gonococcal peritonitis after tubal ligation. A case report. 177 35

A patient with multiple, pyogenic hepatic abscesses is described, and the pathophysiology, etiologies, clinical and laboratory manifestations, and management of the disease are reviewed. A 55-year-old man with a history of ethanol abuse and pancreatitis developed fever, chills, general malaise, and right upper quadrant abdominal pain two weeks before hospitalization. Baseline laboratory and hematology results included serum albumin concentration, 3.2 g/dL; serum alkaline phosphatase concentration, 239 mIU/mL; total serum bilirubin concentration, 1.3 mg/dL; white blood cell count, 18,400/cu mm; red blood cell count, 4.7 million/cu mm; hemoglobin, 12.5 g/dL; and hematocrit, 38.8%. Abdominal ultrasound showed echo-free cavities throughout the hepatic parenchyma; abdominal computed-tomography (CT) scan showed hepatomegaly and multiple radiolucent spaces. CT-guided needle aspiration of a hepatic mass yielded purulent material that grew Fusobacterium necrophorum under anaerobic conditions. On day 7, the patient was started on i.v. ampicillin sodium-sulbactam sodium. A CT scan two weeks later showed a reduction in the number and sizes of abscesses. The patient continued i.v. therapy for one month, then was discharged on a regimen of p.o. amoxicillin trihydrate-clavulanate potassium. Hepatic abscesses are either amebic or pyogenic; the latter usually has a higher mortality. The etiologies of pyogenic hepatic abscesses include ascending cholangitis, portal vein bacteremia, systemic bacteremia, extension from a contiguous focus of infection, and trauma. Diagnosis is difficult and relies highly on clinical suspicion. Clinical symptoms include hepatomegaly, fever, chills, and malaise. Abnormal laboratory values include leukocytosis, anemia, and hypoalbuminemia. The abscesses are frequently polymicrobial; Escherichia coli is the most commonly isolated species. CT is the best radiological technique for diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ampicillin-sulbactam therapy for multiple pyogenic hepatic abscesses. 229 77

A single, selective study was performed in order to evaluate the efficacy and safety of cefotetan in the treatment of complicated urinary tract infections (UTI). Of 34 pre-treatment isolated strains, 60% were pluri-resistant to other antibiotics (ampicillin, carbenicillin, piperacillin, cefalotin, aztreonam) but only 21.2% to cefotetan. Pseudomonas aeruginosa and enterococci were resistant to cefotetan. Escherichia coli was the common strain isolated (50%). Nineteen adult patients, with complicated UTI caused by sensitive organisms, were treated with a 1 g intramuscular (i.m.) daily dose. Duration of treatment ranged from 5-15 days, with a mean of 13.75 days. Within 24-48 h and 30 days post-therapy, the infection was cured in 84% and 52% of patients, respectively. Reinfection, relapse or super-infection occurred in 42% of the cases. In only one patient, the infecting organism did not respond to treatment. The clinical response was evaluated in only seven patients with symptomatic UTI. Six of them (85.7%) were cured after therapy and the cure persisted at follow-up. In most cases, the adverse reactions were local, mild and negligible. In only 15.8% and 10.5% of patients, side-effects (diarrhoea, headache, abdominal pain, tachycardia, chill, pain and erythema in the injection site) were severe and moderate. In these cases, the adverse reactions were reversible when the therapy was discontinued. The relationship between treatment and side-effects was doubtful in two cases. It is concluded that cefotetan, administered at 1 g i.m. daily dose, is effective in treating complicated UTI caused by sensitive organisms, pluri-resistant to other antibiotics.
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PMID:Efficacy and safety of cefotetan in the treatment of complicated urinary tract infections: clinical experience in a selective and single study. 259 2

Endocarditis secondary to Hemophilus parainfluenzae is an uncommon entity that appears to be increasing in frequency, perhaps due to improved laboratory isolation techniques. Although controversial, most of the published literature recommends a penicillin, with or without concomitant gentamicin, as definitive therapy. We report the first successful use of the third-generation cephalosporin ceftizoxime in an ampicillin-allergic patient. A 55-year-old white female was hospitalized after 5 days of experiencing fever, chills, nausea, and vomiting. A cardiac echocardiogram revealed a large mitral valve vegetation, and the patient was treated with intravenous ampicillin, gentamicin, and clindamycin. Two weeks after emergency mitral valve replacement the patient developed spiking fevers and a macular, erythematous rash while receiving ampicillin. Ceftizoxime was initiated and continued to complete a 4-week period of intravenous antibiotics. Follow-up at 14 months showed no further evidence of infection. Ceftizoxime appears efficacious in eradicating H. parainfluenzae in patients allergic to penicillin.
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PMID:Acute bacterial endocarditis due to Hemophilus parainfluenzae. Response to ceftizoxime in an ampicillin-allergic patient. 348 Oct 71

A 27-year old woman admitted to the hospital after 5 days of vaginal bleeding at 12 weeks gestation had had a copper-T IUD inserted 10 months previously. The IUD string was no longer visible at pregnancy testing. Prior to admission she had experienced lower abdominal pain, increasingly heavy vaginal bleeding, fever, malaise, chills, and vomiting. Intravenous ampicillin and metronidazole were commenced and the uterus was evacuated under a general anesthetic. The copper-T was removed from the uterine cavity. A uterine swab at operation and preoperative blood cultures grew E. coli. A moderate degree of disseminated intravascular coagulation (DIC) was indicated by a coagulation profile. The case demonstrates that the copper-T may be associated with intrauterine sepsis and DIC. In the 1st trimester the risk of abortion following removal of a device is near 30%, while the rate of abortion for women in whom the string is no longer visible is near 48%. Patients presenting with pregnancy in the presence of an IUD and symptoms of sepsis should have the uterus evacuated under suitable antibiotic cover.
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PMID:Septic abortion in an IUCD user. 676 7

A case report is presented that involves the extended use of a contraceptive diaphragm and illustrates the problems in promptly establishing a clinical diagnosis of staphylococcal toxin syndrome. A 27-year old woman, 2 months postpartum, was admitted to the hospital after 24 hours of fever, shaking, chills, sweats, nausea and vomiting, and diminished urine output. She had been unable to remove a new coil spring diaphragm, used for the 1st time since parturition, for 3-1/2 days before admission. On the day of admission the diaphragm was removed with some difficulty. A purulent, foul-smelling vaginal discharge at the time the diaphragm was extracted was noted. She was lactating and had had no menses since conception. Her past medical history was unremarkable except for mitral valve prolapse. Evaluation at the time of admission was remarkable for a pulse rate of 120 beats/minute and orthostatic lightheadness. The blood pressure was 110/70 mm Hg when the patient was supine and fell less than 15 mm Hg systolic when she was seated. The white blood cell count was 17,000 with 63% segmented and 33% juvenile polymorphonuclear leukocytes. The sedimentation rate was 45 mm/hour. Multiple cultures of vagina, throat, urine, and blood were obtained. Vigorous intravenous fluid and electrolyte therapy was administered, and the patient was initially begun on ampicillin and tobramycin. Shortly after the appearance of the rash, staphylococcal toxic shock syndrome (TSS) was suspected, and the ampicillin was changed to oxacillin. The rash and strawberry tongue faded within 24 hours, and she became normotensive and afebrile by the 2nd hospital day. She was changed to oral dicloxacillin as the only antibiotic on the 4th hospital day, after the culture results were confirmed. At the time of discharge on the 6th hospital day, desquamation of the skin on the palms and soles had started and continued for another 7-10 days. A 10 day course of dicloxacillin was completed. Follow-up vaginal, cervical, and pharyngeal cultures 3 and 5 months later contained no S. aureus. The patient had resumed menstruation but was not using tampons or a diaphragm. Increased vigilance for the potential dangers of using vaginal occulusive devices when the lower genital tract is colonized by S. aureus is necessary.
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PMID:Prolonged use of a diaphragm and toxic shock syndrome. 710 18

A total of 592 children with clinical diagnosis of typhoid fever admitted to the Dr B. C. Roy Memorial Hospital for Children, Calcutta, India during the period between February 1990 and January 1992, were screened for Salmonella typhi by blood culture. S. typhi was isolated from 221 (37.3%) cases. The majority of the strains (92.3%) showed multi-drug resistant (MDR). They were resistant to chloramphenicol, ampicillin, tetracycline and trimethoprim-sulphamethoxazole. However, all the strains were uniformly (100%) susceptible to gentamicin, amikacin, furazolidone, norfloxacin and ciprofloxacin. Minimum inhibitory concentration of the antimicrobial agents against the resistant strains of S. typhi ranged between 200 and > 1600 micrograms/ml. Phage type 0 was most frequently encountered. The rate of isolation of S. typhi was more or less the same in all the pediatric age groups. The majority of the cases came from lower socio-economic classes with poor personal hygiene. Fever was the main presenting feature in all the cases. Other associated features of the MDR typhoid fever cases, who were uncomplicated during admission, were headache (36.0%), chill and rigor (23.2%), diarrhea (37.2%), anorexia (26.2%), vomiting (23.8%), cough (18.0%) and abdominal pain (19.8%). Hepatosplenomegaly was present in 42.4% cases. However, complications were less frequently encountered among the MDR typhoid fever cases who were uncomplicated during admission and treated as in-patients. Fourteen bacteriologically-confirmed MDR typhoid fever cases had jaundice and another 18 cases had an abnormal state of consciousness during admission. Four (2.0%) bacteriologically-confirmed MDR typhoid fever patients died during the period of observation.
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PMID:Multi-drug resistant typhoid fever in hospitalised children. Clinical, bacteriological and epidemiological profiles. 795 89

An 83-year-old woman suddenly fell ill and was admitted to the hospital on suspicion of a heart attack. After admission she developed high fever, chills and malaise. Vibrio metshnikovii and Staphylococcus hominis were isolated from 2 separately obtained blood cultures. One of the cultures also yielded Escherichia coli. The patient's condition improved rapidly after treatment with ampicillin intravenously. To our knowledge, this is the fourth reported case of V. metschnikovii bacteremia in humans.
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PMID:Mixed bacteremia with Vibrio metschnikovii in an 83-year-old female patient. 798 86


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