From 1990 through 1994, we collected information on all cases of mycotic aneurysms due to non-typhi Salmonella that occurred at the Veterans General Hospital in Kaohsiung, Taiwan. All cases of salmonella bacteremia were reviewed to find any additional cases. A total of 16 cases of salmonella mycotic aneurysms occurred. The mortality rate was 100% among the three patients treated with medical therapy alone. Nine (70%) of the 13 patients who received surgical and medical therapy survived. Ten of the 16 cases were due to Salmonella choleraesuis. Diagnosis was established by computed tomography or aortography. Gallium scans were of no diagnostic utility. A culture of blood from a patient with underlying atherosclerosis that is positive for invasive Salmonella should prompt a search for a mycotic aneurysm. Treatment with a third-generation cephalosporin and resection of the infected vessel is usually successful.
A 68-year-old man had malaise, weight loss, and enlarged right cervical lymph nodes. The first biopsy from a right cervical lymph node showed granulomas with negative acid-fast bacillus (AFB) staining, and he was treated for extrapulmonary tuberculosis with isoniazid, rifampin, ethambutol, and pyrazinamide. Symptoms persisted even after receiving antituberculosis drugs for 2 months. He was transferred to our center for F-18 FDG PET/CT scan under the suspicion of occult malignancy. The PET/CT scan showed increased FDG uptake in the right cervical lymphadenopathy and multiple bony lesions. The second biopsy from the FDG-avid cervical lymph node and bone marrow confirmed nontuberculous mycobacterial (NTM) infection. After another 6 months of adjusted antituberculosis therapy with isoniazid, rifampin, ethambutol, and clarithromycin, a repeat PET/CT scan showed remission of previous lesions.
Repeated electrocardiograms did not show any abnormalities gest an etiological role for indinavir. We believe that the severe except for initial sinus tachycardia. A chest radiograph showed shock and acute respiratory distress syndrome in our patient were diffuse bilateral alveolar infiltrates, consistent with acute respiradue to an idiosyncratic reaction to indinavir. To our knowledge, tory distress syndrome (figure 1). Laboratory investigations reacute respiratory failure and shock associated with first-time use vealed a profile consistent with shock that included high levels of of indinavir have not been reported previously. HIV protease inhibliver enzymes, a low albumin level, and prolonged prothrombin itors represent a new generation of drugs for which relatively little and activated partial thromboplastin times. The level of serum information on rare adverse effects is available, although these cortisol was 807 nmol/L (normal value, 200-700 nmol/L), and drugs are being used on a large scale. Physicians should be aware the level of serum lactate was slightly increased to 3.7 mmol/L of possible unpredictable adverse reactions to these new therapeu-(normal value, 0.6-2.4 mmol/L). In addition, the patient had mild tic agents. leukocytosis (leukocyte count, 10.7 1 10 9 /L; normal value, 4.0-10.0 1 10 9 /L) and thrombocytopenia (platelet count, 62 Although his fever had subsided, general malaise and poor appetite for its diverse clinical manifestations, including pulmonary infections, persisted. Three weeks before presenting at our hospital, he had septicemia, and localized suppurative infections, which may present again been admitted to a local hospital because of recurrent fever acutely or chronically [2]. We present, to our knowledge, the first and was referred to our institution because a diagnosis could not case report of melioidosis manifesting as mycotic aneurysm.be made. A 70-year-old man with hypertension was admitted to Veterans On admission, he had a fever (temperature, 39ЊC); findings of the General Hospital-Kaohsiung, Taiwan, on 25 November 1994 for remainder of the physical examination were unremarkable. bipolar staining of the organism. It is easily grown on standard He was readmitted 10 days after discharge because of persistent culture media and demonstrates a characteristic wrinkling of colofever (temperature, £39ЊC) and progressively increasing general nies with umbonated centers and radiating ridges after 72 hours weakness. A repeated CT scan of the abdomen was obtained on of incubation. B. pseudomallei is unique in that it is intrinsically 5 January 1995 and disclosed a low density, Ç1 cm in size over resistant to numerous antibiotics including aminoglycosides, penithe left, posterior aspect of the infrarenal abdominal aorta. Mural cillin, ampicillin, erythromycin, and first-and second-generation thrombi were seen within the aortic aneurysm with surrounding cephalosporins. Current recommendations for therapy include indesmoplastic reaction, supporting a diagnosis of mycotic aneutravenous cef...
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Patients who participated in the program likely received better patient-centered care given the original Chronic Care Model. Better perceptions of diabetic care assessment also better clinical outcomes. The PACIC instrument can be used for the patient assessment of chronic care in a P4P program.
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