Background: Propionibacterium acnes is increasingly recognized as a cause of post-neurosurgical infection. This review of patients with P. acnes neurosurgical infection was carried out in order to determine clinical characteristics and outcomes in relation to duration of antimicrobial treatment. Methods:We retrospectively reviewed the charts of consecutive patients with P. acnes isolated from neurosurgical specimens from 1 January 1999 to 30 June 2005. We defined P. acnes neurosurgical infection as isolation of P. acnes alone from a sterile neurosurgical site in a patient who clinically improved following treatment with an appropriate antibiotic. Results:We identified 28 patients with definite P. acnes neurosurgical infection; median age 49 years (range 23-77); 15 (54%) male. All patients had prior neurosurgical procedures: 27 (96%) post-craniotomy. The median time from surgery to presentation was 54 days (range 12-1578). Eighteen out of 28 (64%) patients who met the definition of neurosurgical infection had Gram-positive bacilli seen in at least one surgical specimen compared with only 2/56 (4%) patients who did not meet the definition (P < 0.0001). Intravenous benzyl penicillin + + + + + oral penicillin VK was the most common treatment. The median duration of antibiotic treatment for intracranial infection was 29 days. Five of nine patients who had extracranial bone-flap-associated infection had 7 days of intravenous treatment and were cured. Two patients had relapse or reinfection.Conclusions: P. acnes neurosurgical infection often presents in an indolent fashion. Gram-positive bacilli on Gram stain should not be discounted as a contaminant in neurosurgical specimens. Associated bone flaps should be removed. Intravenous benzyl penicillin + + + + + oral penicillin VK remains effective treatment.
The association with fluoroquinolone exposure suggests that measures to reduce unnecessary use may be an effective preventative strategy. Known colonization with ESBL-E is a strong risk factor for ESBL-E bacteremia, and colonization status should be taken into consideration when choosing empirical therapy.
Infection with herpes simplex virus (HSV) is extremely common worldwide. In immunocompromised patients anogenital HSV disease may have atypical features and may be very severe. Treatment of aciclovir-resistant anogenital HSV disease is challenging, as resistance to alternative treatments may occur, and effective treatment generally involves intravenous therapy with relatively toxic agents such as foscarnet. This case report presents three immunocompromised patients with presumed aciclovir-resistant anogenital HSV disease who were successfully treated with topical imiquimod. Imiquimod promotes local immune activation, which results in resolution of viral lesions such as anogenital warts and HSV disease. It is convenient to use and avoids the necessity for intravenous treatment with substantial systemic toxicity. In addition, as the mode of action of imiquimod is related to immune stimulation rather than direct antiviral activity, it may be used repeatedly without resistance developing.
NF remains an important disease in our community with significant morbidity and mortality. Pacific Islanders were disproportionately represented. Early diagnosis of NF can be difficult and requires a high index of suspicion in all patients presenting with cellulitis or unexplained sepsis. Congestive heart failure and gout are independent predictors of mortality and patients with these conditions and sepsis need early assessment with more aggressive hospital triaging.
Background and objective: Yellow nail syndrome (YNS) is a rare and poorly described disease process. In this case-control study, clinical features and findings on HRCT were compared with idiopathic bronchiectasis (IBx).
Background: Guidelines for long term oxygen therapy (LTOT) recommend increasing oxygen flow by 1 l/min overnight. A study was undertaken in patients with COPD on LTOT to determine the prevalence of overnight desaturation if the usual oxygen flow rate is not increased at night, whether resting oxygen saturation predicts overnight desaturation, and whether overnight desaturation correlates with health related quality of life (HRQL) and sleep quality. Methods: A cross sectional prospective study was performed on consecutive patients with COPD on LTOT attending our regional outpatient oxygen service. All patients fulfilled standard criteria for LTOT, had been established on LTOT at a flow to achieve resting oxygen saturations .90%, but had not been instructed to increase oxygen flow overnight. Overnight desaturation was defined as ,90% for >30% of the night on either of two consecutive nights. HRQL was evaluated with the SF-36 Health Survey Questionnaire, Chronic Respiratory Questionnaire, and the Pittsburgh Sleep Quality Index. Results: Thirty eight patients (63% men) of mean (SD) age 73.5 (8.04) years and mean (SD) forced expiratory volume in 1 second 0.77 (0.35) l were evaluated. Overnight desaturation occurred in six (16%; 95% CI 4 to 27). Desaturators had mean (SD) resting oxygen saturation on room air of 88 (4.2)% compared with 90 (4.1)% in non-desaturators (p = 0.15), and corrected saturations of 93 (2.0)% versus 94 (2.0)% (p = 0.18). HRQL and sleep quality were poor but did not differ between desaturators and nondesaturators. Conclusions: Most patients did not exhibit overnight desaturation despite not increasing their LTOT prescription overnight. These results challenge the recommendation of routinely increasing overnight oxygen flow in patients receiving LTOT.
LTBI screening was incomplete in our clinic, but improved between 2011 and 2014. A significant number of patients with LTBI did not originate from a high TB incidence country.
The spectrum of ciliary disease has widened from a primary upper and lower respiratory tract problem with the appreciation of the key role of sensory cilia. Five disease causing mutations have been discovered, but given the complexity of cilia, many more are likely to be found in the future. Primary ciliary dyskinesia may present with upper or lower airway disease, or be diagnosed after the discovery of associated conditions such as heterotaxy, complex congenital heart disease, and severe esophageal disease. Screening tests include nasal nitric oxide and in vivo measurements of mucociliary transport. Definitive diagnosis is by ciliary biopsy with measurement of ciliary beat frequency and pattern, followed by electron microscopy. Ciliary culture may help distinguish primary ciliary dyskinesia from ciliary abnormalities secondary to infection. Increasingly, genetic testing is becoming available. Once diagnosed, the severity is assessed, and follow-up should be in clinics with expertise in all areas of the condition. The evidence base for current treatment is weak, with no randomized controlled trials; all therapies are directed at complications, not the underlying abnormality. Lower airway disease is treated with airway clearance, antibiotics, and encouragement of exercise. A conservative approach to chronic secretory otitis media is advised. Although in many cases the patient is stabilized by medical therapy, some will go on to lung transplantation. In the future, specific therapies to reverse the ciliary dysfunction may become available. (Clin Pulm Med 2009;16: 219 -225) T raditionally, cilia have been thought of as part of the initial stage of the mucociliary escalator, an essential airway defense mechanism. Dysfunction in this system underlies primary ciliary dyskinesia (PCD). It is now clear that cilia have wide importance during embryogenesis and in multiple organs. Defective ciliary function is implicated in polycystic hepatic and renal disease, hydrocephalus, biliary atresia, retinal degeneration, and rare syndromes such as Bardet-Biedl, Alstrom and Meckel-Gruber, and oro-facial-digital syndromes in addition to nephronophthisis. 1,2 Jeune asphyxiating thoracic dystrophy now appears to be a ciliopathy. 3 As well as the motile cilia responsible for airway defenses, sensory cilia are important in many aspects of embryonic development. Motile nodal cilia have long been known to be responsible for normal right-left orientation, but there are likely to be important roles for cilia also in the development of the kidney, neural tube, the cochlear apparatus, the central nervous system, and the limb bud. 1,2 Although this review focuses on motile cilia and PCD, ciliopathies are a truly multisystem issue. GENETICSPCD is an autosomal recessive inherited disorder, with an estimated incidence of 1:15-30,000, 4 although the requirement for specialized diagnostics and variability of disease symptoms means that this is likely to be an underestimate. PCD has a much higher incidence in certain consanguineous and isolated p...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.