Scandinavian journal of infectious diseases
-
Scand. J. Infect. Dis. · Jan 2006
Review Case ReportsSpondylodiscitis due to Bacteroides fragilis: two cases and review.
Non-iatrogenic spondylodiscitis caused by anaerobic bacteria remains exceptional. We describe 2 cases of spondylodiscitis with epidural abscess due to Bacteroides fragilis, 1 after colonoscopy with biopsy and 1 in a cirrhotic patient. The clinical and imaging findings were not discriminant relative to other pyogenic spondylodiscitis. One should consider B. fragilis when treating a spondylodiscitis with epidural abscess, especially in patients with a possibly digestive portal of entry.
-
Scand. J. Infect. Dis. · Jan 2006
Review Case ReportsAcute acalculous cholecystitis: A rare presentation of typhoid fever in adults.
Adult typhoidal acute acalculous cholecystitis is rare with only 2 cases having been reported in the English literature. We present the case of a previously healthy 36-y-old female who suffered fever, chills, epigastralgia and progressive jaundice for 3 d, with acute acalculous cholecystitis subsequently diagnosed. ⋯ Careful tracing of the history of the patient recalled a history of travel to Indonesia. In adults without common risk factors for acalculous cholecystitis, a detailed history including travel to endemic areas and high index of suspicion for typhoidal acute acalculous cholecystitis are important, and appropriate antimicrobial therapy for covering Salmonella typhi should be considered.
-
Scand. J. Infect. Dis. · Jan 2006
Review Case ReportsFulminant varicella hepatitis in a human immunodeficiency virus infected patient: case report and review of the literature.
We report the case of a 35-y-old HIV-infected female, who presented fulminant varicella hepatitis and recovered under medical treatment. Varicella zoster virus is an uncommon cause of acute liver disease which occurs mainly in immunocompromised patients. Acyclovir is the cornerstone of the treatment.
-
Scand. J. Infect. Dis. · Jan 2006
Validating and updating a prediction rule for neurological sequelae after childhood bacterial meningitis.
Recently, a prediction rule for developing neurological sequelae after childhood bacterial meningitis was developed on a small derivation set. Before implementing in practice a prediction rule must first be tested in new patients (external validation). Our aim was to study the external validity of this rule and, if necessary, to update the rule. ⋯ The ROC area was 0.65 (95% CI 0.57-0.72), which was statistically significantly lower than in the derivation set (0.87 (0.78-0.96)), p-value<0.01. The updated prediction rule showed adequate performance in the combined data sets; the ROC area was 0.77 (95% CI 0.72-0.82). Further study of the generalizability of this updated rule may stimulate application in clinical practice.
-
Scand. J. Infect. Dis. · Jan 2006
A survey of physician's attitudes regarding management of severe group A streptococcal infections.
Intravenous immunoglobulins (IVIG) use in the management of streptococcal toxic shock syndrome remains highly controversial. To evaluate the current management of severe group A streptococcal infections and the feasibility of a randomized controlled trial comparing immunoglobulins versus placebo for streptococcal toxic shock syndrome and/or necrotizing fasciitis, a 32-question mail and web-based survey of Canadian infectious disease specialists was conducted between December 2003 and February 2004. Overall, 172 respondents (90.5%) recommended immunoglobulins as adjunctive treatment of streptococcal toxic shock compared to 67 (35.3%) for fasciitis without toxic shock and 93 (48.9%) for invasive group A streptococcal infections with hypotension. ⋯ From these, a great majority would be willing to enroll patients in a trial comparing IVIG to placebo for streptococcal toxic shock (125/131, 95.4%) and necrotizing fasciitis without shock (152/162, 93.8%). These initial results clearly demonstrate ambivalence in the utilization of intravenous immunoglobulins (IVIG) in invasive group A streptococcal infections in Canada and emphasize the need for further clinical data on immunoglobulin use in streptococcal toxic shock syndrome. They also demonstrate that, although the majority of physicians recommend immunoglobulins, there is important variability between physician recommendations with regard to the indications of use, dose, and time of administration.