The Medical clinics of North America
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NSTI is a life-threatening, surgical, and medical emergency. Clinical presentation, at least in the initial phase, can be misleading. ⋯ A high index of suspicion is important in early recognition and in instituting prompt therapy without delay. Early diagnosis, aggressive surgical debridement, aggressive supportive care, and optimal presumptive antibiotic therapy significantly improve morbidity and mortality associated with NSTIs.
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The diversity in intra-abdominal/pelvic infections is more than any other organ system. Several clinical scenarios can end up in intra-abdominal infections. ⋯ Intra-abdominal infections can masquerade as fever of obscure origin or as dysfunction of neighboring organs, such as lower lobe pneumonia related to a subphrenic abscess or an abscess causing small bowel obstruction. An urgent surgical intervention is the mainstay of the management of serious intra-abdominal infections.
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Med. Clin. North Am. · Nov 2012
ReviewRole of molecular diagnostics in the management of infectious disease emergencies.
In the setting of infectious disease emergencies, rapid and accurate identification of the causative agent is critical to optimizing antimicrobial therapy in a timely manner. It is clearly evident that the age of molecular diagnostics is now upon us, with real-time PCR becoming the standard of diagnosis for many infectious disease emergencies in either monoplex or multiplex format. Other molecular techniques such as whole or partial genome sequencing, microarrays, broad-range PCR, restriction fragment length polymorphisms, and molecular typing are also being used. ⋯ These new technologies will not substitute for a proper history and physical examination leading to a thoughtful differential diagnosis. None the less, these new molecular tests increase the capability of the diagnostician to rapidly identify the microbiological etiology of an infection. An added advantage of rapid diagnostic tests often not emphasized is the capability to rule out certain diagnoses for which unnecessary antimicrobial therapy may otherwise be instituted and/or continued.