The Journal of infection
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The Journal of infection · Oct 2008
Vibrio necrotizing soft-tissue infection of the upper extremity: factors predictive of amputation and death.
Vibrio necrotizing soft-tissue infection (VNSTI) is characterized by rapidly progressing soft-tissue necrosis and fulminant septicemia in the at-risk host. Despite advancing antibiotic and infection control practices, VNSTI is still a highly lethal and disabling disease. By evaluating prognostic factors for fatality and major amputation in VNSTI patients, this study was intended to improve treatment strategies, reduce mortality and minimize amputations. ⋯ APACHE II or LRINEC scoring system cannot be used as a reliable tool for early detection of VNSTI. For treating such a highly lethal and disabling disease, clinical acumen remains of paramount importance regardless of the scores. Expanding purpura in these patients is considered an ominous sign and may indicate surgical intervention. A serial survey of ALT/AST or CPK levels can reflect the extent of muscle damage and help determine the optimal time of amputation. Severe hypoalbuminemia also serve as poor prognostic factors implicating a high probability of death or major amputation.
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The Journal of infection · Sep 2008
Native hip joint septic arthritis in 20 adults: delayed presentation beyond three weeks predicts need for excision arthroplasty.
Septic arthritis of native hip joints is an uncommon condition in adults in Western Europe, but continues to present a challenge to medical and surgical management. We set out to study the natural history and bacteriology of the disease in this group, with a particular focus on patients requiring excision arthroplasty (EA). ⋯ In cases that present promptly, combined surgical drainage and intravenous antibiotics should be expected to eradicate infection and to salvage the femoral head. Cases presenting following a delay are more likely to require EA and subsequent hip reconstruction.
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Acute varicella zoster virus (VZV) infection, or chickenpox, is still perceived by many as a mild infection of childhood. However, chickenpox is increasingly common in adults and adolescents who together with immunosuppressed individuals are at a higher risk of severe infection. Antiviral therapy is available which both ameliorates symptoms and decreases the severity of chickenpox if administered early in the course of the infection. ⋯ Active immunisation is available and is universal in many developed countries. This review reflects current best practice in management of chickenpox in adults by specialist physicians in the UK. The accompanying flowchart has been formulated to guide emergency physicians and general practitioners through the decision-making process regarding treatment and admission for specialist care.
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The Journal of infection · Aug 2008
Infective endocarditis in an urban medical center: association of individual drugs with valvular involvement.
Injection drug users (IDUs) develop more right-sided infective endocarditis (IE) than non-IDUs, but it is not known whether this risk is specific to any particular injected drug. This study reviews the clinical characteristics of IE in an urban population and examines the association of drug type with manifestations of IE. ⋯ The epidemiology of IE in this cohort is different from that reported recently in other cohorts, likely due to the high prevalence of IDU. Heroin use may underlie the association between IDU and right-sided endocarditis.