Reviews of infectious diseases
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Occult bacteremia, which precedes many serious infections in children, is most often due Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, or Salmonella species. Diagnosis on the basis of clinical judgment is unreliable, although the presence of certain risk factors may suggest the diagnosis. ⋯ Although results are delayed, a culture of blood is the only definitive test. Studies suggest that treatment with various antibiotics may be helpful, but that some drugs, particularly orally administered amoxicillin, should not be relied on to eliminate occult bacteremia or prevent its most serious sequela, meningitis.
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From a total population of 1,002 children with acute lower respiratory infection (ALRI), identification of virus was achieved in 304 cases. In this survey, 1,000 nasopharyngeal aspirate and 13 lung tissue samples were tested in four cell lines (HEp-2, MRC-5, MDCK, and LLC-MK2) and by indirect immunofluorescence (IIF), while 242 paired sera were studied by complement fixation. Respiratory syncytial virus (RSV) was the most frequently detected agent (n = 183), followed by adenovirus (n = 28), parainfluenza (n = 5) and 3 (n = 16) viruses, and influenza A (n = 10) and B (n = 4) viruses. ⋯ The complement-fixation test proved the least effective, with a sensitivity of only 41.5%. Therefore, on the basis of our experience, it appears that the yield for positive diagnosis of virus is increased if both isolation in multiple cell lines and identification by means of IIF are used. Our survey provides for the first time reliable data on the viral etiology of ALRI in Argentina, as determined by three different methods.
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The group B streptococcus is an opportunistic pathogen that causes a variety of serious infections including bacteremias, puerperal sepsis, and neonatal meningitis. Group B streptococcal infections of muscle are rare. We report here an unusual case of group B streptococcal pyomyositis. ⋯ Diagnosis may be greatly aided by radiologic techniques that can demonstrate the sites of muscle enlargement and the presence of fluid collections. The response to antibiotics is usually rapid, but resolution of the infection may require aspiration of deeply situated muscle abscesses. This report describes a diabetic patient with an unusual presentation of pyomyositis that mimicked an acute abdomen.
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Infectious diseases is a relatively new subspecialty in Canada. During the past decade, however, important advances have been made. These include the formation of the Canadian Infectious Diseases Society and the development of the first Royal College of Physicians and Surgeons examinations in the subspecialty of infectious diseases. ⋯ More physicians with training in infectious diseases will be required in Canada in the next decade to fill positions in patient care, microbiology (for individuals with both clinical and laboratory training), research, epidemiology and infection control, programs related to human immunodeficiency virus infections, geographic and international medicine, the pharmaceutical industry, and education and administration. In Canada, the extent to which infectious diseases physicians are involved in these areas varies from that in the United States. This review suggests a continued need for physicians with appropriate training in infectious diseases.
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Toxic shock syndrome is a multisystem illness frequently complicated by hypocalcemia. The etiology of the hypocalcemia, which may be severe, is not well understood. We report two cases of fatal toxic shock syndrome accompanied by severe hypocalcemia; each patient also had an inappropriately elevated serum calcitonin level, which in one case was as high as 179,000 pg/mL. Hypercalcitoninemia may be a cause of the low serum calcium levels as well as of certain clinical manifestations of toxic shock syndrome.