ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Over 260 cases of human ehrlichiosis have been identified in the United States since 1986. A causative agent was recently isolated from a patient and designated Ehrlichia chaffeensis because of serologic and genotypic differences from Ehrlichia canis. Ehrlichia species are obligate intracellular bacteria that infect hematopoietic cells. Human ehrlichiosis is characteristically a systemic febrile illness with headache, myalgias, and frequent gastrointestinal symptoms associated with leukopenia, thrombocytopenia, and mild to moderate hepatic injury following a recent tick exposure. The pathologic findings in several cases suggest that the major pathophysiologic abnormality results from generalized infection of reticuloendothelial cells and peripheral sequestration of leukocytes and platelets. Tetracycline appears to be an effective therapy. The diagnosis depends upon seroconversion to E. chaffeensis in convalescence. Early diagnosis requires clinical suspicion and is probably important for minimizing morbidity that results from delayed diagnosis.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Recent developments have furthered our understanding of endocardi- tis associated with intravenous drug use. Pathogenic differences between right- and left-sided endocarditis have clinically significant implications. Vancomycin may be suboptimal treatment for endocarditis due to methicillin-sensitive Staphylococcus aureus. Except for advanced disease, infection with the human immunodeficiency virus does not alter the course of endocarditis in drug users with both infections. Patients with left-sided endocarditis caused by Pseudornonas aeruginosa frequently suffer major complications; valve replacement is often required, but the optimal timing of surgical intervention is still debated.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Progress in understanding the causation and immunopathogenesis of Lyme disease has continued in the past year. Only by studying the complex relationship between the infecting organism, Borrelia bugdoderi,and the host will improvements in therapy be possible. Physicians in the United States have evaluated large numbers of patients with late neurologic Lyme disease, and a more consistent clinical description of the North American experience is emerging. Laboratory diagnosis remains a problem. Improvements are being made in both the sensitivity and specificity of existing tests and also in the selection of appropriate patients by physicians. Both of these factors will improve predictive value.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The chronic fatigue syndrome is a poorly understood condition of uncertain etiology. Researchers disagree on its case definition, possible causes, associated immunologic and psychiatric factors, and treatment. Recent publications suggest possible links with a virus resembling human T-cell lymphotropic virus type 2 and with natural killer cell dysfunction and other cell-mediated immunologic abnormalities. Links with Epstein-Barr virus, human herpesvirus-6, coxsackie B virus, and systemic Candida infections are questioned. Placebo-controlled studies suggest that essential fatty acid therapy may be helpful, disagree on a role for intravenous immunoglobulin, and dismiss oral nystatin and intramuscular bovine liver extracts as therapeutic modalities.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Recent reports have called attention to the reemergence of invasive group A streptococcal infection in previously healthy hosts. Epidemics have been reported from several countries and have included cryptogenic bacteremias, necrotizing fasciitis, and a toxic shock-like syndrome. Reference laboratories have noted an upswing in isolates bearing M protein types 1 and 3 in strains producing streptococcal pyrogenic exotoxin A. Recent discoveries have elucidated the immunologic mechanisms behind the production of sheck and multiorgan dysfunction by these virulent organisms.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Cat-scratch disease (CSD) is the most common cause of chronic lymphadenopathy in children and is a relatively common cause of lymphadenopathy in adults. The most common unusual complication of CSD is Parinaud's oculoglandular syndrome. The most serious complication is encephalopathy. Many new complications have been described in recent years including systemic recurrent disease, neuroretinitis, glomerulonephritis, arthropathy, Bell's palsy, and facial paralysis. Another potential complication of CSD is bacillary angioma- tosis. Bacillary angiomatosis occurs most frequently in human immunodeficiency virus-infected patients. It usually begins with an eruption of cutaneous papules or nodules, but in some patients cutaneous lesions are absent. Bacillary angiomatosis lesions have been reported in the lymph node, liver, spleen, bone marrow, soft tissue, and intestine. An unusual hepatic lesion is peliosis hepatis caused by bacillary angiomatosis bacilli in human immunodeficiency virus patients. Many of the patients with bacillary angiomatosis have had contact with cats. CSD bacilli and bacillary angiomatosis bacilli are identical in morphology and appearance in tissue sections. CSD and bacillary angiomatosis bacilli have cross-reacting epitopes in immunohistochemical stains employing rabbit anti-CSD antisera. Erythromycin and doxycycline are effective drugs for treating bacillary angiomatosis but historically have not benefited immunocompetent patients with CSD. Therapy with gentamicin or ciprofloxacin is reported to benefit children or adults with CSD. The bacillary angiomatosis agent was recently shown to be closely related to Rochalimaea quintana based on 16s ribosomal RNA homology experiments. Despite the similarities observed between CSD and bacillary angiomatosis, there remains a question as to whether they are related.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Animal and human bite wounds commonly present to accident and emergency departments worldwide. Breach in the integrity of skin by bites results in the inoculation of a multitude of organisms from the skin of the victim and the oral cavities of the aggressor. Infection by unusual and potentially lethal zoonotic pathogens can easily by overlooked. Apart from local wound infection and surrounding cellulitis, fatal septicemia can follow minor bites, sometimes manifesting even after the wound has healed. While there is consensus of opinion on the treatment strategy of established bite wound infection, disagreement surrounds the management of minor noninfected wounds. The use of prophylactic antibiotics in the management of uninfected animal bite wounds remains a prominent contentious issue. Second and third degree burn injury disrupts the anatomic skin barrier and is known to be associated with disturbances in host immune responses. As a consequence, burn wounds are particularly susceptible to microbial colonization and infection from skin and environmental organisms. Although progress in the overall management of burns continues to improve morbidity and mortality, microbial sepsis remains one of the major threats to survival in burn patients. Burn wound infection with its local and systemic complications remains a serious management problem. Since there is paucity of data on many specific management issues, empiric prophylaxis and treatment protocols based on logical assumption are now well established. Several controversial issues relating to the management of bite wounds and the management and microbiology of burn wound infections are discussed in this review.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In the year that has elapsed since the previous review of this subject, there is some evidence that the prevalence pattern of deep soft tissue infections may be changing. Perhaps not surprisingly, a prominent predisposing factor associated with the occurrence of deep soft tissue infections is the presence of some form of host immunoalteration. Thus, advanced age, administration of exogenous immunosuppressive medication for transplantation and inflammatory diseases, diabetes mellitus, and infection with the human immunodeficiency virus are increasingly common risk factors identified in reports of patients who develop deep soft tissue infections.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID