Infective Endocarditis, a Rare Complication of Late Neonatal Group B Strep Sepsis

Background: Infective endocarditis (IE) is extremely rare in infants with structurally normal hearts. We present a case of Group B Streptococcus (GBS) endocarditis in a 5 week old.Clinical Case: A 5-week old male presented to his local hospital with fever and was diagnosed with GBS sepsis. He received 4 days of intravenous antibiotics and was discharged home with 6 days of oral antibiotics. He re-presented 5 days after discharge with severe sepsis as well as a new pathological pan systolic murmur and was diagnosed with IE following echocardiographic identification of a mitral valve vegetation. He was subsequently transferred to a tertiary cardiology center. Ten days after readmission he developed an intracranial hemorrhage associated with rupture of a mycotic aneurysm requiring emergency evacuation.Conclusion: Late-onset GBS sepsis is rare, but when improperly treated can have severe consequences. Infant IE is extremely rare. When diagnosed prompt treatment must be initiated to provide the best outcome for the patient, including consideration of surgical removal of the vegetation

Epidural abscess caused by Streptococcus milleri in a pregnant woman

BACKGROUND: Bacteria in the Streptococcus milleri group (S. anginosus, S. constellatus, and S. intermedius) are associated with bacteremia and abscess formation. While most reports of Streptococcus milleri group (SMG) infection occur in patients with underlying medical conditions, SMG infections during pregnancy have been documented. However, SMG infections in pregnant women are associated with either neonatal or maternal puerperal sepsis. Albeit rare, S. milleri spinal-epidural abscess in pregnancy has been reported, always as a complication of spinal-epidural anesthesia. We report a case of spinal-epidural abscess caused by SMG in a young, pregnant woman without an antecedent history of spinal epidural anesthesia and without any underlying risk factors for invasive streptococcal disease. CASE PRESENTATION: A 25 year old pregnant woman developed neurological symptoms consistent with spinal cord compression at 20 weeks gestation. She underwent emergency laminectomy for decompression and was treated with ceftriaxone 2 gm IV daily for 28 days. She was ambulatory at the time of discharge from the inpatient rehabilitation unit with residual lower extremity weakness. CONCLUSION: To our knowledge, this is the first reported case of a Streptococcus milleri epidural abscess in a healthy, pregnant woman with no history of epidural anesthesia or invasive procedures. This report adds to the body of literature on SMG invasive infections. Treatment of SMG spinal-epidural abscess with neurologic manifestations should include prompt and aggressive surgical decompression coupled with targeted anti-infective therapy

Viridans streptococcal bacteraemia in paediatric immunocompromised patients with malignant disease

Amongst the paediatric haematology/oncology patients attending the Royal Hospital for Sick Children, Glasgow, episodes of viridans streptococcal bacteraemia increased from 12% of al microbiologically documented bacteraemias (i.e. 10/81) in 1993 to 22% (18/83) in 1994. During the first year of this project (which started in December 1994), ITU support was required following the development of viridans streptococcal bacteraemia on 6 occasions, and of these, there were two fatalities. The overall aim of this study was to improve the management of this infection and to explore preventative strategies. Three different approaches were adopted: (1) an extensive epidemiological analysis was undertaken - to include all episodes of viridans streptococcal bacteraemia from December 1994 to December 2000. (2) Phenotypic, followed by genotypic analyses of isolates of viridans streptococci from mouth swabs and blood cultures were carried out to determine whether the mouth was in fact the source of organisms responsible for this infection. (3) Extensive antibiotic susceptibility studies were performed on all isolates of viridans streptococci from blood culture. In total, 69 episodes of viridans streptococcal bacteraemia occurred in 54 children. The infection was more often associated with patients with haematological malignancy (particularly AML), than those with solid tumours, and in the majority (84%) of episodes, the patients suffered from chemotherapy-induced mucositis or other forms of oral compromise. Forty-eight episodes of infection (70% of total) responded well to antimicrobial therapy with no evidence of additional clinical complications. However, in 21 cases (30% of total), pulmonary complications developed, with 8 of these requiring mechanical ventilation and supplemental oxygen. Five of these 8 cases also developed septic shock. S. oralis was the species most commonly isolated from blood culture (63% of total isolates of viridans streptococci) and S. mitis represented 25% of total isolates. Polymicrobial bloodstream infection occurred in 23% of episodes

Pathology of Gangrene

Pathological features of gangrene are described. Gangrene is commonly caused by infection of anaerobic bacteria. Dry gangrene belongs to noninfectious gangrene. The hypoxic/ischemic condition accelerates the growth of anaerobic bacteria and extensive necrosis of the involved tissue. Clostridial and non-clostridial gangrene provokes gas formation in the necrotic tissue. Acute gangrenous inflammation happens in a variety of tissues and organs, including the vermiform appendix, gallbladder, bile duct, lung, and eyeball. Emphysematous (gas-forming) infection such as emphysematous pyelonephritis may be provoked by Escherichia coli and Klebsiella pneumoniae. Rapidly progressive gangrene of the extremities (so-called “flesh-eating bacteria” infection) is seen in fulminant streptococcal, Vibrio vulnificus, and Aeromonas hydrophila infections. Fournier gangrene is an aggressive and life-threatening gangrenous disease seen in the scrotum and rectum. Necrotizing fasciitis is a subacute form of gangrene of the extremities. Of note is the fact that clostridial and streptococcal infections in the internal organs may result in a lethal hypercytokinemic state without association of gangrene of the arms and legs. Uncontrolled diabetes mellitus may play an important role for vulnerability of the infectious diseases. Pseudomonas-induced malignant otitis externa and craniofacial mucormycosis are special forms of the lethal gangrenous disorder

Multisystem diseases and infections

Differential diagnosis of fevers?, Fever without localizing features?, Sepsis?, Cancer?, General rules of cancer management?, Rheumatoid arthritis?, Osteoarthritis?, Systemic lupus erythematosus?, Typhoid and paratyphoid fevers?, Rickettsioses?, Bartonella?, Ehrlichia?, Coxiella?, Relapsing fevers?, Leptospirosis?, Brucellosis?, Plague?, Melioidosis?, Anthrax?, African trypanosomiasis?, American trypanosomiasis?, Visceral leishmaniasis (kala-azar)?, Infectious mononucleosis?, Measles?, Arboviruses and zoonotic haemorrhagic fever viruses , Ebola and Marburg virus diseases, Crimean-Congo haemorrhagic fever, Rift Valley fever, Lassa fever, Hantavirus infections, Severe fever and thrombocytopenia, Zika virus, Japanese encephalitis , Dengue virus, Yellow fever, West Nile virus , Kyasanur Forest Disease, Chikungunya, Ross River fever, O'nyong nyon

Track 2: Catheter interventions from fetus to adult

Catheter interventions from fetus to adult

Abstracts SA Heart Congress 2014

Index of abstracts: alphabetical listing of first authors