125 research outputs found
Prevention of infections in hyposplenic and asplenic patients: an update
Patients with functional or anatomic asplenia are at a significantly
increased risk of overwhelming infection, particularly involving the
encapsulated bacteria Streptococcus pneumoniae and Haemophilus influenzae.
The risk is highest in infants and young children, but adults also have an
increased risk of infection. Preventive strategies are very important and
fall into three major categories: immunoprophylaxis, antibiotic
prophylaxis and education. Studies have shown that many asplenic patients
are unaware of their increased risk for serious infection and the
appropriate health precautions that should be undertaken. In this article
we emphasise the need for preventive measures in hyposplenic and asplenic
patients. We discuss the value of newly developed conjugate vaccines and
the need for revaccination. Finally we draw up a recommendation for the
preventive management in functional and anatomical asplenic patients
Psoas abscess: report of a series and review of the literature
We describe a series of twelve patients with a psoas abscess seen in a
three-year period in a university hospital and a large teaching hospital
in the Netherlands. In our series, five of the 12 patients had a primary
psoas abscess. The predisposing conditions were intravenous drug use,
diabetes mellitus, prostate carcinoma and haematoma in the psoas muscle in
a patient with haemophilia A. Seven of the 12 patients had a secondary
psoas abscess. Five cases were due to vertebral osteomyelitis including
two cases of tuberculosis. In the other two cases it was due to colitis
and urinary tract infection. It is remarkable that in our series there was
only one patient with a psoas abscess secondary to a disease of the
digestive tract, while this is the most common cause of a secondary psoas
abscess in the literature. There were two cases of tuberculosis which is
an emerging disease again
Liposomal amphotericin B (AmBisome) reduces dissemination of infection as compared with amphotericin B deoxycholate (Fungizone) in a rate model of pulmonary aspergillosis
The efficacy of AmBisome, a liposomal formulation of amphotericin B, was
compared with that of Fungizone (amphotericin B desoxycholate), in a rat
model of unilateral, pulmonary aspergillosis. Repeated administration of
cyclophosphamide resulted in persistent, severe granulocytopenia. The left
lung was inoculated with a conidial suspension of Aspergillus fumigatus,
thus establishing an unilateral infection. Antifungal treatment was
started 40 h after fungal inoculation, at which time mycelial disease was
confirmed by histological examination. Both Fungizone 1 mg/kg and AmBisome
10 mg/kg resulted in increased survival in terms of delayed as well as
reduced mortality. Quantitative cultures of lung tissue showed that only
AmBisome 10 mg/kg resulted in reduction of the number of fungal cfus in
the inoculated left lung. Compared with Fungizone, both AmBisome 1
mg/kg/day and AmBisome 10 mg/kg/day significantly prevented dissemination
from the infected left lung to the right lung. In addition, both AmBisome
regimens reduced hepatosplenic dissemination, and the 10 m/kg dosage fully
prevented this complication. In conclusion, when compared with Fungizone,
in this model AmBisome is more effective in reducing dissemination of
unilateral, pulmonary aspergillosis, even when given in relatively low
dosage. Such low dosages may have a place in prophylactic settings
Clonal expansion of Staphylococcus epidermidis strains causing Hickman catheter-related infections in a hemato-oncologic department
The detailed analysis of 411 strains of coagulase-negative staphylococci
(CoNS) obtained from 40 neutropenic hemato-oncologic patients (61 Hickman
catheter episodes) on intensive chemotherapy is described. By random
amplification of polymorphic DNA (RAPD) analysis, a total of 88 different
genotypes were detected: 51 in air samples and 30 in skin cultures prior
to insertion, 12 in blood cultures after insertion, and only 5 involved in
catheter-related infections (CRI). Two RAPD genotypes of Staphylococcus
epidermidis predominated, and their prevalence increased during patient
hospitalization. At insertion, these clones constituted 11 of 86 (13%)
CoNS isolated from air samples and 33 of 75 (44%) CoNS isolated from skin
cultures. After inser
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