Case report: an unusual presentation of Yersinia enterocolitica infection.

We report on a 30-year-old Dutch marine who was stationed in Eritrea and who was repatriated because of acute paralytic small-bowel ileus. The disease course was short and without signs of infection. After diagnostic work-up, we diagnosed Yersinia enterocolitica infection. To our knowledge this is the first reported case of Yersinia enterocolitica infection causing paralytic ileus in an adult.

Long-term infectious complications and their relation to treatment duration in catheter-related Staphylococcus aureus bacteremia.

The optimal duration of treatment for catheter-related Staphylococcus aureus bacteremia is not known. Short courses (< or = 2 weeks) of therapy should be viewed with caution because essential data on late complications, such as osteomyelitis and metastatic abscesses, are lacking. This study represents a retrospective analysis of the data from 49 adult patients hospitalised in the period 1994-1996 (mean age, 57 years; range, 20-90 years; 47% male) and from whom Staphylococcus aureus was cultured concomitantly from peripheral blood and catheter segments. Forty-six venous catheters, two arterial catheters, and one unknown type of catheter were used. Forty-four patients were treated with effective anti-Staphylococcus aureus antibiotics. Twenty patients had a favourable outcome, defined as no complication and no death during 1 year of follow-up, 24 patients had complications, 14 patients died due to attributable mortality, and 5 other patients died of an underlying disease without showing signs or symptoms of a complication. Patients were categorised according to the duration of treatment. There were small differences between a shorter (1-14 days) and a longer (>14 days) course of antibiotics with regard to favourable outcome (41% vs. 33%), complications (48% vs. 53%), attributable death (31% vs. 20%), and death due to underlying disease (41% vs. 33%), respectively. The rates of complications and death were high, but a definite conclusion cannot be drawn because the study was underpowered. More randomised trials are needed, but, until the results of such trials are available, the duration of therapy should not be shortened to less than 14 days.

Discontinuation of prophylaxis for Pneumocystis carinii pneumonia in HIV-1-infected patients treated with highly active antiretroviral therapy.

BACKGROUND: Prophylactic drugs for Pneumocystis carinii pneumonia (PCP) are strongly recommended for HIV-1-infected patients with CD4 cell counts of less than 200 cells/microL. Because of the highly active antiretroviral therapy (HAART) currently available, we speculated that prophylaxis can be discontinued in patients with CD4 cell counts of more than 200 cells/microL. METHODS: In this prospective observational study, PCP prophylaxis (primary or secondary) was discontinued in HIV-1-infected patients whose CD4 cell count had increased above 200 cells/microL (documented twice with an interval of at least 1 month) as a result of HAART. Patients and their CD4 cell counts were monitored every 3 months. The primary endpoint of the study was the occurrence or reoccurrence of PCP. FINDINGS: 78 patients were enrolled: 62 patients were receiving prophylaxis for primary prevention of PCP and 16 patients for secondary prevention of PCP. At the time of discontinuation of prophylaxis, the mean CD4 cell count was 347 cells/microL, and HIV-1-RNA was not detectable in 61 patients. The lowest mean CD4 cell count during prophylaxis was 79 cells/microL. Patients stopped prophylaxis 9.8 (SD 6.4) months after they started HAART. The mean follow-up after discontinuation of prophylaxis was 12.7 (SD 7.6) months, and none of the patients developed PCP (97.5% one-sided CI 0-4.4%). INTERPRETATION: The preliminary results of this study indicate that PCP prophylaxis can be stopped safely in HIV-1-infected patients whose CD4 cell counts have increased above 200 cells/microL after treatment with HAART.

Perioperative diabetes regulation with the help of a standard protocol.

According to a standard protocol 115 patients (96 type 2 DM, 19 type 1 DM) were treated with a 3 litre glucose 5%/day infusion, KCl and insulin, with the aim of obtaining near-normoglycaemia perioperatively. Blood glucoses of 6.7-10.0 mmol/l were scored as ideal, 3.5-15.0 mmol/l as acceptable, and the remaining values as unacceptable. In 32 patients (28%) the protocol was followed in all aspects, whereas in 45 patients (39%) the protocol was followed in therapeutic aspects (total n = 77.67%, Group 1). In the remaining 38 patients (33%) protocol violations occurred (Group 2). In 48 patients (62%) of Group 1 ideal or acceptable control was obtained perioperatively versus 11 patients (29%) of Group 2 (p < 0.05). In patients with good preoperative long-term regulation (HbA1 < or = 8.0%; n = 81) ideal or acceptable perioperative control was achieved in 58% (n = 47) versus 13% (n = 4) of those (n = 31) with preoperative HbA1 > 8.0% (p < 0.05). Stepwise multiple logistic regression analysis showed that preoperative long-term regulation (HbA1; p < 0.001) and adherence to the protocol (p = 0.022) were the only independent variables with prognostic significance for perioperative blood glucose control. In 17 patients (15%) minor electrolyte disturbances occurred. No patient had frank ketosis. Duration of disease, presence of complications, type of anaesthesia and operation did not affect perioperative diabetes control.(ABSTRACT TRUNCATED AT 250 WORDS)