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1.
Medicine (Baltimore) ; 99(44): e22938, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126360

RESUMO

RATIONALE: Sternoclavicular joint septic arthritis is an unusual disease in healthy adults, and Staphylococcus aureus is the most common causative pathogen. The current treatment of choice is surgery with sternoclavicular joint resection and pectoralis flap closure, especially when the disease is complicated by osteomyelitis and abscess. PATIENT CONCERNS: Here, we report a 76-year-old woman without risk factors who visited our hospital for pain and redness, swelling on the left anterior chest wall. DIAGNOSIS: Magnetic resonance imaging showed infectious arthritis in the left SCJ, with multiple abscess pockets at the subcutaneous layer of anterior chest wall communicating with the joint cavity. Streptococcus agalactiae was isolated from blood culture. INTERVENTION: She was treated with 6 weeks of antibiotic therapy. OUTCOMES: After antibiotic treatment, she was successfully treated without recurrence. LESSONS: Besides surgery, medical treatment should also be considered for sternoclavicular joint septic arthritis, depending on patient status and the causative pathogen. Physicians should be aware of this rare disease to facilitate its prompt diagnosis and management.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Articulação Esternoclavicular , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus agalactiae , Idoso , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/microbiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Testes de Sensibilidade Microbiana , Articulação Esternoclavicular/microbiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/diagnóstico por imagem , Streptococcus agalactiae/efeitos dos fármacos
3.
Ophthalmic Plast Reconstr Surg ; 31(6): e157-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-24901377
4.
J Child Neurol ; 30(6): 749-56, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25117419

RESUMO

We applied PET scanning with (11)C-[R]-PK11195 (PK) to evaluate neuroinflammatory changes in basal ganglia and thalamus in children with clinically diagnosed pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) and Tourette syndrome. Seventeen children with PANDAS (mean age: 11.4 ± 2.6 years; 13 males), 12 with Tourette syndrome (mean age: 11.0 ± 3.0 years; 10 males), and 15 normal adults (mean age: 28.7 ± 7.9 years; 8 males) underwent dynamic PK PET imaging and binding potential, a measure of ligand-TSPO receptor (expressed by activated microglia) binding, was calculated for basal ganglia and thalamus. Binding potential values, suggesting underlying activated microglia-mediated neuroinflammation, were found to be increased in bilateral caudate and bilateral lentiform nucleus in the PANDAS group and in bilateral caudate nuclei only in the Tourette syndrome group, compared to control group. These differences in the pattern and extent of neuroinflammation also signify a possible difference in pathophysiological etiology between PANDAS and Tourette syndrome patients.


Assuntos
Doenças Autoimunes/metabolismo , Gânglios da Base/metabolismo , Inflamação/metabolismo , Tomografia por Emissão de Pósitrons/métodos , Infecções Estreptocócicas/metabolismo , Tálamo/metabolismo , Síndrome de Tourette/metabolismo , Adolescente , Adulto , Envelhecimento/metabolismo , Doenças Autoimunes/diagnóstico por imagem , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/fisiopatologia , Radioisótopos de Carbono/administração & dosagem , Criança , Humanos , Inflamação/diagnóstico por imagem , Isoquinolinas/metabolismo , Transtorno Obsessivo-Compulsivo , Infecções Estreptocócicas/diagnóstico por imagem , Tálamo/diagnóstico por imagem , Tálamo/fisiopatologia , Síndrome de Tourette/diagnóstico por imagem , Adulto Jovem
5.
Vascular ; 21(1): 6-9, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22375044

RESUMO

Infections with Streptococcus equi zooepidemicus are rare and are associated with contact with animals or animal products. There are very few reports about infected vascular grafts or aneurysms with this etiology. We present two patients. The first is a 77-year-old man with an infected bifurcated graft four years after an open operation for an abdominal aortic aneurysm (AAA). The second is a 72-year-old man with a symptomatic mycotic AAA, treated with endovascular aneurysm repair. Both received prolonged treatment with bactericidal antibiotics and responded well. Follow-up time at present is 5.5 years for the first, and 4.5 years for the second, patient.


Assuntos
Aneurisma Infectado , Antibacterianos/uso terapêutico , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Infecções Relacionadas à Prótese , Infecções Estreptocócicas , Streptococcus equi/isolamento & purificação , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/tratamento farmacológico , Aneurisma Infectado/microbiologia , Animais , Aortografia/métodos , Implante de Prótese Vascular/instrumentação , Drenagem , Procedimentos Endovasculares/instrumentação , Cavalos , Humanos , Masculino , Testes de Sensibilidade Microbiana , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/transmissão , Infecções Estreptocócicas/diagnóstico por imagem , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/transmissão , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Zoonoses
7.
Pediatrics ; 102(6): 1376-82, 1998 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9832572

RESUMO

OBJECTIVE: To describe the clinical and microbiological characteristics of infants and children with bone and joint infections caused by penicillin-susceptible and penicillin-nonsusceptible strains of Streptococcus pneumoniae. DESIGN: Multicenter, prospective patient accrual; retrospective chart review of identified patients. SETTING: Eight children's hospitals in the United States. PARTICIPANTS: Forty-two children with bone and/or joint infections prospectively enrolled in the United States Pediatric Multicenter Pneumococcal Surveillance Study from September 1, 1993 to August 31, 1996. OUTCOME MEASURES: Data were collected on multiple variables, including age, gender, race, days of symptoms before and during hospitalization, antibiotic and surgical therapy, laboratory and imaging studies. RESULTS: Of the 42 children enrolled (21 bone, 21 joint infections), 14 had isolates that were not susceptible to penicillin. Eight of 16 (50%) strains isolated from children who received antibiotics within 4 weeks before hospitalization were not susceptible to penicillin, compared with 4 of 15 (27%) strains isolated from children without previous antibiotic exposure. Clinical response to therapy was similar between children infected by penicillin-susceptible strains compared with those infected by penicillin-nonsusceptible strains, including duration of hospitalization (9.1 days vs 11.2 days), days of intravenous antibiotic therapy (25.3 days vs 24.6 days), days of fever (3.6 days vs 3.1 days), and sequelae (14% vs 7%). The most commonly prescribed single agents for parenteral therapy in definitive treatment were ceftriaxone (36%), penicillin (15%), and clindamycin (15%). Oral therapy followed parenteral therapy in 56% of children. The mean (+/- standard deviation) duration of total antibiotic therapy in children with osteomyelitis was 57.5 +/- 48.6 days (range, 23-196 days) and 29.2 +/- 11.8 days (range, 12-67 days) for arthritis. Late sequelae (long-term destructive changes of the bone or joint) were documented in 5 (12%) children, 4 with osteomyelitis, and 1 with arthritis. Sequelae occurred in 30% of children with long bone osteomyelitis associated with infection in the adjacent joint. The age of children with sequelae was younger than those without sequelae (6.4 months vs 18.6 months). CONCLUSIONS: The demographic characteristics and anatomic sites of infection in our patients were similar to previously published series collected from single institutions before the emergence of significant antibiotic resistance in S pneumoniae. Our analysis suggests that children infected by penicillin-nonsusceptible strains have a similar clinical response to therapy when compared with children infected by penicillin-susceptible strains.


Assuntos
Artrite/microbiologia , Osteomielite/microbiologia , Infecções Estreptocócicas , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Penicilinas/farmacologia , Estudos Prospectivos , Radiografia , Infecções Estreptocócicas/diagnóstico por imagem , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/cirurgia , Streptococcus pneumoniae/efeitos dos fármacos , Resultado do Tratamento
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