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Here we report in a human, a renal transplant patient, the first disseminated infection with Nocardia cerradoensis, isolated after a brain biopsy. Species identification was based on 16S rRNA, gyrB, and hsp65 gene analyses. Antibiotic treatment was successful by combining carbapenems and aminoglycosides and then switching to oral trimethoprim-sulfamethoxazole.
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Twelve months of treatment with trimethoprim-sulfamethoxazole was not more effective than 3 months as indicated by clinical findings, laboratory (p = 0.405, p = 0.631, resp.), and histological data (p = 0.456). 36 of 37 surviving patients including 14 with cerebrospinal infection were in remission without evidence of recurrence after a median follow-up time of 80 months. In one patient, Tropheryma whipplei arthritis recurred 63 months after initial therapy. Secondary endpoints indicate that histology of intestinal biopsies was a more useful indicator to determine eradication of T. whipplei than PCR. In submucosal and extra-intestinal tissue, the diagnostic value of the PCR was superior. Prospective data disclosed a heterogeneous spectrum of clinical presentation and course of Whipple's disease.
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Most routines for handling of prostate biopsies, antibiotic prophylaxis, local anaesthesia and number of cores were uniform. However, there is still a need for standardization of the performance of ultrasound-guided biopsies. Although the method used to specify biopsy location varied greatly, most urologists would prefer a national standardized system.
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Prosthetic valve replacement is a safe procedure in patients with Brucella endocarditis. Surgical interventions combined with triple antibiotic therapy yield good results with no recurrence in the long-term follow-up.
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We compared the ability of erythromycin and co-trimoxazole in clearing Bordetella pertussis from the nasopharynx of 22 children admitted to hospital with whooping cough. Both agents appeared effective. Nevertheless, 10 of the 22 patients gave positive cultures four or more days after antimicrobial administration was begun.
We retrospectively analyzed the medical records of patients under 18 years of age in the WakeMed Health and Hospitals system with cultures positive for Staphylococcus aureus over a period of seven and a half months in 2006. Cases were classified as community-acquired, and we then analyzed risk factors and examined trends surrounding CA-MRSA infection.
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The management of patients who have HIV disease, particularly those in early, asymptomatic disease stages, has recently improved. Clinical trials with zidovudine have demonstrated efficacy and greatly reduced toxicity when the drug is used for asymptomatic HIV-infected persons who have fewer than 500 CD4+ cells/mm3. Also, the optimum dose of zidovudine is lower than previously believed, probably in the range of 300-500 mg daily in oral divided doses. The use of antibiotics to prevent Pneumocystis carinii pneumonia (PCP) is also of clear value for HIV-infected asymptomatic or symptomatic persons with fewer than 200 CD4+ cells/mm3. While aerosolized pentamidine is the only regimen approved for PCP prophylaxis, oral drugs, such as trimethoprim/sulfamethoxazole or dapsone, also appear effective. Together, these and similar advances argue for the widespread use of voluntary HIV testing to enable optimum medical monitoring and appropriate intervention. These issues and recommendations for laboratory and clinical monitoring are provided in this review.
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During a community-based study in four rural villages in Pakistan, 617 cases of acute respiratory infections (ARI) in children younger than 5 years of age were assessed, classified and managed according to the WHO ARI case management guidelines. Of these, 509 (82.5%) had 'cough and cold' without clinical evidence of pneumonia, 95 pneumonia, two severe pneumonia and 11 otitis media. Of the 509 without clinical evidence of pneumonia but with cough and cold, 491 (96.5%) were successfully treated without antibiotics and only 18 (3.5%) of these children needed antimicrobial therapy on follow-up. Of the 95 cases of pneumonia, 87 (91.4%) showed a satisfactory clinical response to oral cotrimoxazole and only eight (8.4%) required a change of antibiotic.
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Ninety-five positive cultures were identified. Isolates were more often susceptible to trimethoprim-sulfamethoxazole (TMP-SMX) (87%) and nitrofurantoin (89%) than to ampicillin (72%) (p < 0.03). Escherichia coli accounted for 71 (75%) cases and was more often susceptible to nitrofurantoin (100%) than to TMP-SMX (87%) (p < 0.01). Proteus isolates were all susceptible to TMP-SMX and resistant to nitrofurantoin (p < 0.01).
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To investigate risk factors for pneumococcal carriage and non-susceptibility among HIV-infected mineworkers in South Africa.
Four patients having melioidosis with spondylitis were evaluated. All of them had diabetes mellitus; three had multiple abscesses which required incision and drainage. Their clinical spectrum was similar to that of tuberculous spondylitis; all had back pain and radiology revealed infective spondylodiscitis with prevertebral and paravertebral collections with psoas abscess. Three patients underwent ultrasound-guided drainage of the psoas abscess and one had aspiration of the subcutaneous abscess. Bacteriological cultures showed presence of B. pseudomallei, and histopathology showed non-caseating granulomatous inflammation. All patients were treated with intravenous Ceftazidime for 2 weeks, followed by oral bactrim double strength and Doxycycline for 20 weeks. All patients improved with treatment and were healed at follow up.