Scandinavian journal of infectious diseases
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Scand. J. Infect. Dis. · Jan 2005
Successful management of severe group A streptococcal soft tissue infections using an aggressive medical regimen including intravenous polyspecific immunoglobulin together with a conservative surgical approach.
Intravenous polyspecific immunoglobulin G (IVIG) has been reported to be efficacious as adjunctive therapy in patients with toxic shock syndrome caused by a group A streptococci (GAS). GAS is also an important cause of necrotizing fasciitis, for which an early and extensive surgical intervention is currently advocated. Here we report on the use of an aggressive medical regimen including high-dose IVIG together with a conservative surgical approach in severe GAS soft tissue infection. ⋯ All patients survived. Immunostaining of tissue biopsies from 2 of the patients revealed high levels of GAS, superantigen and pro-inflammatory cytokines initially, which were dramatically reduced in a repeat biopsy of the initial operative site collected from 1 of the patients 66 h post-IVIG administration. The study suggests that the use of a medical regimen including IVIG in patients with severe GAS soft tissue infections may allow an initial non-operative or minimally invasive approach, which can limit the need to perform immediate wide debridements and amputations in unstable patients.
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Scand. J. Infect. Dis. · Jan 2005
Case ReportsPseudomembranous tracheobronchitis caused by Aspergillus in immunocompromised patients.
We report 2 cases of Aspergillus pseudomembranous tracheobronchitis in patients with diabetes. The first patient succumbed to progressive obstructive respiratory failure despite mechanical ventilation and antifungal therapy. ⋯ Early bronchoscopy and histologic examination should be performed. Early, appropriate treatment may be life saving.
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Scand. J. Infect. Dis. · Jan 2005
Case ReportsDrotrecogin alpha (activated) in neonatal septic shock.
A 12-d-old neonate suffering from group B streptococcal septic shock was treated with 24 microg/kg/h recombinant human activated protein C [rhAPC, drotrecogin alpha (activated)] for 96 h. The protein C activity increased from 5% to 53% after rhAPC infusion. The patient recovered within 14 d without any adverse effects.
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Linezolid is a new synthetic antibiotic with a broad spectrum of activity against virtually all important Gram-positive infections. Lactic acidosis is a well known side-effect of metformin and nucleoside reverse-transcriptase inhibitors. We report a case in which lactic acidosis developed as an adverse effect of linezolid treatment.