Scandinavian journal of infectious diseases
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Scand. J. Infect. Dis. · Jan 2002
Case ReportsStreptococcus bovis meningitis in a healthy adult patient.
We describe the first case in the English language of Streptococcus bovis meningitis in a 45-y-old patient without any underlying disease or predisposing condition. S. bovis biotype II was isolated from his spinal fluid and blood. ⋯ The patient was cured after 10 d of therapy with ceftriaxone and, 2.5 y later, is currently healthy. As a result of this case and a similar case published recently in the Spanish literature we conclude that S. bovis should be considered a microorganism capable of causing meningitis in the absence of any underlying condition or clear focus of infection.
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Scand. J. Infect. Dis. · Jan 2002
Case ReportsSevere Legionella pneumophila pneumonia in a patient with iron overload.
Iron plays a crucial role in the energy metabolism of microorganisms. Humans have developed iron-withholding mechanisms as a form of non-specific immunity. We describe a patient with iron overload and severe Legionella pneumophila pneumonia. This report emphasizes the importance of early consideration of and appropriate therapy against Legionella for patients with iron overload who present with community-acquired pneumonia.
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Scand. J. Infect. Dis. · Jan 2001
ReviewThe syndrome of inappropriate secretion of antidiuretic hormone and fluid restriction in meningitis--how strong is the evidence?
In patients with meningitis, fluid restriction is recommended to counter the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and to reduce cerebral oedema. However, any effects of an increased plasma level of ADH upon cerebral oedema would be due not to fluid retention but to hypoosmolality. In a literature review of fluid and electrolyte disturbances and the effect of fluid therapy in bacterial/tuberculous meningitis, the prevalence of hyponatraemia, hypoosmolality and SIADH varied considerably; apparently, non-osmotic stimuli for the secretion of ADH, e.g. intracranial hypertension and hypovolaemia, were present in most patients. ⋯ Furthermore, compared with maintenance therapy, fluid restriction did not improve outcome in a randomized controlled study. Thus, we find no evidence to support the use of fluid restriction in patients with meningitis. Fluid therapy in acute bacterial meningitis should aim at avoiding hypovolaemia and hypoosmolality based on the assumptions that (i) ADH is increased by non-osmotic stimuli; (ii) elevated ADH is less important for cerebral oedema than severe hypoosmolality, which may in itself induce or aggravate oedema; (iii) maintenance fluid therapy aiming at isoosmolality will not worsen neurological outcome; and (iv) hypovolaemia is difficult to detect, and detrimental for cerebral perfusion, in these patients.
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Scand. J. Infect. Dis. · Jan 2001
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA prospective, randomized, multicenter comparative study of clinafloxacin versus a ceftriaxone-based regimen in the treatment of hospitalized patients with community-acquired pneumonia.
In an open-label, phase 3, randomized, multicenter study, clinafloxacin (200 mg/d) was compared to ceftriaxone (2 g/d; with or without erythromycin) in 527 patients with acute community-acquired bacterial pneumonia (CAP). Primary efficacy parameters were clinical cure rate and microbiologic eradication rates (by pathogen and by patient) determined 5-9 d post-therapy (test of cure; TOC). ⋯ Both drugs were tolerated. Treatment of hospitalized CAP patients with clinafloxacin is a reasonable choice, especially when a resistant pathogen is anticipated.
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Scand. J. Infect. Dis. · Jan 2001
Comparative StudyLow sensitivity of serum procalcitonin in bacterial meningitis in adults.
Several studies have suggested high predictive values of serum procalcitonin (PCT) for the discrimination of bacterial and viral meningitis in children and adults. Here, we report PCT serum concentrations in 12 adults suffering from bacterial meningitis. PCT on admission was normal ( < or = 500 pg/ml) in 3 and between 500 and 1,000 pg/ml in 2 patients without evidence of concurrent bacterial infections. ⋯ PCT concentrations were higher with typical meningitis agents (pneumococci and meningococci 12,679 +/- 13,092 pg/ml vs. other bacteria 4048 +/- 9187 pg/ml, p = 0.041) whilst in nosocomial bacterial meningitis after neurosurgery (n = 3) serum PCT remained normal. We believe that PCT is of limited diagnostic value in adults suffering from bacterial meningitis, especially in cases due to unusual agents or of nosocomial origin. Elevated PCT in bacterial meningitis may indicate the presence of bacterial inflammation outside the central nervous system.