Scandinavian journal of infectious diseases
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Scand. J. Infect. Dis. · Jan 1996
Case ReportsCerebrospinal fluid filtration in a case of severe pneumococcal meningitis.
Current therapy of bacterial meningitis includes high doses of antibiotics and, sometimes, addition of corticosteroids in order to reduce a harmful inflammatory response. The persisting high mortality and rate of sequelae, particularly regarding pneumococcal meningitis, calls for new therapeutic approaches. ⋯ The treatment was carried out without complications and the clinical outcome was favourable. We suggest that filtration of the CSF should be considered as a tool to eliminate noxious substances playing a harmful role in deteriorating course of bacterial meningitis.
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Scand. J. Infect. Dis. · Jan 1996
Classification of infective endocarditis by Duke's criteria and transesophageal echocardiography: a 1-year retrospective analysis.
A sensitive, specific, and rapid diagnosis of infective endocarditis (IE) is important for prognosis, and to exclude IE and thus avoid prolonged treatment with antibiotics. The diagnostic system for IE according to Duke's university includes echocardiographic results and classifies patients in 3 categories--'definite', 'possible', and 'rejected'--by combining pathologic, echocardiographic, clinical, and blood culture findings. Transesophageal echocardiography (TEE) has better diagnostic sensitivity compared to transthoracic echocardiography. ⋯ The remaining 37 patients (15 of whom were intravenous drug users) were treated and classified as follows: 'definite', 26 episodes in 24 patients, 'possible', 11 episodes in 11 patients; and 'rejected', 2 episodes in 2 patients. In this retrospective analysis Duke's criteria were easy to apply. A negative TEE made IE unlikely and a positive TEE made IE probable when other signs of infection were present.
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The quantitative aerobic and anaerobic microbiology of bronchial aspirates, obtained using protective brush catheters, from 10 children with ventilator-associated pneumonia, is presented. Aerobic or faculative organisms only were isolated in 1 child, anaerobic bacteria only in 3, and aerobic mixed with anaerobic bacteria in 6. There were 10 aerobic or faculative and 17 anaerobic isolates. ⋯ A total of 10 beta-lactamase-producing aerobic and anaerobic bacteria were isolated in 8 patients. All patients except 1 responded to antimicrobial therapy directed against the recovered isolates. These data highlight the polymicrobial aerobic-anaerobic flora isolated from pulmonary specimens of patients with ventilator-associated pneumonia.
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Scand. J. Infect. Dis. · Jan 1995
Clinical TrialDiagnostic and prognostic value of interleukin-6 and C-reactive protein in community-acquired pneumonia.
The diagnostic and prognostic value of admission serum levels of interleukin-6 (IL-6) and C-reactive protein (CRP) was investigated in 203 hospital-treated patients with community-acquired pneumonia (CAP). In serum samples obtained during the first 24 h after admission, IL-6 was detectable in 198 patients (98%), with a median value of 50 ng/l. Ten % of the patients had IL-6 values of 1000 ng/l. ⋯ High IL-6 values were also seen in patients with non-bacteremic pneumococcal pneumonia, while all patients with pneumonia due to other bacterial, or viral, aetiology had IL-6 levels of < or = 300 ng/l. In conclusion, IL-6 and CRP are promising diagnostic and prognostic tools in the management of CAP. Further studies are needed to establish the usefulness of repeated measurements early in the hospital course of the disease.
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Scand. J. Infect. Dis. · Jan 1995
Response and decline of serum IgG antibodies to pertussis toxin, filamentous hemagglutinin and pertactin in children with pertussis.
The serum IgG antibody response and decrease to 3 Bordetella pertussis antigens was compared in children with pertussis. Sera were obtained at the first clinical visit and 1, 3 and 12 months later from 89 children with > or = 3 weeks of paroxysmal cough. IgG antibodies to pertussis toxin (PT), to filamentous hemagglutinin (FHA) and to pertactin were determined with ELISA. ⋯ We conclude that a serum IgG reaction to PT and FHA occurs in almost all children with pertussis. An increase in pertactin IgG antibodies occurs less frequently than against PT and FHA. Significant decreases in PT or FHA IgG antibodies in children with clinical pertussis might be of use as a diagnostic criterion in children brought late for examination.