The Journal of infection
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The Journal of infection · Jul 2006
Diagnosis and evaluation of febrile infants under 4 months of age in Japan by using RT-PCR for enterovirus.
In order to establish an effective management for febrile infants under 4 months of age we analysed the causes of fever by using bacterial work up and a highly sensitive RT-PCR method during a 3-year-period. From February 1998 to January 2001, 263 infants under 4 months of age were admitted to our hospital because of fever (>38.0 degrees C) and enrolled in this study. ⋯ Clinicians should consider age, sex and seasons when evaluating and treating infants with fever. Previously lumbar puncture, urinalysis and chest X-ray were recommended to avoid useless assays. These results also revealed that RT-PCR is a useful and significant assay to establish an exact diagnosis in very young infants.
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The Journal of infection · Jun 2006
Review Case ReportsWhat is subacute necrotizing fasciitis? A proposed clinical diagnostic criteria.
Subacute necrotizing fasciitis is a poorly defined clinical entity. Its very existence has been the subject of much controversy. While rarely reported, subacute forms of necrotizing fasciitis have been documented in the literature by many authors. This paper highlights some recently reported cases in the literature that clearly shows that subacute forms of necrotizing fasciitis indeed exist and may in fact be under-reported because of the lack of awareness and a consistent diagnostic criteria. ⋯ This proposed diagnostic criterion serves to facilitate future reporting and documentation of this condition. The clinical significance and implication of this are discussed.
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The Journal of infection · Jun 2006
Comparative StudyManagement of patients with Streptococcus milleri brain abscesses.
We evaluated the efficacy of cefotaxime in the management of brain abscesses caused by Streptococcus milleri. Twenty two patients with a S. milleri brain abscess were treated with metronidazole and cefotaxime, in accordance with recent recommendations by the British Society Of Antimicrobial Chemotherapy (BSAC). Seven patients who had Glasgow Coma Scales < or =11 also received rifampicin and high dose cefotaxime. The clinical response of the patients was determined. ⋯ This cohort of patients responded favourably to the guidelines recommended by the BSAC. This was confirmed by the Glasgow Outcome Score (GOS 4-5) at 6 months review. Cefotaxime at a higher dose with rifampicin was prescribed for patients presenting with a decreased conscious level (GCS 8-11), subsequent failure of anticipated clinical improvement or clinical deterioration. There was no clinically significant difference in GOS between the two treatment groups. An algorithm for management of brain abscess is presented, based on our clinical experience and review of the literature.
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The Journal of infection · May 2006
Case ReportsCommunity-acquired Klebsiella oxytoca endocarditis: a case report.
We report the case of a 71-year-old woman who presented with persistent high fever and progressive weakness for 10 days. Klebsiella oxytoca infective endocarditis was diagnosed based on four sets of positive blood culture of K. oxytoca together with fluttering vegetation (0.6 cm in diameter x 1.3 cm long) on the base of the anterior mitral leaflet. The diagnosis was documented using transthoracic and transesophageal echocardiograms. After 4 weeks of intravenous cefazolin therapy, the patient completely recovered.
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The Journal of infection · May 2006
Lumbar puncture in the management of adults with suspected bacterial meningitis--a survey of practice.
Assess the use of lumbar puncture (LP) in the management of suspected community acquired bacterial meningitis in adults. ⋯ Reported clinical practice in the investigation and management of meningitis in adults is not in line with current published guidance. Efforts to target interventions that promote consensus in practice are needed.