Internal medicine
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Multicenter Study
Identifying low-risk patients for bacterial meningitis in adult patients with acute meningitis.
To derive and validate a clinical prediction model with high sensitivity for differentiating aseptic meningitis (AM) patients from bacterial meningitis (BM) patients. ⋯ This simple and sensitive model might be useful to safely identify low-risk patients for BM who would not require antibiotic treatment.
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A 78-year-old woman was admitted for severe heat stroke with brain damage. She was unconscious on arrival at the emergency room. ⋯ On magnetic resonance imaging, T1- and T2-weighted images showed no significant signals, but diffusion-weighted images demonstrated localized symmetrical injuries of the cerebellum and thalami. She gradually became conscious, but severe cerebellar ataxia persisted.
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Multicenter Study
Hospital-based study of the prognostic factors in adult patients with acute community-acquired bacterial meningitis in Tokyo, Japan.
Prognostic factors related to community-acquired bacterial meningitis (BM) in adult patients have been evaluated using multivariate analysis in The Netherlands, where the rate of antibiotic resistance was low. However, an evaluation of these factors in countries with a high rate of antibiotic resistance has not yet been done. Thus, we studied the prognostic factors in adults with community-acquired BM in our hospitals, which are located in Tokyo, Japan, where the rate of antibiotic resistance is high. ⋯ Patients with a low GCS at the initiation of antibiotic therapy and low thrombocyte counts had unfavorable outcomes. With appropriate antibiotic administration, the antibiotic-resistant bacteria were not identified as an unfavorable prognostic factor, even in an area with a high rate of antibiotic resistance.
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Multicenter Study Clinical Trial
Efficacy of azithromycin in the treatment of community-acquired pneumonia, including patients with macrolide-resistant Streptococcus pneumoniae infection.
The growing problem of drug resistance among respiratory pathogens in community-acquired pneumonia (CAP), particularly Streptococcus pneumoniae, (S. pneumoniae) has complicated initial empiric therapy of CAP. This study was undertaken to evaluate the efficacy and tolerability of a 3-day course of azithromycin in adults with mild to moderately severe CAP, and to determine whether in vitro macrolide resistance among strains of S. pneumoniae is related to clinical efficacy/failure. ⋯ Most patients responed well to azithromycin, indicating that azithromycin might be clinically effective for the treatment of CAP with macrolide-resistant S. pneumoniae. However, a larger study is necessary to prove the efficacy against macrolide-resistant S. pneumoniae.
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Review Case Reports
Purulent pericarditis caused by the Streptococcus milleri group: a case report and review of the literature.
A 69-year-old woman with a history of diabetes mellitus presented at our emergency room with chest pain and dyspnea. A chest computed tomography revealed a pericardial effusion. Pericardiocentesis was performed; strains of the Streptococcus milleri group were detected on culture of the fluid thus obtained. ⋯ Emergency pericardial drainage was performed, after which the condition resolved without any complications. We report an extremely rare case of purulent pericarditis caused by a strain of the Streptococcus milleri group. In addition, we review 5 previously reported cases of purulent pericarditis caused by strains.