Another one on epidemiology. In splenectomized patients, the risk of acquiring serious infections by encapsulated germs is increased, again Pneumococcus being the most frequent.

A patient comes to the Emergency Department with fever without focus of 24 h of evolution, hypothyroidism and impression of severity. She underwent a splenectomy 2 years ago for staging of Hosgkin's disease. Which microorganism is most frequently implicated?

List of clinically important bacteria

S Salmonella Salmonella enteritidis Salmonella typhi Salmonella typhimurium Serratia marcescens Shigella dysenteriae Spirillum volutans Staphylococcus Staphylococcus aureus Staphylococcus epidermidis Stenotrophomonas maltophilia Streptococcus Streptococcus agalactiae Streptococcus avium Streptococcus bovis Streptococcus cricetus Streptococcus faceium Streptococcus faecalis Streptococcus ferus Streptococcus gallinarum Streptococcus lactis Streptococcus mitior Streptococcus mitis Streptococcus mutans Streptococcus oralis Streptococcus pneumoniae Streptococcus pyogenes Streptococcus rattus Streptococcus salivarius Streptococcus sanguis Streptococcus sobrinus T Treponema U Ureaplasma urealyticum V VibrioVibrio choleraeVibrio commaVibrio parahaemolyticusVibrio vulnificusWWolbachia Y YersiniaYersinia enterocoliticaYersinia pestisYersinia pseudotuberculosis'' See also List of bacterial orders List of bacteria genera List of human diseases associated with infectious pathogens

Overwhelming post-splenectomy infection

Patients without a spleen often need immunizations against pathogens that normally require opsonization and phagocytosis by macrophages in the spleen. These include common human pathogens with bacterial capsules (Streptococcus pneumoniae, Salmonella typhi, Neisseria meningitidis, E. coli, Hemophilus influenzae, Streptococcus agalactiae, Klebsiella pneumoniae, Pseudomonas aeruginosa ). Capsules made of polysaccharides (sugars) permit bacteria to evade phagocytosis by macrophages alone, since only proteins are directly recognized by macrophages in phagocytosis. So humoral immunity in forms of IgG and complement proteins is the human immune system's response against bacterial capsules. Prevention Measures to prevent OPSI include vaccination, prophylactic antibiotics and patient education.

InternalMed_Harrison

Overwhelming Infection in Asplenic Patients (See also Chap. 325) Patients without splenic function are at risk for overwhelming bacterial sepsis. Asplenic adult patients succumb to sepsis at 58 times the rate of the general population. Most infections are thought to occur within the first 2 years after splenectomy, with a mortality rate of ~50%, but the increased risk persists throughout life. In asplenia, encapsulated bacteria cause the majority of infections. Adults, who are more likely to have antibody to these organisms, are at lower risk than children. Streptococcus pneumoniae is the most common isolate, causing 50–70% of cases, but the risk of infection with Haemophilus influenzae or Neisseria meningitidis is also high. Severe clinical manifestations of infections due to E. coli, S. aureus, group B streptococci, P. aeruginosa, Bordetella holmesii, and Capnocytophaga, Babesia, and Plasmodium species have been described.

InternalMed_Harrison

The most serious consequence of splenectomy is increased susceptibility to bacterial infections, particularly those with capsules such as Streptococcus pneumoniae, Haemophilus influenzae, and some gram-negative enteric organisms. Patients under age 20 years are particularly susceptible to overwhelming sepsis with S. pneumoniae, and the overall actuarial risk of sepsis in patients who have had their spleens removed is about 7% in 10 years. The case–fatality rate for pneumococcal sepsis in splenectomized patients is 50–80%. About 25% of patients without spleens will develop a serious infection at some time in their life. The frequency is highest within the first 3 years after splenectomy. About 15% of the infections are polymicrobial, and lung, skin, and blood are the most common sites. No increased risk of viral infection has been noted in patients who have no spleen. The susceptibility to bacterial infections relates to the inability to remove opsonized bacteria from the bloodstream

Human pathogen

Bacterial Although the vast majority of bacteria are harmless or beneficial to one's body, a few pathogenic bacteria can cause infectious diseases. The most common bacterial disease is tuberculosis, caused by the bacterium Mycobacterium tuberculosis, which affects about 2 million people mostly in sub-Saharan Africa. Pathogenic bacteria contribute to other globally important diseases, such as pneumonia, which can be caused by bacteria such as Streptococcus and Pseudomonas, and foodborne illnesses, which can be caused by bacteria such as Shigella, Campylobacter, and Salmonella. Pathogenic bacteria also cause infections such as tetanus, typhoid fever, diphtheria, syphilis, and Hansen's disease. They typically range between 1 and 5 micrometers in length. Fungal

Functional Asplenism -- Complications -- Overwhelming Post-Splenectomy Infection (OPSI)

OPSI is a syndrome that is encountered in post-splenectomy, hyposplenic and functional asplenic patients. Bacteremia caused by encapsulated microorganisms characterize the syndrome. The syndrome might present without a visible primary source of infection, and with a short prodromal phase, Clinical presentations include septic shock, disseminated intravascular coagulopathy, and bilateral adrenal hemorrhage. OPSI is a medical emergency and administration of antibiotics should be administered promptly along with supportive measures. Hyposplenic patients might already be on prophylactic antibiotics, and hence, cultures might be negative; however, antibiotic therapy should continue. Empiric parental antibiotic therapy should include vancomycin and either cefotaxime or ceftriaxone. Although the efficacy of intravenous immunoglobulin  (IVIg) treatment for asplenic sepsis has not been proven, some experts recommend its administration in this situation. The morbidity of OPSI is high, and death may result in 24 to 48 hours, with mortality rates of 50% to 70%. This syndrome has been observed up to 10 to 30 years post-diagnosis with hyposplenism. Some series indicate that the risk of OPSI decreases with the time elapsed since splenectomy, while other studies do not show a significant reduction. The most commonly reported pathogen in OPSI is Streptococcus pneumoniae.

Meningitis and septicaemia in adults splenectomized for Hodgkin's disease.

Splenectomized and asplenic persons are at risk of developing sudden episodes of meningitis and/or septicaemia, frequently due to Streptococcus pneumoniae (overwhelming postsplenectomy infection, or OPSI). The application of staging splenectomy to patients with Hodgkin's disease (HD) generated a new population at risk for OPSI. We reviewed the cases of sudden meningitis and/or septicaemia in a series of 491 consecutive adults with HD. No case was recorded among 149 non-splenectomized patients. 6 episodes of OPSI were observed in 5 of 342 splenectomized patients (crude frequency 1.75%, actuarial frequency at 10 yr 3.87%). The infecting organisms were Streptococcus pneumoniae (5 cases) and Salmonella enteritidis (1 case). 2 episodes (1 fatal) occurred during first complete remission (CR), 15 and 120 months, respectively, after splenectomy, 4 episodes (2 fatal) occurred after first relapse. For splenectomized patients in continuous CR, the cumulative risk of OPSI was 2.30% (95% CL 0-6.10%), and it was 15.25% (95% CL 0-35.37%) for splenectomized patients who had relapsed. These data suggest that, in adults with HD, the risk of OPSI should not limit the indication to staging splenectomy and does not warrant systematic prophylaxis. However, in splenectomized relapsed patients, OPSI can be a troublesome complication and appropriate prophylaxis could be useful.

[Epidemiology and clinical features in diabetic patients with invasive infections treated at the Clinical Hospital of Infectious Diseases of Iaşi, Romania, between 2008-2010].

Infections in the diabetic population can be severe and life threatning at least for two reasons: clinical signs are often torpid, masqued by chronical complications of diabetes leading to late recognition and medical adresability and also because of the inability to control established infection due to complex cell-mediated and humoral immunity deffects. The aim of the study was to evaluate the etiology, clinical features and outcome in diabetic patients with invazive disease. A retrospective study was conducted between January 2008 and December 2010 at The Clinical Hospital of Infectious Diseases Iaşi among 75 diabetic patients with sepsis of microbiologically confirmed etiology (positive cultures from normally sterile sites) and sepsis with clinically suspected etiology (positive cultures from pus). Cases with positive urocultures and coprocultures only, were excluded. From 75 diabetics, 56% were males, 90,7% being over 50 years. Severe cases of sepsis (33/75, 44%) were associated more often with insulin-treated diabetes than non-insulin treated group (40% vs. 4%, p<0,005) probably because of multiple comorbidities associated as suggested by a high Charlson score (6,09 vs. 4,09, p<0,05). There were 64 cases with confirmed etiology and 11 cases with clinically suspected etiology. Staphylococcus aureus and Escherichia coli were the most common agents isolated, being involved in 16 (21,3%) cases each, followed by coagulase negative Staphylococci (14/18,66%), Enterococcus spp.(6/8%), group B Streptococcus (3/4%), Streptococcus pneumoniae, Enterobacter spp., Salmonella spp. (2/2,66% each), Aerococcus viridans, Streptococcus equi, Klebsiella pneumoniae, Neisseria meningitidis, Sphyngomonas paucimobilis, Pseudomonas aeruginosa, Proteus mirabilis (1/1,33%). Multiple septic disseminations occured in 17(22,6%) cases and meningeal involvment was doccumented in 10(15,6%) cases. Meticillin resistance was noted in 53,3% for invasive isolates of S. aureus. Among 16 invazive strains of E. coli, 25% were resistant to 3rd generation cephalosporins, 17% to ciprofloxacin and 6,6% to aminoglycosides and colimycin. There were no E. coli strains resistant to imipenem, piperacillin-tazobactam and aztreonam. The mean mortality rate was 14,66%. The high level of resistance of S. aureus and E. coli to commonly used antibiotics and meningeal involvement imposes a multidisciplinary approach of the diabetic patient. Proper knowledge of the pathogers involved in the potential invazive diseases is an important tool for successful treatment with appropriate empirical broad-spectrum antimicrobial agents.

Overwhelming postsplenectomy infection with vaccine-type Streptococcus pneumoniae in a 12-year-old girl despite vaccination and antibiotic prophylaxis.

This report describes a 12-year-old girl who developed vaccine-type pneumococcal septicemia (type 4, Danish nomenclature) 2 years after splenectomy for recurrent idiopathic thrombocytopenia despite vaccination with the 23-valent vaccine 4 weeks before surgery and antibiotic prophylaxis with penicillin V. The disease presented as high fever with shivering and vomiting followed by disseminated petechiae and a deteriorated general condition. Initial laboratory studies showed severe sepsis with leucocytopenia and thrombocytopenia, a markedly elevated CRP, and disseminated intravascular coagulation. Despite antibiotic treatment, which was initiated with clindamycin, cefotaxime and trimethoprim/sulfamethoxazole and was switched to cefotaxime and penicillin after the result of the blood culture had been obtained, the patient had to be ventilated, and hemofiltration became necessary because of acute renal insufficiency. Furthermore, she required amputation of all her toes because of severe necrosis. No type-specific pneumococcal antibody titers were detected during and after infection. It remains unclear whether the susceptibility to Streptococcus pneumoniae was due to primary failure of antibody production or a decline in antibody levels after vaccination. Patients and/or their relatives should be informed that neither vaccination nor continuous antibiotic prophylaxis can guarantee full protection against infection with S. pneumoniae in patients after splenectomy.

Splenomegaly

Diagnosis Abdominal CT is the most accurate and spleen need to be larger 2-3 times to be palpable below the costal margin in physical examination that can help in diagnosis. Treatment If the splenomegaly underlies hypersplenism, a splenectomy is indicated and will correct the hypersplenism. However, the underlying cause of the hypersplenism will most likely remain; consequently, a thorough diagnostic workup is still indicated, as, leukemia, lymphoma and other serious disorders can cause hypersplenism and splenomegaly. After splenectomy, however, patients have an increased risk for infectious diseases. Patients undergoing splenectomy should be vaccinated against Haemophilus influenzae, Streptococcus pneumoniae, and Meningococcus. They should also receive annual influenza vaccinations. Long-term prophylactic antibiotics may be given in certain cases.

Pediatric Pneumonia -- Etiology

The etiology of pneumonia in the pediatric population can be classified by age-specific versus pathogen-specific organisms. [3] Neonates are at risk for bacterial pathogens present in the birth canal, and this includes organisms such as group B streptococci, Klebsiella, Escherichia coli, and Listeria monocytogenes . [4] [5] [6] Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus can be identified in late-onset neonatal pneumonia. [4] Viruses are the main cause of pneumonia in older infants and toddlers between 30 days and 2 years old. [7] In children 2 to 5 years old, respiratory viruses are also the most common. [8] [9] The rise of cases related to S. pneumoniae and H. influenzae type B is observed in this age group. [10] [11] Mycoplasma pneumonia frequently occurs in children in the range from 5 to 13 years old [12] [13] ; however, S. pneumoniae is still the most commonly identified organism. [8] Adolescents usually have the same infectious risks as adults. It is important to consider tuberculosis (TB) in immigrants from high prevalence areas, and children with known exposures. Children with chronic diseases are also at risk for specific pathogens. In cystic fibrosis, pneumonia secondary to S. aureus and Pseudomonas aeruginosa is ubiquitous. [14] Patients with sickle cell disease are at risk of infection from encapsulated organisms. [15] Children who are immunocompromised should be evaluated for Pneumocystis jirovecii , cytomegalovirus, and fungal species if no other organism is identified. [16] Unvaccinated children are at risk for vaccine-preventable pathogens.

Trimethoprim/sulfamethoxazole

Proteus vulgaris Providencia rettgeri Providencia stuartii Salmonella typhi (typhoid fever) Non-typhi Salmonella Serratia spp. Shigella spp. Staphylococcus aureus Staphylococcus epidermidis Staphylococcus saprophyticus Stenotrophomonas maltophilia Streptococcus agalactiae Streptococcus pneumoniae Streptococcus pyogenes Streptococcus viridans Toxoplasma gondii (toxoplasmosis) Tropheryma whippelii (Whipple's disease) Vibrio cholerae (cholera) Yersinia enterocolitica Yersinia pestis (bubonic plague) Yersinia pseudotuberculosis

[Fulminant pneumococcal septicemia in splenectomized patients].

Four cases of fulminant pneumococcal septicemia in splenectomized patients are reported. Three had undergone splenectomy for trauma 42, 28 and 14 years prior to the septicemia. The fourth had been splenectomized for suspected lymphoma 3 years earlier. In 3 out of 4 patients the symptomatology was so rapidly progressive that a physician was consulted within 12 hours. Two patients hospitalized after a second consultation and 20 hours after the first symptoms had evidence of septic shock, disseminated intravascular coagulation and hypoglycemia, and died within a few hours despite early antibiotherapy. Diplococci were seen in peripheral smears of these 2 patients and in the buffy coat of the 3 cases in which this was carried out. These four cases reemphasize the fact that during their entire life splenectomized patients are at risk for development of overwhelming septicemia even when the splenectomy was performed because of trauma. Therefore, such patients should be aware of this risk, should be treated promptly with antibiotics in the event of a febrile episode, and should be vaccinated against pneumococci and possibly other encapsulated bacteria such as Haemophilus influenzae and Neisseria meningitidis.

Classification of pneumonia

Opportunistic pneumonia People with weakened immune defense, such as HIV/AIDS patients, are highly susceptible to opportunistic infections affecting the lungs. Most common pathogens are Pneumocystis jiroveci, Mycobacterium avium-intracellulare complex, Streptococcus pneumoniae, Haemophilus species. Less frequent pathogens are Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, cytomegalovirus (CMV), and Toxoplasma gondii. Chemotherapy-induced immunodeficiency may lead to severe lung infections. Pathogens commonly associated with lung infectioins are bacteria (like Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Nocardia species), viruses (eg, respiratory syncytial virus, parainfluenza virus, influenza virus A and influenza B, and cytomegalovirus), and fungi (eg, Aspergillus, Fusarium, and Mucorales species, and Pneumocystis jirovecii).

[Changes in infectious endocarditis in 3 decades].

The course, clinical picture and outcome were compared in 101 patients with infective endocarditis (1975-79, phase III) with our earlier investigations 1947-57 (phase I) and 1961-74 (phase II). An impressive change in this disease was found: - The average age of the patients is higher. - Acute cases and postoperative courses (after valve replacement) are more common and the outcome in these cases is better. Subacute courses are on the decrease. The clinical picture often is oligosymptomatic: - Fever is absent in a quarter, cardiac murmur in nearly a fifth and splenomegaly in four fifths of the patients. - For the first time 5 patients with right-heart endocarditis were observed in phase III. Three of these patients were intravenous drug abusers. The initial clinical picture was misinterpreted as pneumonia or pulmonary embolism. - The most common infective agents were streptococci, followed by staphylococci. The portion of negative blood cultures was strikingly high (35%). - Despite the higher frequency of acute courses, mortality has decreased. Urgent cardiac valve replacement, which has been performed in a fifth of our patients, can prevent irreversible congestive heart failure.

Pine oil

Properties as a disinfectant Pine oil is a disinfectant that is mildly antiseptic. It is effective against Brevibacterium ammoniagenes, the fungi Candida albicans, Enterobacter aerogenes, Escherichia coli, Gram-negative enteric bacteria, household germs, Gram-negative household germs such as those causing salmonellosis, herpes simplex types 1 and 2, influenza type A, influenza virus type A/Brazil, influenza virus type A2/Japan, intestinal bacteria, Klebsiella pneumoniae, odor-causing bacteria, mold, mildew, Pseudomonas aeruginosa, Salmonella choleraesuis, Salmonella typhi, Salmonella typhosa, Serratia marcescens, Shigella sonnei, Staphylococcus aureus, Streptococcus faecalis, Streptococcus pyogenes, and Trichophyton mentagrophytes.

[Abscess of the spleen].

Splenic abscess is a rare disease but with increasing frequency. The authors present 9 patients with splenic abscess treated at the Institute of Digestive System Diseases, Clinical Centre of Serbia, in a period from January 1, 1986 to May 15, 2004. Splenic abscess was the complication of septic endocarditis in 4, trauma in 2, dental infection in 1, while in 2 cases it was the complication of chemotherapy in myeloproliferative disorders. All 9 patients had fever, 7 - abdominal pain, 4 - left shoulder pain, and 1 patient had nausea and vomiting. Higher white blood count was found in 6 patients, pleural effusion in 4, elevated left hemidiaphragm in 1 and basal pneumonia in 1 patient as well. Ultrasonography and CT were the most reliable diagnostic procedures. CT was superior in diagnosis of multiple small abscesses. Culture of the pus recovered the Enterococcus in 3 cases, Streptococcus a hemolyticus in 1, Staphylococcus epidermidis and Candida albicans in 1, Staphylococcus aureus, E. Coil and Candida albicans in 1, Staphylococcus aureus i Salmonella enteritidis in 1 case. Eight patients underwent splenectomy and 1 was cured by combined antibiotics in high doses. One patient died postoperatively due to septic endocarditis that had been present before surgery. The authors believe that splenectomy and antibiotics administered according to drug susceptibility test as well as management of underlying disease are the method of choice for splenic abscess treatment. Conservative antibiotic treatment is indicated in selected cases only.

Pneumocystis jirovecii Prophylaxis -- Differential Diagnosis

Due to their poor immune response, patients with HIV and those with immunosuppression for other causes, such as malignancy, autoimmune disease, or iatrogenic due to underlying condition or organ transplant patients, require prophylaxis for numerous pathogens. These pathogens include: Aspergillus species Candida albicans Clostridium difficile Coccidioides immitis Cryptococcus neoformans Cytomegalovirus Histoplasma capsulatum Legionella pneumophila Microsporidium Mycobacterium avium complex Mycobacterium tuberculosis Pseudomonas aeruginosa Salmonella Staphylococcus aureus Streptococcus pneumoniae Streptococcus pyogenes Toxoplasma gondii [2] [3] [5]

Surgery_Schwartz

Clinical manifestations include fever, left upper quadrant pain, leukocytosis, and splenomegaly in about one-third of patients. The diagnosis is confirmed by ultrasound or CT scan, which has a 95% sensitivity and specificity. Common organ-isms are aerobic microbes (streptococci and Escherichia coli), but other microorganisms have also been isolated (Mycobac-terium tuberculosis and Salmonella typhi). Upon discovery of a splenic abscess, broad-spectrum antibiotics should be initi-ated, with adjustment to more specific therapy based on culture results and continuation of treatment for a minimum of 14 days. Splenectomy is the operation of choice, but percutaneous and open drainage are options for patients who either cannot toler-ate splenectomy or where the clinical scenario warrants splenic preservation, particularly in children.90 Percutaneous drainage is often successful for patients with unilocular disease and may result in avoidance of splenectomy. Patients with multilocular disease

Pus

Some disease processes caused by pyogenic infections are impetigo, osteomyelitis, septic arthritis and necrotizing fasciitis. Pyogenic bacteria A great many species of bacteria may be involved in the production of pus. The most commonly found include: Staphylococcus aureus Staphylococcus epidermidis Streptococcus pyogenes Escherichia coli (Bacillus coli communis) Streptococcus pneumoniae (Fraenkel's pneumococcus) Klebsiella pneumoniae (Friedländer's bacillus) Salmonella typhi (Bacillus typhosus) Pseudomonas aeruginosa Neisseria gonorrhoeae Actinomyces Burkholderia mallei (Glanders bacillus) Mycobacterium tuberculosis (tubercle bacillus) Staphylococcus aureus bacteria is the most common cause of boils. Historical terminology

Silane quats

Anabaena cylindricia Chlorella Chlorophyta (green) Chrysophyta (brown) Oscillatoria borneti Pleurococcus Protococcus Scenedesmus quadricauda Selenastrum gracile Acinetobacter calcoaceticus Aeromonas hydrophilia Bacillus cereus Bacillus subtilis Bacillus typhimurium Citrobacter diversus Clostridium perfringens Corynebacterium bovis Corynebacterium diphtheriae Cutibacterium acnes Enterobacter aerogenes Enterobacter agglomerans Enterobacter cloacae Enterococcus Enterococcus faecalis Escherichia coli Klebsiella pneumoniae Klebsiella terrigena MHV-A59 MS2 Virus Mycobacterium tuberculosis Phi6 Proteus mirabilis Proteus vulgaris Pseudomonas aeruginosa Pseudomonas cepacia Salmonella enterica Salmonella typhi Salmonella typhimurium SARS-CoV-2 Serratia liquefaciens Serratia marcescens Stachybotrys chartarum Staphylococcus aureus Staphylococcus epidermidis Streptococcus faecaliis Streptococcus pyrogenes Vancomycin-resistant enterococci Alternaria alternata Aspergillus flavus

[Management of infection risk in asplenic patients].

Each year in France 6000 to 9000 patients are splenectomised or spleen embolized. As spleen has immunological functions, it contributes to protect against infections. Thus, hypo or asplenia increase the risk of infection, especially the risk of Overwhelming Post-Splenectomy Infection (OPSI). OPSI is a medical emergency, characterized by aspecific symptoms, which may rapidly progress to fulminant infection and death in 50% of cases within 48 h. Encapsulated bacteria as Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis are most of the time responsible of these infections in asplenic patients. To prevent OPSI, several measures are essential and must begin before a scheduled surgery or just after an urgent splenectomy. Patients must carry a card. The first proposed prevention measure is to enhance partial surgery when it's possible. Then, the two other measures, antibiotic prophylaxis and vaccination, shall be implemented whatever is the indication of surgery. Postoperative antibiotic prophylaxis by phenoxymethyl-penicillin is prescribed for two years minimum and lifelong prophylaxis should be offered to high risk of pneumococcal infection patients. Pneumococcal, H. influenzae type b and meningococcal vaccination should be administered 2 to 6 weeks before scheduled splenectomy and 2 weeks after urgent surgery. Yearly, patients must receive Influenza vaccination. As an interindividual variation exists in vaccinal response, measurement of serotype-specific antibodies can be used, if available, to individualized risk patients and to organize revaccination. Finally, to prevent OPSI, patient and next-of-kin must be educated about prevention measures and infectious risk to optimize patient's compliance.

Lung abscess in patients with AIDS.

We identified 31 patients with human immunodeficiency virus (HIV) infection and lung abscess. All patients had advanced HIV disease, and the mean CD4 cell count was 17/mm3 (range, 2-50/mm3). Twenty-two patients (71%) had previous opportunistic infections, and 24 (77%) had previous pulmonary infections. Symptoms at the time of presentation included fever (90% of patients), cough (87%), dyspnea (35%), pleuritic chest pain (26%), and hemoptysis (10%). The microbiological etiology was established for 28 patients, and the pathogens recovered were bacteria (65%), Pneumocystis carinii (6%), fungi (3%), and mixed microorganisms (16%). The pathogens included Pseudomonas aeruginosa (11), Streptococcus pneumoniae (6), P. carinii (5), Klebsiella pneumoniae (5), Staphylococcus aureus (4), Aspergillus species (3), viridans streptococcus (2), Haemophilus influenzae (1), Streptococcus milleri (1), Proteus mirabilis (1), and Cryptococcus neoformans (1). Mycobacterium tuberculosis was not isolated; two patients for whom a microbiological etiology was not established responded to antituberculous therapy. Patients were treated for 2-12 weeks; 25% of the patients received > 4 weeks of therapy. The outcome was poor: 36% of the patients had recurrences, and 19% died. In patients with AIDS, lung abscess is associated with advanced HIV infection, is due to a broad spectrum of pathogens, responds poorly to antibiotics, and has a poor prognosis.

[High incidence and mortality of systemic pneumococcal disease among persons without spleen].

We surveyed 472 cases of culture-confirmed systemic pneumococcal disease that were reported to the Norwegian Notification System for Infectious Diseases during a 12-month period in 1992-93. The clinicians in charge of the patients filled in a questionnaire providing information on underlying disease and outcome for 461 (98%) of the patients. Eight of these patients were splenectomized; all of them more than ten years before. Four died, two survived but had serious sequelae, and two survived without obvious sequelae upon discharge from hospital. Using a rough estimate of the prevalence of unvaccinated splenectomized persons in Norway, we estimate that this group, compared to the normal population, has a relative risk of 25 of developing systemic pneumococcal disease and a relative risk of 75 of dying from pneumococcal disease. The serotype of the pneumococcal strain that caused the disease was determined for seven of the eight patients. All serotypes were represented in the 23-valent pneumococcal polysaccharide vaccine. We strongly recommend that doctors trace and vaccinate splenectomized individuals.

Austrian syndrome

The oldest recorded patient with Austrian syndrome had a history of health concerns such as hypertension, and diabetes mellitus which increased her risk of Austrian syndrome. Mechanism/pathophysiology Osler's triad, also known as Austrian syndrome, was first introduced in the 19th century. Streptococcus pneumoniae is the cause of Osler's triad of meningitis, pneumonia, and endocarditis. The portal of entry for this triad is said to be the lungs, followed by meningitis and endocarditis. Significant risk factors are heavy alcohol consumption, old age, splenectomy, immunosuppression, etc. Endocarditis typically involves the aortic valve. The native aortic valve is the most frequent vegetation site for Streptococcus pneumoniae and is considered the most common cardiac lesion.

Innate immune defect

Interleukin-1 receptor-associated kinase deficiency is an inherited disorder of the immune system. This immunodeficiency leads to recurrent infections caused by the pyogenic bacteria, for example Streptococcus pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa, but not by other infectious agents. Most patients with IRAK-4 deficiency suffer from invasive bacterial infections, which can cause sepsis, meningitis or they affect the joints that can lead to inflammation and arthritis. These invasive infections can also cause areas of tissue breakdown and pus production (abscesses) on internal organs. In addition, patients are characterized by infections of the upper respiratory tract, eyes or skin. Although fever is a common reaction to bacterial infections, many people with IRAK-4 deficiency do not at first develop a high fever in response to these infections, even if the infection is severe. Most patients have their first bacterial infection before age 2, and the infections can

Clinical features of patients with recurrent invasive Streptococcus pneumoniae disease.

Invasive Streptococcus pneumoniae (pneumococcal) disease (IPD) carries a high risk of death, approximately 15% to 20% in pneumonia, 40% in meningitis and 10% to 15% in septicemia. The occurrence of 2 or more IPD (recurrent) in the same individual is uncommon. The authors investigated the clinical features of patients with recurrent IPD to assess whether they possessed risk factors that increased their likelihood of recurrent IPD. Between 1983 and 2010, the authors identified 27 patients with recurrent IPD during inpatient surveillance of 889 patients with IPD in Huntington, WV, by recovery of pneumococci from otherwise sterile sites. Serotype/serogroup (ST/SG) was determined by capsular swelling and the penicillin MIC by E-strip. Clinical data were abstracted from hospital charts. Sixteen (59%) of 27 patients were 65 years and older at first IPD, males predominated (67%), two-thirds had pneumonia and 21 (78%) had the same clinical diagnosis at both IPD. Four (80%) of 5 patients with the same ST experienced their second IPD 1 to 6 months apart, unlike most patients with discordant ST/SGs (P = 0.047). Eighty-four percent of ST/SGs were included in the 23-valent pneumococcal vaccine and occurred as often during the first and second IPD. Twenty (77%) of 26 adults suffered from comorbid diseases placing them at high risk of IPD, including multiple myeloma, HIV/AIDS, neoplasia of hematological origin and sickle cell disease. Recurrent IPD occurred uncommonly. Comorbid conditions including multiple myeloma and immunosuppressive/immunodeficient conditions, chronic alcoholism and splenectomy represented unique risk factors for recurrent IPD but did not predict recurrences.

Acute infectious thyroiditis

Causes Despite the thyroid gland being extremely resistant to infection, it is still susceptible to infection by various bacteria. The cause can be almost any bacterium. Staphylococcus aureus, Streptococcus pyogenes, Staphylococcus epidermidis, and Streptococcus pneumoniae in descending order are the organisms most commonly isolated from acute thyroiditis cases in children. Other aerobic organisms are Klebsiella sp, Haemophilus influenza, Streptococcus viridans, Eikenella corrodens, Enterobacteriaceae, and salmonella sp.

Surgery_Schwartz

In fact, encapsulated bacteria, such as S pneumoniae, N meningitidis, and H influenzae, were rarely encountered in those series in whom vaccination was routinely adopted.193-196Sepsis by uncommon bacteria as well by protozoa infec-tions such as malaria and babesiosis are also known to affect asplenic patients.196-200Clinical Features. OPSI is uniformly fatal without treat-ment, and thus sepsis in a splenectomized patient is a medical emergency.21,187,192 Therefore, any clinical suggestion of infec-tion, including seemingly isolated fevers, must be viewed with a high index of suspicion and treated empirically as thorough investigation proceeds. OPSI may begin with a relatively mild-appearing prodrome of symptoms. In addition to fever, nonspe-cific symptoms such as malaise, myalgias, headache, vomiting, diarrhea, abdominal pain, and others should be viewed with alarm in the asplenic patient. This process can progress rapidly to fulminant bacteremic septic shock, with hypotension,

Neonatal infection

Clostridium tetani can cause a generalised form of tetanus in the neonate. This usually occurs when the mother has not been vaccinated against tetanus and the baby has not acquired passive immunity. The umbilical cord region is the most susceptible. Other bacterial pathogens include Streptococcus agalactiae, Streptococcus pyogenes, Viridans streptococci, Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa. Viruses

[Purulent pericarditis with pericardial tamponade caused by Streptococcus agalactiae and Salmonella enterica no typhi].

Purulent pericarditis (PP) is an uncommon condition with high mortality. In the preantibiotic period, Staphyloccocus aureus and Streptococcus pneumoniae were the most common etiologic agents. We describe the case of a 75-year old man with septic shock, PP and cardiac tamponade caused by Streptococcus agalactiae and Salmonella enterica no-typhi. To our knowledge this association of pathogenic organisms has not been previously reported in the literature. The pathogenesis is here reviewed, and in our patient presumably, purulent pericarditis occurred via hematogeneus spread undergoing upper gastrointestinal endoscopy. The patient's course was complicated and he died on 34th hospital day. After this case report it is considered that differential etiologic diagnosis of PP should include these agents, especially in immunodepressed patients with predisposing factors.

Sacroiliitis due to Salmonella Typhi: A case report.

Pyogenic infections of the sacroiliac joint are observed quite rarely. The most frequent causative microorganisms are Staphylococcus aureus, Streptococcus species, and Pseudomonas aeruginosa that are commonly found in patients under intravenous medication. In this paper, a rare sacroiliitis case that developed due to Salmonella Typhi is discussed. A woman at the age of twenty applied to our clinic with complaints of fever, headache and diarrhea with which she had been suffering for five days. On physical examination, she had a slight fever, with a body temperature of 38.6°C. She was hospitalized, and Salmonella Typhi was isolated from her blood culture. Later on, the patient described pain during left hip movement. Diffusion-weighted magnetic resonance imaging and scintigraphic examinations revealed left sacroiliitis. Although sacroiliitis arising from Salmonella Typhi infection is a rare entity, it should not be ignored in patients who have a clinical history for sacroiliitis.