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Kikuchi-Fujimoto disease is a rare histiocytic necrotizing lymphadenitis that affects typically young women causing fever and painful laterocervical lymphadenopathy. The etiology is unknown, but several viral infections and autoimmune diseases have been related with the disease. Bacterial infections are less frequent. Diagnosis needs for excisional lymph node biopsy that shows paracortical areas of coagulative necrosis with abundant debris, distortion of the nodal architecture, and a large amount of histiocytes at the margins of the necrotic areas. There is no specific treatment for the disease. We present the case of a young woman with Kikuchi-Fujimoto disease associated with lower respiratory tract infection by Streptococcus pneumoniae and review the literature.
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Content available remote A triad of endocarditis, endophthalmitis, and meningitis
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Streptococcus pneumoniae is an uncommon cause of infective endocarditis; it often requires prolonged antibacterial treatment and involves a high mortality rate. We report a rare case of pneumococcal endocarditis manifesting with unusual complications - meningitis and endophthalmitis. Streptococcus pneumoniae species grew from the cerebrospinal fluid. The diagnosis of native aortic valve infective endocarditis was confirmed after some delay by transesophageal echocardiography. The patient’s eye was lost because of infective complications, but his life was saved following an aggressive antibacterial therapy in combination with an immediate aortic valve replacement.
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Content available remote Spontaneous Bacterial Peritonitis Due to Streptococcus Pneumoniae - Case Report
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Spontaneous bacterial peritonitis is caused by infection of ascitic fluid without any apparent intraabdominal source of infection. The disease most commonly occurs in patients with cirrhosis and 70% of cases of infections are caused by pathogenes from gastrointestinal tract. The article presents the case of 38-year-old patient with spontaneous peritonitis who was treated surgically. The primary nature of the disease was confirmed by laparotomy and bacteriological examination results (Streptoccocus pneumonia) of ascitic fluid. After 54 days of hospitalisation and undergoing re-laparotomy, he was discharged in good condition.
EN
Spontaneous bacterial peritonitis is caused by infection of ascitic fluid without any apparent intraabdominal source of infection. The disease most commonly occurs in patients with cirrhosis and 70% of cases of infections are caused by pathogenes from gastrointestinal tract. The article presents the case of 38-year-old patient with spontaneous peritonitis who was treated surgically. The primary nature of the disease was confirmed by laparotomy and bacteriological examination results (Streptoccocus pneumonia) of ascitic fluid. After 54 days of hospitalisation and undergoing re-laparotomy, he was discharged in good condition.
EN
We investigated children aged 2-5, who had gone adenoidectomy for recurrent and/or persistent symptoms of upper respiratory tract infections for prevalence of pneumococci in adenoid tissue. Serotypes and antibiotic resistance patterns of the isolated pneumococci were determined and also risk factors of pneumococcal colonization were defined. S. pneumoniae colonization in adenoids was found in 62 (60.2%) children. Serotypes belonged to 10-valent and 13-valent pneumococcal conjugated vaccines (PCVs) constituted 56.1% and 68.2% of the isolates, respectively. Decreased susceptibility to penicillin was found in 45.5% of isolates; pneumococci were resistant to co-trimoxazole (62.1%), tetracycline (43.9%), erythromycin (54.5%), clindamycin (54.5%) and chloramphenicol (31.8%). Multidrug resistant S. pneumoniae comprised 57.6% of the isolates. Antibiotic resistant pneumococci were mostly distributed among serotypes belonged to 10-valent and 13-valent PCVs. Good vaccine coverage among the isolated pneumococci confirmed that the introduction of PCVs in the national immunization programme may reduce the pool of resistant and multidrug resistant pneumococci in a community.
EN
In this study we present an analysis of prescription numbers of various antibiotic classes to Bavarian (Southern Gennany) outpatients between 2000 and 2006 compared to fluctuating resistance patterns in representative respiratory pathogens. Prescriptions of "narrow-spectrum" antibiotics (e.g. penicillins, macrolides) decreased by 39% while prescriptions of "broad-spectrum" antibiotics increased by 38%. The most prominent increase was for quinolones and cephalosporines class II. Prescriptions of these antibiotics exhibited prominent seasonal alterations suggesting that these drugs had been used for treatment of respiratory infections. In contrast, the numbers of S. pneumoniae and H. influenzae detected in respiratory specimen decreased. Almost constant resistance rates of S. pneumoniae for first line antibiotics do not justify an increased use of cephalosporins class II and quinolones. Compared to Europe and Gennany in general, consumption of antibiotics is low in Bavaria. Even at this low level we propose an education of physicians treating outpatients in a way to avoid an excessive use of antimicrobials.
EN
An abrupt antimicrobial resistance increase among Streptococcus pneumoniae strains has become a serious therapeutic problem in the recent years. The aim of this study was to describe the resistance increase of S. pneumoniae strains isolated in the West Pomerania Province over three years (2001-2003). Using E-tests method and NCCLS criteria for 80 pneumococal resistant strains the resistance degrees and patterns have been determined and analyzed in connection with their clinical origin. The majority of specimens of resistant strains isolated came from nasopharynx (80% strains) of infected ambulatory patients (81.3%), from children at nursery school age (65.7%), suffering from chronic upper respiratory tracts infection (86.7%). However, strains originated from older patients, hospitalized, in serious health condition showed higher resistance degrees. The greatest number of isolates (27.5%) showed resistance to 3 out of 9 tested drugs and over a half (53.8%) of the tested strains belonged to MDR strains, with increasing percentage over time: from 62.5% in 2001 to 69.8% in 2003. Resistance to 8 out of 9 determined antibiotics (except vancomycin) has occurred and domination of 4 resistance patterns: ELTS, S, TSH, PSI, present in 50.1% of the tested strains was observed. The phenomena observed in the study: growing resistance degree, increasing amount of MDR strains, emergence of new resistance patterns, testify to gradual pneumococcal resistance increase and give a picture of local trends in antibiotic therapy. Also the epidemiological data concerning patients, from whom the tested strains were isolated are adequate to risk factors of infection with resistant pneumococci.
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