Catastrophic chest pain: blinded by cardiopulmonary disease.
*Decompression; *Laminectomy; *Magnetic Resonance Imaging; Administration; Anti-Bacterial Agents/*administration & dosage; Chest Pain/diagnosis/drug therapy/*etiology; Coronary Disease; Diabetic Foot; Drug-Eluting Stents/*adverse effects; Epidural Abscess/*etiology/surgery; Humans; Hypertension; Intravenous; Male; Middle Aged; Nafcillin/*administration & dosage; Osteomyelitis/*complications/diagnosis/drug therapy; Surgical; Treatment Outcome
A 53-year-old man with a history of diabetic foot ulcer, osteomyelitis, coronary artery disease, hypertension and hyperlipidaemia, presented with chest pain of 3 weeks duration. Eleven days earlier, the patient had had a drug-eluting stent (DES) placed in a branch of the right coronary artery (RCA) after similar chest pain, leading to the findings of a positive nuclear stress test. Since discharge, he was not compliant with taking clopidegrel (Plavix), a concern for in-stent thrombosis with recurrent myocardial ischaemia; but work up was negative and medications were restarted. Within 24 h of admission, he developed bilateral flaccid leg weakness, urine retention and loss of sensation from the umbilicus level down. MRI revealed a T4-T6 epidural abscess. Emergent decompression laminectomy and abscess drainage was completed. Neurological symptoms improved hours after surgery with complete resolution of sensory deficits. Cultures grew Streptococcus sp., treated with intravenous nafcillin for 8 weeks. He regained leg strength with continued improvement seen in rehabilitation.
Barreiro Timothy John; Asiimwe Denis D; Gemmel David; Brine Patrick
BMJ case reports
2015
2015-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1136/bcr-2015-209928" target="_blank" rel="noreferrer noopener">10.1136/bcr-2015-209928</a>
Use of procalcitonin for the prediction and treatment of acute bacterial infection in children.
Anti-Bacterial Agents/*administration & dosage; Antibiotics – Administration and Dosage; Bacteremia – Blood; Bacteremia – Diagnosis; Bacteremia/blood/diagnosis; Bacterial Infections – Blood; Bacterial Infections – Diagnosis; Bacterial Infections – Drug Therapy; Bacterial Infections/blood/*diagnosis/drug therapy; Biological Markers – Blood; Biomarkers/blood; Calcitonin – Blood; Calcitonin Gene-Related Peptide; Calcitonin/*blood; Child; Humans; Inflammation – Blood; Inflammation – Diagnosis; Inflammation/blood/diagnosis; Predictive Value of Tests; Preschool; Prognosis; Protein Precursors – Blood; Protein Precursors/*blood; Sensitivity and Specificity
PURPOSE OF REVIEW: Procalcitonin (PCT) is increasingly utilized to determine the presence of infection or to guide antibiotic therapy. This review will highlight the diagnostic and prognostic utility of serum PCT in children. RECENT FINDINGS: Recent studies endorse the use of serum PCT to detect invasive infection, to differentiate sepsis from noninfectious systemic inflammatory response syndrome, and to guide antibiotic therapy. Typical values for maximal sensitivity and specificity are less than 0.5 ng/ml for noninfectious inflammation and greater than 2.0 ng/ml for bacterial sepsis. PCT appears to be a reliable indicator of infection. PCT has performed better than C-reactive protein in some settings, though pediatric comparative data are lacking. PCT may aid in diagnosing infection in challenging patient populations such as those with sickle cell disease, congenital heart defects, neutropenia, and indwelling central venous catheters. Antibiotic therapy tailored to serial PCT measurements may shorten the antibiotic exposure without increasing treatment failure. SUMMARY: PCT is a reliable serum marker for determining the presence or absence of invasive bacterial infection and response to antibiotic therapy. Tailoring antibiotics to PCT levels may reduce the duration of therapy without increasing treatment failure, but more research is needed in children.
Pierce Richard; Bigham Michael T; Giuliano John S Jr
Current opinion in pediatrics
2014
2014-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MOP.0000000000000092" target="_blank" rel="noreferrer noopener">10.1097/MOP.0000000000000092</a>
Management of community-acquired pneumonia: a focus on conversion from hospital to the ambulatory setting.
*Ambulatory Care; *Hospitalization; Anti-Bacterial Agents/*administration & dosage; Bacterial/*therapy; Community-Acquired Infections/therapy; Humans; Pneumonia
Patients with community-acquired pneumonia (CAP) are treated in hospital or in the ambulatory care setting depending on the severity of illness. Despite numerous guidelines proposed, there is no agreement on specific criteria for hospitalization other than the clinicians' experience. The purpose of this review is to discuss the importance of the appropriate choice and timely administration of antibacterial agents, either in the hospital or in the outpatient setting. Since a high proportion of CAP patients will not have an etiologic agent identified at the time of initiation of treatment, the choice of antibacterial therapy is usually empiric. Antibacterial agents with activity against pneumococci and atypical pathogens causing pneumonia are the preferred choices. Macrolides, doxycycline, or respiratory fluoroquinolones have been recommended by various guidelines committees in North America for the treatment of pneumonia in patients with or without underlying comorbidities. Because of the increasing resistance to beta-lactams as well other antibacterial agents such as macrolides, doxycycline, and sulfamethoxazole/trimethoprim (cotrimoxazole), it is important that clinicians are aware of local statistics on resistance to Streptococcus pneumoniae, as infection with this bacterium is associated with high rates of morbidity and mortality. More recently, fluoroquinolone resistance has been reported, but the percentage of pneumococcal strains resistant to this agent is relatively low compared with the other antibacterial agents. Switch (intravenous to oral) therapy is recommended for hospitalized patients with CAP to facilitate early discharge, which has been shown to improve patient satisfaction and reduce hospital costs. Early conversion to oral therapy has not been shown to be associated with increased complications or higher mortality. Following prompt intravenous therapy and stabilization, patients with CAP should be treated with oral therapy in the ambulatory setting.
Tan James S; File Thomas M Jr
American journal of respiratory medicine : drugs, devices, and other interventions
2003
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/bf03256666" target="_blank" rel="noreferrer noopener">10.1007/bf03256666</a>