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Susanne Samuelsson - One of the best experts on this subject based on the ideXlab platform.
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clinical presentation and prognostic factors of streptococcus pneumoniae meningitis according to the Focus of Infection
BMC Infectious Diseases, 2005Co-Authors: Christian Ostergaard, Helle Bossen Konradsen, Susanne SamuelssonAbstract:Background We conducted a nationwide study in Denmark to identify clinical features and prognostic factors in patients with Streptococcus pneumoniae according to the Focus of Infection.
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clinical presentation and prognostic factors of streptococcus pneumoniae meningitis according to the Focus of Infection
BMC Infectious Diseases, 2005Co-Authors: Christian Ostergaard, Helle Bossen Konradsen, Susanne SamuelssonAbstract:We conducted a nationwide study in Denmark to identify clinical features and prognostic factors in patients with Streptococcus pneumoniae according to the Focus of Infection. Based on a nationwide registration, clinical information's was prospectively collected from all reported cases of pneumococcal meningitis during a 2-year period (1999–2000). Clinical and laboratory findings at admission, clinical course and outcome of the disease including follow-up audiological examinations were collected retrospectively. The Focus of Infection was determined according to the clinical diagnosis made by the physicians and after review of the medical records. 187 consecutive cases with S. pneumoniae meningitis were included in the study. The most common Focus was ear (30%), followed by lung (18%), sinus (8%), and other (2%). In 42% of cases a primary Infection Focus could not be determined. On admission, fever and an altered mental status were the most frequent findings (in 93% and 94% of cases, respectively), whereas back rigidity, headache and convulsion were found in 57%, 41% and 11% of cases, respectively. 21% of patients died during hospitalisation (adults: 27% vs. children: 2%, Fisher Exact Test, P < 0.001), and the causes of death were due to neurological – and systemic complications or the combination of both in 8%, 5% and 6% of cases, respectively. Other causes (e.g. gastrointestinal bleeding, incurable cancer) accounted for 2% of cases. 41% of survivors had neurological sequelae (hearing loss: 24%, focal neurological deficits: 16%, and the combination of both: 1%). The mortality varied with the Focus of the Infection (otogenic: 7%, sinusitic: 33%, pneumonic: 26%, other kind of Focus: 50%, no primary Infection Focus: 21%, Log rank test: P = 0.0005). Prognostic factors associated with fatal outcome in univariate logistic regression analysis were advanced age, presence of an underlying disease, history of headache, presence of a lung Focus, absence of an otogenic Focus, having a CT-scan prior to lumbar puncture, convulsions, requirement of assisted ventilation, and alterations in various CSF parameters (WBC <500 cells/μL, high protein levels, glucose levels<1 mmol/L, low CSF/blood glucose levels), P < 0.05. Independent prognostic factor associated with fatal outcome in multivariate logistic regression analysis was convulsions (OR: 4.53, 95%CI: (1.74–11.8), p = 0.002), whereas presence of an otogenic Focus was independently associated with a better survival (OR: 6.09, 95%CI: (1.75–21.2), P = 0.005). These results emphasize the prognostic importance of an early recognition of a predisposing Focus to pneumococcal meningitis.
Christian Ostergaard - One of the best experts on this subject based on the ideXlab platform.
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six cases of aerococcus sanguinicola Infection clinical relevance and bacterial identification
Scandinavian Journal of Infectious Diseases, 2008Co-Authors: Kristina Ibler, Christian Ostergaard, Kjeld Truberg Jensen, Ute Wolff Sonksen, Brita Bruun, Henrik Carl Schonheyder, Michael Kemp, Rimtas Dargis, Keld Andresen, Jens Jorgen ChristensenAbstract:Aerococcus sanguinicola is a Gram-positive coccus first described in 2001. Infections in humans are rare but the use of 16S rRNA gene sequencing and improved phenotypic methods has facilitated the identification of A. sanguinicola. We report here 6 cases of A. sanguinicola bacteraemia, 2 of which were associated with infective endocarditis. Most patients were elderly (median age 70 y) and had underlying neurological disorders including dementia, cerebral degeneration, and myelomeningocele. The primary Focus of Infection was the urinary tract in 3 cases and the gallbladder in 1; no Focus was detected in 2 cases. Long-term prognosis was poor reflecting the frailty of the patients. All strains were susceptible to penicillin, ampicillin, cefuroxime, vancomycin, erythromycin, and rifampicin. The optimal treatment of Infection with A. sanguinicola has yet to be determined.
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clinical presentation and prognostic factors of streptococcus pneumoniae meningitis according to the Focus of Infection
BMC Infectious Diseases, 2005Co-Authors: Christian Ostergaard, Helle Bossen Konradsen, Susanne SamuelssonAbstract:Background We conducted a nationwide study in Denmark to identify clinical features and prognostic factors in patients with Streptococcus pneumoniae according to the Focus of Infection.
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clinical presentation and prognostic factors of streptococcus pneumoniae meningitis according to the Focus of Infection
BMC Infectious Diseases, 2005Co-Authors: Christian Ostergaard, Helle Bossen Konradsen, Susanne SamuelssonAbstract:We conducted a nationwide study in Denmark to identify clinical features and prognostic factors in patients with Streptococcus pneumoniae according to the Focus of Infection. Based on a nationwide registration, clinical information's was prospectively collected from all reported cases of pneumococcal meningitis during a 2-year period (1999–2000). Clinical and laboratory findings at admission, clinical course and outcome of the disease including follow-up audiological examinations were collected retrospectively. The Focus of Infection was determined according to the clinical diagnosis made by the physicians and after review of the medical records. 187 consecutive cases with S. pneumoniae meningitis were included in the study. The most common Focus was ear (30%), followed by lung (18%), sinus (8%), and other (2%). In 42% of cases a primary Infection Focus could not be determined. On admission, fever and an altered mental status were the most frequent findings (in 93% and 94% of cases, respectively), whereas back rigidity, headache and convulsion were found in 57%, 41% and 11% of cases, respectively. 21% of patients died during hospitalisation (adults: 27% vs. children: 2%, Fisher Exact Test, P < 0.001), and the causes of death were due to neurological – and systemic complications or the combination of both in 8%, 5% and 6% of cases, respectively. Other causes (e.g. gastrointestinal bleeding, incurable cancer) accounted for 2% of cases. 41% of survivors had neurological sequelae (hearing loss: 24%, focal neurological deficits: 16%, and the combination of both: 1%). The mortality varied with the Focus of the Infection (otogenic: 7%, sinusitic: 33%, pneumonic: 26%, other kind of Focus: 50%, no primary Infection Focus: 21%, Log rank test: P = 0.0005). Prognostic factors associated with fatal outcome in univariate logistic regression analysis were advanced age, presence of an underlying disease, history of headache, presence of a lung Focus, absence of an otogenic Focus, having a CT-scan prior to lumbar puncture, convulsions, requirement of assisted ventilation, and alterations in various CSF parameters (WBC <500 cells/μL, high protein levels, glucose levels<1 mmol/L, low CSF/blood glucose levels), P < 0.05. Independent prognostic factor associated with fatal outcome in multivariate logistic regression analysis was convulsions (OR: 4.53, 95%CI: (1.74–11.8), p = 0.002), whereas presence of an otogenic Focus was independently associated with a better survival (OR: 6.09, 95%CI: (1.75–21.2), P = 0.005). These results emphasize the prognostic importance of an early recognition of a predisposing Focus to pneumococcal meningitis.
Helle Bossen Konradsen - One of the best experts on this subject based on the ideXlab platform.
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clinical presentation and prognostic factors of streptococcus pneumoniae meningitis according to the Focus of Infection
BMC Infectious Diseases, 2005Co-Authors: Christian Ostergaard, Helle Bossen Konradsen, Susanne SamuelssonAbstract:Background We conducted a nationwide study in Denmark to identify clinical features and prognostic factors in patients with Streptococcus pneumoniae according to the Focus of Infection.
-
clinical presentation and prognostic factors of streptococcus pneumoniae meningitis according to the Focus of Infection
BMC Infectious Diseases, 2005Co-Authors: Christian Ostergaard, Helle Bossen Konradsen, Susanne SamuelssonAbstract:We conducted a nationwide study in Denmark to identify clinical features and prognostic factors in patients with Streptococcus pneumoniae according to the Focus of Infection. Based on a nationwide registration, clinical information's was prospectively collected from all reported cases of pneumococcal meningitis during a 2-year period (1999–2000). Clinical and laboratory findings at admission, clinical course and outcome of the disease including follow-up audiological examinations were collected retrospectively. The Focus of Infection was determined according to the clinical diagnosis made by the physicians and after review of the medical records. 187 consecutive cases with S. pneumoniae meningitis were included in the study. The most common Focus was ear (30%), followed by lung (18%), sinus (8%), and other (2%). In 42% of cases a primary Infection Focus could not be determined. On admission, fever and an altered mental status were the most frequent findings (in 93% and 94% of cases, respectively), whereas back rigidity, headache and convulsion were found in 57%, 41% and 11% of cases, respectively. 21% of patients died during hospitalisation (adults: 27% vs. children: 2%, Fisher Exact Test, P < 0.001), and the causes of death were due to neurological – and systemic complications or the combination of both in 8%, 5% and 6% of cases, respectively. Other causes (e.g. gastrointestinal bleeding, incurable cancer) accounted for 2% of cases. 41% of survivors had neurological sequelae (hearing loss: 24%, focal neurological deficits: 16%, and the combination of both: 1%). The mortality varied with the Focus of the Infection (otogenic: 7%, sinusitic: 33%, pneumonic: 26%, other kind of Focus: 50%, no primary Infection Focus: 21%, Log rank test: P = 0.0005). Prognostic factors associated with fatal outcome in univariate logistic regression analysis were advanced age, presence of an underlying disease, history of headache, presence of a lung Focus, absence of an otogenic Focus, having a CT-scan prior to lumbar puncture, convulsions, requirement of assisted ventilation, and alterations in various CSF parameters (WBC <500 cells/μL, high protein levels, glucose levels<1 mmol/L, low CSF/blood glucose levels), P < 0.05. Independent prognostic factor associated with fatal outcome in multivariate logistic regression analysis was convulsions (OR: 4.53, 95%CI: (1.74–11.8), p = 0.002), whereas presence of an otogenic Focus was independently associated with a better survival (OR: 6.09, 95%CI: (1.75–21.2), P = 0.005). These results emphasize the prognostic importance of an early recognition of a predisposing Focus to pneumococcal meningitis.
Bernard Prendergast - One of the best experts on this subject based on the ideXlab platform.
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challenges in infective endocarditis
Journal of the American College of Cardiology, 2017Co-Authors: Thomas J Cahill, Larry M. Baddour, Gilbert Habib, Bruno Hoen, Erwan Salaun, Gosta B Pettersson, Hans Joachim Schafers, Bernard PrendergastAbstract:Infective endocarditis is defined by a Focus of Infection within the heart and is a feared disease across the field of cardiology. It is frequently acquired in the health care setting, and more than one-half of cases now occur in patients without known heart disease. Despite optimal care, mortality approaches 30% at 1 year. The challenges posed by infective endocarditis are significant. It is heterogeneous in etiology, clinical manifestations, and course. Staphylococcus aureus, which has become the predominant causative organism in the developed world, leads to an aggressive form of the disease, often in vulnerable or elderly patient populations. There is a lack of research infrastructure and funding, with few randomized controlled trials to guide practice. Longstanding controversies such as the timing of surgery or the role of antibiotic prophylaxis have not been resolved. The present article reviews the challenges posed by infective endocarditis and outlines current and future strategies to limit its impact.
Chandy C John - One of the best experts on this subject based on the ideXlab platform.
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frequency and risk factors for deep Focus of Infection in children with staphylococcus aureus bacteremia
Pediatric Infectious Disease Journal, 2008Co-Authors: Allison C Ross, Philip Toltzis, Mary Ann Oriordan, Leah Millstein, Troy Sands, Allison Redpath, Chandy C JohnAbstract:Background: Staphylococcus aureus bacteremia (SAB) in children may be associated with development of deep-seated foci of Infection, often prompting extensive diagnostic testing. The objective of this study was to establish the frequency and risk factors for deep foci of Infection from SAB in pediatric patients. Methods: Medical charts of all children admitted with SAB to a tertiary-care center from January 1992 to June 2006 were reviewed. Study outcome was the presence of a deep Focus of Infection as documented by positive echocardiogram, bone imaging or abdominal imaging. Results: We studied 298 children, of whom 190 (64%) had echocardiograms, 116 (39%) had abdominal imaging, and 103 (35%) had bone imaging. Forty-seven subjects (16%) had symptoms of a deep Focus of Infection on discovery of SAB, which then was confirmed by 1 of the 3 tests. Eleven (3.7%) additional subjects had a clinically unsuspected deep Focus identified before discharge. All children with an unsuspected deep Focus of Infection had either an underlying medical condition that potentially obscured the diagnosis or a central venous catheter. More than 1 day of positive blood cultures was associated with an unsuspected deep-seated Infection (P < 0.01). Endocarditis was uncommon (2.7%), and occurred only in children with known congenital heart disease or with a central catheter. Conclusions: Deep-seated Infections from SAB in children are most often clinically apparent at discovery of bacteremia. Unsuspected deep-seated Infection is uncommon and confined to specific hosts. Routine diagnostic imaging is not indicated in all children with SAB.