Pneumococcal pericarditis successfully treated with catheter drainage and intravenous antibiotics.

Bacterial pericarditis is commonly a disease of children for which the primary treatment is surgical drainage. We report the case of a 19-yr-old patient presenting with pneumococcal pericarditis and tamponade treated successfully with intrapericardial catheter drainage and intravenous antibiotics. The technical aspects are discussed.     

Pneumococcal pericarditis successfully treated with catheter drainage and intravenous antibiotics

Bacterial pericarditis is commonly a disease of children for which the primary treatment is surgical drainage. We report the case of a 19-yr-old patient presenting with pneumococcal pericarditis and tamponade treated successfully with intrapericardial catheter drainage and intravenous antibiotics. The technical aspects are discussed.     

Candida albicans septicemia in a premature infant successfully treated with oral fluconazole.

A premature male infant, birth-weight 1460 g, was treated successfully for a Candida albicans septicemia with orally administered fluconazole for 20 days. Dosage was 5 mg/kg/day. No side effects were seen. Fluconazole may present a major progress in treatment of invasive C. albicans infections in neonatology.     

Successful long-term catheter drainage in an immunocompromised patient with purulent pericarditis

A case of extensive staphylococcal pericarditis following renal transplantation is described. Purulent pericarditis resolved after 18 days of continuous catheter drainage from the pericardium combined with antibiotic therapy. This case illustrates that life-threatening purulent staphylococcal pericarditis after renal transplantation in an immunocompromised patient may respond to medical therapy.     

Treatment of Candida albicans pericarditis in a heart transplant patient

Pericarditis due to Candida species is a rare clinical entity, associated with thoracic surgery and immunosuppression. We report here the second case of pericarditis due to Candida albicans in a heart transplant patient, which presented as tamponade approximately 3 weeks post transplant, in the absence of evidence of sternal osteomyelitis. The patient was treated with pericardiocentesis and a combination of caspofungin and fluconazole, but the patient ultimately required the explantation of retained epicardial leads and the creation of a pericardial window. This case illustrates that Candida species must be considered in the differential diagnosis in post-transplant pericarditis, and that foreign body removal is, as always, key in helping to resolve such infections. This case also demonstrates the first use of caspofungin with fluconazole to treat Candida pericarditis. We discuss the conflicting data regarding the use of caspofungin, alone or in combination therapy, in treating infections involving biofilms, such as the infected pericardium.     

Candida albicans prosthetic arthritis treated with fluconazole alone.

Conventional treatment of Candida prosthetic joint infection usually includes surgery followed by a long period of antifungal medication. We report a case of Candida albicans prosthetic arthritis successfully treated with fluconazole alone.     

Clinical, microbiologic and therapeutic aspects of purulent pericarditis.

Twenty-six patients with purulent pericarditis were seen at the Massachusetts General Hospital between 1960 and 1974. The diagnosis was made in 18 of them during life, but only 6 survived, with an over-all mortality rate of 77 per cent. In eight patients, purulent pericarditis developed in the early postoperative period after thoracic surgery. In seven, purulent pericarditis was the result of contiguous spread of infection from a pleural, mediastinal or pulmonary focus in nonsurgical patients. In five patients, it was the result of direct spread to the pericardium from an intracardiac infection. In the remaining six patients, purulent pericarditis developed as the result of a systemic bactermia. Immunosuppressive therapy, extensive thermal burns, lymphoproliferative disease and other systemic processes affecting host resistance were present in at least half the patients. Staphylococcus aureus was the etiologic agent in the largest number of patients (8 of 26 in this report). However, in contrast to previous studies, in a significant number of the patients (five), purulent pericarditis was the result of fungal infection (in three patients subjected to thoracic surgery and in two immunosuppressed patients). This report confirms that purulent pericarditis is an acute disease with a fulminant course. The diagnosis is easily missed since classic signs of pericarditis (including chest pain, friction rub and diagnostic electrocardiographic abnormalities) may be absent. The echocardiogram shows considerable promise in allowing earlier diagnosis of the pericardial effusion which accompanies purulent pericarditis. Optimal therapy consists of prolonged antibiotic therapy and aggressive drainage of the pericardium. In this series, there were 6 survivors among the 11 patients (55 per cent) who received appropriate therapy.     

Candida albicans fungemia with pulmonary localization treated with fluconazole. A case report

We report a case of Candida albicans fungemia complicated by a pulmonary localization in a non-immunocompromised patient. Complete recovery was obtained after a long course of high-dose fluconazole in spite of in vitro resistance of the Candida to fluconazole. The usefulness of fluconazole therapy, the best dosage regimen and the in vitro and in vivo correlations are discussed.     

A successfully treated case of infective endocarditis due to Candida tropicalis

A 34-year-old man, a heavy drinker, was admitted with a high fever and hematuria two months previously. Surgery was performed for acute sever pancreatitis and postoperatively antibiotics were administered with intravenous hyperalimentation. After discharge he was readmitted and infective endocarditis was strongly suspected because of high fever, hematuria, Osler's nodes, Janeway's lesions, splinter hemorrhages and mitral regurgitation. Penicillin G in combination with Gentamycine therapy was started on the first hospital day. On the second hospital day, blood culture revealed Candida tropicalis so Miconazole therapy was commenced. On the forth hospital day, he underwent surgery for replacement of a mitral prosthesis with a prosthetic valve because he had embolus in the radial artery. Despite intensive antifungal therapy, he showed no improvement in clinical symptoms. Then we changed the antifungal drug from Miconazole to Amphotericin B and 5-fluorocytosine. On the 109th hospital day, his clinical symptoms improved. Antifungal therapy was halted and at present 10 months later, he is healthy.     

Case of pancreatic ascites successfully treated with endoscopic pancreatic drainage]

We report a 47-year-old man with abdominal distension without other distinct signs. Massive ascites with any singular lesions was revealed on computed tomography, and the ascites was high-amylase and high-protein. on these findings, pancreatic ascites was suspected and he was first treated with conservative therapy, but it failed. Computed tomography one month from the start of therapy demonstrated a pancreatic cyst, and endoscopic retrograde pancreatography revealed transudation of contrast medium from the cyst. A pancreatic duct stent was placed, and the ascites was smoothly eliminated. Endoscopic pancreatic stenting is considerable treatment for pancreatic ascites.     

Two cases of lung abscesses successfully treated with percutaneous drainage]

We report two cases of lung abscesses treated with percutaneous drainage. A 69-year-old man with diabetes mellitus was admitted to our hospital because of fever. Chest radiograph and chest CT scan demonstrated a lung abscess adjacent to the chest wall in right S10. Antibiotics did not achieve an adequate response. A drainage catheter was inserted percutaneously. We washed the abscess cavity daily using 1% povidone iodine saline. There was a clear improvement on the chest radiograph. A 74-year-old man with cerebral infarct was admitted to our hospital because of persistent cough and fever. Chest radiograph and chest CT scan demonstrated a lung abscess adjacent to the chest wall in left S10. Antibiotics did not achieve an adequate response. A drainage catheter was inserted percutaneously. We washed the abscess cavity daily using 1% povidone iodine saline. There was a clear improvement on the chest radiograph. We think that percutaneous drainage is a very useful method to treat lung abscesses in which antibiotics do not achieve an adequate response.     

Fulminant pseudomembranous colitis of the left colon successfully treated by surgical resection.

Pseudomembranous colitis is the classical and most dramatic manifestation of Clostridium difficile infection. Surgery is required for patients with perforation and for those who fail to respond to medical treatment. This is a report of a patient with severe pseudomembranous inflammation confined to the left colon, which was successfully treated by surgical resection.     

Pseudallescheria boydii brain abscess successfully treated with voriconazole and surgical drainage: case report and literature review of central nervous system pseudallescheriasis.

Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous, saprophytic fungi that commonly cause cutaneous infection. However, in certain circumstances, P. boydii can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited, and the prognosis is poor. We report a case of Pseudallescheria brain abscess successfully treated with surgical drainage and systemic voriconazole, the first such case to be described in the literature. We also review previously reported cases of CNS pseudallescheriasis and evaluate therapeutic options.     

A case of cryptococcal meningitis successfully treated with miconazole and CSF drainage

Cryptococcal meningitis is the most frequent fungal infection of the central nervous system, known readily to complicate with immuno-compromised patients. There are only a few cases of primary infection in healthy non-immuno-compromised patients. Amphotericin-B (AMPH-B) and 5-Fluorocytosine (5-FC) are effective agents against Cryptococcal meningitis, although, their toxicity and drug resistance are limiting factors. However, in recent years Miconazole has been widely used against fungal infections and it's effectiveness has been reported. This is a 68 y.o. male who was admitted to Toyohashi Municipal Hospital on March 15, 1987 because of headache, vomiting, diplopia and gait disturbance. Continuous lumbar drainage was performed since lumbar puncture revealed surprisingly high cerebrospinal fluid (CSF) pressure and presence of many Cryptococcus neoformans, i.v. AMPH-B and p.o. 5-FC was also administrated. A 7 day course of i.v. AMPH-B and p.o. 5-FC showed no improvement with side effects of macrohematuria and anorexia. Then Miconazole was administrated i.v. and intrathecal (i.t.). The clinical signs and CSF laboratory data improved after a 90 day course of Miconazole therapy and the patient was discharged on August 24. But the patient was readmitted from March 10 to April 30, 1988, because of a slight increase of C. neoformans in CSF (17/mm3) and improved by i.v. and i.t. Miconazole. The total Miconazole dosage was 90.6 g (i.t.: 505 mg) at the first admission and 36 g (i.t.: 50 mg) at the second admission, but no side effect was seen. The reduction of elevated CSF pressure with continuous CSF drainage was also important for the treatment of such cases with increased intracranial pressure.