Haemophilus influenzae infections in adults: report of nine cases and a review of the literature.

Haemophilus influenzae is an aerobic pleomorphic gram-negative coccobacillus that requires both X and V factors for growth. It grows poorly, if at all, on ordinary blood agar unless streaked with Staph. aureus. It grows well on chocolate agar. Because this medium is often not used in culturing specimens from adults and because the organism may be overgrown by other bacteria, the frequency of H. influenzae infections has undoubtedly been seriously underestimated. This is aggravated by the failure of many physicians to obtain blood cultures in suspected bacterial infections and the failure of many laboratories to subculture them routinely onto chocolate agar. H. influenzae, along with Streptococcus pneumoniae, is a major factor in acute sinusitis. It is probably the most frequent etiologic agent of acute epiglottitis. It is probably a common, but commonly unrecognized, cause of bacterial pneumonia, where it has a distinctive appearance on Gram stain. It is unusual in adult meningitis, but should particularly be considered in alcoholics; in those with recent or remote head trauma, especially with cerebrospinal fluid rhinorrhea; in patients with splenectomies and those with primary or secondary hypogammaglobulinemia. It may rarely cause a wide variety of other infections in adults, including purulent pericarditis, endocarditis, septic arthritis, obstetrical and gynecologic infections, urinary and biliary tract infections, and cellulitis. Antimicrobial susceptibility testing is somewhat capricious in part from the marked effect of inoculum size in some circumstances. In vitro and in vivo results support the use of ampicillin, unless the organism produces beta-lactamase. Alternatives in minor infections include tetracycline, erythromycin, and sulfamethoxazole-trimethoprim. For serious infections chloramphenicol is the best choice if the organism is ampicillin-resistant or the patient is penicillin-allergic.     

Haemophilus influenzae osteomyelitis in adults: a report of 4 frontal bone infections and a review of the literature

Haemophilus influenzae occasionally causes hematogenous long-bone osteomyelitis in children. In adults, however, bone infections caused by this organism are extremely rare. We report four adult cases of H. influenzae frontal bone osteomyelitis and review 12 cases from the literature.     

Bacteremic disease due to Haemophilus influenzae capsular type f in adults: report of five cases and review

Five cases of bacteremic infections due to Haemophilus influenzae type f in adults are described, and previous reports of type f disease in nonpediatric patients are reviewed. Respiratory tract infections were most common in our series (two cases of pneumonia, one of epiglottitis, and one of nosocomial septicemia probably resulting from aspiration pneumonitis). All of these patients had factors predisposing them to respiratory tract infections, e.g., neurologic disease, congestive heart failure, or cigarette smoking. A fifth patient, who was bacteremic without an apparent primary focus, had dysgammaglobulinemia. Six episodes of bacteremia occurred in five patients; 11 of 13 cultures of blood obtained before parenteral antibiotic therapy were positive. All isolates were biotype I and susceptible to ampicillin. Antibiotic therapy was curative in cases of proved respiratory tract infection but failed in the setting of nosocomial septicemia, perhaps because of delayed initiation. The brevity of antibiotic treatment of the cryptogenic bacteremia permitted infection of a prosthetic vascular graft and recurrent bacteremia. Graft removal and repeated antibiotic therapy were curative.     

Agranulocytosis caused by thiouracil: A review of fifty-nine cases in the literature and a report of two additional cases

Fifty-nine cases of thiouracil-induced agranulocytosis collected from the literature and two additional cases herewith reported are analyzed and discussed.The importance of early diagnosis and prompt institution of treatment is stressed.Penicillin, given early and in massive doses, has been found to be the most effective agent in the treatment of the complications of agranulocytosis.Adjunct treatment, especially the administration of whole blood and pyridoxine may be of considerable value in hastening the recovery.     

Psychogenic cough in adults: a report of two cases and review of the literature.

Psychogenic cough, also known as "habit cough," is a well-documented condition in the pediatric and adolescent population, with numerous cases reported in the medical literature. Many of these patients are strikingly similar in their clinical characteristics and, although the data are limited, a variety of treatment options may be successful in terminating this form of cough. However, psychogenic cough in adults has been reported infrequently and is less well defined. We report two cases of psychogenic cough in adult patients referred to our service for an evaluation of refractory, chronic cough and review the relevant medical literature. Our patients seemingly represent the first cases of psychogenic cough reported in the geriatric population and share clinical features with children, adolescents, and young adults. One case is unique in the sense that the cough responded to a distracter in the form of a throat lozenge, and this patient consumed > or = 20 lozenges/day for approximately 13 years. Psychogenic cough should be considered in adult patients who present with a chronic cough of no obvious organic basis that has failed therapy directed at postnasal drip, asthma, and gastroesophageal reflux. We propose criteria to assist in making a diagnosis of psychogenic cough in adult patients and review the limited information that exists concerning treatment modalities.     

Descending thoracic aortitis due to Haemophilus influenzae: a case report and literature review

Aortitis due to Haemophilus influenzae especially involving the descending thoracic aorta is rarely encountered. We present a case and literature review concerning Haemophilus influenzae aortitis. This article serves to enhance the awareness of this extremely rare disease.     

Hemophilus influenzae septic arthritis in adults. A report of four cases and a review of the literature

The clinical and diagnostic features of 29 adult patients with H. influenzae septic arthritis are reviewed. Twelve men and 17 women ranging in age from 22 to 82 years developed the infection. H. influenzae septic arthritis is an acute, febrile disease with a mean duration of symptoms before diagnosis of 4 days. Fifteen patients had monoarticular arthritis, 6 with an infected knee. Polyarticular involvement, with a range of 2 to 9 joints, was diagnosed in 14 patients. Nineteen patients had concurrent extraarticular sites of infection, including meningitis, pneumonia, pharyngitis, sinusitis, conjunctivitis, and cellulitis. Twenty-two of 29 patients had predisposing factors for infection, including ethanolism, trauma, rheumatoid arthritis, systemic lupus erythematosus, diabetes mellitus, splenectomy, multiple myeloma, lymphoma, gout, and acquired common variable hypogammaglobulinemia. Characteristic synovial fluid findings included purulent, greenish fluid, elevated WBC count, and gram-negative pleomorphic microorganisms. Treatment for these patients included antibiotic therapy, most often ampicillin and chloramphenicol, and joint drainage by repeated arthrocentesis or arthrotomy. A favorable outcome was reported in 25 of 29 patients. Hemophilus influenzae septic arthritis should be suspected in adults who are immunocompromised and have a concurrent extraarticular source of infection.     

Annular pancreas in adults. A report of two cases and a review of the literature

Annular pancreas is an uncommon developmental abnormality of the ventral pancreas. Half of all patients present in adulthood. Abdominal pain and duodenal obstruction are the commonest presenting features. Despite newer imaging modalities, the diagnosis is mostly made at surgery. We report on two patients and review the embryology, presentation, diagnosis and the current surgical management options of annular pancreas.     

Autoimmune pancreatitis:report of two cases and literature review

BACKGROUND:Autoimmune pancreatitis(AIP)is a unique chronic inflammation of the pancreas in which autoimmune mechanisms are involved in the pathogenesis.It is characterized by clinical,histopathological,radiographic,serologic and therapeutic features.Since it was first described in 1995,increasing numbers of AIP patients have been diagnosed.METHODS:In this study,the data from 2 patients with AIP who had elevation of serum immunoglobulin G,positive autoantibody,swelling of the pancreas and narrowing of the ma...     

Paraquat poisoning: report of two cases and literature review

Cases of poisoning with pesticides, especially suicidal ones, continue to be an important therapeutic problem. The heribicide paraquat (1.1' dimethyl-4.4' bipyridylium dichloride) is the second cause of pesticide poisoning in our country, which is associated with a high mortality rate. We report two cases of suicidal ingestion of paraquat who developed multiorgan failure with a lethal outcome. We also present a brief review of the literature, mainly focused on the different therapeutic options.     

Bladder leiomyoma: report of two cases and literature review

Mesenchymal tumors of the urinary bladder are rare and the majority of them are malignant. We report two cases of leiomyoma of the urinary bladder presenting with symptoms of bladder outlet obstruction. The first patient was managed with staged transurethral resections, and the second with holmium laser transurethral inoculation. The outcome was excellent in both cases. A review of the literature is also outlined.     

Retrocaval ureter: report of two cases and literature review

Retrocaval ureter is a rare congenital anomaly in which the ureter passes behind, and is compressed by, the inferior vena cava. Its etiology is assumed to be abnormal embryologic development of the inferior vena cava as a result of atrophy failure of the right subcardinal vein in the lumbar portion. We report two cases of retrocaval ureter and review the relevant literature. One patient was a 7-year-old boy who presented with right flank pain. The other was a 40-year-old male who was found to have right hydronephrosis accidentally on abdominal sonography during a health examination. Both underwent retrograde pyelography which showed the typical S-shape of a retrocaval ureter. Abdominal computerized tomography and magnetic resonance imaging confirmed the diagnosis of retrocaval ureter. Ureteroureterostomies were performed. One patient showed focal squamous metaplasia of the ureter and the other had chronic inflammation and fibrosis. Follow-up studies showed improvement in hydronephrosis and renal function in both patients. We conclude that retrocaval ureter is a rare disorder and surgical correction is usually effective.     

Salmonella meningitis: report of three cases in adults and literature review

Salmonella meningitis is an unusual complication of Salmonella sepsis and occurs almost exclusively in infants and young children. One case of Salmonella meningitis and two cases of cerebrospinal fluid (CSF) pleocytosis in adult patients with Salmonella bacteremia were studied and the literature was reviewed. On a retrospective review of the charts of 100 sequential patients with Salmonella typhi and S. paratyphi-positive blood cultures, we found one patient with fulminant Salmonella meningitis and two others with CSF pleocytosis. All three patients survived. The patient with Salmonella meningitis had significant residual neurologic sequela. Salmonella encephalopathy occurred in six other patients who presented with headache and were confused or drowsy. Cases of meningitis in adults do occur and are associated with a high morbidity and mortality. Newer cephalosporin antibiotics may be the therapy of choice in these infections. Received: July 3, 2001 · Revision accepted: December 27, 2001