Transmission of Streptococcus equi Subspecies zooepidemicus Infection from Horses to Humans

Streptococcus equi subspecies zooepidemicus (S. zooepidemicus) is a zoonotic pathogen for persons in contact with horses. In horses, S. zooepidemicus is an opportunistic pathogen, but human infections associated with S. zooepidemicus are often severe. Within 6 months in 2011, 3 unrelated cases of severe, disseminated S. zooepidemicus infection occurred in men working with horses in eastern Finland. To clarify the pathogen’s epidemiology, we describe the clinical features of the infection in 3 patients and compare the S. zooepidemicus isolates from the human cases with S. zooepidemicus isolates from horses. The isolates were analyzed by using pulsed-field gel electrophoresis, multilocus sequence typing, and sequencing of the szP gene. Molecular typing methods showed that human and equine isolates were identical or closely related. These results emphasize that S. zooepidemicus transmitted from horses can lead to severe infections in humans. As leisure and professional equine sports continue to grow, this infection should be recognized as an emerging zoonosis.     

Haematogenous Osteomyelitis of the Patella: Report of Three Cases

Three cases of osteomyelitis of the patella are reported. One presented as an acute septic arthritis and another developed a sterile arthritis despite antibiotics. The clinical signs, diagnosis and treatment are discussed. Treatment with rest and antibiotics failed to cure the disease. in all three cases a sequestrectomy was carried out resulting in healing of the affected patella and recovery of knee mobility.     

从《伤寒论》厥证探讨临床感染性休克与低血容量休克的证治

休克是临床危重病症,临床对感染性休克及低血容量休克患者的救治,往往遇到感染不能得到有效控制,体温持续或反复升高;液体复苏后,血压不能恢复或维持的情况。《伤寒论》厥阴病篇中热厥与寒厥的论述,与临床部分感染性休克与低血容量休克的临床表现有类似之处。通过对《伤寒论》热厥与寒厥理论与临床休克证治关系的探讨,有助于拓展中医药治疗感染性休克与低血容量性休克的临床新思路。     

Intravenous ketamine for treatment of super-refractory convulsive status epilepticus with septic shock: A report of two cases

Refractory and super-refractory status epilepticus is a life-threatening neurological emergency, associated with high morbidity and mortality. Treatment should be aimed to stop seizure and to avoid cerebral damage and another morbidity. Published data about effectiveness, safety and outcome of various therapies and treatment approaches are sparse and are mainly based on small case series and retrospective data. Here we report successful management of two cases of super-refractory status epilepticus refractory to anesthetic therapy with midazolam and complicated by septic shock, managed successfully with ketamine infusion.     

早期集束化治疗在经皮肾镜碎石术后感染性休克患者的应用价值

目的：探索早期集束化治疗在经皮肾镜碎石（PCNL ）术后感染性休克患者的应用价值。方法回顾性分析2011年1月至2013年9月因PCNL术后并发感染性休克入住该院中心ICU的患者,根据是否采取感染性休克集束化治疗分为非集束化治疗组28例,集束化治疗组26例。比较两组患者治疗前、治疗后第1、3、5天APACHE‐Ⅱ评分和SOFA评分,ICU停留时间情况。根据28 d随访结果比较两组患者病死率。结果同非集束化治疗组比较,集束化治疗组第1、3、7天APACHE‐Ⅱ评分和SOFA评分均明显降低,差异有统计学意义（P＜0．05）。随访28 d ,集束化治疗组患者病死率（15．38％）明显低于非集束化治疗组（35．71％） ,差异有统计学意义（ P＜0．05）。非集束化治疗组和集束化治疗组患者IC U 停留时间分别为（9．04±4．48）d和（7．00±2．32）d ,差异有统计学意义（ P＜0．05）。结论早期集束化治疗有利于减轻PC N L术后感染性休克患者病情严重程度,减少病死率。     

Complications from Administration of Vasopressors Through Peripheral Venous Catheters: An Observational Study

Background

The placement of a central venous catheter for the administration of vasopressors is still recommended and required by many institutions because of concern about complications associated with peripheral administration of vasopressors.

液体复苏综合疗法对感染性休克疗效研究

目的 :探讨液体复苏联合抗感染的综合疗法治疗感染性休克的临床疗效。方法 :选取280例感染性休克患者为研究对象,根据其意愿分成液体复苏组(A组,n=140)和对照组(B组,n=140)两组,观察并记录两组患者用药后治疗目标达到时间、治疗第1h输液量、ICU总住院时间等指标差异,对比其治疗后死亡及肺水肿发生情况。结果 :1 A组患者在治疗达标时间及ICU总治疗时间对比上均明显短于B组,对比差异明显;B组治疗第一小时输液量明显低于A组;2 A组死亡率为15.0%,明显低于B组的42.8%,对比差异具有统计学意义;两组在治疗肺水肿发生率对比上无明显差异。结论 :对感染性休克患者予以液体复苏联合抗感染治疗方案,临床效果确切,预后质量良好,值得临床推广。     

Clinical problem‐solving: ‘persistent knee arthritis and prolonged fever in a lupus patient’

Salmonella infections occur more frequently among immunocompromised patients such as those with systemic lupus erythematosus (SLE), with high propensity for extra‐intestinal, including osteoarticular, involvement. Hemarthrosis following trauma, typhoid fever and septic arthritis of the knee developed in a 20‐year‐old female lupus patient with pulmonary hypertension, maintained on corticosteroids and warfarin. This article takes the reader through the clinical problem‐solving process with an SLE patient whose illness is confounded by prolonged fever, with manifestations indistinguishable from that of either lupus activity and/or an infection. Early diagnosis, appropriate antibiotics, and if necessary, surgical intervention are essential principles of management to improve prognosis and prevent long‐term disabilities such as destructive arthropathy.     

Acute bone and joint infections in children: current concepts

Paediatric bone and joint infections can be associated with devastating consequences for the growing child. The diagnosis is challenging, requiring experienced clinical examination with adjunct diagnostic tests to aid the distinction between a multitude of differential diagnoses which includes transient synovitis, fracture, neoplasia, rheumatological conditions, blood disorders and infection. Emergent diagnosis is required to prevent consequences such as sepsis, chronic infection, angular deformity and disruption of longitudinal bone growth. The clinical presentation of bone and joint infections in children is varied and includes pain, erythema and swelling, fever, reduced range of movement and the inability to weight bear. Blood and tissue samples should be obtained, if possible, prior to commencing antimicrobial therapy in order to secure the best chance of identifying a causative organism and guide treatment. However, this should not delay treatment. Various imaging modalities can be helpful. Whilst there is some variation depending on the child's age, Staphylococcus aureus is the commonest causative organism in both septic arthritis and osteomyelitis. Septic arthritis and osteomyelitis in children should be treated jointly by paediatricians and orthopaedic surgeons, with input from the wider multi-disciplinary team. Trends towards reduced rates of surgical intervention and shorter antibiotic courses have been evident over recent decades. In this article we present a review of the continuously evolving concepts for the management of paediatric bone and joint infections.     

间羟胺对感染性休克患者血压和肾脏功能的影响

目的观察间羟胺对感染性休克患者血压、心率和肾脏功能的影响。方法根据病情相近、病因相同、年龄相仿的原则收集1995年以来在我科ICU接受治疗的感染性休克患者70例。所有患者在休克发生后,均根据病情变化随时调整间羟胺用量,以维持血压稳定。然后根据临床使用间羟胺剂量的大小,将患者分成3组:小剂量组[A组,n=23,最大泵速为0.5～5μg/（kg.min）]、中剂量组[B组,n=23,最大泵速为6～10μg/（kg.min）]、大剂量组[C组,n=24,最大泵速为>11μg/（kg.min）]。在治疗前对患者进行APACHEIII评分,记录其血压、心率变化及尿量、BUN（血尿素氮）、CRE（肌酐）、尿ALB（白蛋白）和β2-MG（β2-微球蛋白）定量等肾功指标变化。结果抗休克治疗前,B组患者的APACHEIII评分显著高于A组,但低于C组（P<0.01）,说明3组患者的病情依次加重;所有患者BUN、CRE、尿ALB和β2-MG定量均异常升高,但组间差异无统计学意义;抗休克治疗开始后,患者尿量、BUN、CRE及尿ALB和β2-MG定量也逐步恢复（与治疗前相比,均P<0.01）,但组间各指标随时间变化差异无统计学意义。结论间羟胺用于感染性休克时,患者肾功的恢复与血流动力学的稳定相关,而与间羟胺剂量的关系不大。