373 research outputs found
Chronic Candida dubliniensis meningitis in a lung transplant recipient
No full textCandida spp. are common colonizers of the oral mucosa and respiratory tract in lung transplant recipients. Although thought to be non-pathogenic in most cases, donor derived infections related to Candida spp. have been described. Among the manifestations of invasive candidiasis, chronic meningitis is one of the rarest and one of the most challenging to diagnose, due to the indolence of the disease and the low yield of the CSF cultures. It is associated with severe morbidity and a high mortality. Fungal PCR and BD glucan assays can be assistance in its diagnosis, although these tests are not widely available. We report a case of a possible donor derived Candida dubliniensis infection in a lung transplant recipient, who initially presented with empyema that was treated successfully, but subsequently developed chronic meningitis. Diagnosis was delayed due to the low yield of CSF cultures, and was confirmed with fungal PCR and BD glucan assay. Keywords: Candida meningitis, Chronic meningitis, Candida dubliniensis, Lung transplant, Immunocompromise
Hospital-Acquired Methicillin-Resistant Staphylococcus aureus: Epidemiology, Treatment and Control
No full textAntimicrobial-resistant organisms are an expanding problem, resulting
in increased morbidity and mortality, prolonged hospital stay, and
heightened health care costs for care and antimicrobial management.
Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a
major hospital-acquired, antimicrobial-resistant pathogen. MRSA not
only colonizes hospitalized patients but has a propensity to produce
more serious, life- threatening infection than methicillin-susceptible
strains. Numerous risk factors, including antimicrobial use and proximity
to a patient harbouring MRSA, have been linked to the acquisition
of MRSA. Although vancomycin has been the mainstay of
therapy for MRSA, failures have been reported due to reduced susceptibility
to this agent. Other available therapeutic agents for MRSA
include trimethoprim-sulfamethoxazole, tetracycline, fusidic acid,
rifampin (in combination with other effective agents) and linezolid.
Potential therapeutic agents that are currently under investigation
include daptomycin, dalbavancin, tigecycline, ceftobiprole and
iclaprim. Only enhanced infection control practices can halt the progressive
transmission of MRSA in the hospital environment. However,
such measures have not quite fulfilled their promise in clinical studies.
Moreover, eradication of MRSA colonization is controversial and may
promote greater resistance. A multidisciplinary approach to the prevention,
containment and treatment of MRSA is necessary
Jealous Men but Evil Women: The Double Standard in Cases of Domestic Homicide
No full textIn 1989, Sarah Thornton killed her abusive husband with a knife, after years of abuse and threats to her daughter. She was convicted of murder and sentenced to life imprisonment. Also in 1989, Kiranjit Ahluwalia soaked her husband’s bedclothes with petrol and set them alight. He died from burns 10 days later, and she was subsequently convicted of murder and sentenced to life in prison.
In 1991, Joseph McGrail kicked his alcoholic common-law wife to death whilst she lay unconscious. He walked free from court, the judge telling him that “this lady would have tried the patience of a saint”. In 1992, Les Humes told a court that he “saw a red mist” after his wife admitted loving someone else. He fatally stabbed her whilst their teenage children struggled with him. He was convicted of manslaughter due to provocation and was imprisoned for 7 years.
Double standards in judicial processes are notorious. Chivalric justice is the case in which women are given lighter sentences for similar offences to men. This does not apply in the case of domestic homicide, where women are seen as evil and calculating when killing a spouse, men are seen as provoked beyond reason. Women who kill husbands do so with weapons that they need to acquire, men do it with their hands or weapons that are immediately available. So it is seems the defence of crime passionnel is reserved for men; women, it is implied, premeditate the murder of abusive husbands, and are justifiably punished. This paper explores the double standard in uxoricide vs. mariticide, and why it appears that killing a wife is justified and killing a husband is evi
infections in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
No full textReduction in the Nephrotoxicity of Amphotericin B when Administered in 20% Intralipid
No full textThe administration of amphotericin B (AmB) is often limited by the development of nephrotoxicity. In a pilot crossover trial, aqueous AmB followed by a new preparation of a mixture of AmB with 20% intralipid (AmB-IL) was administered to 10 immunocompromised patients for systemic fungal infections caused by Candida species. Mean total dose and duration of therapy with AmB-IL exceeded that of aqueous AmB (649±165 mg versus 394±105 mg, P=0.061 and 13.2±2.5 days versus 9±2.1 days, P=0.31). However, mean creatinine clearance of the patients rose during AmB-IL therapy by 10.7±7.7 mL/min (P=0.03). AmB-IL warrants further investigation to assess its stability and efficacy for treating serious fungal infections
Bacterial Skin and Soft Tissue Infections in Adults: A Review of Their Epidemiology, Pathogenesis, Diagnosis, Treatment and Site Of Care
No full textSkin and soft tissue infections (SSTIs) involve microbial invasion of the skin and underlying soft tissues. They have variable presentations, etiologies and severities. The challenge of SSTIs is to efficiently differentiate those cases that require immediate attention and intervention, whether medical or surgical, from those that are less severe. Approximately 7% to 10% of hospitalized patients are affected by SSTIs, and they are very common in the emergency care setting. The skin has an extremely diverse ecology of organisms that may produce infection. The clinical manifestations of SSTIs are the culmination of a two-step process involving invasion and the interaction of bacteria with host defences. The cardinal signs of SSTIs involve the features of inflammatory response, with other manifestations such as fever, rapid progression of lesions and bullae. The diagnosis of SSTIs is difficult because they may commonly masquerade as other clinical syndromes. To improve the management of SSTIs, the development of a severity stratification approach to determine site of care and appropriate empirical treatment is advantageous. The selection of antimicrobial therapy is predicated on knowledge of the potential pathogens, the instrument of entry, disease severity and clinical complications. For uncomplicated mild to moderate infections, the oral route suffices, whereas for complicated severe infections, intravenous administration of antibiotics is warranted. Recognition of the potential for resistant pathogens causing SSTIs can assist in guiding appropriate selection of antibiotic therapy
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