Multiresistant Pseudomonas aeruginosa associated with contaminated transrectal ultrasound.
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Antibiotic Prophylaxis↗
Biomedical subjects
I Potasman
Publications and source records attributed to I Potasman.
Candida sepsis following transcervical chorionic villi sampling.
BACKGROUND: The use of invasive devices and broad spectrum antibiotics has increased the rate of candidal superinfections. Candida sepsis associated with pregnancy is rare. Candida sepsis following chorionic villi sampling (CVS) has never been reported. CASE: A 31 -year-old pregnant woman presented with signs of sepsis one day after undergoing transcervical CVS. Blood culture and curettage material yielded C. albicans. She was treated with 400 mg of fluconazole daily for 4 weeks and completely recovered. CONCLUSION: Candida sepsis should be considered in the differential diagnosis of sepsis following CVS.
Adult↗
Serious adverse events of mefloquine in relation to blood level and gender.
Mefloquine is widely used for prophylaxis in areas with chloroquine-resistant falciparum malaria. As the use of mefloquine has increased, so have the reports on its adverse effects. We sought to evaluate the possible association between serum levels of mefloquine and serious side effects caused by this drug by means of a case-control design study. The study population included 17 patients who presented to emergency rooms or travel clinics with symptoms suggesting serious adverse effects of mefloquine and 28 controls (healthy people, still taking mefloquine after travel). The mean age of the patients and the controls was 31.5 +/- 11.6 years and 34 +/- 12.2 years, respectively. The percentage of women among the patients was higher than in the control population (76% versus 40%, respectively; P = 0.03). Most of the complaints were related to the central nervous system (13 of 17); 5 patients interrupted their trip and 2 others were hospitalized. No difference in the level of mefloquine in the blood was found between the patients and the control groups. Also, no significant difference was found between mefloquine levels in the blood of men and women. These results suggest that blood levels of mefloquine do not correlate with its severe adverse events. Women tended to be more susceptible than men, despite having similar blood levels of the drug.
Adult↗
Inadequate protection against yellow fever of children visiting endemic areas.
The guidelines of the World Health Organization call for immunization against yellow fever at least 10 days before travel to endemic areas. The goal of this study was to determine whether these guidelines have been applied in 2 travel clinic settings in teaching hospitals in Israel and the United Kingdom specifically for children traveling to endemic areas. Two groups of children aged 9 months to 15 years (n = 98), who were planning to travel to yellow fever-endemic areas, were evaluated regarding characteristics related to the administration of yellow fever vaccine before travel. Overall, 19 children in both clinics (19.4%; 95% confidence interval, 12.1-28.6) had received their yellow fever vaccination < 10 days before departure (no interclinic difference). Eleven of these children received the vaccine < 7 days before departure. We found that the World Health Organization guidelines for yellow fever vaccination are frequently not followed. An initiative to explain to the public the importance of vaccination well before travel to endemic areas should be undertaken.
Adolescent↗
Changing epidemiology of dengue fever in travelers to Thailand.
A study was conducted to evaluate the incidence and seasonal pattern of dengue fever occurring among Israeli travelers to Southeast Asia. The illness was diagnosed by Israeli physicians stationed abroad and by serological methods carried out in Israel. Between 1994 and 1998 dengue fever was confirmed in 103 travelers, 80 of whom were diagnosed in Israel. A sharp increase in the incidence was noted in 1998 as compared with the previous 4 years. The attack rate during 1998 in a defined group of travelers was 3.4/1,000 and reached a peak of 5/1,000 during the dry season of 1998.
Dengue↗
Ehrlichiosis associated vasculitis.
OBJECTIVE: To test the hypothesis that some cases of primary vasculitis are caused by ehrlichiosis. DESIGN: A retrospective case study and serological analysis of stored sera. SETTING: University hospital. SUBJECTS: Fifty-five patients discharged with any type of vasculitis over a 6-year period. MAIN OUTCOME MEASURES: Serology for human monocytic ehrlichiosis, and the human granulocytic ehrlichiosis agent, and polymerase chain reaction (PCR) analysis of biopsy specimens. RESULTS: Three patients (5.5%) had titres of 1 : 128 or higher against E. chaffeensis; none was positive for the human granulocytic ehrlichiosis agent. Skin biopsies of these patients showed lesions compatible with polyarteritis nodosa, allergic purpura and unspecified vasculitis. PCR analysis of the biopsies was unrevealing. CONCLUSIONS: Infection with human monocytic ehrlichiosis may underlie some forms of vasculitis. If confirmed, these findings may help identify patients with vasculitis who would benefit from antibiotic treatment.
Adult↗
Controlled trial of the effect of cinnamon extract on Helicobacter pylori.
BACKGROUND: Helicobacter pylori has been associated with the pathogenesis of antral gastritis, duodenal ulcer, and gastric lymphoma. Eradication of H. pylori has been shown to reverse or prevent relapse of these diseases. Antimicrobials employed in the eradication of H. pylori are not without adverse effects. Newer treatment modalities, therefore, are required. In vitro studies have shown the effectiveness of cinnamon extract against H. pylori and its urease. In this pilot study, we tested the activity of an alcoholic extract of cinnamon in a group of patients infected with H. pylori. MATERIALS AND METHODS: Fifteen patients (11 women, 4 men) aged 16 to 79 years were given 40 mg of an alcoholic cinnamon extract twice daily for 4 weeks; eight patients aged 35 to 79 (7 women, 1 man) received placebo. The amount of H. pylori colonization was measured by the 13C urea breath test before and after therapy. RESULTS: The mean urea breath test counts in the study and control groups before and after therapy were 22.1 and 23.9 versus 24.4 and 25.9, respectively. The cinnamon extract was well tolerated, and side effects were minimal. CONCLUSIONS: We concluded that cinnamon extract, at a concentration of 80 mg /day as a single agent, is ineffective in eradicating H. pylori. Combination of cinnamon with other antimicrobials, or cinnamon extract at a higher concentration, however, may prove useful.
Adolescent↗
Iatrogenic meningitis: an increasing role for resistant viridans streptococci? Case report and review of the last 20 years.
Iatrogenic meningitis following lumbar puncture is a rare event. We present a 52-y-old man who developed symptoms of meningitis within 12 h after spinal anaesthesia. Cerebrospinal fluid cultures grew Streptococcus salivarius partially resistant to penicillin and ceftriaxone. The patient was successfully treated with ceftriaxone and vancomycin and left the hospital with minor sequelae. A literature review of 60 cases revealed the median age of the patients to be 44 y. The median incubation period was 24 h. Most cases occurred after spinal anaesthesia (n = 27), myelography (n = 20) and diagnostic lumbar puncture (n = 5). Organisms were isolated in 52 cases, and streptococcal species were responsible for 33 (63%) of them. An upward trend in resistance of S. viridans isolates is cause for concern and may change empirical treatment strategies. Death was reported in 3 cases (5%) and was associated with Pseudomonas and staphylococcal isolates. The recognition of this entity and the importance of proper infection control measures are underlined.
Anesthesia, Spinal↗
Outbreak of Q fever following a safari trip.
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Adult↗
Neuropsychiatric problems in 2,500 long-term young travelers to the tropics.
BACKGROUND: The prevalence and features of travel associated neuropsychiatric problems (NPP) and their relation to previous psychological consultations, antimalarials and recreational drug use have not been adequately studied. METHODS: A two-phase postal and telephone survey has been conducted among 2,500 young travelers to tropical countries. We measured the rate and duration of NPP, characterized their features, and their association with previous psychological profiles, itinerary, type of travel, consumption of recreational drugs, and malaria prophylaxis. RESULTS: First phase: Out of 1,340 respondents, 151 (11.3%) indicated that they had NPP during travel, in contrast with 2.3% who needed psychological consultation before travel (p<.001). Second phase: 117 of 151 responded to the study questionnaire. The mean age of the respondents was 24.4 years, 54.7% were female, and the mean stay abroad was 5.3 months. The most common NPP were sleeping disturbances (52.1%), fatigue (48.7%) and dizziness (39.3%). Thirty-three travelers (2.5%) had severe symptoms, and 16 (1.2%) had symptoms lasting more than 2 months. Seven travelers had pure or mixed depressive symptoms. Consumption of recreational drugs was admitted by 22.2%. Mefloquine was used significantly more often by those who suffered NPP, than by the entire cohort (98.2% vs. 70.7%; p<.001). CONCLUSIONS: Long-term travel to the tropics was associated, in this cohort, with a considerable rate of neuropsychiatric symptoms. The majority of the responding travelers were females, used mefloquine as prophylaxis, and at least one fifth used recreational drugs.
Adolescent↗
[Listeria monocytogenes infections--ten years' experience].
7 cases of listeriosis were diagnosed here between 1988-1997 (6 in last 3 years), or 2.94/100,000 admissions. 2 elderly patients suffered from meningitis and 2 pregnant women presented with premature contractions, 1 of whom delivered a premature, infected baby. 2 other patients had fever and gastroenteritis. Listeria monocytogenes was isolated from blood in 4, CSF in 2 and the placenta in 1. It was isolated from those with bacterial meningitis. All patients recovered. Both increased awareness for prevention and better diagnosis are essential to reduce morbidity from this unusual pathogen.
Adult↗
[Monocytic ehrlichiosis--an emerging zoonotic disease in Israel].
Ehrlichiosis is an emerging zoonotic disease transmitted to man by ticks. Its clinical features include fever, headache, myalgia, nausea and rash. The diagnosis requires a high index of suspicion; the disease has a specific serology, and has never been reported in Israel. We describe a 52-year-old man hospitalized with fever, a diffuse rash, arthralgia and epididymitis. Skin biopsy disclosed necrotizing small vessel disease consistent with periarteritis nodosa. Acute phase serum titer for E. chaffeensis was 1:256. Fever promptly subsided following ciprofloxacin.
Animals↗
Isolation of Ureaplasma urealyticum and Mycoplasma hominis from public toilet bowls.
The presence of Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis was explored in 50 public restroom toilet bowls. We used culture, antigen detection, polymerase chain reaction, and survival assay. Five bowls (10%) were contaminated with at least one organism. U. urealyticum was found in four bowls, M. hominis in three, and C. trachomatis in one. U. urealyticum survived on the toilet rim for up to 2 hours.
Chlamydia Infections↗
[Intradermal hepatitis B vaccination in workers not responsive to intramuscular vaccination].
Health care workers are at continuous risk of hepatitis B infection. Currently recommended intramuscular vaccination confers immunity in only 85-90%. We examined the immunogenicity and safety of intradermal vaccination of hepatitis B vaccine in nonresponders. 400 hospital employees who had been immunized as recommended were screened for anti-HBs antibodies and 50 were found seronegative. Each received an intramuscular booster injection and antibody level was measured a month later. Excluded were 33 employees, including 24 late responders, 2 HbsAg carriers and 7 uncooperative employees. 17 employees (mean age 47.1 yrs) then received a series of 3 intradermal injections of Energix B, 0.25 ml in the forearm, 2-3 weeks apart. The mean number of previous intramuscular injections was 4.6 +/- 1.4. A month later there was a mean titer of 315.4 +/- 347.0 miu/ml of antibody in 16/17 workers. Side effects were minimal. Intradermal injection of hepatitis B vaccine for nonresponders seems effective for inducing seroconversion. Its cost-effectiveness for the health care system warrants assessment.
Adult↗
A unique case of mefloquine-induced psoriasis.
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Antimalarials↗
Cutaneous larva migrans, sacroileitis, and optic neuritis caused by an unidentified organism acquired in Thailand.
We report the case of a 32-year-old pregnant woman with an unidentified intraocular parasite. The parasite, which had been acquired in Thailand, caused cutaneous larva migrans, sacroileitis, and 2 years later optic neuritis and panuveitis. The patient was successfully treated with ivermectin and albendazole. The diagnostic possibilities of this peculiar presentation are discussed. Parasitic infections are a leading cause of medical problems in travelers to tropical countries.1 While most parasites cause gastrointestinal problems, some may migrate throughout the body and lodge in critical organs. Ocular parasitic infections may occur by direct inoculation onto the eye,2 or incidentally during systemic migration. Subconjunctival parasites are easily diagnosed by removal and careful microscopic examination.3 Parasites, which lodge within the eye, are more difficult to diagnose, especially if not removed. In this report we describe a patient who presented with an intraocular parasite causing optic neuritis and panuveitis, 2 years after travel to Thailand.
Adult↗
Helicobacter pylori serostatus in backpackers following travel to tropical countries.
The mode of transmission of Helicobacter pylori is unknown. The seroprevalence of H. pylori and the rate of transmission of feco-oral pathogens in developing countries are both high. Long-term travelers to these regions, who come from developed countries are thus potentially at increased risk of an infection with this bacterium. We studied the H. pylori serology status before and after travel of 104 backpackers who traveled to tropical countries; 76 medical students who did not leave Israel served as controls. Southeast Asia (70%) and South America (24%) were the major destinations, but the area of travel had no effect on the seroconversion rate. The total time spent abroad was 53 person-years. Thirty six of the travelers and 30 controls were positive at the outset. Seropositivity at entry was significantly associated with being a Sepharadic Jew or having a parent with a peptic ulcer disease. The majority of travelers (86.5%) and controls (92.1%) did not change their serostatus. Four travelers seroconverted, but 10 seroreverted, while three controls seroconverted, and three others seroreverted. No significant association with gastroenteritis was found. Serostatus may have been affected by mefloquine use because none of the four seroconverters, but eight of 10 seroreverters used it as malaria prophylaxis. In vitro studies demonstrated that mefloquine has anti-H. pylori activity. Feco-oral transmission is apparently not an important route of transmission of this organism among travelers.
Adult↗
Primary Herpes Labialis Acquired during Scuba Diving Course.
Primary herpes infections usually require intimate contact of mucous membranes by either oral or sexual means.1,2 Infrequently, other types of contact have been described.3-5 Such was the case with an outbreak of herpes gladiatorum at a high-school wrestling camp, or a dental student who became infected from a patient.3,4 Reports charging fomites as vehicles of transmission of this virus seem anecdotal.6-8 Is it really that rare? We wish to present a hitherto unreported mode-of-transmission of primary herpes simplex virus (HSV) infection.
Journal Article↗