Bacillary angiomatosis

Bacillary angiomatosis is a bacterial disease which affects mainly immunosuppressed patients. It may compromise any tissue, especially the skin, presenting papules, nodules or angiomatous tumors. We studied three young men with AIDS, all of them with 1-2 papules, nodules or subcutaneous tumors suggesting telangiectatic granuloma, sarcoma and lipoma. Microscopically, they were misdiagnosed as telangiectatic granuloma, Kaposi's sarcoma and "angioma with secondary inflammation". After reviewing the histopathology, we saw them to be composed by vessels with prominent endothelium and stroma rich in leukocytoclastic polymorphonuclears. Fibrinoid deposits were observed in the neighborhood of vessels as well as minute eosinophilic granular interstitial masses corresponding to Bartonella aggregates, criteria which answer to the diagnosis of bacillary angiomatosis with HE staining. The Warthin-Starry stain was not useful; using resin embedded tissue from paraffin-embedded material, bacterial clusters, both in semithin section stained with toluidine blue and in thin sections observed under the electron microscope, were clearly seen, confirming bacillary angiomatosis diagnosis. Patients were successfully treated with surgery and either erythromycin or doxycycline. We reviewed the entity as well as its differential diagnoses with telangiectatic granuloma, Kaposi's sarcoma, Carrion's disease, and cat-scratch disease. In conclusion, we showed the presence of bacillary angiomatosis in three patients, illustrated its typical histopathological appearance with HE staining and demonstrated the causal bacteria in thick sections and with the electron microscope. It is essential to recognize bacillary angiomatosis, as it can be cured with antibiotics.

Retroperitoneal actinomycosis due to dropped gallstones.

Dropped bile and gallstones after accidental perforation of the biliary gallbladder is a frequent event during laparoscopic cholecystectomy and is generally of no clinical importance. However, calculi left in the abdominal cavity can produce a series of severe late complications. We present a patient with retroperitoneal actinomycosis produced by dropped gallstones after a laparoscopic cholecystectomy.

Clinical relevance of Penicillin VK (V-Cillin K)-resistant Streptococcus pneumoniae.

Streptococcus pneumoniae is the most important respiratory tract pathogen in otitis, sinusitis, bronchitis, and community-acquired pneumonia. Over the past decades, there has been an increase in minimum inhibitory concentrations (MICs) to Penicillin VK (V-Cillin K). Decreased susceptibility to Penicillin VK (V-Cillin K) is not the same as Penicillin VK (V-Cillin K) resistance. Decreased susceptibility to Penicillin VK (V-Cillin K) has occurred worldwide from dissemination of several resistant pneumococcal clones, and, to a lesser extent, from excessive use of Ciprofloxacin (Cipro), macrolides, and trimethoprim-sulfamethoxazole (TMP-SMX). Currently, Penicillin VK (V-Cillin K) resistance is defined by using a breakpoint of 2 microg/mL or more. Intermediately resistant strains (MIC 1-2 microg/mL) are also relatively sensitive depending on antibiotic concentration. Intermediate antibiotic susceptibility is concentration dependent. Antibiotic concentration at various body sites is determined by pharmacokinetic considerations. Except for very highly resistant strains, the treatment of Penicillin VK (V-Cillin K)-resistant S. pneumoniae causing bacteremia, sinusitis, otitis, bronchitis, or community-acquired pneumonia remains Penicillin VK (V-Cillin K) or any beta-lactam. Only in pneumococcal meningitis caused by Penicillin VK (V-Cillin K)-resistant pneumococci does the clinician have to use care in selecting an antipneumococcal antibiotic with adequate cerebrospinal fluid penetration and favorable kill ratios. Clinicians should be selective in antibiotic selection to minimize further decreases in Penicillin VK (V-Cillin K) susceptibility to S. pneumoniae. This is best achieved by using low-resistance potential antibiotics oral/intravenous mono-therapy at the full recommended dose. Therapeutic failure may occur in using lower doses at certain body sites. Macro-lides as monotherapy or as part of combination therapy should be minimized. Optimal therapy for non-central nervous system pneumococcal infection is with a respiratory quinolone (eg, Levofloxacin ( Levaquin ), gatifloxacin, moxifloxacin), clindamycin, doxycycline, third-generation cephalosporins. For highly resistant pneumococci, Levofloxacin ( Levaquin ), gatifloxacin, moxifloxacin, cefepime, meropenem, vancomycin, or linezolid may be used. Copyright 2002, Elsevier Science (USA). All rights reserved.

Doxycycline (Doryx)in the management of pseudomonas corneal melting: two case reports and a review of the literature.

BACKGROUND: Pseudomonas keratitis can result in the breakdown of collagen with subsequent corneal melting and perforation. The use of antimetalloproteinases may help to stabilize melting and prevent imminent perforation of the cornea. The use of topical protease inhibitors and neutrophil inhibitors is of limited value. Tetracyclines, however, have been shown to have anticollagenolytic activity and inhibit metalloproteinases, and they may suppress connective tissue breakdown. PURPOSE: To establish the stabilization of corneal melting in cases of Pseudomonas keratitis. METHODS: Two young patients with severe contact lens-associated Pseudomonas keratitis and corneal melting were treated with oral doxycycline (Doryx)and standard topical treatment. RESULTS: Corneal melting was stabilized in each patient, and perforation was avoided. CONCLUSIONS: Tetracyclines have an anticollagenolytic action in addition to their antimicrobial activity. The use of doxycycline (Doryx)as an adjunctive therapy in the management of Pseudomonas corneal melting may help to stabilize corneal breakdown and prevent subsequent perforation.