19 February 2012

Infectious Disease, week #2

Day #6:

A person with a history of E. coli sepsis (blood infection) who now has findings on a brain scan suspicious for abscess, but could also represent tumor. Abscess is more likely, so we will treat with antibiotics for 4 weeks, scan their head again, and see if there has been any response.

A person with an infection of the skull bone behind the ear on the right side, recovered, had a stroke, had a portion of skull removed to accomodate swelling, had the skull replaced and now appears to have developed an infection of the skull bone behind the left ear. Cultured the drainage and tested the susceptibility of the bacteria. Antibiotics recommended, person is recovering.

Day #7:
A person who had their hip replaced, had an infection in that hip, had the replacement removed and a new one inserted, had another infection, had the second replacement removed, now has no hip on that side and is undergoing treatment to clear... infection. They fell and now their knee is swollen too - blood from the fall, blood clot, or spreading infection? Likely from the fall. Continue antibiotics, check inflammatory markers and use ultrasound to rule out clot.

A person on dialysis with endocarditis and known brain abscesses. We helped identify the organism, choose antibiotics and he is undergoing pre-surgical workup. Kinda grumpy.

Day #8:
A Chinese immigrant who is coughing up blood. They have a lung disorder that can cause episodic blood, but there is also concern for tuberculosis (which is endemic in China). More likely to be their underlying condition (based on physical exam) - testing confirms. We set them up with pulmonary follow-up.

Day #9:
A person who arrived in liver failure due to purposeful overdose who continued to have fevers despite antibiotics. Given chest x-ray, more likely drug fever or chemical pneumonitis, but will treat with a short course of antibiotics to rule out aspiration given their altered mental status and vomiting on admission.

Day #10:
A person who has cancer and no immune cells due to chemotherapy now has a fever and trouble breathing. Chest imaging is suspicious for fungus. Lots of antibiotics started until we can clarify the nature of the infection.

A person with multiple antibiotic allergies who has an infection of the inside of the nose. There is always a concern that if inadequately treated, an infection like this will spread backwards to the brain. Broad antibiotics were started until we can grow the bug in culture and narrow them.

Still following:
The endocarditis patient from last week who has vegetations on their pacer leads. They went to surgery and had their pacemaker removed. Labs are still negative, so a 4-6 weeks course of broad spectrum antibiotics before a new device can be placed. Still unclear what their lung findings are: septic emboli vs pneumonia.

The patient with ulcerative colitis who had a blood infection and a clot in their arm... the clot was not surgically removed and they cleared the bacteria from their blood. Was discharged to complete antibiotics at home.

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