Lege Artis Medicinae

[Catheter related infection caused by Rhizobium radiobacter in hemodialysis patient]

SÁGI Veronika, OROSZ Attila

AUGUST 20, 2016

Lege Artis Medicinae - 2016;26(07-08)

[INTRODUCTION - Rhizobium radiobacter is a rare opportunistic pathogen. The bacteria present in soils causes systemic infection mostly in immuncompromised patients and frequently forms biofilm on intravascular and other indwelling plastic catheters. Majority of the pathogen stems shows sensitivity to cephalosporins, carbapenems and ciprofloxacin. CASE REPORT - In case of our hemodialysis patient a vegetation developed on the tip of the tunneled central venous catheter. The patient was exposed to dust emerging from soil during agricultural work before the infection. After removal of the intravascular device and ceftazidim treatment for seventeen days the patient recovered. CONCLUSION - Overcoming the infection is in greater part of the cases only possible if the plastic device is removed because it forms an infective focus.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[End-of-Life Decision Situations Medical Assistance to Death: Clinical Criteria, USA ]

KŐMÜVES Sándor

Lege Artis Medicinae

[Soul and Abortion ]

MAGYAR László András

Lege Artis Medicinae

[Parallel Lives – a Painter and their Model Isaac Israëls: Portrait of Aletta Jacobs ]

NÉMETH István

Lege Artis Medicinae

[Zoltán Arányi, the Most Famous Hungarian Child Mummy ]

SCHEFFER Krisztina

Lege Artis Medicinae

[Findings from the Fortepan Archives International Medical Congress – 1929 ]

ARADI Péter

All articles in the issue

Related contents

Hypertension and nephrology

[Nutritional status of hemodialysis patients, and the role of dietician in the complex care of renal patients]

POLNER Kálmán, KOVÁCS Lívia, HARIS Ágnes

[In chronic renal failure severe cardiovascular complications develop, which are the cause of death in 50% of the patients. According to recent results, behind the accelerated atherosclerosis, malnutrition and inflammation, developing in patients with chronic renal failure, play significant role. Malnutrition and inflammation show close relationship to the serum albumin level, which is an independent predictor of mortality. Authors studied the nutritional parameters of 94 chronically hemodialysis patients. Patients had been dialysed for more than three months, for 3×4-4.5 hours weekly. Among them 36% had diabetes. According to BMI (body mass index) 42.5% of the patients was normally nourished (20-24 kg/m2), 11.7% of them had malnutrition, 28.7% was overweight, and 17.1% was mildly or moderately obese. Subjective Global Assessment (SGA), calculated by dietician, revealed, that 47.9% of the patients has normal nutritional condition, all the others had some degree of malnutrition. Serum albumin level showed close correlation with the nutritional status, also with an inflammatory marker, the CRP. Only 63.8% of the patients had higher than 40g/l serum albumin. Those, who had higher than 10 mg/l CRP value, had significantly lower serum albumin (38.7±3.4 g/l), comparing to the albumin of the patients, whose CRP was below 10 mg/l (40.5±3.9 g/l, p=0.04). Comparing anthropometrical data, there was no significant difference between diabetic and non-diabetic patients. Grouping patients by their ages, the malnutrition, defined by SGA scores and by serum albumin level, was significantly worse in patients older than 80 years, than in the younger than 50 years old subjects, which signals increased risk of mortality of the elderly patients. A case presentation demonstrates, that malnutrition can be diagnosed at early stage by appropriate nutritional assessment, and it can be corrected by timely and satisfactory energy- and nutrient-substitution, in severe cases by specially prepared nutritional supplements, and thereby the patient’s severe cardiovascular risk can be ameliorated. The successful treatment of hemodialysis patients requires change in medical practice, and close cooperation between physicians and dieticians.]

Lege Artis Medicinae

[ANTIBIOTIC TREATMENT OF SKIN AND SOFT TISSUE INFECTIONS - THE USE OF RESPIRATORY FLUOROQUINOLONS]

MAGYAR Tamás

[The paper reviews the classification and grading of skin and soft tissue infections and their most common pathogens. The recommended antibiotics are itemized taking into account their antibacterial and pharmacokinetic properties and side effects. The use of levofloxacin, an antibiotic that have so far been almost exclusively given in respiratory tract infections, is noted as a new therapeutic option. In unusually severe infections hospitalisation of the patient can be avoided since levofloxacin can also be prescribed by general practitioners. Both published data and the author's own experience suggest that levofloxacin may gain a prominent role in the treatment of skin and soft tissue infections both in primary and specialist care.]

LAM KID

[Vitamin D deficiency and infections]

LUDWIG Endre, KRIVÁN Gergely

[Studies performed in the past few years have confirmed that vitamin D is essential for maintaining the optimal immune defense, and its immunomodulatory effect has a role in the defense against infections as well. A lot of data suggest that low serum 25-(OH)-D concentration is associated with an increased frequency of certain infections and it adversely influences pathological processes. Data on this adverse effect are available mostly in case of Mycobacterium tuberculosis, respiratory viral infections in general, HIV, hepatitis C and sepsis. The outcomes of severe infections are usually influenced by a number of factors and it seems that vitamin D deficiency is one of those factors that shift the process towards an unfavourable outcome. Further studies should evaluate the significance of this role and the influence of vitamin D supplementation on pathological processes.]

Hungarian Radiology

[Initial experiences with upper limb MR-angiography]

PAVLIKOVICS Gábor, KISS Máté, ENGLONER László, LOMBAY Béla

[INTRODUCTION - Cimino fistula is created for chronic hemodialysis. As a common complication steal syndrome may occur. Till recently, color Doppler and catheter angiography were the gold-standard diagnostic tools. We have performed MR-angiography of the upper limb to replace the more invasive conventional angiography in patients with poor general condition. PATIENT AND METHODS - A case of a 64 years old female patient with known type II diabetes is presented. Due to azotemia, the patient has received hemodialysis for 24 months, via a left upper limb fistula. This fistula occluded, and the Cimino-fistula was later created on the right arm. This new fistula demonstrated steal syndrome, and required formal ligation. In the meantime a necrotising drygangrene of the 4th and 5th digits was recognised. This required an emergent conventional angiography, but due to the unavailability of accessible artery, MR-angiography was performed. 1.0 mmol/ml concentration gadobutrol (Gadovist 1.0, BayerSchering, Berlin) was used to reduce the chances of nephrogenic systemic fibrosis in this patient with poor renal function. CONCLUSION - Correctly performed MR-angiography to examine the possibility of steal syndrome in patients with a Cimino fistula can be a feasible alternative. The advantages of the procedure include its minimal invasiveness, no ionizing radiation and the risk of iodine-based contrast material nephrotoxicity. Also, as compared to digital substraction angiography, with MR-angiography we obtain a high-resolution, isotrope voxel-sized 3D acquisition which can be better read in many different planes. As a drawback, currently on-location intervention cannot be performed, if needed. Also, the waiting periods may be long.]

Hungarian Immunology

[Immunology of Felty’s syndrome]

BÁLINT Géza, BÁLINT Péter

[Felty’s syndrome can be regarded as “super-rheumatoid” disease. Immungenetically the syndrome is much more homogenous, than rheumatoid arthritis. HLA-DRB1*0401 antigen is present in 83% of the patients. Felty’s syndrome develops usually after a longer course of rheumatoid arthritis, in 1% of rheumatoid patients. Rheumatoid arthritis patients with long lasting unexplained neutropenia can be diagnosed having Felty’s syndrome, even without detectable splenomegaly. On the contrary, rheumatoid arthritis with splenomegaly, but without present or previous neutropenia with unexplained origin cannot be regarded as having Felty’s syndrome. Inspite of the fact, that the arthritis of Felty’s syndrome can be inactive, because of the neutropenia and increased risk of recurrent infections, the patients should be kept under tight supervision, and should be properly treated, if required. Immunologically Felty’s syndrome is characterized by rheumatoid factor positivity in 95-100%, ANA positivity in 50-100%, antihistone positivity in 63-83%. Antibodies against dsDNA rarely, but against ssDNA frequently occur. No anti Sm and interestingly no anti Ro and anti La antibodies can be detected inspite of the high incidence of associated Sjögren’s syndrome. Immunoglobulin levels are higher and complement levels are lower, than in rheumatoid arthritis. Circulating immuncomplex level is usually high. Non-specific antineutrophil anticitoplasmatic antibodies can be found in high percentage. The neutropenia of Felty’s syndrome can be either caused by increased IgG neutrophilic binding activity or by inhibition of the granulocytes colony growing in the bone marrow, by peripheral blood mononuclear cells. Expansion of large granular lymphocytes can be seen in 30-40% of patients with Felty’s syndrome. Large granular lymphocyte syndrome is not rarely associated with rheumatoid arthritis. The neutrophil account is normal or elevated in this syndrome, but splenomegaly occurs. These cases are called as pseudo Felty’s syndrome. The patients with Felty's syndrome suffering from recurrent infections required treatment even if the arthritis is inactive. Methotrexate treatment should be started first, if this treatment fails, other disease modifying drugs or colony stimulating factor can be given. There is no experience with other biological treatments. In treatment of resistant cases splenectomy is indicated. Non-steroid anti-inflammatory drugs should be better avoided.]