With the increased movement of the world population, acquaintance with the clinical picture of the Madura foot is of growing importance beyond its original endemic areas. The characteristic triad of symptoms consists of indurated swelling, multiple sinus tracts with purulent discharge filled with grains and localization at the foot. An increasing number of new etiologic agents are recognized today. For a better choice of therapy an adequate diagnostic procedure is essential ; a deep biopsy for histology appears to give a more substantial contribution to identification of the causal organism than culture. The treatment which should be started early, is at first essentially a drug treatment. However, in spite of high expectations with regard to new antimycotic drugs, amputation or disarticulation is often inevitable even today, particularly when the lesion is caused by Eumycetes. The first two documented patients with this disease in the Netherlands are described. They developed serious deformities of the lower extremity despite long-term use of antimycotic and antibiotic medication.
Le suivi. La mortalité chez les patients qui ont et qui n'ont pas commencé à prendre le cotrimoxazole au cours des 6 premiers mois de la TAR était de 5,3 et 7,0 pour 100 personnes-années, respectivement. Le cotrimoxazole était associé avec 37% de réduction de la mortalité (rapport des risques, RR: 0,63; intervalle de confiance à 95%, IC 95%: 0,56-0,70). Le cotrimoxazole ajouté à la TAR a réduit significativement la mortalité au cours du suivi des 6 derniers mois (RR: 0,65; IC 95%: 0,59–0,73), des 12 derniers mois (RR: 0,58; IC 95%: 0,49-0,70), des 18 derniers mois (RR: 0,49; IC 95%: 0,38-0,63) et des 24 derniers mois (RR: 0,66; IC 95%: 0,48-0,90). La réduction de la mortalité était évidente chez les patients avec un nombre de cellules CD4+ à la ligne de base inférieur à 50 cellules/µL (RR: 0,60; IC 95%: 0,54–0,67), 50–99 cellules/µL (RR: 0,66; IC 95%: 0,56-0,78) et 100-199 cellules/µL (RR: 0,78; IC 95%: 0,62-0,98).
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Although controversies remain regarding the definition, diagnosis, and management of urinary tract infections, such infections can pose a major risk to a child's well-being. Bacteriuria or recurrent urinary tract infections often pose difficult management problems. Symptomatic and asymptomatic bacteriuria during infancy are generally characterized by a benign outcome. In some children repeated episodes and, possibly, renal scarring result. The prognosis in young boys may be guarded if neonatal bacteriuria, with or without symptoms, occurs in the presence of anatomic defects. Although a variety of pathogens have been identified as causing urinary tract infections, Enterobacteriaceae are usually the cause of initial uncomplicated lower tract infections. Accepted therapy for such infections is reviewed, as are the combination therapies used for hospitalized patients with upper tract infections. An investigation of piperacillin, a new, extended-spectrum acylaminopenicillin, raises the hope that it may provide effective monotherapy for upper tract infections. The criteria for selecting patients who require radiologic evaluation in the management of urinary tract infections are reviewed.
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COSTOP is a randomised double blind placebo controlled non-inferiority trial among HIV infected Ugandan adults stabilised on anti-retroviral treatment (ART). Participants with CD4 count of 250 or more cells/mm(3) are randomised to two arms: the intervention arm in which CTX is discontinued and the control arm in which CTX prophylaxis is continued. The study aims to assess whether the intervention regimen is not inferior, with respect to the incidence of pre-defined CTX-preventable events, to the control regimen and superior with respect to the incidence of haematological adverse events.
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Cyclospora cayetanensis is an emerging pathogen. It is a new human coccidian agent of intestinal disease. Twenty years ago, the first known human cases of cyclosporiasis were reported in the medical literature. Cyclosporiasis occurs in persons of all ages and either in immunocompetent or immunocompromised hosts. The most characteristic feature of this infection is a syndrome of acute or chronic diarrhea. This parasite has a world-wide distribution. In previous reports, Cyclospora cayetanensis was associated with prolonged diarrhea in travellers, returning from developing countries. However, Cyclospora infection has recently been reported in non travellers in the United States and Canada. Cyclospora can be transmitted by ingestion of water or food contaminated with oocysts. The life cycle of Cyclospora cayetanensis is not fully known. Diagnosis of cyclosporiasis is made by direct examination of stool samples. To date, oral trimethoprim-sulfamethoxazole is the only effective treatment for Cyclospora infection.
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In Malawi, where the efficacy of SP for the treatment of malaria in children is decreasing, we conducted a randomized, nonblinded study to compare the efficacy of monthly SP IPTp with a 2-dose regimen for the prevention of placental parasitemia in HIV-positive and -negative primigravid and secundigravid women.
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Medical records were reviewed and age, CD4 count, lactate dehydrogenase, room air (RA) PaO2, coinfections, and day of admission to day of intubation (DOA-DOI) data were recorded.
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A postpartum patient had a unilateral breast infection that responded to cephalosporin treatment. During therapy, the contralateral breast developed a methicillin-resistant Staphylococcus aureus infection. The patient was hospitalized and treated successfully with intravenous vancomycin. Obstetricians should be alert to this possibility when treating patients with postpartum mastitis.