Case History #8
from Dr. Tortora

MORE THAN
A SORE THROAT

A young man came to the emergency room complaining of a fever and rash on his abdomen and arms. He had a history of a sore throat. His CBC showed a high white count. A chest X-ray was done and CT scan showed inflammation of the jugular vein of his neck. This resulted in a diagnosis of Lemierre's Disease. As expected, his blood cultures grew out Fusobacterium necrophorum, and he was put on appropriate antimicrobial therapy for this anaerobe.

CT scan of the neck showing a jugular vein  with a gas filled abscess indicative of Lemierre's Disease.

But wait!  His symptoms did not resolve. A second set of blood cultures revealed growth of a gram positive rod resembling Corynebacterium spp. It turned out to be beta hemolytic on a blood plate.

Gram stain of organisms from second set of blood cultures after failure of therapy for the Fusobacterium .

What is it?

~ ~ ~

At the Karolinska University Hospital, 140 participants were assigned to receive 4000 IU vitamin D3 or placebo daily for one year. Participants included patients with antibody deficiency (selective immunoglobulin A deficiency, immunoglobulin G subclass deficiency, common variable immunodeficiency) or with more than four bacterial respiratory tract infections per year. All participants had respiratory symptoms for at least 42 days before randomization.

The main study outcome was an infectious score calculated from five clinical characteristics that the patients recorded in a daily diary: respiratory symptoms, ear symptoms, sinus symptoms, malaise, and antibiotic use.

Compared with the placebo group, the vitamin D group had a significantly lower overall infectious score (202 points vs 249 points). In the vitamin D group, symptoms of respiratory tract infection decreased by nearly 25%. The odds of taking antibiotics during the study period decreased by 63.5% in the vitamin D group, and the absolute number of days on antibiotics decreased by 50% (from 33 days in the placebo group to 16 days in the vitamin D group).

All patients tolerated vitamin D treatment well, with no serious adverse effects.

C an a dog be more efficient at detecting Clostridium difficile than a hospital microbiologist? And with a faster turn around time?

A recent study published in the British Medical Journal showed that a dog trained to sniff out C. difficile could do so with a sensitivity of 100% and a specificity of 94%.

Cliff, a two year old beagle from Amsterdam pictured above, has proven himself to be a valuable asset in combating C. difficile , the most common cause of hospital acquired diarrhea.

After proving a 100% sensitivity with specimens, Cliff was then taken to two hospital wards to conduct further detection tests in a live environment. The dog managed to correctly identify 25 of 30 cases (83 percent sensitivity) and 265 of 270 negative controls (98 percent specificity).

Researchers added that the dog was efficient and quick, managing to screen a complete hospital ward for the presence of patients infected with C. difficile in fewer than 10 minutes.

When Cliff finds a patient with a C. difficile infection, he simply sits down by the patient's bed and awaits his reward in the form of a biscuit.

A dog's sense of smell is hundreds of times more sensitive than ours, which is why dogs have been used successfully for detecting many disease states, including cancer.

Watch a delightful 10 minute video about Cliff, the C diff sniffing dog, who puts microbiologists to shame!

Optical oddities...

Tilt your head to the left and see a new image!

~ Marvin Gaye

Find more

of Leigh Rubin's cartoon humor.

"Football is a mistake.

It combines two of the worst things about American life.

It is violence punctuated by committee meetings."

~ George F. Will ~

"Never doubt that a small group of thoughtful, committed citizens

can change the world...

Indeed,

it is the only thing that ever has."

~ Margaret Mead ~

"Politics is supposed to be the second oldest profession. I have come to realize that it bears a very close resemblance to the first." ~ Ronald Reagan

"I think politicians and diapers have one thing in common. They should both be changed regularly and for the same reason." ~ Anonymous

~ Thomas Jefferson ~