Septic arthritis to Proteus mirabilis

Septic arthritis is an acute disease infrequent but burdened with a heavy prognosis in terms of mortality and morbidity. We report a case of Proteus mirabilis septic arthritis occurred spontaneously in a patient with diabetes mellitus complicated. The outcome was favorable with early diagnosis and institution of appropriate antibiotic therapy combined with lavage of the joint. The Proteus mirabilis septic arthritis is rare, which prompted us to review the literature in a series of pyogenic arthritis including Proteus mirabilis on risk factors, pathogenesis, treatment and evolution of these pathologies. The results of this study leads us to recommend the creation of early joint aspiration represents the key examination for the diagnosis by direct examination after Gram stain, culture and sensitivity that will guide the choice of antibiotic. When Gram-negative is found, empiric antibiotic therapy should be started based on a combination of third-generation cephalosporin or a quinolone and an aminoglycoside pending the results of susceptibility testing. Further washing of the joint may be an essential part of treatment

[Community pneumonia Klebsiella pneumoniae producing beta-lactamase with extended spectre]

Klebsiella pneumoniae is the prerogative of nosocomial infections. Rarely Community lung infection by a strain of Klebsiella pneumoniae producing extended-spectrum beta-lactamase have been reported. We report a case of a case of pyopneumothorax due to infection by Community Klbsiella pneumoniae producing extended spectrum beta lactamase in a young patient of 29 years bacteriological examinations of pleural fluid drainage made the admission of the patient during his stay in intensive care have resulted in a K pneumoniae isolate producing extended spectrum beta lactamases. Despite treatment with imipenem and colistin prescribe 48 hours after admission of our patient, the evolution was fatal with death of the patient in an array of multi-visceral failure at 21 days of hospitalization. The isolation of an extended-spectrum beta-lactamase strain is often responsible for a fatal outcome, think about when you're facing a particular field, in the presence of risk factors such as outpatient antibiotic where the need 'control' strategy

[Diabetic ketoacidosis and thyroid storm occurring while awaiting radical treatment, about 2 cases]

The association of uncontrolled type 1 diabetes and Grave's disease may induce metabolic decompensation leading to the simultaneous occurrence of diabetic ketoacidosis and thyroid storm. This double endocrine emergency, although rare, is known to be life-threatening. Diagnostic difficulties due to an atypical presentation of thyroid storm that can be masked by diabetic ketoacidosis result in delayed diagnosis and treatment and therefore in a fatal outcome. We report two cases in whom early recognition and intensive treatment have led to an improved outcome. Radical treatment of the Grave's disease immediately at the diagnosis of the associated type 1 diabetes may prevent this double complication

Role of laboratory in diagnosis of multiresistance tuberculosis

Multiresistant tuberculosis associates a reduction in the sensitivity to isoniazid, the rifampicin and possibly to the other antituberculous ones. It is in constant progression in the whole world and constitutes a major problem of public health. The multiresistance seems to be the consequence of an inadequate former treatment [acquired resistance] or of a contamination by a stock from the start multiresistant [primary resistance]. The patients infected by the virus of the AIDS are a privileged target. New biological techniques are developed in order to identify the stocks resistant to antituberculous and to implement as soon as possible an adapted antituberculous treatment. Three processes are theoretically in competition for the fast antibiogram of Mycobacterium tuberculosis: - The direct antibiogram on solid medium remains the method of choice for the measurement of the sensitivity to antibiotics of second line in the event of multiresistance. - The Bactec method allows the culture and the identification of Mycobacterium tuberculosis in 8 days, then with additional 8 days, establishes the antibiogram with isoniazid, the rifampicine, the ethambutol and the streptomycine without making it possible to establish in a reliable way, the antibiogram facing antibiotics of second line. - The technique PCR [polymerase chain reaction] amplification of a segment of the gene followed by denaturation and hybridisation has been used for rapid detection of tuberculosis resistance