Disseminated Streptococcus gallinaceus infection. A new breed of zoonotic Streptococcus.

Streptococcus gallinaceus is a new species of Streptococcus that was first isolated in 2004 in chickens. Infections in humans are associated with chicken exposure. There are very few case reports of human infections with this organism and none with disseminated infection. We report a case of Streptococcus gallinaceus bacteremia complicated by aortic valve endocarditis and lumbar osteomyelitis and paraspinal abscess in a patient with chicken exposure. The patient presented with progressive lower back pain and malaise. Blood culture was positive for Streptococcus gallinaceus. Magnetic resonance imaging (MRI) of the spine showed L2-L3 osteomyelitis with a compression fracture and paraspinal abscess. Transthoracic echocardiography revealed severe aortic insufficiency, 1-cm aortic valve echo density suspected to be a vegetation, and perforation of the right coronary cusp. He subsequently underwent anaortic valve repair. Pathology confirmed acute endocarditis with associated vegetations and granulation tissues. He was successfully treated with a six-week course of ceftriaxone.

A pragmatic low carbohydrate diet intervention changes neither carbohydrate consumption nor glycemia in adolescents and young adults with type 1 diabetes in a randomized trial.

OBJECTIVE: Despite enthusiasm for low carbohydrate diets (LCDs) among patients with type 1 diabetes (T1DM), no prospective study has investigated outcomes in adolescent T1DM. We aimed to quantify a pragmatic LCD intervention's impact on glycemia, lipidemia, and quality of life (QOL) in adolescents with T1DM. RESEARCH DESIGN AND METHODS: At an academic center, we randomized 39 patients with T1DM aged 13-21 years to one of three 12-week interventions: an LCD, an isocaloric standard carbohydrate diet (SCD), or general diabetes education without a prescriptive diet. Glycemic outcomes included glycosylated hemoglobin (HbA1c) and continuous glucose monitoring. RESULTS: There were no significant differences in glycemic, lipidemic, or QOL parameters between groups at any timepoint. Median HbA1c was similar at baseline between groups and did not change appreciably (7.9%-8.4% in LCDs, 7.9%-7.9% in SCDs, and 8.2%-7.8% in controls). Change in carbohydrate consumption was minimal with only one participant reaching target carbohydrate intake. CONCLUSIONS: This pragmatic LCD intervention did not alter carbohydrate consumption or glycemia. Although this study was unable to evaluate a highly controlled LCD, it indicates that adolescents are unlikely to implement an educational LCD intervention in routine clinic settings. Thus, this approach is unlikely to effectively mitigate hyperglycemia in adolescents.

Aortic stenosis and Heyde's syndrome: A comprehensive review.

Heyde's syndrome is an under reported systemic disease of gastrointestinal and cardiac manifestation in older adults. It is characterized by a triad of aortic stenosis, angiodysplasia with bleeding and acquired von Willebrand syndrome. It is characterized by proteolysis of high molecular weight multimers of von Willebrand Factor and loss of platelet mediated homeostasis. Heyde's syndrome is a treatable condition in most cases, especially in the current era of evolution in interventional cardiology and gastroenterology. There are currently no established guidelines in the management of this condition due to paucity of high quality studies, which warrant future trials. High index of suspicion and increasing the awareness of the syndrome among the general practitioners and sub-specialists will improve the diagnostic potential of Heyde's syndrome. Future studies may change the management aspect of Heyde's syndrome and pave a path for drawing specific guidelines and algorithms. The aim of our review article is to summarize the basic pathophysiology, diagnostics and management of Heyde's syndrome with a special attention to Transcatheter aortic valve replacement.