Abstract:
:The rising incidence of Clostridium difficile (C. difficile) infection or CDI is now a problem of pandemic proportions. The NAP1 hypervirulent strain of C. difficile is responsible for a majority of recent epidemics and the widespread use of fluoroquinolone antibiotics may have facilitated the selective proliferation of this strain. The NAP1 strain also is more likely to cause severe and fulminant colitis characterized by marked leukocytosis, renal failure, hemodynamic instability, and toxic megacolon. No single test suffices to diagnose severe CDI, instead; the clinician must rely on a combination of clinical acumen, laboratory testing, and radiologic and endoscopic modalities. Although oral vancomycin and metronidazole are considered standard therapies in the medical management of CDI, recently it has been demonstrated that vancomycin is the more effective antibiotic in cases of severe disease. Moreover, early surgical consultation is necessary in patients who do not respond to medical therapy or who demonstrate rising white blood cell counts or hemodynamic instability indicative of fulminant colitis. Subtotal colectomy with end ileostomy is the procedure of choice for fulminant colitis. When applied to select patients in a judicious and timely fashion, surgery can be a life-saving intervention. In addition to these therapeutic approaches, several investigational treatments including novel antibiotics, fecal bacteriotherapy and immunotherapy have shown promise in the care of patients with severe CDI.
journal_name
Eur J Intern Medjournal_title
European journal of internal medicineauthors
Pant C,Sferra TJ,Deshpande A,Minocha Adoi
10.1016/j.ejim.2011.04.009subject
Has Abstractpub_date
2011-12-01 00:00:00pages
561-8issue
6eissn
0953-6205issn
1879-0828pii
S0953-6205(11)00088-4journal_volume
22pub_type
杂志文章,评审abstract:BACKGROUND:The epidemiological pattern of hepatitis B virus infection in Italy has greatly changed over the past decades. The aim of the study was to evaluate during time the epidemiological features of acute hepatitis B cases referred to an Infectious Disease Unit in North-East of Italy between 1978 and 1995. PATIENT...
journal_title:European journal of internal medicine
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journal_title:European journal of internal medicine
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doi:10.1016/j.ejim.2013.08.004
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journal_title:European journal of internal medicine
pub_type: 杂志文章
doi:10.1016/s0953-6205(00)00088-1
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abstract:BACKGROUND:Proteinuria is a common presentation of mesangioproliferative glomerulonephritis (MsPGN). No studies are available on the long-term effect of treatment by renin-angiotensin system (RAS) inhibitors on renal outcome in MsPGN patients. This study prospectively evaluates the effects of RAS inhibitors on renal ou...
journal_title:European journal of internal medicine
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doi:10.1016/j.ejim.2011.08.021
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abstract::There is growing evidence suggesting a causative relationship between adrenal adenomas and metabolic and cardiovascular deteriorations. Although demonstrated frequently in subjects with subclinical Cushing Syndrome, subjects with non-functioning adrenal adenomas feature a variety of metabolic and cardiovascular conseq...
journal_title:European journal of internal medicine
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journal_title:European journal of internal medicine
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journal_title:European journal of internal medicine
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journal_title:European journal of internal medicine
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abstract::Of the six known species of Listeria, Listeria monocytogenes is classified as the only human pathogen causing listeriosis, a highly fatal, opportunistic infection contracted via food. Listeria ivanovii is the only other pathogenic species of the genus and is considered to be specific to ruminants, except for extremely...
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journal_title:European journal of internal medicine
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abstract::Vasculitis is characterized by inflammation of the vascular wall. It reaches vessels of different sizes and locations, conditioning multisystem and complex manifestations that require a holistic approach. Antineutrophil cytoplasmic antibody-associated vasculitis has an annual incidence rate of 20 per million inhabitan...
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abstract::Patients with systemic lupus erythematosus (SLE) are frequently immunodepressed making them more vulnerable to infections. Preventive vaccination is therefore warranted but has often been withheld owing to fears of a link between infection and autoimmunity, and the possibility of inducing or exacerbating lupus after v...
journal_title:European journal of internal medicine
pub_type: 杂志文章,评审
doi:10.1016/j.ejim.2008.07.017
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