A previously healthy 22-year-old man acquired tonsillitis due to Streptococcus equisimilis, a group C Streptococcus. He rapidly developed pneumonia, empyema, septicemia, and metastatic arthritis, and despite appropriate therapy with antibiotics and drainage of abscesses, he experienced progressive respiratory insufficiency and died. The four species of group C streptococci are described in terms of their biochemical properties, the infections they cause in animals, and their tendency to produce disease in humans. Pharyngeal carriage of these organisms is not rare, and outbreaks of pharyngitis and tonsillitis occur. Group C streptococcal pneumonia, like group A pneumonia, is often a severe disease with a prolonged febrile course and frequently is complicated by empyema. Appropriate management includes isolation of the patient, penicillin G therapy, drainage, and respiratory support.

Adult↗

PubMedDate not supplied

Listeriosis in renal transplant recipients: report of an outbreak and review of 102 cases.

We observed six renal transplant recipients with listeriosis during a 10-week period in the autumn of 1979. Investigation of this outbreak established that the first four cases wer close contacts, all infected by Listeria monocytogenes serotype 1b. The source of infection and route of spread were not identified. A total of 102 renal transplant recipients with listeriosis have now been reported. The major manifestation of disease was meningitis in 50% of the patients, parenchymal disease of the central nervous system in 10%, both meningitis and parenchymal disease of the central nervous system in 9%, and primary bacteremia in 30%. The overall mortality rate was 26%. Pneumonia due to L. monocytogenes, a previously neglected finding, was present in seven patients (7%); five of the seven died. The route of transmission may sometimes be respiratory. Special techniques for isolation of L. monocytogenes from sputum are usually required but not complicated. We recommend that individual renal transplant patients with listeriosis be cared for with secretion and excretion precautions and that they be treated with ampicillin and gentamicin. We advocate the serotyping of all isolates and a careful case-control analysis of all epidemics, but we do not support the use of serologic testing or surveillance cultures.

Adult↗

PubMedDate not supplied

Effects of a decision support system on physicians' diagnostic performance.

PURPOSE: This study examines how the information provided by a diagnostic decision support system for clinical cases of varying diagnostic difficulty affects physicians' diagnostic performance. METHODS: A national sample of 67 internists, 35 family physicians, and 6 other physicians used the Quick Medical Reference (QMR) diagnostic decision support system to assist them in the diagnosis of written clinical cases. Three sets of eight cases, stratified by diagnostic difficulty and the potential of QMR to produce high-quality information, were used. The effects of using QMR on three measures of physicians' diagnostic performance were analyzed using analyses of variance. RESULTS: Physicians' diagnostic performance was significantly higher (p < 0.01) on the easier cases and the cases for which QMR could provide higher-quality information. CONCLUSIONS: Physicians' diagnostic performance can be strongly influenced by the quality of information the system produces and the type of cases on which the system is used.

Analysis of Variance↗