Blood Cultures (blood + culture)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Blood Cultures

  • positive blood culture

  • Terms modified by Blood Cultures

  • blood culture bottle

  • Selected Abstracts


    Pneumonia Core Measures and Blood Cultures

    ACADEMIC EMERGENCY MEDICINE, Issue 3 2007
    Howard Blumstein MD
    No abstract is available for this article. [source]


    A child with spider bite and glomerulonephritis: a diagnostic challenge

    INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2000
    Jennifer M. Lung MD
    A previously healthy 7-year-old white boy presented to St. Louis Children's Hospital with a 1-day history of headache, malaise, temperature of 38.7 °C, and a progressively erythematous, tender calf with central dusky purpura. On the morning of admission, his mother noticed a 2-mm crust on the patient's right calf with a 3-cm × 3-cm area of surrounding erythema. No history of recent trauma or bite was obtained. He had suffered two episodes of nonbloody, nonbilious emesis during the last day. In addition, over the previous 12 h, he presented brown urine without dysuria. His mother and brother had suffered from gastroenteritis over the previous week without bloody diarrhea. On initial physical examination, there was a 6-cm × 11-cm macular tender purpuric plaque with a central punctum on the right inner calf, which was warm and tender to the touch, with erythematous streaking towards the popliteal fossa ( Fig. 1). The inguinal area was also erythematous with tender lymphadenopathy and induration, but without fluctuance. Laboratory studies included an elevated white blood cell count of 20,800/,L with 6% bands, 86% segs, and 7% lymphocytes, hemoglobin of 12.5 g/dL, hematocrit of 35.1%, and platelets of 282,000/,L. The prothrombin time/activated partial tissue thromboplastin was 10.4/28.0 s (normal PT, 9.3,12.3 s; normal PTT, 21.3,33.7 s) and fibrinogen was 558 mg/dL (normal, 192,379 mg/dL). Urinalysis showed 1+ protein, 8,10 white blood cells, too numerous to count red blood cells, and no hemoglobinuria. His electrolytes, blood urea nitrogen (BUN), and creatine were normal. The urine culture was negative. Blood culture after 24 h showed one out of two bottles of coagulase negative Staphylococcus epidermidis. Figure 1. (A) 7-year-old boy with painful purpura of the calf The patient's physical examination was highly suggestive of a brown recluse spider bite with surrounding purpura. Over the next 2 days, the surrounding rim of erythema expanded. The skin within the plaque cleared and peeled at the periphery. The coagulase negative staphylococci in the blood culture were considered to be a contaminant. Cefotaxime and oxacillin were given intravenously. His leg was elevated and cooled with ice packs. The patient's fever resolved within 24 h. The lesion became less erythematous and nontender with decreased warmth and lymphadenopathy. The child was discharged on Duricef for 10 days. Because the patient experienced hematuria rather than hemoglobinuria, nephritis was suggested. In this case, poststreptococcal glomerulonephritis was the most likely cause. His anti-streptolysin-O titer was elevated at 400 U (normal, <200 U) and C3 was 21.4 mg/dL (normal, 83,177 mg/dL). His urine lightened to yellow,brown in color. His blood pressure was normal. Renal ultrasound showed severe left hydronephrosis with cortical atrophy, probably secondary to chronic/congenital ureteropelvic junction obstruction. His right kidney was normal. [source]


    Evaluation of the alkaline wash/lysis procedure for the molecular diagnosis of a positive bacterial blood culture in clinical routine practice

    JOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 3 2010
    Sheng-Chuan Hsi
    Abstract Blood culture is commonly used to detect microorganisms in patients with a suspected blood infection. This study evaluated the alkaline wash/lysis procedure to extract DNA of microorganisms in a clinical blood culture. A multiplex polymerase chain reaction (PCR) targeting the 16S rDNA (ribosomal DNA) gene and the fungal ITS (internal transcribed spacer) gene was used as a reliable indicator for the presence of microorganism DNA in the extracts. A total of 535BacT/ALERT positive blood culture bottles were evaluated. Multiplex PCR showed positive results in 530 DNA extracts, but 5 DNA extracts gave negative results. We conclude that the alkaline wash/lysis procedure in combination with the multiplex PCR is a simple and sensitive method, which can be used in a standard diagnostic laboratory to detect microorganisms in blood culture material. J. Clin. Lab. Anal. 24:139,144, 2010. © 2010 Wiley-Liss, Inc. [source]


    Acute generalized exanthematous pustulosis mimicking toxic epidermal necrolysis

    INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 7 2001
    Arnon D. Cohen MD
    A 91-year-old patient presented with a nonfebrile, pruritic, widespread eruption that appeared 10 days after starting therapy with cefuroxime tablets, 1000 mg/day, due to stasis dermatitis with secondary infection. The patient was also treated with paracetamol tablets, 500,1000 mg/day, 10 days before the onset of the eruption. Previous diseases included congestive heart disease, hyperglycemia, and ectropion. There was no personal or family history of psoriasis. Additional medications, taken for more than 2 years at the time of the eruption, included indomethacin, captopril, hydrochlorothiazide, isosorbide-5-mononitrate tablets, and a combination drug Laxative®. Examination revealed widespread erythema involving 95% of the total body surface area, with numerous 1,2 mm nonfollicular pustules (Fig. 1). There was no predilection to the body folds. Within 24 h of hospitalization, during intravenous therapy with cefuroxime, the patient's condition worsened and bullae containing clear fluid appeared. Nikolsky's sign was positive on erythematous skin, and eventually skin detachment involved 41% of the total body surface area (Fig. 2). There were no target or target-like lesions and there was no involvement of the mucous membranes. Figure 1. Numerous, 1,2 mm, nonfollicular pustules, with confluence (viewed in the lower left part of the photograph), on erythematous skin Figure 2. Widespread skin detachment An early biopsy from a pustule revealed subcorneal and intraepidermal spongiform pustules, papillary edema, perivascular mononuclear infiltrate with a few eosinophils in the dermis, and leukocytoclastic vasculitis. A later biopsy showed similar findings with no evidence of full-thickness epidermal necrosis or necrotic keratinocytes. Direct immune fluorescence (DIF) taken from erythematous skin was negative. Laboratory studies showed the following results: sedimentation rate, 80 mm/h; white blood cell count, 26,200/mm3 with 87% polymorphonuclears and 1.8% eosinophils; hemoglobin, 13.0 g/dL; albumin, 2.8 g/dL (normal, 3.5,5.5 g/dL); other blood chemistry tests were normal. Immunologic studies for rheumatoid factor, antinuclear antibodies, antismooth muscle antibodies, antiparietal cell antibodies, antimitochondrial antibodies, C3, and C4 were normal or negative. Serology for venereal disease research laboratory (VDRL) test, Epstein,Barr virus, cytomegalovirus, hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and antistreptolysin titer was negative. Chest X-ray was normal. Blood cultures were negative. Swab cultures taken from the pustules revealed Staphylococcus aureus as well as coagulase-negative Staphylococcus. All systemic drugs, including intravenous cefuroxime, were withdrawn with close monitoring for signs of heart failure or infection. Topical therapy consisted of application of wet dressings. Within 10 days, the eruption resolved with re-epithelialization of the erosions and the appearance of widespread post-pustular desquamation (Fig. 3) Figure 3. Post-pustular desquamation on the trunk [source]


    Incidence, spectrum and antibiotic sensitivity pattern of bacterial infections among patients with acute pancreatitis

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2001
    Pramod Kumar Garg
    Abstract Background and Aim: Secondary infection of pancreatic necrotic tissue and peripancreatic fluid is a serious complication of acute pancreatitis resulting in significant morbidity and mortality. The aim of this study was to find out the spectrum of bacterial infections, and their antibiotic sensitivity pattern in patients with acute pancreatitis. Methods: All consecutive patients with acute pancreatitis were studied prospectively. Detailed investigations were carried out to identify bacterial infections and their antibiotic sensitivities in patients with suspected infection. These investigations included cultures of various body fluids, throat swabs, indwelling cannula and catheter tips. Pancreatic tissue was obtained by using needle aspiration or at surgery for Gram's stain, culture and sensitivity. All cultures were repeated until the presence of infection was confirmed or excluded. Results: A total of 169 patients with acute pancreatitis were studied during the period between January 1997 and June 2000 (mean age 41.3 years; 116 males and 53 females). Of the 169 patients, 63 had infections at various sites. A total of 80 cultures were positive, and 12 different bacterial isolates were cultured from samples taken from these 63 patients. Polymicrobial infection was seen in 32% of patients. Twenty-four patients had a confirmed pancreatic infection. Blood cultures had a growth of organisms in 19 patients, with evidence of ongoing or worsening pancreatitis, thus raising a strong suspicion of infected necrosis in them. The commonest organisms were Escherichia coli from 20 cultures and Pseudomonas aeruginosa from 18 cultures. The antibiotic sensitivity pattern showed that most bacteria were sensitive to third generation cephalosporins and quinolones; notably among them were cefotaxime, ceftazidime, and ciprofloxacin. Conclusion: Bacterial infections were seen in 37% of patients with acute pancreatitis. The commonest organisms were Pseudomonas aeruginosa and Escherichia coli. Most bacterial isolates were sensitive to third generation cephalosporins and quinolones. [source]


    Prospective evaluation of the management of moderate to severe cellulitis with parenteral antibiotics at a paediatric day treatment centre

    JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2008
    Serge Gouin
    Aim: To assess the clinical outcome of patients with moderate to severe cellulitis managed at a paediatric day treatment centre (DTC). Methods: Prospective observational study of all patients (3 months to 18 years) with a presumed diagnosis of moderate to severe cellulitis made in a university-affiliated paediatric emergency department (ED) (September 2003 to September 2005). Patients treated at the DTC were given ceftriaxone or clindamycin. Results: During the study period, a presumed diagnosis of moderate to severe cellulitis was made in 224 patients in the ED. Ninety-two patients were treated at the DTC (41%). The cellulitis had a median width of 7.0 cm (range: 1.0,50.0 cm) and a median length of 6.5 cm (range: 1.0,40.0 cm). Blood cultures were performed in 95.7%; one was positive for Staphylococcus aureus. After a mean of 2.5 days of intravenous therapy (first injection in the ED and a mean of 1.5 days at the DTC), 73 patients (79.3%) were successfully discharged from the DTC and switched to an oral agent. For these patients no relapse occurred. Nineteen patients (20.7%) required inpatient admission for further therapy. No patient was diagnosed with necrotizing fasciitis in the course of therapy. Seventy-eight satisfaction questionnaires were handed in and revealed very good to excellent parental satisfaction with treatment at the DTC in 94.8%. Conclusion: Treatment with parenteral antibiotic at a DTC is a viable alternative to hospitalisation for moderate to severe cellulitis in children. [source]


    Blood cultures for febrile patients in the acute care setting: Too quick on the draw?

    JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 11 2008
    ACNP-BC, Barbara K. Chesnutt MSN
    Abstract Purpose: To review the fever literature and determine how 38.3°C was deemed the optimal fever threshold that predicts bacteremia. Data sources: PubMed, MEDLINE, Cochrane database, and the Cumulative Index to Nursing and Allied Health. Conclusions: A temperature of 38.3°C has come to be the threshold value that typically triggers diagnostic fever evaluation for bacteremia in hospitalized patients. Studies that define predictors of bacteremia provide conflicting results, and most bacteremia predictor models have not been externally validated. Therefore, current fever guidelines are based on consensus opinion rather than large clinical trials identifying a specific threshold with high sensitivity and a high negative predictive value. Implications for practice: The use of a single temperature threshold of 38.3°C for the prediction of bacteremia is not sufficient in all patients. Additional factors should be considered, including patient population, supporting clinical signs and symptoms, and the patient's medical history. [source]


    Typhoid and Paratyphoid Fever: A 10-Year Retrospective Study of 41 Cases in a Parisian Hospital

    JOURNAL OF TRAVEL MEDICINE, Issue 6 2001
    Eric Caumes
    Background: Enteric fever remains a major cause of fever in travelers. We evaluated new trends in enteric fever. Methods: We reviewed the epidemiological, clinical, biological, bacteriological data, and outcome of all cases of typhoid and paratyphoid fever seen in our department over the last decade. The inclusion criteria were the presence of signs compatible with enteric fever and isolation of Salmonella typhi or Salmonella paratyphi A, B, or C from blood or stool cultures or any other site. Results: Among the 41 patients, 38 (93%) had travel-associated enteric fever. The main geographic source of contamination was the Indian subcontinent. One patient had been vaccinated with parenteral Vi vaccine 1 year previously. Fever and headaches were the only signs which were present in more than 80% of patients. The Widal test at inclusion was positive in 27%, and a second serological test was found to be positive in 50% of evaluated cases. Blood cultures and stool cultures were positive in 34 cases and 10 cases, respectively. Salmonellae spp were isolated in both hemocultures and stool cultures in 4 cases and in urine in 1 case. Two strains of S. typhi were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole. One strain of S. typhi and one of S. paratyphi B were nalidixic acid resistant. All evaluable patients were cured with the exception of 2 patients (1 failure, 1 relapse). We observed 3 toxic reactions. No patients died. Conclusion: The diagnosis and outcome of enteric fever are hampered by the lack of specificity of clinical and biological signs, the increasing rates of antimicrobial resistance, and the occurrence of toxic reactions during treatment. [source]


    Post-tooth extraction sepsis without locoregional infection , a population-based study in Taiwan

    ORAL DISEASES, Issue 8 2009
    J-J Lee
    Objective:, To investigate the incidence and risk factors of post-tooth extraction sepsis in patients without locoregional infection. Subjects and Methods:, We assessed all claim records of the Taiwanese National Health Insurance program in 2005. Admissions for patients aged ,16 years containing a discharge diagnosis of sepsis, and who received tooth extraction within 14 days before the admission were identified. Patient charts were reviewed to confirm the diagnosis of sepsis and rule out other infection sources. The relationship between postextraction sepsis (PES) and clinical parameters was analyzed. Results:, Thirty-three of the 2 223 971 extraction cases met the criteria of PES, an incidence of 1.48 per 100 000, and seven patients (21.2%) died of the disease. Aging significantly increased the risk of PES (P < 0.001). Pre-existing comorbidities were found in 20 of the 33 cases, with diabetes mellitus and hematologic diseases the most common. The method, number, and position of extraction had no influence on PES incidence. Blood cultures were positive in 25 patients (75.8%) and isolates included species of the Streptococcus, Actinomyces, Klebsiella, Bacteroides, Prevotella, and Enterococcus genera. Conclusion:, Tooth extraction is associated with a low but significant risk of postoperative sepsis, especially in the elderly and patients with underlying diseases. [source]


    Pacemaker Lead Endocarditis Caused by Staphylococcus Hominis

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2006
    MUSTAFA SUNBUL
    Infective endocarditis related to pacemaker is a rare but serious condition in permanent venous tracing. A 65-year-old man was admitted to the hospital with high fever and chills. A DDD pacemaker had been implanted via the right subclavian vein because of sick sinus syndrome 6 years earlier. Transesophageal echocardiogram identified an oscillating round hyperechoic mass with a stalk near the tricuspid valve. Blood cultures grew Staphylococcus hominis. The patient was treated with antibiotics and operated on after the acute phase of the illness had subsided. We hereby report a case of lead endocarditis caused by S. hominis in a patient with pacemaker, which has been rarely reported in the English literature. [source]


    Eleven-year study of causes of neonatal bacterial meningitis in Ahvaz, Iran

    PEDIATRICS INTERNATIONAL, Issue 3 2010
    Mohammad Hasan Aletayeb
    Abstract Background:, Bacterial meningitis is a devastating infection with a high mortality rate, especially in neonates. The aim of this study was to determine the causative agents that cause bacterial meningitis in Khuzestan province in the south-western region of Iran. Methods:, A descriptive, cross-sectional study was carried out from 1997 to 2007 at the neonatal ward of a university teaching hospital (Emam Khomeini hospital) in Ahvaz. All infants younger than 29 days old who suffered from meningitis were included. Laboratory tests included Gram stain, culture, and biochemical tests. Cases were defined as meningitis if the cerebrospinal fluid culture was positive. Results:, Based on cerebrospinal fluid culture, 31 infants were identified as having bacterial meningitis. Eleven (35.5%) of these cases were caused by Klebsiella pneumoniae, nine (29%) were caused by Enterobacter spp., three (9.6%) were caused by Escherichia coli, three (9.6%) were caused by Enterococcus spp., two (6.4%) were caused by Acinetobacter, and one case each (3.2%) was caused by Staphylococcus aureus, Pseudomonas aeruginosa and nontypeable Haemophilus influenzae. The male-to-female ratio was 2 : 1 (67.7% were male). The birthweights of 20 (64.5%) patients were under 2500 g and 11 (35.4%) patients had normal birthweights. Thirteen (42%) were early-onset cases and 18 (58%) were late-onset cases. More than half of the cases (54.8%) acquired the infection from the hospital. Blood cultures were positive for 18 (58%) patients. Thirty-two percent of cases died in spite of treatment. Conclusions:,Klebsiella pneumoniae and Enterobacter spp. were the two main causative agents that caused neonatal bacterial meningitis, and nosocomial meningitis was the most common type in our ward. [source]


    Impaired virus-induced interferon-,2 release in adult asthmatic patients

    CLINICAL & EXPERIMENTAL ALLERGY, Issue 3 2006
    K. Gehlhar
    Summary Background Interferon-, (IFN-,) not only serves as a first defence line of the immune system against viral attacks but also interacts with T-helper type 1 (Th1)/ T-helper type 2 (Th2) regulation and various other cell types like basophils and monocytes, thereby linking innate and acquired immunity. Recently, we demonstrated that children with allergic asthma produced significantly lower amounts of virus-induced IFN-,2 compared with healthy children or those with intrinsic asthma. Objective In this study, we extend our analysis to examine in a cohort study whether IFN-,2 is also reduced in allergic asthma of adults. Methods Adults with allergic asthma and healthy controls were prospectively recruited. Blood cultures were stimulated with different viruses (respiratory syncytial virus (RSV), newcastle disease virus (NDV)) and analysed for IFN-,2 protein release and gene transcription. Results Virus-induced IFN-,2 release from blood cells of allergic asthmatic patients was significantly reduced compared with healthy controls, independent of the virus used (NDVasthma=221±134 pg/mL, NDVhealthy=555±341 pg/mL, P=0.003 and RSVasthma=46±27 pg/mL, RSVhealthy=108±90 pg/mL, P=0.014). Values=mean±standard deviation). It was not influenced by medication, especially cortico-steroids. IFN-,2 mRNA expression 5 h after NDV stimulation confirmed the ELISA results and correlated well with release data (r=0.397, P=0.033). Conclusion Like children, adults with allergic asthma show impaired virus-induced IFN-,2 release in whole blood, indicating a systemic phenomenon in patients with bronchial asthma and atopic phenotype. Impaired virus-induced IFN-, release could be a marker of inflammation in chronic allergic asthma. [source]


    Rose Bengal test: diagnostic yield and use for the rapid diagnosis of human brucellosis in emergency departments in endemic areas

    CLINICAL MICROBIOLOGY AND INFECTION, Issue 3 2005
    J. D. Ruiz-Mesa
    Abstract The aim of the present study was to analyse the diagnostic yield of the rose Bengal test for the rapid diagnosis of human brucellosis in an emergency department in an area where the disease is endemic. The study included 711 patients diagnosed initially with brucellosis and 270 controls. Brucellosis patients were divided into three groups: group I, individuals with no regular exposure to or history of brucellosis; group II, individuals exposed repeatedly to Brucella infection; and group III, individuals infected with Brucella who had received appropriate treatment during the previous 12 months. Blood cultures were positive for 445 (62.6%) brucellosis patients, while the remaining 266 (37.4%) patients were diagnosed according to clinical and serological criteria. The overall sensitivity of the rose Bengal test was 92.9%. The specificities for groups I, II and III were 94.3%, 91.7% and 76.9%, respectively, with positive likelihood ratios of 16.5, 10.4 and 4.2, respectively. The diagnostic gain after the performance of the rose Bengal test was good or very good in patients with no previous exposure to Brucella or history of brucellosis, but poor in patients who were exposed repeatedly to Brucella or had a history of brucellosis and a low pre-test probability. Use of the rose Bengal test as the sole technique for the diagnosis of brucellosis in endemic areas should be considered very carefully in the context of patients who are exposed repeatedly to Brucella or have a history of brucellosis. [source]


    Intravenous catheter infections associated with bacteraemia: a 2-year study in a University Hospital

    CLINICAL MICROBIOLOGY AND INFECTION, Issue 5 2004
    M. Paragioudaki
    Abstract The aim of this retrospective study was to assess the incidence and aetiology of central and peripheral venous catheter (C/PVC) infections during a 2-year period (1999,2000) and to determine the susceptibility of isolated microorganisms to various antimicrobial agents. Catheter tips were processed using the semiquantitative method and blood cultures were performed with the BacT/Alert automated system. Antibiotic susceptibilities were performed by disk agar diffusion and MICs were determined by Etest, according to NCCLS standards. During the study period, samples from 1039 C/PVC infections were evaluated, yielding 384 (37.0%) positive cultures. Blood cultures were also available from 274 patients, of which 155 (56.6%) yielded the same microorganism as from the catheter. No bloodstream infections were detected in 104 C/PVC-positive cases. Methicillin-resistant coagulase-negative staphylococci were the most frequent isolates, followed by Gram-negative bacteria, especially Pseudomonas aeruginosa. Resistance to glycopeptides among staphylococci and enterococci was not detected, whereas 60% of Gram-negative bacilli were resistant to ,-lactams. [source]


    Effect of Point-of-care Influenza Testing on Management of Febrile Children

    ACADEMIC EMERGENCY MEDICINE, Issue 12 2006
    Srikant B. Iyer MD
    Abstract Objectives To determine the effect of point-of-care testing (POCT) for influenza on the physician management of febrile children who are at risk for serious bacterial illness (SBI) on the basis of age and temperature and who are presenting to a pediatric emergency department (ED) during an influenza outbreak. Methods Patients 2,3 months of age with temperature of ,38°C and patients 3,24 months of age with temperature of ,39°C who were presenting to a pediatric ED during an influenza outbreak were enrolled into a prospective, quasi-randomized, controlled trial. Influenza testing was performed on enrolled patients by either the POCT or the standard-testing (ST) methods. The two groups were compared in terms of laboratory testing, chest radiography, antibiotic use, visit-associated costs, pediatric ED lengths of stay, inpatient admission, and return visits to the pediatric ED. Similar analyses also were performed on the resulting subgroups of patients on the basis of method of testing (POCT or ST) and test result (positive or negative). Results Of 767 eligible patients, 700 (91%) completed the study. No significant differences were demonstrated between the POCT and ST groups with respect to laboratory tests ordered, chest radiographs obtained, antibiotic administration, inpatient admission, return visits to the pediatric ED, lengths of stay, or visit-associated costs. In the subgroup analysis, the adjusted odds ratios (ORs) for blood culture in influenza test,positive to ,negative patients were 0.59 and 0.71 in the POCT and ST groups, respectively (p = 0.088). The adjusted ORs for urine culture in influenza test,positive to ,negative patients were 0.46 and 0.67 in the POCT and ST groups, respectively (p = 0.005). Conclusions When using a strategy of performing influenza testing on all patients at risk for SBI who presented to a pediatric ED during an influenza outbreak, the method of testing (POCT or ST) did not appear to significantly alter physician management, cost, or length of stay in the pediatric ED. However, if the interaction of the method of testing and the test result (positive or negative) were considered, a positive POCT for influenza was associated with a significant reduction in orders for urinalyses and urine cultures. [source]


    Blood Cultures Do Not Change Management in Hospitalized Patients with Community-acquired Pneumonia

    ACADEMIC EMERGENCY MEDICINE, Issue 7 2006
    Prasanthi Ramanujam MD
    Objectives: To determine if blood cultures identify organisms that are not appropriately treated with initial empiric antibiotics in hospitalized patients with community-acquired pneumonia, and to calculate the costs of blood cultures and cost savings realized by changing to narrower-spectrum antibiotics based on the results. Methods: This was a retrospective observational study conducted in an urban academic emergency department (ED). Patients with an ED and final diagnosis of community-acquired pneumonia admitted between January 1, 2001, and August 30, 2003, were eligible when the results of at least one set of blood cultures obtained in the ED were available. Exclusion criteria included documented human immunodeficiency virus infection, immunosuppressive illness, chronic renal failure, chronic corticosteroid therapy, documented hospitalization within seven days before ED visit, transfer from another hospital, nursing home residency, and suspected aspiration pneumonia. The cost of blood cultures in all patients was calculated. The cost of the antibiotic regimens administered was compared with narrower-spectrum and less expensive alternatives based on the results. Results: A total of 480 patients were eligible, and 191 were excluded. Thirteen (4.5%) of the 289 enrolled patients had true bacteremia; the organisms isolated were sensitive to the empiric antibiotics initially administered in all 13 cases (100%; 95% confidence interval = 75% to 100%). Streptococcus pneumoniae and Haemophilus influenzae were isolated in 11 and two patients, respectively. The potential savings of changing the antibiotic regimens to narrower-spectrum alternatives was only 170. Conclusions: Appropriate empiric antibiotics were administered in all bacteremic patients. Antibiotic regimens were rarely changed based on blood culture results, and the potential savings from changes were minimal. [source]


    Charlson Index Is Associated with One-year Mortality in Emergency Department Patients with Suspected Infection

    ACADEMIC EMERGENCY MEDICINE, Issue 5 2006
    Scott B. Murray MD
    Abstract Objectives: A patient's baseline health status may affect the ability to survive an acute illness. Emergency medicine research requires tools to adjust for confounders such as comorbid illnesses. The Charlson Comorbidity Index has been validated in many settings but not extensively in the emergency department (ED). The purpose of this study was to examine the utility of the Charlson Index as a predictor of one-year mortality in a population of ED patients with suspected infection. Methods: The comorbid illness components of the Charlson Index were prospectively abstracted from the medical records of adult (age older than 18 years) ED patients at risk for infection (indicated by the clinical decision to obtain a blood culture) and weighted. Charlson scores were grouped into four previously established indices: 0 points (none), 1,2 points (low), 3,4 points (moderate), and ,5 points (high). The primary outcome was one-year mortality assessed using the National Death Index and medical records. Cox proportional-hazards ratios were calculated, adjusting for age, gender, and markers of 28-day in-hospital mortality. Results: Between February 1, 2000, and February 1, 2001, 3,102 unique patients (96% of eligible patients) were enrolled at an urban teaching hospital. Overall one-year mortality was 22% (667/3,102). Mortality rates increased with increasing Charlson scores: none, 7% (95% confidence interval [CI] = 5.4% to 8.5%); low, 22% (95% CI = 19% to 24%); moderate, 31% (95% CI = 27% to 35%); and high, 40% (95% CI = 36% to 44%). Controlling for age, gender, and factors associated with 28-day mortality, and using the "none" group as a reference group, the Charlson Index predicted mortality as follows: low, odds ratio of 2.0; moderate, odds ratio of 2.5; and high, odds ratio of 4.7. Conclusions: This study suggests that the Charlson Index predicts one-year mortality among ED patients with suspected infection. [source]


    Effective interventions with chlorhexidine gluconate (CHG) to decrease hemodialysis (HD) tunneled catheter-related infections

    HEMODIALYSIS INTERNATIONAL, Issue 1 2005
    N. Redman
    Purpose:,Identify practices to reduce HD catheter access related bacteremias (ARB). Methods:,Data was collected per the CDC Dialysis Surveillance Network protocol. ARB was defined as a patient with a positive blood culture with no apparent source other than the vascular access catheter. ARB's were calculated in events per 100 patient months with 3 cohorts. Cohort 1 was observed for 12 months, Cohort 2 for the subsequent 10 months, and Cohort 3 for the final 10 months. Cohort 1 had weekly transparent dressing changes, cleansing of the skin and 5 minute soaking of the connection lines with 10% povidone-iodine (PI) solution, and HCW use of clean gloves and face shield without a mask. Cohort 2 changes consisted of thrice weekly gauze dressing changes, skin cleansing with ChloraPrep, a 2% CHG/70% isopropyl alcohol applicator, masks on the patients, adding a face mask to the shield, and application of 10% PI ointment to the exit site. Cohort 3 changes included weekly application of BioPatch (BioP), an antimicrobial dressing with CHG, sterile glove use, and replacing the PI line soaks with 4% CHG. Results:,The catheter-associated ARB rate per 100 patient months was 7.9 (17ARB/216 patient months) in Cohort 1, 8.6 (13/151) in Cohort 2, and 4.7 (5/107) in Cohort 3(p = 0.31 compared with Cohorts 1 and 2 combined). During the last 2 months, in Cohort 3, 9 catheter lumen cracks occurred, with one of the patients having a bacteremia. Conclusions:,Addition of CHG line soaks and BioP reduced tunneled catheter infections, although this is not statistically significant. The increased number of catheter lumen cracks raises concern with the use of CHG line soaks. Further investigation with use of CHG line soaks and the BioP for decreasing ARB is needed. [source]


    A child with spider bite and glomerulonephritis: a diagnostic challenge

    INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2000
    Jennifer M. Lung MD
    A previously healthy 7-year-old white boy presented to St. Louis Children's Hospital with a 1-day history of headache, malaise, temperature of 38.7 °C, and a progressively erythematous, tender calf with central dusky purpura. On the morning of admission, his mother noticed a 2-mm crust on the patient's right calf with a 3-cm × 3-cm area of surrounding erythema. No history of recent trauma or bite was obtained. He had suffered two episodes of nonbloody, nonbilious emesis during the last day. In addition, over the previous 12 h, he presented brown urine without dysuria. His mother and brother had suffered from gastroenteritis over the previous week without bloody diarrhea. On initial physical examination, there was a 6-cm × 11-cm macular tender purpuric plaque with a central punctum on the right inner calf, which was warm and tender to the touch, with erythematous streaking towards the popliteal fossa ( Fig. 1). The inguinal area was also erythematous with tender lymphadenopathy and induration, but without fluctuance. Laboratory studies included an elevated white blood cell count of 20,800/,L with 6% bands, 86% segs, and 7% lymphocytes, hemoglobin of 12.5 g/dL, hematocrit of 35.1%, and platelets of 282,000/,L. The prothrombin time/activated partial tissue thromboplastin was 10.4/28.0 s (normal PT, 9.3,12.3 s; normal PTT, 21.3,33.7 s) and fibrinogen was 558 mg/dL (normal, 192,379 mg/dL). Urinalysis showed 1+ protein, 8,10 white blood cells, too numerous to count red blood cells, and no hemoglobinuria. His electrolytes, blood urea nitrogen (BUN), and creatine were normal. The urine culture was negative. Blood culture after 24 h showed one out of two bottles of coagulase negative Staphylococcus epidermidis. Figure 1. (A) 7-year-old boy with painful purpura of the calf The patient's physical examination was highly suggestive of a brown recluse spider bite with surrounding purpura. Over the next 2 days, the surrounding rim of erythema expanded. The skin within the plaque cleared and peeled at the periphery. The coagulase negative staphylococci in the blood culture were considered to be a contaminant. Cefotaxime and oxacillin were given intravenously. His leg was elevated and cooled with ice packs. The patient's fever resolved within 24 h. The lesion became less erythematous and nontender with decreased warmth and lymphadenopathy. The child was discharged on Duricef for 10 days. Because the patient experienced hematuria rather than hemoglobinuria, nephritis was suggested. In this case, poststreptococcal glomerulonephritis was the most likely cause. His anti-streptolysin-O titer was elevated at 400 U (normal, <200 U) and C3 was 21.4 mg/dL (normal, 83,177 mg/dL). His urine lightened to yellow,brown in color. His blood pressure was normal. Renal ultrasound showed severe left hydronephrosis with cortical atrophy, probably secondary to chronic/congenital ureteropelvic junction obstruction. His right kidney was normal. [source]


    Unusual presentation of necrotizing fasciitis in a patient who had achieved long-term remission after irradiation for testicular cancer

    INTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2005
    TOMOAKI MIYAGAWA
    Abstract, We report a case of a 60-year-old man with necrotizing fasciitis complicated by streptococcal toxic shock syndrome. The patient had received high-dose chemotherapy and radiotherapy to the pelvis for relapsed seminoma 7 years previously. He had been in long-term remission. He was admitted to the Tsukuba University Hospital, Tsukuba-City, Ibaraki, Japan, with complaints of fever and localized erythema over the foreskin. The patient suffered from septic shock and multiple organ failure. Despite intensive care, he died 18 h after admission. Streptococcus pyogenes was isolated from both the wound and blood culture. To our knowledge, this is the first description of necrotizing fasciitis primarily affecting the penile skin. [source]


    Systemic Inflammatory Response Syndrome in Nosocomial Bloodstream Infections with Pseudomonas aeruginosa and Enterococcus Species: Comparison of Elderly and Nonelderly Patients

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2006
    Alexandre R. Marra MD
    OBJECTIVES: To determine whether the systemic inflammatory response syndrome (SIRS), clinical course, and outcome of monomicrobial nosocomial bloodstream infection (BSI) due to Pseudomonas aeruginosa or Enterococcus spp. is different in elderly patients than in younger patients. DESIGN: Historical cohort study. SETTING: An 820-bed tertiary care facility. PARTICIPANTS: One hundred twenty-seven adults with P. aeruginosa or enterococcal BSI. MEASUREMENTS: SIRS scores were determined 2 days before the first positive blood culture through 14 days afterwards. Elderly patients (,65, n=37) were compared with nonelderly patients (<65, n=90). Variables significant for predicting mortality in univariate analysis were entered into a logistic regression model. RESULTS: No difference in SIRS was detected between the two groups. No significant difference was noted in the incidence of organ failure, 7-day mortality, or overall mortality between the two groups. Univariate analysis revealed that Acute Physiology And Chronic Health Evaluation (APACHE) II score of 15 or greater at BSI onset; adjusted APACHE II score (points for age excluded) of 15 or greater at BSI onset; and respiratory, cardiovascular, renal, hematological, and hepatic failure were predictors of mortality. Age, sex, use of empirical antimicrobial therapy, and infection with imipenem-resistant P. aeruginosa or vancomycin-resistant enterococci did not predict mortality. Multivariate analysis revealed that hematological failure (odds ratio (OR)=8.1, 95% confidence interval (CI)=2.78,23.47), cardiovascular failure (OR=4.7, 95% CI=1.69,13.10), and adjusted APACHE II , 15 at BSI onset (OR=3.1, 95% CI=1.12,8.81) independently predicted death. CONCLUSION: Elderly patients did not differ from nonelderly patients with respect to severity of illness before or at the time of BSI. Elderly patients with pseudomonal or enterococcal BSIs did not have a greater mortality than nonelderly patients. [source]


    Evaluation of the alkaline wash/lysis procedure for the molecular diagnosis of a positive bacterial blood culture in clinical routine practice

    JOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 3 2010
    Sheng-Chuan Hsi
    Abstract Blood culture is commonly used to detect microorganisms in patients with a suspected blood infection. This study evaluated the alkaline wash/lysis procedure to extract DNA of microorganisms in a clinical blood culture. A multiplex polymerase chain reaction (PCR) targeting the 16S rDNA (ribosomal DNA) gene and the fungal ITS (internal transcribed spacer) gene was used as a reliable indicator for the presence of microorganism DNA in the extracts. A total of 535BacT/ALERT positive blood culture bottles were evaluated. Multiplex PCR showed positive results in 530 DNA extracts, but 5 DNA extracts gave negative results. We conclude that the alkaline wash/lysis procedure in combination with the multiplex PCR is a simple and sensitive method, which can be used in a standard diagnostic laboratory to detect microorganisms in blood culture material. J. Clin. Lab. Anal. 24:139,144, 2010. © 2010 Wiley-Liss, Inc. [source]


    Selective Th2 pattern of cytokine secretion in Mycobacterium avium subsp. paratuberculosis infected Crohn's disease

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2 2008
    Zhigang Ren
    Abstract Background and Aims:, The pathogenesis of Crohn's disease (CD) remains unclear. A major controversy has been whether infection with Mycobacterium avium subspecies paratuberculosis (MAP) plays a significant role. Current support for a role of MAP is largely based on epidemiological data. The aim of this study was to determine whether MAP detection in gut biopsies is associated with a different cytokine secretion profile as observed in whole blood culture. Methods:, A whole blood culture system was employed to measure cytokine secretion, using an ELISA assay, in subjects with CD (n = 46), ulcerative colitis (n = 30), irritable bowel syndrome (n = 22) and normal controls (n = 18). MAP status was defined by nested PCR using an IS900 sequence unique to MAP. Results:, Significantly higher levels of interleukin (IL)-4 (P < 0.05) and IL-2 (P < 0.05) were found in MAP+ CD compared to MAP, CD. This was selective, as MAP+ subjects in both normal and disease controls had similar levels of IL-4 and IL-2 to those with no detectable MAP. IL-4 secretion was correlated with IL-2 production in blood cultures in CD (P < 0.01), consistent with a skewed Th2 immune response. Conclusions:, This data set provides the first evidence of altered T cell function linked to MAP infection in CD, and provides a link between detection of MAP and disease. The pattern of cytokine shift in CD is consistent with the concept that the increasing incidence of CD is in part related to the hygiene theory. [source]


    Clinical significance of polymicrobial bacteremia in newborns

    JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2005
    Piyush Gupta
    Objective: To identify whether polymicrobial bacteremia in newborns is associated with any predisposing factors, distinguishing clinical features, or higher mortality. Methods: Results of blood cultures obtained over a period of 1 year from neonates admitted to the paediatric ward and Neonatal Intensive Care Unit of a tertiary care hospital were retrospectively analysed. The study group included all cases with polymicrobial bacteremia (isolation of two or more organisms). Controls (double the number of study cases) were randomly selected from the monomicrobial group. Case records of included cases were retrieved and scrutinized. Results: Of 770 positive cultures during the study period, 52 (6.8%) cultures were positive for more than one organism. Complete case records were retrieved for 40 polymicrobial and 78 monomicrobial cases. The two groups were comparable for maternal and neonatal parameters including: maternal and obstetric complications; period of gestation; mode of delivery; birthweight and perinatal asphyxia; clinical symptomatology; invasive therapeutic interventions; and mortality. Conclusions: Isolation of more than one organism from the blood culture of a suspected septic newborn is not rare. It does not always represent a true invasion by multiple organisms. Polymicrobial isolation per se should not be the criterion for hastily changing the therapeutic decisions. [source]


    Hansenula anomala infection in a neonate

    JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2000
    A R Wong
    Abstract: We present an unusual neonatal fungal infection, Hansenula anomala in a very low birthweight infant who underwent abdominal surgery for an omphalocele. Despite treatment with adequate doses of amphotericin B, the yeast continued to grow from the blood culture, and was only eradicated with the use of oral ketoconazole. [source]


    A retrospective study of the clinical presentation of 140 dogs and 39 cats with bacteraemia

    JOURNAL OF SMALL ANIMAL PRACTICE, Issue 8 2008
    M. Greiner
    Objectives: To evaluate retrospective data from 140 dogs and 39 cats with positive blood cultures that were presented to the Clinic for Small Animal Medicine in Munich from 1995 to 2004. Methods: The identity of bacteria isolated from blood cultures of dogs and cats with bacteraemia was determined, and clinical and laboratory findings and outcome of animals with Gram-negative versus Gram-positive bacteraemia were compared. Results: Sepsis was diagnosed in 81·7 per cent of dogs and 59·5 per cent of cats with bacteraemia. Escherichia coli was isolated in one third of the animals. Dogs with bacteraemia more often showed monocytosis and increased alkaline phosphatase activity, while in cats, hyperglycaemia was found more commonly. Dogs with Gram-negative bacteraemia had hypoalbuminaemia significantly more often than dogs with Gram-positive bacteraemia, while among the remaining parameters, there were no statistically significant differences. Clinical Significance: Not all dogs and cats with a positive blood culture met the criteria for sepsis. Bacteraemia caused by Gram-positive versus Gram-negative bacteria cannot be distinguished based on clinical or laboratory parameters, and bacterial culture and susceptibility testing have to be performed for the right choice of antibiotic treatment. [source]


    Preliminary evaluation of hemostasis in neonatal foals using a viscoelastic coagulation and platelet function analyzer

    JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2009
    Barbara L. Dallap Schaer VMD, DACVECC, DACVS
    Abstract Objectives , To compare coagulation and platelet function parameters measured using a viscoelastic analyzer in 3 groups: foals presenting to a neonatal intensive care unit with presumed sepsis, normal foals, and adult horses. Design , Preliminary prospective trial. Setting , Veterinary teaching hospital. Animals , Ten clinically healthy foals, 13 clinically healthy adult horses, and 17 foals sequentially admitted for suspected sepsis. Intervention , A single citrated (3.8%) blood sample collected at admission was submitted for coagulation evaluation using a viscoelastic analyzer. Measurements and Main Results , Time to initial clot formation (ACT), clot rate (CR), platelet function, and time to peak parameters were collected from the signature generated with the associated software. Peak clot strength was collected manually from signature tracings. Signalment, presenting complaint, blood culture results, clinical progression, and outcome were collected from the medical record. Kruskal-Wallis testing was used to determine differences in coagulation parameters between groups, as well as to identify any associations between coagulation variables, foal variables, and outcome. Normal foals were more likely to have increased platelet function (P=0.04) compared with normal adult horses. Prolonged ACT (P=0.004) and decreased CR (P=0.03) were associated with foals with positive blood culture. There was a trend toward prolonged ACT and increased likelihood of death (P=0.06). Conclusions , Healthy foals differ in values measured by the viscoelastic coagulation and platelet function analyzer compared with healthy adult horses. ACT and CR abnormalities were more likely to be observed in foals with positive blood cultures. The viscoelastic coagulation and platelet function analyzer may be useful in identifying early hemostasic and platelet dysfunction in critically ill foals, particularly those that are septic. [source]


    Evaluation of a score designed to predict sepsis in foals

    JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2003
    DACVECC, DACVIM, Kevin T. T. Corley BSc, MRCVS
    Abstract Objective: To evaluate the accuracy of a published score designed to predict sepsis in foals in a clinical setting and to evaluate the association of clinical and clinicopathological variables with sepsis. Design: Observational study. Retrospective for data from 1998. Prospective in 1999,2001. Setting: Foal intensive care unit of a university hospital. Animals: Client-owned foals of less than 10 days of age, presenting from 1998 to 2001. Interventions: None. Measurements and main results: Data from the history and physical examination, together with admission hematology, biochemistry and arterial blood gas analysis were used to generate the published sepsis scores. The same data were investigated for their statistical relationship with sepsis. The presence or absence of sepsis was determined from blood culture, culture of sites of suspected local infection, clinical course and/or post-mortem examination. The modified sepsis score was calculated for 168 foals, which were classified as septic (86), non-septic (45) or not possible to classify (37). The modified sepsis score correctly predicted sepsis in 58 out of 86 foals and non-sepsis in 34 out of 45 foals, resulting in a sensitivity of 67%, a specificity of 76%, a positive predictive value of 84% and a negative predictive value of 55%. Abnormal neutrophil cytology, an immunoglobulin concentration of less than 400 mg/dl, and low blood glucose concentration had the strongest association with sepsis. Conclusions: The low negative predictive value of the sepsis score limited its clinical utility. The sepsis score should not be used to define sepsis in clinical studies, unless previously validated in the study center. [source]


    Epidemiology, treatment and outcome of candidemia: a five-year review at three Canadian hospitals

    MYCOSES, Issue 5-6 2002
    Behandlung und ausgang von Candidämien: Eine Fünfjahresübersicht an drei kanadischen Hospitälern, Epidemiologie
    Candidämie; Epidemiologie; Kanada Summary. To determine treatment regimens and epidemiological patterns in the occurrence of candidemia, a review of cases occurring from 1992 to 1996 in three large Canadian hospitals, University of Alberta Hospital (UAH) and Royal Alexandra Hospital (RAH), Edmonton, and Foothills Medical Center (FMC), Calgary, was carried out. Cases were detected by reviewing microbiology laboratory records. There were 202 cases in all (UAH 104, FMC 70, RAH 28). For the five study years the candidemia rate was 4.5/10 000 discharges (UAH 7.6, FMC 4.9, and RAH 1.7; P < 0.05 for all interhospital comparisons). The rate remained stable between 1992 and 1995 but rose dramatically in 1996 to 7.6/10 000 (P < 0.01 compared to 1995) as a result of increases at UAH and RAH. Of the 208 species identified, Candida albicans accounted for 135 (65%). During hospitalization 93 (46%) patients died. Species did not influence outcome. Antifungal treatment with fluconazole alone was given to 14% of patients, and increased in frequency throughout the study. No antifungal therapy was given to 47 patients (23%). This group had a much higher mortality (68%) than those who received treatment (39% P < 0.01). Twenty of the untreated patients had already died by the time the blood culture had been reported as growing a yeast. Candidemia rates vary significantly between hospitals and increased in some but not all over the five study years. As many patients with candidemia will have died by the time laboratory diagnosis is made, presumptive antifungal therapy in high-risk patients may be necessary if outcome is to be improved. Zusammenfassung. Um epidemiologische Muster zu erkennen und Behandlungsmethoden zu optimieren, wurden die Candidämiefälle in der Zeit von 1992 bis 1996 in drei großen kanadischen Kliniken analysiert: University of Alberta Hospital (UAH) Royal Alexander Hospital (RAH), Edmonton und Foothills Medical Center (FMC), Calgary. Es wurden die archivierten mikrobiologischen Laborbefunde ausgewertet, insgesamt 202 Fälle (UAH 104, FMC 70, RAH 28). Im 5-Jahreszeitraum betrug die Candidämierate 4.5/10 000 Entlassungen (UAH 7.6, FMC 4.9, RAH 1.7, P < 0.05 für den Interklinikvergleich). Die Rate blieb zwischen 1992 und 1995 stabil, stieg aber im Jahr 1996 auf 7.6/10 000 (P < 0.01 im Vergleich zu 1995) infolge der Zunahme im UAH und RAH. Unter den 208 identifizierten Isolaten waren 135 Candida albicans (65%). Während der Hospitalisierung verstarben 93 Patienten (46%). Die Erregerart hatte keinen Einfluß auf den Krankheitsausgang. Fluconazol allein wurde 14% der Patienten verabreicht, die Verordnungshäufigkeit stieg während der Studie an. Keine antimykotische Therapie wurde 47 Patienten verordnet (23%). Diese Gruppe hatte eine wesentlich höhere Mortalität, nämlich 68%, im Vergleich zu der behandelten mit 39% (P < 0.01). 20 der nichtbehandelten Patienten waren schon zu dem Zeitpunkt verstorben, als der Befund ,Hefewachstum' aus der Blutkultur erhoben wurde. Die Candidämieraten unterschieden sich signifikant zwischen den Kliniken und stiegen in einigen, aber nicht allen im 5-Jahreszeitraum an. Da viele Patienten bereits während des Zeitraumes der Labordiagnostik verstarben, erscheint bei Hochrisikopatienten eine empirische Frühtherapie unabdingbar, wenn der Krankheitsausgang optimiert werden soll. [source]


    Unique histological characteristics of Scedosporium that could aid in its identification

    PATHOLOGY INTERNATIONAL, Issue 2 2010
    Masatomo Kimura
    Scedosporium prolificans has been increasingly recognized as an etiological agent of disseminated mycelial infections in profoundly immunocompromised patients. Reported herein is a case of disseminated S. prolificans infection in a patient undergoing anti-neoplastic chemotherapy for acute myeloid leukemia. Antemortem blood culture yielded S. prolificans, which was confirmed on conventional morphological examination and polymerase chain reaction-based DNA sequencing targeting internally transcribed spacer regions. Histopathology of autopsy specimens indicated fungal infection in the heart, lungs, liver, kidneys, spleen, pancreas and gastrointestinal tract, with the development of hemorrhagic and ischemic necrosis. The infecting fungus had developing septate hyphae and was identified as belonging to the genus Scedosporium, on in situ hybridization of tissue. The combination of haphazardly branching hyphae and lemon-shaped conidia appeared to be the most useful distinguishing features to allow differentiation of this fungus from other filamentous fungi in tissue. Three other unique histopathological characteristics of the fungus were noted: (i) parallel hyphae bridged at right angles to produce letter-H patterns; (ii) intravascular conidiation; and (iii) purple conidia in tissue, though these are usually described as brown in most text books. Precise histopathology, in addition to other techniques such as in situ hybridization, can aid in the identification of etiological fungi. [source]