All Posts Tagged With: "infective endocarditis"

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“Q fever epidemic in the Chamonix valley” (France), is a recent headline from ProMed-mail.1 To date, 79 clinical cases have been identified with a further 22 seropositive individuals. This report has been followed by an outbreak affecting up to 86 people from Newport, South Wales.2 The causative organism, Coxiella burnetii has its reservoir in a broad range of vertebrates and arthropods.3 It is typically transmitted by the aerosol route, where it causes a zoonotic infection, but the source of this current outbreak remains elusive, as is often the case in retrospective epidemiological investigations.

Primary infection in human beings is symptomless in more than half of those infected.4,5 Signs of acute disease have no typical presentation, but tend to manifest as a self-limiting debilitating febrile illness for 2—14 days, non-typical pneumonia, or hepatitis.3 It is estimated that less than 5% of those with acute Q fever will develop chronic disease, the most common presentation of which is endocarditis. C burnetii accounts for 35% of all cases of infective endocarditis after infection with slow-growing or fastidious bacterial species (3% of total endocarditis cases), especially in those with prosthetic valves, previous valve injury, or rheumatic heart disease.6 Other cases are associated with immuno-suppression through corticosteroid use, cancer, AIDS, or lymphoma.6Manifestation of chronic disease may be delayed for several years possibly requiring C burnetii reactivation from a persistent latent form.

Full article: http://www.bmj.com/cgi/content/full/340/mar18_1/c1268

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Acupuncture, which is based on the theory that inserting and manipulating fine needles at specific acupuncture points located in a network of meridians will promote the harmonious flow of “Qi,” is one of the most widely practised modalities of alternative medicine. Because needles are inserted up to several centimetres beneath the skin, acupuncture may pose risks to patients. One of the most important complications is transmission of pathogenic micro-organisms, from environment to patient or from one patient to another.

In the 1970s and 1980s most infections associated with acupuncture were sporadic cases involving pyogenic bacteria.1 So far, more than 50 cases have been described globally. In most cases, pyogenic bacteria were transmitted from the patient’s skin flora or the environment because of inadequate skin disinfection before acupuncture. In localised infections, meridian specific and acupuncture point specific lesions were typical. About 70% of patients had musculoskeletal or skin infections, usually in the form of abscesses or septic arthritis, corresponding to the site of insertion of the acupuncture needles.1 2 A minority had infective endocarditis, meningitis, endophthalmitis, cervical spondylitis, retroperitoneal abscess, intra-abdominal abscess, or thoracic empyema.3 4