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A 74-year old woman presented to the emergency room with difficulties in speaking and standing. The patient was not able to answer the clinicians’ questions, but her husband explained that she had been ill with a fever and a worsening cough for the last 2 weeks and had taken a fall 2 days before

Answer: Streptococcus pneumoniae. The figure in the photo quiz shows an uncommon Gram stain of a Streptococcus pneumoniae isolate. The subcultured isolate did not grow either on blood agar (BBL Columbia agar with 5% sheep blood; Becton Dickinson) or on chocolate agar (chocolate agar-PolyViteX; bioM

We assessed both the effectiveness of two Helicobacter pylori (Hp) eradication triple therapies and the usefulness of serology in the follow-up. Fifty patients with active or scarred duodenal ulcer were randomized to lansoprazole or omeprazole for 1 to 4 weeks, with clarithromycin 250 mg twice a day and tinidazole 500 mg twice a day for the first week. Endoscopies were scheduled before treatment, after 8 weeks, and after I year. H. pylori status was determined before therapy by rapid urease test and histology and during the follow-up by histology and culture. Serology was determined at baseline and at 6 and 12 months. The regimens were equally effective in inducing ulcer healing (95.8% vs. 87.5%) and eradicating Hp with no recurrences at 12 months. Among 44 patients eradicated, a significant reduction of immunoglobulin G (IgG) titer occurred at 6 (p < 0.0001) and 12 months (p < 0.0001). If a titer reduction of more than 30% was taken as an indicator for Hp eradication, the specificity of enzyme-linked immunosorbent assay was 75% at 6 and 95.4% at 12 months with a 100% sensitivity. Either lansoprazole or omeprazole combined with antibiotics are effective in eradicating Hp. Serology is useful for monitoring Hp eradication provided that an appropriate percent reduction in IgG titer is used after more then 6 months after therapy.

The recognition of sepsis is a crucial aspect in the management of critically ill patients. Recent guidelines strongly recommend the initiation of broad-spectrum antibiotic therapy within 1 hour after the recognition of a case of sepsis ([1][1]). The adjustment of antibiotic therapy is also

We report the case of a 69-year-old man with acute pulmonary echinococcosis. A computed tomographic scan of the thorax revealed the presence of multiple nodules in both lungs, and laboratory tests showed eosinophilia and the presence of antibodies against Echinococcus granulosus . Therapy with albendazole led to resolution of the pulmonary nodules and a normalization of the white cell count. To our knowledge this is the first described case of acute echinococcosis, as the diagnosis of this disease is usually delayed to chronic phases. Therefore, finding unexplained eosinophilia, especially in association with pulmonary nodules, should lead one to suspect acute hydatid disease.