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New regimens, including those with new fluoroquinolones, have been developed to overcome the antibiotic resistance of Helicobacter pylori. We aimed to assess the antibiotic resistance rates, as well as the molecular mechanisms of fluoroquinolone resistance, of the clinical isolates obtained in Korea.
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Relapses were demonstrated by the stability of genotypes and the slight genetic variability of strains on macro-arrays. Two patients suffered from relapses, one and three years after H. pylori treatment. For the third patient, both the polymorphism of glmM and hspA genotypes and the diversity of CDSs identified on macro-arrays suggested that several episodes of re-infection occurred, 1-8 years after eradication.
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Ranitidine bismuth citrate-clarithromycin-amoxycillin is more effective when used as second-line therapy rather than when used as first-line therapy; second, ranitidine bismuth citrate-clarithromycin-amoxycillin shows lower and slighter side-effects when used as second-line therapy rather than when used as first-line therapy; finally, the excellent tolerability of ranitidine bismuth citrate + clarithromycin + amoxycillin influences positively the patients' compliance, both as first- and second-line therapy.
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Infections with Bartonella henselae or Bartonella quintana present with vasoproliferative lesions in skin and parenchymatous organs in immunocompromised patients. A case report of a 38-year-old patient with HIV infection and hepatitis B surface antigen status is described. The dominant clinical symptoms in our patient were fever and icterus. Ultrasonography of the abdomen showed a picture similar to that of liver cirrhosis. Irregular (echorich) nodes with hyper-vascularization were suspected to be hepatocellular carcinoma. Ultrasound guided puncture of one of these lesions and histological examination revealed the diagnosis of bartonella infection. Under antibiotic treatment with clarithromycin and doxycycline the fever and the hyperbilirubinemia decreased. The sonographically detectable lesions reduced in size. Vasoproliferative lesions in immunodeficient patients caused by bartonella infection show a characteristic slightly hyperechogenic irregular pattern at ultrasound. Typically, circumscribed hypervascularization might be shown by color Doppler imaging. Liver cirrhosis and diffuse tumor infiltration should be excluded.
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Reversal of severe Crohn's disease has been achieved in 6/12 patients using prolonged combination anti-Mycobacterium avium subspecies paratuberculosis therapy alone. Three patients remain in long-term remission with no detectable Crohn's disease off all therapy These results support a causal role for Mycobacterium avium subspecies paratuberculosis in Crohn's disease while also suggesting that a cure may become possible.
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Fusobacterium species are anaerobic Gram-negative bacilli, which colonise the mucus membranes of man and animals and can cause a number of clinical manifestations including Lemierre's disease (postanginal septicaemia), abdominal infection and deep-seated abscesses. The incidence of fusobacterium infections appears to be increasing, and we present three cases of fusobacteriosis who presented with features of community acquired pneumonia (CAP). Cases were treated with benzyl penicillin and metronidazole, co-amoxiclav and metronidazole and amoxicillin and clarithromycin. Since some of the Fusobacterium species are resistant to penicillin and erythromycin, treatment with these antibiotics in cases of fusobacteriosis presenting as CAP may lead to treatment failure. A high index of clinical suspicion is required to recognise this rare cause of CAP.
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An urban AIDS clinic
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We aimed to study differences between H. pylori strains isolated before and after eradication failure.
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Pertussis is increasing in frequency among adults, but early diagnosis requires special attention to details in the medical history. We describe a 64 year-old male with classic signs and symptoms of pertussis and documented Bordetella pertussis infection that were overlooked because he presented with a chief complaint of cough and fear of falling asleep. Coughing paroxysms and a feeling of suffocation (30-60 seconds) only occurred at night after short periods of deep sleep (30-45 minutes). The physicians did not observe these episodes during daytime examinations, and the basis of the patient's fear of sleep was not explored. We recommend reassessment of how adults describe symptoms of pertussis, including fear of sleep, and we suggest the use of PCR technology to allow early diagnosis and prompt treatment.
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Our data confirm that the homeopathic treatment in question has potential benefits for cough in children as well, and highlight the strong safety profile of this treatment. Additional antibiotic prescription was not associated with a greater cough reduction, and presented more adverse events than the homeopathic syrup alone.