amoxicillin-potassium-clavulanate-combination and Fever-of-Unknown-Origin

A 72-year-old gentleman with significant cardiac history and a pacemaker in situ initially presented to the emergency department 5 days after he had his pacemaker-unit batteries changed. He had deranged vital signs, productive cough and fever. His chest plain radiograph did not show evidence of infection; however, he had right basal crackles on auscultation, which suggested a lower respiratory tract infection. He was treated with intravenous co-amoxiclav and supportive therapy, which led to his improvement. The patient was discharged but had to be readmitted a total of four times over the span of 4 months due to recurrent fever and associated symptoms. Transthoracic and transoesophageal echocardiograms and CT of the neck/thorax/abdomen/pelvis were done to look for endocarditis, pacemaker-unit infection and other sources of infection. However, these did not show any evidence of infection. He did have persistent raised inflammatory markers and two blood cultures growing

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Blood Culture; Device Removal; Enterobacter cloacae; Enterobacteriaceae Infections; Fever of Unknown Origin; Fluorodeoxyglucose F18; Hospitalization; Humans; Male; Pacemaker, Artificial; Patient Readmission; Positron-Emission Tomography; Prosthesis-Related Infections; Radiopharmaceuticals

Toxic shock syndrome (TSS) was first described by Todd in 1978. The relevant Lancet publication reported 7 cases of children with fever, exanthema, hypotension and diarrhoea associated with multiple organ failure. An association between TSS and use of hyper-absorbent tampons in menstruating women was discovered in the 1980s. Following the market withdrawal of such tampons, TSS virtually disappeared. Herein we report a new case of TSS in a 15-year-old girl.. A 15-year-old patient was admitted to intensive care for severe sepsis and impaired consciousness associated with diffuse abdominal pain. Dermatological examination revealed diffuse macular exanthema. Laboratory tests showed hepatic cytolysis (ASAT 101 U/L, ALAT 167 U/L, total bilirubin 68μmol/L) and an inflammatory syndrome. Lumbar puncture and blood cultures were sterile while thoraco-abdomino-pelvic and brain scans were normal. The patient was menstruating and had been using a tampon over the previous 24hours. Vaginal sampling and tampon culture revealed TSST-1 toxin-producing S. aureus. Management consisted of intensive care measures and treatment with amoxicillin-clavulanic acid and clindamycin for 10 days.. In case of septic shock associated with diffuse macular exanthema a diagnosis of TSS must be envisaged, particularly in menstruating women.

Topics: Abdominal Pain; Adolescent; Amoxicillin-Potassium Clavulanate Combination; Bacterial Toxins; Clindamycin; Critical Care; Diagnosis, Differential; Drug Therapy, Combination; Enterotoxins; Erythema; Female; Fever of Unknown Origin; Humans; Menstrual Hygiene Products; Shock; Shock, Septic; Staphylococcus aureus; Superantigens

Acute osteomyelitis of the clavicle accounts for less than 3% of osteomyelitis cases, with its usual location in the middle third. It may be hematogenous, due to contiguity, or secondary to catheterization of the subclavian vein or neck surgery. The diagnosis is often delayed, and clinical symptoms may simulate obstetric brachial plexus palsy in young children. We report a new case of osteomyelitis of the clavicle in a 30-day-old newborn.

Topics: Abscess; Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Catheterization, Central Venous; Cefotaxime; Clavicle; Female; Fever of Unknown Origin; Follow-Up Studies; Fosfomycin; Fractures, Spontaneous; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Infusions, Intravenous; Male; Osteomyelitis; Pregnancy; Pregnancy Complications, Infectious; Radionuclide Imaging; Sepsis; Streptococcal Infections; Ultrasonography

We report the case of a 39-year old patient with septicemia treated for pharyngitis with antibiotics since a few days. She wasn't able to swallow her antibiotics anymore because of dysphagia. Radiologic examination revealed pulmonary infiltrates and Vena iugularis interna-thrombosis. These findings and anamnesis led to the diagnosis of Lemierre syndrome inspite of lacking detection of bacteria. After changing the antibiotic therapy and start of anticoagulation further course of illness was favorable. The long duration of hospitalization was indepted to high morbidity typically seen in Lemierre syndrome.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anticoagulants; Ceftriaxone; Clindamycin; Deglutition Disorders; Diagnosis, Differential; Drug Therapy, Combination; Female; Fever of Unknown Origin; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Jugular Veins; Pneumonia, Bacterial; Sepsis; Syndrome; Thrombosis; Tomography, X-Ray Computed; Tonsillitis; Ultrasonography

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Combined Modality Therapy; Diagnosis, Differential; Dyspnea; Emergencies; Esophageal Neoplasms; Esophageal Stenosis; Fever of Unknown Origin; Fusobacterium Infections; Humans; Male; Mediastinitis; Streptococcal Infections; Streptococcus anginosus; Therapeutic Irrigation; Tomography, X-Ray Computed

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arthralgia; Diagnosis, Differential; Escherichia coli Infections; Female; Fever of Unknown Origin; Humans; Middle Aged; Nephritis; Tomography, X-Ray Computed; Weight Loss

In two patients, men aged 35 and 69 years admitted postoperatively to the intensive care unit, fever of unknown origin developed. One had been admitted because aspiration was suspected. He had been treated immediately with amoxicillin and clavulanic acid. The other had undergone oesophageal excision and gastric reconstruction because of oesophageal carcinoma and had been subjected to antibiotic decontamination (amphotericin B, norfloxacine en fungizone). No cause for the fever was detected, but it quickly subsided after discontinuation of the amoxicillin-clavulanic acid and the norfloxacine, respectively. When encountering fever of unknown origin in intensive care patients it is always important to think of drug fever.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Drug Hypersensitivity; Drug Therapy, Combination; Esophageal Diseases; Fever of Unknown Origin; Humans; Intensive Care Units; Male; Norfloxacin; Postoperative Complications; Suction; Treatment Outcome