meropenem and Fusobacterium-Infections

We present here the challenging case of severe Lemierre syndrome in a healthy woman in her late twenties, whose clinical presentation was characterised by lung abscesses and disseminated systemic abscesses in the brain, the abdomen and the soft-tissues, as a likely consequence of a patent foramen ovale. Blood cultures were positive for

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Lemierre Syndrome; Meropenem; Metronidazole

Topics: Aged; Anti-Bacterial Agents; Brain Abscess; Fusobacterium; Fusobacterium Infections; Humans; Male; Meropenem; Polymerase Chain Reaction

Infections caused by fusobacteria have a wide clinical spectrum, and in certain patients, they can lead to severe systemic illness. We report the case of an immunocompromised young woman who presented with severe pneumonia complicated by parapneumonic pleural effusion, despite wide-spectrum antibiotic treatment.

Topics: Adult; Anti-Bacterial Agents; Diagnosis, Differential; Empyema, Pleural; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Immunocompetence; Lemierre Syndrome; Meropenem; Pleural Effusion; Pneumonia; Treatment Outcome

Topics: Anti-Bacterial Agents; Child; Craniotomy; Drainage; Endoscopy; Epidural Abscess; Female; Fusobacterium Infections; Humans; Magnetic Resonance Imaging; Meropenem; Paranasal Sinuses; Pott Puffy Tumor; Staphylococcal Infections; Thienamycins; Tomography, X-Ray Computed; Vancomycin

A 2-year-old girl presented to hospital, with reduced consciousness and fever. She had a 4-week history of fever treated with two courses of amoxicillin for tonsillitis diagnosed in primary care. Neuroimaging revealed multiple cerebral abscesses and subdural empyema. Pus aspirated from the intracranial collections grew Fusobacterium necrophorum and meropenem was started. Following neurosurgery, the patient continued to be agitated with fluctuating fever. She underwent close monitoring with regular neuroimaging. To control the progression of intracranial infection, she underwent three separate neurosurgical procedures following which she made a good recovery. This case demonstrates how an organism rarely associated with childhood illnesses presented atypically and progressed into a complex potentially fatal intracranial infection requiring a high degree of neurosurgical intervention. Awareness of this organism is important. The combination of source control together with appropriate antibiotic use was crucial in controlling the infection.

Topics: Amoxicillin; Anti-Bacterial Agents; Brain Abscess; Child, Preschool; Empyema, Subdural; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Meropenem; Thienamycins; Tomography, X-Ray Computed

A 33-year-old previously healthy man injured his gums and subsequently developed dyspnea and fever. A chest X-ray showed nodules and infiltrates in both lungs, and the patient was initially diagnosed with pneumonia and administered meropenem hydrate, although his symptoms did not improve. A blood culture identified Fusobacterium necrophorum, and thrombophlebitis in the internal jugular vein of the neck was observed on computed tomography and ultrasound scans. We replaced the meropenem with clindamycin, sulbactam/ampicillin and metronidazole, and the patient's symptoms improved.

Topics: Adult; Anti-Bacterial Agents; Clindamycin; Dyspnea; Fever; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Jugular Veins; Lemierre Syndrome; Male; Meropenem; Metronidazole; Periodontitis; Radiography, Thoracic; Thienamycins; Tomography, X-Ray Computed; Treatment Outcome; Wound Infection

An increasingly reported entity, Lemierre's syndrome classically presents with a recent oropharyngeal infection, internal jugular vein thrombosis and the presence of anaerobic organisms such as Fusobacterium necrophorum. The authors report a normally fit and well 17-year-old boy who presented with severe sepsis following a 5-day history of a sore throat, myalgia and neck stiffness requiring intensive care admission. Blood cultures grew F. necrophorum and radiological investigations demonstrated left internal jugular vein, cavernous sinus and sigmoid sinus thrombus, left vertebral artery dissection and thrombus within the left internal carotid artery. Imaging also revealed two areas of acute ischaemia in the brain, consistent with septic emboli, skull base (clival) osteomyelitis and an extensive epidural abscess. The patient improved on meropenem and metronidazole and was warfarinised for his cavernous sinus thrombosis. He has an on-going left-sided hypoglossal (XIIth) nerve palsy.

Topics: Adolescent; Anti-Infective Agents; Anticoagulants; Cranial Fossa, Posterior; Fever; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Hypoglossal Nerve Diseases; Jugular Veins; Lemierre Syndrome; Male; Meropenem; Metronidazole; Osteomyelitis; Pharyngitis; Sepsis; Thienamycins; Treatment Outcome; Warfarin

Streptobacillus moniliformis is the etiological agent of rat-bite fever, a rare disease in Asia that is difficult to diagnose. We describe an elderly patient living in rat-infested conditions who presented with severe sepsis. He was successfully treated with meropenem, and blood culture revealed infection with S. moniliformis.

Topics: Aged; Animals; Asian People; Bacteremia; Fusobacterium Infections; Humans; Male; Meropenem; Rat-Bite Fever; Rats; Streptobacillus; Thienamycins

Topics: Anti-Bacterial Agents; Cefepime; Cephalosporins; Child; Diagnosis, Differential; Drug Therapy, Combination; Female; Fever; Fusobacterium Infections; Fusobacterium necrophorum; Headache; Hip; Humans; Magnetic Resonance Imaging; Meropenem; Thienamycins; Tomography, X-Ray Computed; Vancomycin

Serious infections in children represent unique challenges for the treating physician. For the pediatric patient, considerations of drug toxicity are especially critical to avoid potential long-term complications of therapy. There are several advantages associated with using single, broad-spectrum, empiric antibiotic therapy, including reduced potential for drug-mediated toxicity or drug interactions and facilitation of home therapy. Of the antibiotics available for monotherapy, the carbapenems have the broadest spectrum of activity. However, a major obstacle toward the use of the carbapenems in pediatrics has been the risk of seizures occurring during therapy with imipenem/cilastatin. In clinical studies of meningitis and other infections in children, no drug-related seizures were reported when treated with the carbapenem meropenem. Meropenem monotherapy has been shown to be similar to ceftriaxone- and cefotaxime-based single or multiple antibiotic regimens, in terms of clinical and microbiologic efficacy and tolerability. Thus, meropenem represents a favorable treatment choice for the seriously ill child, either as empiric monotherapy or as definitive therapy of polymicrobial or nosocomial infections.

Topics: Child; Critical Illness; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Male; Meropenem; Thienamycins