ro13-9904 and Anaphylaxis

Ceftriaxone is a widely used antibiotic in pediatric clinical practice. Usually ceftriaxone is well tolerated and serious adverse effect like anaphylaxis is rare. We report a near fatal anaphylaxis reaction in a child after the first dose of intravenous ceftriaxone who revived successfully.

Topics: Anaphylaxis; Anti-Bacterial Agents; Ceftriaxone; Child; Humans; Male

Although rare in Portugal, snakebite envenoming entails severe morbidity and mortality. We present the case of a 65-year-old woman bitten on her leg in a northern coastal region in Portugal, on a walk during the COVID-19 pandemic lockdown. Despite first looking for help at the nearest pharmacy, she developed anaphylactoid shock and was promptly driven to a tertiary hospital, where antivenom was administered in a timely manner under close monitoring. Prophylactic antibiotics were started and maintained based on elevated inflammatory markers and signs of wound inflammation. She evolved favorably, with rapid weaning of vasopressors and resolution of end-organ dysfunction. This case highlights the importance of prompt recognition and describes crucial steps in envenomation management in a country where snakebite is infrequent, but potentially fatal.

Topics: Aged; Anaphylaxis; Anti-Bacterial Agents; Antivenins; Ceftriaxone; Clindamycin; Female; Humans; Portugal; Snake Bites; Tetanus Toxoid; Treatment Outcome

Topics: Acute Disease; Adolescent; Anaphylaxis; Antigens, CD; Ceftriaxone; Fatal Outcome; Female; Gene Expression; Heart Failure; Hematologic Neoplasms; Humans; Leukemia, Mast-Cell; Mast Cells; Pneumonia, Bacterial; Respiratory Distress Syndrome

Both probiotics and pathogens in the human gut express pathogen-associated molecular patterns (PAMPs) and die with the release of endotoxin and bacterial DNA, which can stimulate our immune system and cause immune reaction. However, it's interesting and fascinating to address why the normal intestinal flora will not generate immunological rejection like the pathogen does. By investigating the changes in cells and molecules relevant to immune tolerance in mice with ceftriaxone-induced dysbacteriosis, our study discovered that both the Evenness indexes and Shannon Wiener index of intestinal flora showed a decrease in dysbacteriosis mice. Moreover, the proportion of αβ

Topics: Allergens; Anaphylaxis; Animals; Anti-Bacterial Agents; Ceftriaxone; Cytokines; Dysbiosis; Gastrointestinal Microbiome; Immunoglobulin E; Intestines; Lymph Nodes; Male; Mice, Inbred BALB C; Ovalbumin; Peyer's Patches; Spleen; T-Lymphocytes, Regulatory

Topics: Aged; Anaphylaxis; Anti-Bacterial Agents; Ceftriaxone; Drug Hypersensitivity; Fibrin Fibrinogen Degradation Products; Fibrinogen; Humans; Immunoglobulin E; Male; Pulmonary Embolism; Saphenous Vein; Thrombophlebitis; Tomography, X-Ray Computed; Ultrasonography

Topics: Anaphylaxis; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Clindamycin; Cross Reactions; Dexamethasone; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate; Male; Middle Aged; Skin Tests

One of the most used cephalosporin in clinical practice is ceftriaxone. Anaphylaxis due to the administration of ceftriaxone is considered a rare event. Here, we report a case of fatal anaphylactic shock after the administration of ceftriaxone in a child who had tolerated the drug in past exposures. The allergic pathogenesis is sustained by the clinical data (short time between the inoculation of the drug and the onset of the symptoms; past exposure to the same molecule and probable sensitization) and the postmortem examination findings (polivisceral congestion and intense eosinophilia found in the histological examination).

Topics: Anaphylaxis; Anti-Bacterial Agents; Autopsy; Ceftriaxone; Child, Preschool; Drug Hypersensitivity; Fatal Outcome; Humans; Male; Retrospective Studies

Lyme borreliosis is a disease transmitted by ticks to mammals, especially in horses and humans. Caused by a spirochete Borrelia burgdorferi, it can result in lameness, arthritis, carditis, dermatitis and neurological signs. Anaphylactoid reactions are severe responses caused by direct action of substances (drugs, toxins), which can pose risks to life. Still poorly documented in horses, these reactions are caused by the effects of inflammatory mediators such as histamine, kinins and arachidonic acid metabolites. The last two are the most clinically relevant for the species.. The simultaneous occurrence of anaphylactoid reaction in two horses experimentally infected by Borrelia burgdorferi undergoing intravenous treatment with ceftriaxone sodium is reported. It was administered 4.7 × 10(8) spirochetes intradermal and subcutaneous applications in both horses to evaluate clinical aspects of the Lyme disease, 95 days before the application of sodium ceftriaxone. During the administration, one horse (a gelding) showed immediate and severe anaphylactoid symptoms such as urticaria, dyspnea, tachycardia, and eyelid edema, which were controlled by injecting dexamethasone. After 1 day, it expressed signs of abdominal discomfort, caused by severe bloat, which was treated surgically via celiotomy. Subsequently, this gelding had piroplasmosis and severe anemia, requiring treatment with an antimicrobial and blood transfusion. Second horse (a mare) showed signs of hypotension during the application of the antibiotic, which disappeared only when the application was interrupted. Days after the event, the mare developed moderate large colon bloat, which was treated with medication only. Subsequently the mare was evolved into the prodromal phase of laminitis in one of the forelimbs, which was treated for 10 days with non-steroidal anti-inflammatory and rheology modifying drugs and cryotherapy.. From the two cases presented here, it does appear that sodium ceftriaxone can induce anaphylactoid reactions in horses infected by Borrelia burgdorferi, which may evolve into colic syndrome, laminitis and the occurrence of opportunistic infections. However, further evidence should be collected in order to draw definite conclusions.

Topics: Adrenal Cortex Hormones; Anaphylaxis; Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Borrelia burgdorferi; Ceftriaxone; Colic; Dexamethasone; Female; Foot Diseases; Hoof and Claw; Horse Diseases; Horses; Inflammation; Lyme Disease; Male

The incidence of ceftriaxone-related hypersensitivity skin reactions is between 1% and 3%, whereas anaphylaxis is rare. To the best of our knowledge, the following case is the first report of asystole after the administration of single-dose ceftriaxone. A 55-year-old man was admitted to our emergency department because of high fever, abdominal pain, dysuria, and weakness. To determine the cause of his fever, blood and urine cultures were obtained. Then, an infusion of 1 g ceftriaxone was started slowly. One minute later, cardiac arrest occurred. The rhythm was asystole. Cardiopulmonary resuscitation and tracheal intubation were performed immediately, and the ceftriaxone infusion was discontinued. Within 20 minutes, circulation was restored. The time of onset was suggestive of ceftriaxone-induced anaphylaxis. The patient was discharged in good clinical condition on the 10th day of admission. Emergency physicians should be mindful of the possibility of anaphylaxis and asystole that could occur with the first dose of ceftriaxone and should also make sure to offer receiving detailed informed patient consent, too.

Topics: Anaphylaxis; Anti-Bacterial Agents; Cardiopulmonary Resuscitation; Ceftriaxone; Death, Sudden, Cardiac; Emergency Service, Hospital; Heart Arrest; Humans; Male; Middle Aged

Stress-induced cardiomyopathy, a reversible left ventricular dysfunction, has been reported following anaphylaxis; this clinical circumstance seems to be linked to elevated levels of circulating catecholamines. We present a 36-year-old woman diagnosed as stress-induced cardiomyopathy following ceftriaxone-induced anaphylaxis. After anaphylactic reaction, the patient initially presented with cardiogenic shock, and subsequently developed multiple organ failure. She recovered basically by multiple organ supportive therapies including intra-aortic balloon pump and continuous veno-venous hemofiltration. This case provides a unique opportunity to observe the triggering of stress-induced cardiomyopathy, and also it provides evidence to support the role of catecholamine in the pathogenesis of this disease.

Topics: Adult; Anaphylaxis; Ceftriaxone; Cephalosporins; Female; Humans; Multiple Organ Failure; Takotsubo Cardiomyopathy

Topics: Adrenal Cortex Hormones; Adrenergic Agonists; Anaphylaxis; Anti-Bacterial Agents; Atropine; Bronchodilator Agents; Ceftriaxone; Diabetes Mellitus, Type 2; Epinephrine; Fatal Outcome; Humans; Intubation, Intratracheal; Male; Malpractice; Middle Aged; Multiple Trauma; Obesity; Skin Tests

Topics: Adult; Anaphylaxis; Anti-Bacterial Agents; Ceftriaxone; Cesarean Section; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Obstetric Labor Complications; Pregnancy; Streptococcal Infections

Topics: Anaphylaxis; Anti-Bacterial Agents; Calcium; Ceftriaxone; Diagnosis, Differential; Humans; Infant, Newborn; Infant, Premature; Male; Shock

Radiocontrast media (RCM) is used commonly in clinical practice, and can be associated with significant adverse effects. We report a patient who experienced severe anaphylaxis after being given multiple drugs. Challenge testing established allergy to both RCM and ceftriaxone. Premedication did not prevent recurrence of anaphylaxis on repeat challenge with RCM. The haemodynamic and serum tryptase consequences of the challenges are discussed, and a summary of RCM allergy is provided.

Topics: Anaphylaxis; Anti-Bacterial Agents; Ceftriaxone; Contrast Media; Drug Hypersensitivity; Humans; Male; Middle Aged; Premedication; Treatment Failure

A 48-year-old woman with a questionable history of an unspecified ceftriaxone allergy was treated with cefazolin for surgical antibiotic prophylaxis. After she tolerated cefazolin therapy for 4 days, the medical staff concluded that her allergy history was inaccurate, and she was treated with intravenous ceftriaxone for suspected nosocomial pneumonia. Approximately 10 minutes after the start of the infusion, the patient experienced anaphylaxis. Initial symptoms of oral angioedema and laryngopharyngeal constriction progressed to dyspnea, tachypnea, hypotension, and tachycardia, all of which quickly resolved after immediate treatment with hydrocortisone, diphenhydramine, and epinephrine. Skin testing with cefazolin, cefepime, and ceftriaxone revealed that the likely allergic determinant mediating the patient's hypersensitivity reaction was the unique ceftriaxone R2 side chain and not the beta-lactam ring, which initially was suspected by the physician. Immunoglobulin E-mediated hypersensitivity reactions to cephalosporins may occur due to antibody complexes with the beta-lactam ring or various cephalosporin side chains. Misconceptions regarding the nature of cephalosporin allergies complicate antibiotic selection for patients with questionable allergy histories and may lead to inappropriate drug reexposure and anaphylaxis. Detailed understanding of the antigenic determinants that mediate hypersensitivity reactions is essential for clinicians to avoid type 1 reactions in patients with a suspected allergy to cephalosporins.

Topics: Anaphylaxis; Cefazolin; Ceftriaxone; Cephalosporins; Drug Hypersensitivity; Female; Humans; Middle Aged; Skin Tests; Structure-Activity Relationship

During an hospitalization, a ten-day-old newborn infant was treated with ceftriaxone (Rocephine i.v., 390 mg/day) for an infection secondary to the presence of an umbilical catheter. A few minutes after the end of the fifth injection, the infant presented with cyanosis, initially localized at the perfusion site, then generalized, a tachycardia followed by acute circulatory failure with arterial hypotension and finally a multiple organe failure with coagulation, kidney and liver dysfunction. The infant received classical resuscitation treatment and recovered without short term sequelae. The time of onset was in favour of drug-induced accident. A postnatal sensitization during previous injections might have occurred, although the latency of immediate hypersensitivity reactions after a first sensitizing contact is usually longer. A sensitization in utero or via breast feeding was ruled out due to the absence of maternal exposure to ceftriaxone. The absence of urticaria and bronchospasm, and the initial localization of cyanosis were not in favour of a classic allergic disease. An other cause, toxic or infectious cannot be ruled out.

Topics: Anaphylaxis; Anti-Bacterial Agents; Catheterization; Ceftriaxone; Hospitalization; Humans; Infant, Newborn; Male; Resuscitation; Treatment Outcome; Umbilicus

Topics: Adult; Anaphylaxis; Anti-Bacterial Agents; Ceftriaxone; Cross Reactions; Dermatitis, Occupational; Diagnosis, Differential; Drug Hypersensitivity; Facial Dermatoses; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Intradermal Tests; Male

Life-threatening anaphylaxis developed in a 5-y-old boy with septic shock within minutes of receiving his first intravenous injection of ceftriaxone. Hypersensivity could not be demonstrated by skin testing and ceftriaxone-specific IgE. However, an in vivo, controlled, intravenous challenge was clearly positive.. Clinicians should be aware of the possibility of anaphylaxis occurring with the first dose of ceftriaxone, especially since such a reaction could go unnoticed in patients with life-threatening infections and unstable vital signs.

Topics: Anaphylaxis; Ceftriaxone; Child, Preschool; Drug Hypersensitivity; Follow-Up Studies; Humans; Injections, Intravenous; Male; Patch Tests; Risk Assessment; Severity of Illness Index; Shock, Septic

Topics: Adolescent; Anaphylaxis; Ceftriaxone; Cephalosporins; Drug Hypersensitivity; Humans; Immunoglobulin E; Male; Skin Tests

Topics: Anaphylaxis; Ceftriaxone; Cephalosporins; Female; Humans; Middle Aged