ro13-9904 and Communicable-Diseases--Emerging

Scrub typhus can present with atypical signs and symptoms such as those of acute kidney injury, gastroenteritis, pneumonitis, and acute respiratory distress syndrome. Meningitis, encephalitis, and hepatic dysfunction have also been reported, particularly in severe cases with multisystem involvement. Scrub typhus has never been reported in the literature to cause urinary tract infections (UTIs) which includes cystitis and pyelonephritis.. A 45-year old male presenting to the outpatient unit with fever, right flank pain, and burning micturition for three days was initially treated for UTI. However, he returned to the hospital on the fourth day of illness with persistent symptoms. He was hospitalized, with intravenous (IV) ceftriaxone. Computerized tomography scan of his abdomen-pelvis showed features of acute pyelonephritis, so his antibiotics were upgraded to meropenem and teicoplanin. Despite this, the patient's condition deteriorated. Laboratory investigations showed multisystem involvement: decreasing platelets, raised creatinine, and deranged liver panel. As Kathmandu was hit by dengue epidemic during the patient's hospitalization, on the seventh day of his illness, blood samples were sent for tropical fever investigation. All tests came out negative except for scrub typhus-IgM antibodies positive on rapid diagnostic test. The patient's symptoms subsided after 48 h of starting doxycycline and he became fully asymptomatic four days later. Fever did not recur even after discontinuing other IV antibiotics, favoring scrub typhus disease rather than systemic bacterial sepsis.. Scrub typhus is an emerging infectious disease of Nepal. Therefore, every unexplained fever cases (irrespective of clinical presentation) should be evaluated for potential Rickettsiosis. Moreover, for cases with acute pyelonephritis, atypical causative agents should be investigated, for example scrub typhus in this case.

Topics: Anti-Bacterial Agents; Ceftriaxone; Communicable Diseases, Emerging; Doxycycline; Fever; Humans; Male; Meropenem; Middle Aged; Nepal; Pyelonephritis; Scrub Typhus; Teicoplanin

Neisseria meningitidis sequence type 11 is an emerging cause of urethritis. We demonstrate by using whole-genome sequencing orogenital transmission of a N. meningitidis sequence type 11 isolate causing urethritis in a monogamous couple of men who have sex with men. These results suggest dissemination of this clonal complex among low-risk patients.

Topics: Acute Disease; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Communicable Diseases, Emerging; Humans; Injections, Intramuscular; Male; Meningococcal Infections; Neisseria meningitidis; Sexual and Gender Minorities; Sexually Transmitted Diseases; Treatment Outcome; Urethritis; Whole Genome Sequencing; Young Adult

Topics: Anti-Bacterial Agents; Cardiotonic Agents; Ceftriaxone; Combined Modality Therapy; Communicable Diseases, Emerging; Drug Therapy, Combination; Humans; Immunocompetence; Male; Meningitis, Bacterial; Middle Aged; Pharyngitis; Respiration, Artificial; Sepsis; Streptococcal Infections; Streptococcus agalactiae; Vancomycin

Shigellosis is endemic in many resource-poor countries due to feco-oral transmission, resulting in considerable morbidity and mortality. There is rapid emergence of multi-drug resistant (MDR) Shigella spp. resulting in poor reliability of first line antibiotics like quinolones, co-trimoxazole and ampicillin. Ceftriaxone has been used as a reserved antibiotic for treatment of MDR Shigella spp. The authors report a case of ceftriaxone resistant Shigella flexneri successfully managed with meropenem. As occurrence of ceftriaxone resistant Shigella is still rare, the objective of reporting this case is to highlight the possible failure of ceftriaxone in treating shigellosis which if not detected timely can result in mortality.

Topics: Anti-Bacterial Agents; Ceftriaxone; Communicable Diseases, Emerging; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Female; Humans; Infant; Shigella

We report an immunocompetent 24-year-old man who presented with a severe, invasive non-typhoidal salmonella (iNTS) infection. He presented with lumbar back pain associated with fever and rigours, which had been preceded by diarrhoea. Blood cultures grew Salmonella enteritidis. An MRI scan of his pelvis and spine showed that he had a small gluteal abscess and sacroiliitis. His condition subsequently deteriorated due to the development of a secondary pneumonia and respiratory failure. He was managed conservatively with 2 weeks of intravenous ceftriaxone, followed by 6 weeks of oral ciprofloxacin. Detailed investigations did not reveal any predisposing factors or evidence of an underlying immunodeficiency. Follow-up showed complete resolution of symptoms with no long-term sequelae.

Topics: Abscess; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Communicable Diseases, Emerging; Diagnosis, Differential; Humans; Immunocompromised Host; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Pneumonia, Bacterial; Sacroiliitis; Salmonella enteritidis; Salmonella Infections; Young Adult

Neisseria gonorrhoeae has developed resistance to most antimicrobials used for treatment. Worryingly, treatment failures with oral extended-spectrum cephalosporins (ESCs) have been reported, especially in the WHO Western Pacific Region, and susceptibility to all ESCs (oral and injectable), the last remaining treatment options in many settings, is decreasing globally.. To examine the emergence, spread and characteristics of Neisseria gonorrhoeae isolates with decreased susceptibility and resistance to ESCs in Sweden.. All available Swedish isolates from 1998-2009, collected from many countries worldwide, displaying decreased susceptibility to cefixime and/or ceftriaxone (minimum inhibitory concentration (MIC) ≥ 0.032 mg/l; n=331) were examined using antibiograms, full-length porB gene sequencing, N gonorrhoeae multi-antigen sequence typing (NG-MAST), and sequencing of ESC resistance determinants (penA, mtrR and porB1b (penB alteration)).. Based on EUCAST breakpoints, 30 (9.1%) and one (0.3%) of the isolates displayed in vitro resistance to cefixime and ceftriaxone, respectively. penA mosaic alleles and penA A501 alteration were detected in 24% and 11%, respectively, of the isolates, and in increasing prevalence over the years. Moreover, among these isolates 38 NG-MAST sequence type (STs) were detected, with ST1407 (n=29), ST1103 (n=9) and ST3378 (n=8) being most common.. The proportions of N gonorrhoeae isolates with decreased susceptibility and resistance to ESCs have substantially increased over the years in Sweden. Both penA mosaic alleles and the penA A501 alteration, together with mtrR and penB, are important for the decreased susceptibility and resistance to ESCs. At least one gonococcal penA mosaic strain (ST1407), including its evolving subtypes, with decreased susceptibility/resistance to ESCs circulates worldwide.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antigens, Bacterial; Cefixime; Ceftriaxone; Communicable Diseases, Emerging; Drug Resistance, Multiple, Bacterial; Female; Genome, Bacterial; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mutation; Neisseria gonorrhoeae; Phylogeny; Sweden; Young Adult

Chronic granulomatous disease (CGD) is a rare inherited disease of the phagocyte NADPH oxidase system that causes defective production of toxic oxygen metabolites, impaired bacterial and fungal killing, and recurrent life-threatening infections, mostly by catalase-producing organisms. We report for the first time, to our knowledge, chronic infections with Actinomyces species in 10 patients with CGD. Actinomycosis is a chronic granulomatous condition that commonly manifests as cervicofacial, pulmonary, or abdominal disease, caused by slowly progressive infection with oral and gastrointestinal commensal Actinomyces species. Treatment of actinomycosis is usually simple in immunocompetent individuals, requiring long-term, high-dose intravenous penicillin, but is more complicated in those with CGD because of delayed diagnosis and an increased risk of chronic invasive or debilitating disease.. Actinomyces was identified by culture, staining, 16S ribosomal DNA polymerase chain reaction, and/or a complement fixation test in 10 patients with CGD.. All 10 patients presented with a history of fever and elevated inflammatory signs without evident focus. Diagnosis was delayed and clinical course severe and protracted despite high-dose intravenous antibiotic therapy and/or surgery. These results suggest an unrecognized and unanticipated susceptibility to weakly pathogenic Actinomyces species in patients with CGD because these are catalase-negative organisms previously thought to be nonpathogenic in CGD.. Actinomycosis should be vigorously sought and promptly treated in patients with CGD presenting with uncommon and prolonged clinical signs of infection. Actinomycosis is a catalase-negative infection important to consider in CGD.

Topics: Actinomyces; Actinomycosis; Adolescent; Adult; Amoxicillin; Anti-Bacterial Agents; Azithromycin; Bone Marrow Transplantation; Ceftriaxone; Child; Clindamycin; Communicable Diseases, Emerging; DNA, Ribosomal; Female; Granulomatous Disease, Chronic; Humans; Male; Meropenem; Penicillin G; Penicillin V; Polymerase Chain Reaction; Sulfamethoxazole; Thienamycins; Trimethoprim; Young Adult

Topics: Acyclovir; Ceftriaxone; Child, Preschool; Communicable Diseases, Emerging; Drug Therapy, Combination; Follow-Up Studies; Glasgow Coma Scale; Humans; Infusions, Intravenous; Male; Ontario; Risk Assessment; Severity of Illness Index; Treatment Outcome; West Nile Fever; West Nile virus