ro13-9904 and Empyema--Pleural

Staphylococcus aureus is a well recognized pathogen with global distribution. In recent years community-associated, methicillin-resistant S. aureus has emerged as an increasing cause of severe infections among adults and children. Herein, a case is reported of a previously healthy, 19-month-old male, who presented with empyema necessitans and acute osteomyelitis due to a community-associated, methicillin-resistant, S. aureus strain. This report highlights the evolving epidemiology of S. aureus, as important pathogen in the community as well as the hospital setting, and the importance of establishing appropriate guidelines for diagnosis, management and surveillance of this public health problem.

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Clindamycin; Combined Modality Therapy; Community-Acquired Infections; Drug Therapy, Combination; Empyema, Pleural; Femoral Vein; Femur; Gentamicins; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Osteomyelitis; Popliteal Vein; Radiography; Staphylococcal Infections; Thoracoscopy; Vancomycin; Venous Thrombosis

Topics: Ceftriaxone; Empyema, Pleural; Humans

Extra-intestinal complications of Salmonella Typhi (S. Typhi) infections usually occur in endemic countries and in patients with underlying risk conditions. A 14-year-old immunocompetent girl was admitted with respiratory distress owing to S. Typhi pneumonia and pleural empyema. She was a native of Ivory Coast but had lived in France for 4 years and had not travelled abroad for several years. There were no gastro-intestinal symptoms and no S. Typhi carriage was detected in her family. She recovered completely with ceftriaxone and ciprofloxacin and pleural drainage was not required. An atypical presentation of S. Typhi should be considered even in settings where there are no risk factors.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drainage; Empyema, Pleural; Female; France; Humans; Pneumonia, Bacterial; Salmonella typhi; Treatment Outcome; Typhoid Fever

We describe a case of pneumonia and empyema thoracis caused by trimethoprim-sulfamethoxazole-susceptible, but imipenem-resistant Nocardia abscessus in a cancer patient. The isolate was confirmed to the species level by 16S rRNA sequencing analysis. The patient did not respond to antibiotic therapy, including ceftriaxone and imipenem, and died of progressing pneumonia and multiple organ failure.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Empyema, Pleural; Hemangiosarcoma; Humans; Imipenem; Immunocompromised Host; Male; Middle Aged; Multiple Organ Failure; Nocardia; Nocardia Infections; Pneumonia; RNA, Ribosomal, 16S; Trimethoprim, Sulfamethoxazole Drug Combination

Purulent pericarditis is an extremely rare complication of invasive Streptococcus pneumoniae infection among children in the antibiotic era, and its mortality remains high if left untreated. This report involves a 4½-year-old girl who presented to our emergency department with productive cough, shortness of breath, and left-sided chest pain with a diagnosis of pneumococcal pneumonia. She subsequently developed life-threatening conditions including bilateral empyema with respiratory failure, purulent pericarditis, and multiple organ failure leading to death. The case highlights that purulent pericarditis is a rare yet possible disorder complicating pneumococcal disease in the antibiotic era. The increase in strains resistant to penicillin should alert emergency physicians to the potential for reemergence of pneumococcal pericarditis in children.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Empyema, Pleural; Fatal Outcome; Female; Humans; Pericarditis; Pleural Effusion; Pneumonia, Pneumococcal; Respiration, Artificial; Thoracostomy; Ultrasonography; Vancomycin

Transient hypogammaglobulinemia of infancy (THI) is originally defined as a physiological maturation defect of immunoglobulin G (IgG) production that occurs at 3-6 months of age and lasts until 18 to 36 months of age. We report here on a 22-month-old child with THI and IgA deficiency, who had massive pneumococcal empyema. Her depressed IgG level returned to normal within 6 months, but IgA level was still low at 6 yr of age. Although THI is an age-dependent and self-limiting disorder, severe infection that includes an atypical presentation of an infection may occur in some patients and this requires evaluation with immunologic study.

Topics: Agammaglobulinemia; Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Bacterial; Empyema, Pleural; Female; Humans; IgA Deficiency; Immunoglobulin A; Immunoglobulin G; Infant; Staphylococcal Infections; Tomography, X-Ray Computed

Streptococcus pneumoniae ( S. pneumoniae ) has been associated with hemolytic uremic syndrome (HUS), which is an unusual but serious disease in childhood. We conducted a retrospective review of children aged less than 18 years with S. pneumoniae -associated HUS in northern Taiwan from January 2000 to June 2005. The demographic characters, clinical courses, and outcomes were analyzed. Seven children (three girls, four boys) with S. pneumoniae -associated HUS were studied. The median age at onset of HUS was 40 months (range: 25-60 months). The median duration of hospital stay was 36 days (range: 15-50 days). The interval between the onset of illness attributable to S. pneumoniae and the development of HUS was around 1-2 weeks. The onset of oliguria developed within 2 weeks after illness. Six patients required dialysis with median duration of 16 days. Three patients had leukopenia as the initial presentation. All seven patients had pneumococcal pneumonia complicating with empyema, and two of them received decortication via video-assisted thoracoscopic surgery. Between patients who needed dialysis or not, there was no significant difference in age, sex, duration of thrombocytopenia, incidence of extra-renal complications, such as hepatitis, pancreatitis, and hypertension, and length of hospital stay. The seven patients survived with normal renal function. HUS is a potentially fatal complication of S. pneumoniae infection. Clinicians managing patients with pneumococcal pneumonia with empyema accompanied by leukopenia should beware of the development of HUS. The long-term prognosis for recovery of renal function appears to be good in these patients in northern Taiwan.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Empyema, Pleural; Erythrocyte Transfusion; Female; Hemolytic-Uremic Syndrome; Humans; Length of Stay; Leukopenia; Male; Oliguria; Platelet Transfusion; Pneumonia, Pneumococcal; Renal Dialysis; Respiration, Artificial; Retrospective Studies; Taiwan; Thoracostomy; Thrombocytopenia

Parapneumonic effusion and empyema are recognized complications of bacterial pneumonia. Optimal management in children, especially the duration of parenteral antibiotics and the role of surgery, is controversial. This study analyzed the clinical characteristics, management, outcome, and bacterial etiology of 59 patients with complicated parapneumonic effusion and empyema treated at a single medical center in Kaohsiung from January 1995 to March 2004.. The diagnosis of complicated parapneumonic effusion was based on the specific characteristics of pleural fluid, computed tomography or ultrasound findings, or direct visualization of loculations during the surgical procedure.. Causative agents were culture-confirmed in 42% of the cases. Streptococcus pneumoniae was the leading pathogen in this series (20% of cases). None of the S. pneumoniae isolates were susceptible to penicillin. Mycoplasma pneumoniae accounted for 19% of cases based on immunoglobulin M assay.. An initial combination therapy regimen consisting of cefotaxime or ceftriaxone plus macrolide provided reasonable activity against 80% of the pathogens isolated in this series. This study also revealed that prolonged parenteral antibiotic treatment resulted in longer length of hospital stay.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Drug Therapy, Combination; Empyema, Pleural; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin M; Infant; Infant, Newborn; Macrolides; Male; Mycoplasma pneumoniae; Penicillin Resistance; Penicillins; Pleural Effusion; Pneumonia, Bacterial; Pneumonia, Mycoplasma; Retrospective Studies; Seasons; Streptococcus pneumoniae; Taiwan; Treatment Outcome

Topics: Anti-Bacterial Agents; Ceftriaxone; Empyema, Pleural; Humans; Male; Middle Aged; Salmonella enteritidis; Salmonella Infections

To determine the degree to which bioactive penicillin, metronidazole, ceftriaxone, clindamycin, vancomycin, and gentamicin penetrate into empyemic pleural fluid using our new rabbit model of empyema.. An empyema was created via the intrapleural injection of 10(8)()Pasteurella multocida bacteria into the pleural space of New Zealand white rabbits. After an empyema was verified by thoracentesis and pleural fluid analysis, penicillin, 24,000 U/kg; metronidazole, 37 mg/kg; ceftriaxone, 30 mg/kg; clindamycin, 9 mg/kg; vancomycin, 15 mg/kg; or gentamicin, 1 mg/kg, were administered IV. Antibiotic levels in samples of pleural fluid and serum, collected serially for up to 480 min, were then determined using a bioassay.. The degree to which the different antibiotics penetrated into the infected pleural space was highly variable. Penicillin penetrated most easily, followed by metronidazole, ceftriaxone, clindamycin, vancomycin, and gentamicin. Of the antibiotics tested, penicillin and metronidazole equilibrated the most rapidly with the infected pleural fluid. Penicillin levels remained elevated in pleural fluid even after serum levels had decreased.. Using this rabbit model of empyema, there was marked variation in the penetration of antibiotics into the empyemic fluid. Although there are species differences between rabbit and human pleura, the variance in degree of penetration of antibiotics into the pleural space should be considered when antibiotics are selected for the treatment of patients with empyema.

Topics: Animals; Anti-Bacterial Agents; Biological Availability; Ceftriaxone; Clindamycin; Disease Models, Animal; Empyema, Pleural; Gentamicins; Humans; Infusions, Intravenous; Metronidazole; Pasteurella Infections; Pasteurella multocida; Penicillins; Rabbits; Vancomycin

To compare the clinical characteristics, treatment, and outcome of pediatric patients with pneumonia attributable to isolates of Streptococcus pneumoniae that were either susceptible or nonsusceptible to penicillin.. Multicenter, retrospective study.. Eight children's hospitals in the United States.. Two hundred fifty-four children with pneumococcal pneumonia identified from patients enrolled in the United States Pediatric Multicenter Pneumococcal Surveillance Study during the 3-year period from September 1, 1993 to August 31, 1996.. Demographic and clinical variables including necessity for and duration of hospitalization, frequency of chest tube placement, antimicrobial therapy, susceptibility of isolates, and clinical outcome.. There were 257 episodes of pneumococcal pneumonia that occurred in 254 patients. Of the 257 isolates, 22 (9%) were intermediate and 14 (6%) were resistant to penicillin; 7 (3%) were intermediate to ceftriaxone and 5 (2%) were resistant to ceftriaxone. There were no differences noted in the clinical presentation of the patients with susceptible versus nonsusceptible isolates. Twenty-nine percent of the patients had a pleural effusion. The 189 (74%) hospitalized patients were more likely to have an underlying illness, multiple lung lobe involvement, and the presence of a pleural effusion than nonhospitalized patients. Fifty-two of 72 hospitalized patients with pleural effusions had a chest tube placed, and 27 subsequently underwent a decortication drainage procedure. Eighty percent of the patients treated as outpatients and 48% of the inpatients received a parenteral second or third generation cephalosporin followed by a course of an oral antimicrobial agent. Two hundred forty-eight of the patients (97.6%) had a good response to therapy. Six patients died; however, only 1 of the deaths was related to the pneumococcal infection.. The clinical presentation and outcome of therapy did not differ significantly between patients with penicillin-susceptible versus those with nonsusceptible isolates of S pneumoniae. Hospitalized patients were more likely to have underlying illnesses, multiple lobe involvement, and the presence of pleural effusions than patients who did not require hospitalization. In otherwise normal patients with pneumonia attributable to penicillin-resistant pneumococcal isolates, therapy with standard beta-lactam agents is effective.

Topics: Adolescent; Adult; Ambulatory Care; Anti-Bacterial Agents; Ceftriaxone; Cefuroxime; Cephalosporins; Child; Child, Preschool; Empyema, Pleural; Female; Hospitalization; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Pleural Effusion; Pneumonia, Pneumococcal; Retrospective Studies; Streptococcus pneumoniae; Treatment Outcome

Topics: Ascitic Fluid; Bacterial Infections; Ceftriaxone; Cephalosporins; Empyema, Pleural; Escherichia coli Infections; Female; Hepatitis C; Humans; Liver Cirrhosis; Middle Aged