ro13-9904 and HIV-Infections

Diagnosing multifactorial, multidimensional symptoms unexplained by presumptive diagnosis is often challenging for infectious disease specialists.. We report a rare case of a 30-year-old Japanese bisexual man with a history of virally suppressed human immunodeficiency virus and syphilis infections who developed chest pain and an erosive lesion under the lower midline jaw.. Imaging examinations revealed erosive lesions on the sternum and left the ninth rib. Biopsy and polymerase chain reaction testing of sternal tissue specimens were noncontributory. However, due to elevated rapid plasma regain levels, a diagnosis of syphilitic osteomyelitis and gumma of the jaw was made.. The patient was treated with 5 weeks of intravenous ceftriaxone and then with 8 weeks of oral amoxicillin.. After the antibiotic treatment, bone pain disappeared. We conducted a literature review on syphilitic osteomyelitis, and all of the articles included were case reports. Approximately half of the 46 patients with syphilitic osteomyelitis had HIV coinfection, and 10 (22%) patients lacked signs of early syphilis. Given its rarity, clinical data to establish appropriate guidelines for diagnosing and treating syphilitic osteomyelitis are still lacking. Cognitive biases, such as anchoring, cognitive overload bias, and premature closure, may contribute to diagnostic delays.. In cases of idiopathic multiple bone lesions, syphilis must always be ruled out, and clinicians should guard against cognitive pitfalls when diagnosing rare diseases.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Bias; Ceftriaxone; Clinical Reasoning; Cognition; HIV Infections; Humans; Male; Osteomyelitis; Syphilis

Topics: Adult; Aged; Ceftriaxone; China; Coinfection; Female; HIV Infections; Humans; Incidence; Male; Middle Aged; Neurosyphilis; Penicillin G; Penicillin G Benzathine; Retrospective Studies; Syphilis Serodiagnosis; Syphilis, Cutaneous

Benzathine Penicillin G has been used to treat syphilis for over 50 years; however, the precise regimen of penicillin for treatment of syphilis in HIV-positive individuals remains a hot topic of debate. Although international guidelines recommend the same treatment for syphilis, regardless of HIV status, there are inconsistencies in prescribing practices among clinicians.. Two previous systematic reviews have found limited evidence for enhanced treatment of syphilis in the presence of HIV. However, a growing body of literature indicates that the rate of asymptomatic neurosyphilis may be higher in HIV, and that syphilis infection is associated with poorer long-term neurocognitive outcomes. A number of retrospective studies propose that serological response may be slower, or serological failure may be higher, among HIV-positive individuals, but these studies are limited by high loss to follow-up, high reinfection rates and a focus on serological rather than clinical response. Beyond penicillin, some evidence suggests equivalence of macrolides, cephalosporins and doxycycline, although macrolide resistance is an increasing concern.. Until a prospective, randomized study is conducted, inconsistency with treatment will continue. We offer a pragmatic approach to recognizing patients who may require further investigation or neuropenetrative antibiotic treatment.

Topics: Anti-Bacterial Agents; Ceftriaxone; Coinfection; Doxycycline; Drug Resistance, Bacterial; HIV Infections; Humans; Penicillin G Benzathine; Recurrence; Spinal Puncture; Syphilis; Syphilis Serodiagnosis; Treponema pallidum

Nontyphoidal Salmonella (NTS), mainly serotypes Typhimurium and Enteritidis, cause invasive infections with high mortality in children in sub-Saharan Africa. Multidrug resistance is common, and resistance to third-generation cephalosporins has emerged.. We reviewed clinical features, outcomes, and antimicrobial resistance patterns in invasive NTS infections among children aged 6 weeks to 5 years participating in malaria vaccine studies in an area of high malaria and human immunodeficiency virus (HIV) transmission in Siaya, western Kenya. Blood culture was performed in hospitalized children and pediatric outpatients with prolonged fever.. From July 2009 to December 2013, 1696 children aged 6 weeks to 17 months were enrolled into vaccine trials and followed for up to 53 months. We obtained 1692 blood cultures from 847 children. Of 134 bacterial pathogens isolated, 102 (76.1%) were Salmonella serogroup B or D. Invasive NTS disease occurred in 94 (5.5%) children, with an incidence of 1870, 4134, and 6510 episodes per 100 000 person-years overall, in infants, and in HIV-infected children, respectively. Malaria infection within the past 2 weeks occurred in 18.8% (3/16) of invasive NTS episodes in HIV-infected and 66.2% (53/80) in HIV-uninfected children. Case fatality rate was 3.1%. Salmonella group B resistant to ceftriaxone emerged in 2009 and 2010 (6.2% [2/32 isolates]), rising to 56.5% (13/23 isolates) in 2012 and 2013.. Incidence of invasive NTS disease was high in this area of high malaria and HIV transmission, especially in HIV-infected children. Rapidly emerging resistance against ceftriaxone requires urgent reevaluation of antibiotic recommendations and primary prevention of exposure to Salmonella.

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Child, Preschool; Drug Resistance, Multiple, Bacterial; Female; HIV Infections; Hospitalization; Humans; Incidence; Infant; Kenya; Malaria; Male; Outpatients; Residence Characteristics; Rural Population; Salmonella enterica; Salmonella Infections; Time Factors

Syphilis has challenged scientists and clinicians since its first appearance in the late 1400s and debate continues to surround the best practice in management. Difficulties in defining the goals of successful treatment have contributed to problems in determining recommendations for the ideal management. Treatment regimens currently in use were developed before randomised controlled trials became standard. This, combined with national differences in disease definition, staging and varying interpretations of the studies, as well as the emergence of complicating comorbid conditions, such as HIV, has resulted in a lack of consensus for treatment. This paper will discuss the history and current treatment of syphilis focusing on dilemmas faced by clinicians today, including the emergence of a resistant strain. Despite the difference between current national guidelines, penicillin G largely remains the treatment of choice. Close follow up, monitoring and ensuring adequate compliance remain the most important aspects in the treatment of syphilis.

Topics: Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Drug Hypersensitivity; Female; HIV Infections; Humans; Infant, Newborn; Patient Compliance; Penicillin G; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Infectious; Randomized Controlled Trials as Topic; Syphilis

Pyomyositis, a purulent infection of skeletal muscle, is usually caused by Staphylococcus aureus. Many cases of pyomyositis in human immunodeficiency virus (HIV) seronegative patients have been reported in North America and have been reviewed extensively. Moreover, pyomyositis has been reported in association with HIV infection in patients with or without the acquired immunodeficiency syndrome (AIDS). We describe two patients with pyomyositis and HIV and review the available English language literature. Leukocytosis and bacteremia tend to occur less frequently in those with HIV infection and pyomyositis. However, fever, S aureus infection, and bilateral involvement occur more frequently in HIV-positive patients. Antibiotic therapy together with surgical drainage or aspiration is usually sufficient.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Bacteremia; Cefazolin; Ceftriaxone; Cephalosporins; Drainage; Follow-Up Studies; HIV Infections; Humans; Leukocytosis; Male; Muscle, Skeletal; Muscular Diseases; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Ceftriaxone; Cephalosporins; Chancroid; Ciprofloxacin; Erythromycin; HIV Infections; Humans

A 30-year-old bisexual man who was infected with human immunodeficiency virus (HIV) and had a history of anaphylaxis to penicillin developed lues maligna, or ulceronodular secondary syphilis. Therapy with parenteral erythromycin failed, and he was subsequently treated with ceftriaxone following penicillin desensitization. A review of the English-language literature identified 14 cases of lues maligna reported between the early 1900s and 1988. From 1989 to 1994, an additional 12 cases (including the current case) were reported. Of those 12 cases, 11 occurred in patients who either were infected with HIV or were at high risk for HIV infection. Patients infected with HIV may be at increased risk of developing this severe form of secondary syphilis. Lues maligna should be considered in the differential diagnosis of HIV-infected patients who present with ulceronodular lesions.

Topics: Adult; AIDS-Related Opportunistic Infections; Bisexuality; Ceftriaxone; HIV Infections; Humans; Male; Risk Factors; Syphilis, Cutaneous

To evaluate if treatment with ceftriaxone and a macrolide, improved patient outcome when compared with monotherapy with ceftriaxone, in hospitalized patients with human immunodeficiency virus/acquired immunodeficient syndrome (HIV/AIDS) with community-acquired pneumonia (CAP).. Adult patients with HIV hospitalized due to suspected CAP were randomized to receive one of two regimens, ceftriaxone plus macrolide or ceftriaxone plus placebo, at a 1:1 proportion (Brazilian Clinical Trials Registry: RBR-8wtq2b). The primary outcome was in-hospital mortality and the secondary outcomes were mortality within 14 days, need for vasoactive drugs, need for mechanical ventilation, time to clinical stability and length of hospitalization.. A total of 227 patients were randomized, two were excluded after randomization; 225 patients were analysed (112 receiving ceftriaxone plus placebo and 113 receiving ceftriaxone plus macrolide). The frequency of the primary outcome, in-hospital mortality, was not statistically different between the regimens: 12/112 (11%) patients who received ceftriaxone plus placebo and 17/113 (15%) who received ceftriaxone plus macrolide died during hospitalization (hazard ratio 1.22, 95% CI 0.57-2.59). We did not find differences between the regimens for any of the secondary outcomes, including mortality within 14 days, which occurred in 5/112 (4%) patients with ceftriaxone plus placebo and in 12/113 (11%) patients with ceftriaxone plus macrolide (relative risk 2.38, 95% CI 0.87-6.53).. Among hospitalized patients with HIV/AIDS with CAP, treatment with ceftriaxone and a macrolide did not improve patient outcomes, when compared with ceftriaxone monotherapy.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Female; HIV Infections; Hospitalization; Humans; Macrolides; Male; Pneumonia, Bacterial

The objective of this prospective pilot study was to evaluate the response of HIV-infected patients with asymptomatic syphilis to one of two intensive antibiotic treatment regimens. Thirty-one HIV-infected patients with serum rapid plasma reagin titre > or =1:4 and no clinical findings of syphilis were randomized to receive daily intramuscular injections of ceftriaxone or procaine penicillin (plus oral probenecid) for 15 days; 24 returned for follow-up study. Seven of 10 (70%) procaine penicillin-treated patients and 10 of 14 (71%) ceftriaxone-treated patients had a > or =4-fold decline in RPR (P=0.94); two penicillin-treated and one ceftriaxone-treated patient relapsed. Two patients failed ceftriaxone therapy. Three penicillin-treated, and two ceftriaxone-treated patients were serofast. Serological responses were similar in those patients with and without asymptomatic neurosyphilis. There was no difference in the serologic response to daily treatment with ceftriaxone vs that with procaine penicillin plus probenecid; both treatments were associated with comparatively high rates of serological non-response and relapse.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Female; HIV Infections; Humans; Injections, Intramuscular; Male; Middle Aged; Penicillin G Procaine; Pilot Projects; Prospective Studies; Reagins; Recurrence; Syphilis; Treatment Outcome

To compare intravenous (iv) ceftriaxone and penicillin G as therapy for neurosyphilis, blood and CSF were collected before and 14-26 weeks after therapy from 30 subjects infected with human immunodeficiency virus (HIV)-1 who had (1) rapid plasma reagin (RPR) test titers >/=1&rcolon;16, (2) reactive serum treponemal tests, and (3) either reactive CSF-Venereal Disease Research Laboratory (VDRL) tests or CSF abnormalities: (a) CSF WBC values >/=20/microL or (b) CSF protein values >/=50 mg/dL. At baseline, more ceftriaxone recipients had skin symptoms and signs (6 [43%] of 14 vs. 1 [6%] of 16; P=.03), and more penicillin recipients had a history of neurosyphilis (7 [44%] of 16 vs. 1 [7%] of 14; P=.04). There was no difference in the proportion of subjects in each group whose CSF measures improved. Significantly more ceftriaxone recipients had a decline in serum RPR titers (8 [80%] of 10 vs. 2 [13%] of 15; P=. 003), even after controlling for baseline RPR titer, skin symptoms and signs, or prior neurosyphilis were controlled for. Differences in the 2 groups limit comparisons between them. However, iv ceftriaxone may be an alternative to penicillin for treatment of HIV-infected patients with neurosyphilis and concomitant early syphilis.

Topics: Adult; Ceftriaxone; Cephalosporins; Female; HIV Infections; Humans; Male; Middle Aged; Neurosyphilis; Penicillin G; Penicillins; Pilot Projects

To examine correlates of. The sentinel surveillance network is an open cohort of gonococcal infection cases from Québec, Canada. Cross-sectional results are reported herein.. Between 1 January 2016 and 31 December 2019, data from 886 individuals accounting for 941 gonorrhoea cases were included.. Epidemiological and clinical data were collected using an auto-administered questionnaire, direct case interviews and chart reviews. Antimicrobial susceptibility testing was performed using the agar dilution method. Generalised estimating equations were used for regression.. Significant correlates of

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Cefixime; Ceftriaxone; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Bacterial; Female; Gonorrhea; HIV Infections; Homosexuality, Male; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Quebec; Sentinel Surveillance; Sexual and Gender Minorities

In South Africa, male urethritis syndrome (MUS) is the most common sexually transmitted infection (STI) syndrome in men. We determined the distribution of STI etiologies and the susceptibility profiles of Neisseria gonorrhoeae isolates from men presenting with MUS to 3 sentinel surveillance health care facilities. Secondary objectives were to determine the seroprevalence of coinfections (HIV, syphilis, herpes simplex virus 2).. Consecutive, consenting men with symptomatic urethral discharge were enrolled between January 1, 2019, and December 31, 2020. Genital discharge swab and blood specimens were collected and transported to a central STI reference laboratory in Johannesburg, South Africa.. Among 769 men enrolled, N. gonorrhoeae was the commonest cause of MUS (674 [87.8%]; 95% confidence interval [CI], 85.2%-89.9%), followed by Chlamydia trachomatis (161 [21.0%]; 95% CI, 18.2%-24.0%). Of 542 cultivable N. gonorrhoeae isolates, all were susceptible to ceftriaxone (modal minimum inhibitory concentration, 0.004 mg/L) and azithromycin (modal minimum inhibitory concentration, 0.128 mg/L). Seroprevalence rates of HIV, syphilis, and HSV-2 were 21.4% (95% CI, 18.5%-24.5%), 2.3%, and 50.1%, respectively. Condom use at last sexual encounter was reported by only 7%, less than 50% had been medically circumcised, and only 66.7% (58 of 87) who self-reported an HIV-positive status were adherent on antiretroviral drugs.. Neisseria gonorrhoeae and C. trachomatis were the predominant causes of MUS. Currently recommended dual ceftriaxone and azithromycin therapy are appropriate for MUS syndromic management; however, surveillance must be maintained to timeously detect emerging and increasing gonococcal resistance. Clinic-based interventions must be intensified in men seeing sexual health care to reduce the community transmission and burden of STI and HIV.

Topics: Azithromycin; Ceftriaxone; Chlamydia trachomatis; Gonorrhea; Herpesvirus 2, Human; HIV Infections; Humans; Male; Neisseria gonorrhoeae; Seroepidemiologic Studies; Sexually Transmitted Diseases; South Africa; Syphilis; Urethritis

Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis occurs only in 0.6 percent of patients. A resurgence of syphilis cases has been observed for several years in many countries, especially in HIV-infected subjects. These patients often present with concomitant primary and secondary lesions or extensive presentations of syphilis.. We report 2 patients with syphilitic uveitis diagnosed and treated at the department of infectious diseases at the University hospital of Marrakech. Ocular involvement was inaugural in both HIV patients. Each had a specific treatment, but none had a complete recovery of visual function; the first patient was treated by ceftriaxone and the second one was treated by penicillin.. Syphilis must be discussed in all patients diagnosed with uveitis or papillitis. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Although not evidence-based, prompt therapy may lead to functional recovery. Ceftriaxone could be a suitable alternative to penicillin in the treatment of early syphilis in HIV-infected patients. This treatment has a concomitant effectiveness even for asymptomatic forms of neurosyphilis. Ocular syphilis is a form of neurosyphilis and requires neurosyphilis therapy regardless of when it develops after primary infection.Conventional syphilis staging is of little use in understanding ocular syphilis. Co-infection between HIV and ocular syphilis is common, but does not affect response to a neurosyphilis regimen of penicillin in the short term.

Topics: Ceftriaxone; Coinfection; Endophthalmitis; Eye Infections, Bacterial; HIV Infections; Humans; Morocco; Neurosyphilis; Penicillins; Syphilis; Uveitis

Topics: Adult; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Exanthema; Fever; HIV Infections; Humans; Male; Mpox (monkeypox); Pharyngitis; Tonsillitis

Actinomyces odontolyticus is not commonly recognized as a causative microbe of liver abscess. The detection and identification of A. odontolyticus in laboratories and its recognition as a pathogen in clinical settings can be challenging. However, in the past decades, knowledge on the clinical relevance of A. odontolyticus is gradually increasing. A. odontolyticus is the dominant oropharyngeal flora observed during infancy [Li et al. in Biomed Res Int 2018:3820215, 2018]. Herein we report a case of severe infection caused by A. odontolyticus in an immunocompromised patient with disruption of the gastrointestinal (GI) mucosa.. We present a unique case of a patient with human immunodeficiency virus infection who was admitted due to liver abscess and was subsequently diagnosed as having coinfection of A. odontolyticus, Streptococcus constellatus, and Candida albicans during the hospital course. The empirical antibiotics metronidazole and ceftriaxone were replaced with the intravenous administration of fluconazole and ampicillin. However, the patient's condition deteriorated, and he died 3 weeks later.. This report is one of the first to highlight GI tract perforation and its clinical relevance with A. odontolyticus infection. A. odontolyticus infection should be diagnosed early in high-risk patients, and increased attention should be paid to commensal flora infection in immunocompromised individuals.

Topics: Actinomyces; Ampicillin; Ceftriaxone; HIV Infections; Humans; Liver Abscess; Male

Pulmonary nocardiosis is a common disease in human immunodeficiency virus (HIV)infected patients. In most cases, the disease progresses slowly. Here, we have presented a case of pulmonary nocardiosis that rapidly progressed. A 35-year-old woman with acquired immune deficiency syndrome and superior vena cava (SVC) syndrome, who was previously lost to follow-up, presented to our hospital chronic non-productive cough. Her CD4 count was 33 cells/µL (4%). Chest X-ray revealed opacity in the right upper lobe of the lung, and the results of sputum acid-fast staining were negative. Anti-tuberculosis agents were prescribed. Two weeks later, superficial vein dilatation was noted on her chest wall and the chest X-ray revealed worse findings. Chest CT showed a heterogeneous mass measuring 9.6 × 9.8 × 8.3 cm in the right lung. Further, necrotic mediastinal nodes nearly obliterated the SVC. Gram-positive beaded branching filamentous organisms were identified in the sputum by modified acid-fast staining. Hence, she was diagnosed with pulmonary nocardiosis. Culture results confirmed the presence of Nocardia beijingensis with SVC syndrome. She responded to treatment. After 2 weeks of parenteral administration, we switched her to oral trimethoprim/sulfamethoxazole, which was later followed by antiretroviral agents.

Topics: Adult; Anti-Bacterial Agents; CD4 Lymphocyte Count; Ceftriaxone; Female; HIV Infections; Humans; Lung; Nocardia; Nocardia Infections; Sputum; Superior Vena Cava Syndrome; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Gonorrhea; HIV; HIV Infections; Humans; Male; Neisseria gonorrhoeae; Pregnancy; RNA, Viral

Topics: Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Ceftriaxone; Female; HIV Infections; Humans; Salmonella enterica; Salmonella Infections; Treatment Outcome; Vasculitis, Leukocytoclastic, Cutaneous

Ocular involvement in

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Ceftriaxone; Chorioretinitis; Doxycycline; Endophthalmitis; Eye Infections; Female; HIV Infections; Humans; Injections, Intravenous; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Untreated syphilis may lead to severe complications. This infection has recently re-emerged in developed countries with a high number of cases coinfected with human immunodeficiency virus. In these patients, the skin lesions of secondary syphilis can be very atypical.. We report the case of a 38-year-old Bulgarian homosexual man who was coinfected with human immunodeficiency virus and syphilis. His skin contained multiple extensive necrotic lesions with abundant purulent secretion that covered his face, lips, scalp, and torso. Initial clinical diagnoses included varicella pustulosa and staphylococcal dermatitis. Human immunodeficiency virus infection in our patient had been established 2 years earlier in prophylactic studies, but had not been treated. Due to lack of penicillin, he was successfully treated with ceftriaxone, and the skin lesions underwent complete reversal. He also began antiretroviral therapy, which resulted in a significant effect on his immune status. Three months after the onset of antiretroviral therapy, he also achieved optimal viral suppression.. This case emphasizes the importance of considering cutaneous secondary syphilis in the differential diagnosis of any inflammatory cutaneous disorder in individuals infected with human immunodeficiency virus.

Topics: Adult; Anti-Bacterial Agents; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Ceftriaxone; Coinfection; Diagnosis, Differential; Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; HIV Infections; Humans; Male; Syphilis; Syphilis, Cutaneous

Topics: Acute Retroviral Syndrome; Adult; Anti-HIV Agents; Ceftriaxone; Diarrhea; Dysentery, Bacillary; HIV Infections; Humans; Injections, Intravenous; Male; Shigella flexneri; Treatment Outcome

Preventing the emergence of ceftriaxone-resistant Neisseria gonorrhoeae can potentially avert hundreds of millions of dollars in direct medical costs of gonorrhea and gonorrhea-attributable HIV infections. In the illustrative scenario we examined, emerging ceftriaxone resistance could lead to 1.2 million additional N. gonorrhoeae infections within 10 years, costing $378.2 million.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Bacterial; Gonorrhea; Health Care Costs; HIV Infections; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae

Topics: Anti-Bacterial Agents; Antiviral Agents; Bacterial Translocation; Benzimidazoles; Ceftriaxone; Coinfection; Disease Susceptibility; Esophageal and Gastric Varices; Esophagoscopy; Female; Fluorenes; Gastrointestinal Hemorrhage; Hepatitis C, Chronic; HIV Infections; Humans; Immunocompromised Host; Middle Aged; Peritonitis; Sofosbuvir; Streptococcus salivarius; Substance Abuse, Intravenous

Topics: Anti-Bacterial Agents; Ceftriaxone; HIV Infections; Humans; Male; Middle Aged; Neurosyphilis; Recurrence; Stroke

With recent increases in annual gonorrhoea incidence and disproportionately high infection rates amongst men who have sex with men, the clinical picture of disseminated gonococcal infection is changing. We present two cases where consideration of, and investigation for, disseminated Neisseria gonorrhoeae infection provided the answer when routine inpatient diagnostics had been unsuccessful.

Topics: Anti-Bacterial Agents; Anti-HIV Agents; Ceftriaxone; Delayed Diagnosis; Gonorrhea; Heterosexuality; HIV Infections; Humans; Male; Middle Aged; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Tenosynovitis; Treatment Outcome

Shigella flexneri is an emerging pathogen in men who have sex with men (MSM); recent outbreaks related to sexual practices have been noted in this population in the UK and other developed countries. While the majority of cases of shigellosis present with gastroenteritis, some vulnerable patients with underlying immunosuppression can develop complications like bacteraemia and may present atypically as an acute surgical emergency. This case report highlights such a case of S. flexneri bacteraemia in a man who had sex with men.

Topics: Administration, Intravenous; Adult; Anti-Bacterial Agents; Anti-Retroviral Agents; Ceftriaxone; Dysentery, Bacillary; HIV Infections; Homosexuality, Male; Humans; Immunosuppression Therapy; Male; Shigella flexneri; Treatment Outcome

Invasive non-typhoidal Salmonella (iNTS) infections are now a well-described cause of morbidity and mortality in children and HIV-infected adults in sub-Saharan Africa. In contrast, the epidemiology and clinical manifestations of iNTS disease in Asia are not well documented. We retrospectively identified >100 cases of iNTS infections in an infectious disease hospital in Southern Vietnam between 2008 and 2013. Clinical records were accessed to evaluate demographic and clinical factors associated with iNTS infection and to identify risk factors associated with death. Multi-locus sequence typing and antimicrobial susceptibility testing was performed on all organisms. Of 102 iNTS patients, 71% were HIV-infected, >90% were adults, 71% were male and 33% reported intravenous drug use. Twenty-six/92 (28%) patients with a known outcome died; HIV infection was significantly associated with death (p = 0.039). S. Enteritidis (Sequence Types (ST)11) (48%, 43/89) and S. Typhimurium (ST19, 34 and 1544) (26%, 23/89) were the most commonly identified serovars; S. Typhimurium was significantly more common in HIV-infected individuals (p = 0.003). Isolates from HIV-infected patients were more likely to exhibit reduced susceptibility against trimethoprim-sulfamethoxazole than HIV-negative patients (p = 0.037). We conclude that iNTS disease is a severe infection in Vietnam with a high mortality rate. As in sub-Saharan Africa, HIV infection was a risk factor for death, with the majority of the burden in this population found in HIV-infected adult men.

Topics: Adult; Aged; Anti-Infective Agents; Ceftriaxone; Drug Therapy, Combination; Female; Fluoroquinolones; HIV Infections; Hospitals; Humans; Logistic Models; Male; Middle Aged; Multilocus Sequence Typing; Multivariate Analysis; Retrospective Studies; Salmonella enterica; Salmonella Infections; Serogroup; Sex Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Vietnam

To assess mortality risk among adults presenting to an African teaching hospital with sepsis and severe sepsis in a setting of high HIV prevalence and widespread ART uptake.. Prospective cohort study of adults (age ≥16 years) admitted with clinical suspicion of severe infection between November 2008 and January 2009 to Queen Elizabeth Central Hospital, a 1250-bed government-funded hospital in Blantyre, Malawi. Demographic, clinical and laboratory information, including blood and cerebrospinal fluid cultures were obtained on admission.. Data from 213 patients (181 with sepsis and 32 with severe sepsis; M:F = 2:3) were analysed. 161 (75.6%) patients were HIV-positive. Overall mortality was 22%, rising to 50% amongst patients with severe sepsis. The mortality of all sepsis patients commenced on antiretroviral therapy (ART) within 90 days was 11/28 (39.3%) compared with 7/42 (16.7%) among all sepsis patients on ART for greater than 90 days (p = 0.050). Independent associations with death were hypoxia (OR = 2.4; 95% CI, 1.1-5.1) and systolic hypotension (OR 7.0; 95% CI: 2.4-20.4).. Sepsis and severe sepsis carry high mortality among hospitalised adults in Malawi. Measures to reduce this, including early identification and targeted intervention in high-risk patients, especially HIV-positive individuals recently commenced on ART, are urgently required.

Topics: Adult; Anti-Bacterial Agents; Anti-Retroviral Agents; Bacteremia; Ceftriaxone; Cohort Studies; Female; HIV Infections; Hospitalization; Hospitals, Public; Humans; Longitudinal Studies; Malawi; Male; Middle Aged; Proportional Hazards Models; Sepsis; Young Adult

Non-typhoidal salmonellae are important pathogens causing bacteraemia, especially in immunocompromised patients, but there are limited data explicitly describing the clinical characteristics and outcome in these individuals. Recurrent invasive salmonellosis has been recognised as an AIDS-defining condition in HIV-positive patients since the 1980s. Salmonella meningitis is an infrequent complication of Salmonella sepsis, accounting for 0.8-6% of all cases of bacterial meningitis, and is associated with a high mortality rate.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Female; HIV Infections; Humans; Meningitis, Bacterial; Salmonella Infections

Gonococcal urethritis is common with HIV, but gonococcal arthritis is rare. We report two HIV-positive patients with gonococcal arthritis and review previously published reports. A 27-year-old HIV-positive female presented with a pustular skin rash and acute oligoarthritis. Neisseria gonorrhoeae was cultured from the right elbow aspirate. The second patient, a 24-year-old HIV-positive female on zidovudine for one month, presented at 28 weeks gestation with acute oligoarthritis and peroneal tenosynovitis. Neisseria gonorrhoeae was cultured from the throat swab. Both patients responded to ceftriaxone. Gonococcal arthritis must be considered in HIV patients with acute arthritis.

Topics: Adult; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Female; Gonorrhea; HIV Infections; Humans; Neisseria gonorrhoeae; Treatment Outcome

Topics: Anti-Bacterial Agents; Borrelia; CD4 Lymphocyte Count; Ceftriaxone; Epstein-Barr Virus Infections; Genome; HIV Infections; HIV-1; Humans; Lyme Disease; Lyme Neuroborreliosis; Male; Middle Aged; Remission Induction

An increase of syphilis cases has been recorded in the past few decades, especially among HIV-infected patients. These patients often present with concomitant primary and secondary lesions or extensive presentations of syphilis.. Our goal was to compare alternative regimens to the recommended penicillin treatment.. We retrospectively studied 116 patient files (80% HIV1-infected) treated for a first episode of early syphilis.. Patients mainly presented with symptoms of secondary syphilis. In 15.5% of the cases patients were asymptomatic and 17.2% of patients with secondary syphilis presented with neurologic or ophthalmic symptoms. Some less usual clinical presentations included diffuse polyadenopathy or isolated fever. The time to serological response was similar among those treated with benzathine-penicillin (n=52), ceftriaxone (n=49), or doxycycline (n=15).. Ceftriaxone and doxycycline could be suitable alternatives to penicillin in the treatment of early syphilis in HIV-infected patients. These two treatments have a concomitant effectiveness even for asymptomatic forms of neurosyphilis.

Topics: Adult; Asymptomatic Diseases; Ceftriaxone; Doxycycline; Drug Evaluation; Early Diagnosis; Female; HIV Infections; HIV-1; Humans; Male; Middle Aged; Neurosyphilis; Penicillin G Benzathine; Recurrence; Retrospective Studies; Syphilis; Young Adult

Topics: Adult; Azithromycin; Ceftriaxone; HIV Infections; Humans; Male; Meningococcal Infections; Neisseria meningitidis; Unsafe Sex; Urethritis

Ceftriaxone is commonly used as an alternative antibiotic drug in treating syphilis but clinical data on its efficacy are limited.. To evaluate the response of HIV-infected patients with active syphilis to treatment with penicillin or ceftriaxone. -. A retrospective study involving 24 consecutive patients with a positive Veneral Disease Research Laboratory test (VDRL) and at least one specific treponemal test. 12 patients were treated with different regimens of high-dose penicillin G for at least 2 weeks. Another 12 patients were treated with ceftriaxone 1-2g per day intravenously for 10-21 days. -. After a median follow up of 18,3 months all patients of the penicillin-treated group and 11 of 12 ceftriaxone-treated patients showed a ≥ 4-fold decline in VDRL-titers; 91% of them already within 6 months after therapy. -. Our serological data demonstrate a comparable efficacy of currently recommened penicillin and ceftriaxone treatment regimens for active syphilis in HIV-infected patients.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; HIV Infections; Humans; Injections, Intravenous; Male; Middle Aged; Neurosyphilis; Penicillins; Retrospective Studies; Syphilis Serodiagnosis; Treatment Outcome

Symptoms of urethritis in men typically include urethral discharge, penile itching or tingling, and dysuria. A diagnosis can be made if at least one of the following is present: discharge, a positive result on a leukocyte esterase test in first-void urine, or at least 10 white blood cells per high-power field in urine sediment. The primary pathogens associated with urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae. Racial disparities in the prevalence of sexually transmitted infections persist in the United States, with rates of gonorrhea 40 times higher in black adolescent males than in white adolescent males. Recent studies have focused on identifying causes of nongonococcal urethritis and developing testing for atypical organisms, such as Mycoplasma genitalium and Ureaplasma species. Less common pathogens identified in patients with urethritis include Trichomonas species, adenovirus, and herpes simplex virus. History and examination findings can help distinguish urethritis from other urogenital syndromes, such as epididymitis, orchitis, and prostatitis. The goals of treatment include alleviating symptoms; preventing complications in the patient and his sexual partners; reducing the transmission of coinfections (particularly human immunodeficiency virus); identifying and treating the patient's contacts; and encouraging behavioral changes that will reduce the risk of recurrence. The combination of azithromycin or doxycycline plus ceftriaxone or cefixime is considered first-line empiric therapy in patients with urethritis. Expedited partner treatment, which involves giving patients prescriptions for partners who have not been examined by the physician, is advocated by the Centers for Disease Control and Prevention and has been approved in many states. There is an association between urethritis and an increased human immunodeficiency virus concentration in semen.

Topics: Adolescent; Adult; Azithromycin; Black or African American; Cefixime; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Contact Tracing; Doxycycline; Drug Therapy, Combination; Gonorrhea; HIV Infections; Humans; Male; Mycoplasma Infections; Ureaplasma Infections; Urethritis; White People; Young Adult

The ocular manifestations of syphilis are protean and can affect every structure of the eye. There has been a recent increase of syphilis infection in Europe. We report recent cases of ocular syphilis infection in a tertiary center.. During a 2.5-year period (2005-2007) we collected the medical records of eight male patients with ocular syphilis. The diagnosis was based on serological tests on blood samples and cerebrospinal fluid. All patients underwent a check-up to rule out another etiological diagnosis and to detect the presence of any other sexually transmitted infections.. The ocular lesions included: chorioretinitis (one case), retinitis (two cases), panuveitis with macular edema (two cases), episcleritis (one case), anterior optic neuritis (one case), and retrobulbar optic neuropathy (one case). Infection of the cerebrospinal fluid was detected in three of the five patients tested. In six cases, the inflammation was unilateral, and the anatomical and functional prognosis was excellent at the 6-month follow-up visit. Co-infection with human immunodeficiency virus was reported in five patients, with a CD4 T lymphocyte count greater than 300/mm(3). Most of the patients were treated with parenteral ceftriaxone (1 g daily) for 3 weeks with good tolerance. One patient was treated with intravenous penicillin G (18 MUI daily). Only one patient with anterior optic neuritis required systemic steroid therapy associated with antibiotics. Sequelae included sectorial atrophy of the optic nerve with visual field loss (n = 1) and abnormalities of the retinal pigment epithelium (n = 3).. All patients with ocular syphilis exhibited functional improvement and resolution of ocular inflammation after a specific antibiotic treatment. As a great imitator, syphilis should be considered in all patients with uveitis, scleritis, episcleritis, or optic neuritis, especially in men with high-risk sexual behavior.

Topics: Adult; Aged; Anti-Bacterial Agents; CD4 Lymphocyte Count; Ceftriaxone; Chorioretinitis; Doxycycline; Eye Infections, Bacterial; Fluorescent Antibody Technique; HIV Infections; Humans; Macular Edema; Male; Middle Aged; Optic Neuritis; Panuveitis; Retrospective Studies; Scleritis; Syphilis; Syphilis Serodiagnosis

Topics: Adult; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Chlamydia; Chlamydia Infections; DNA, Bacterial; Glucocorticoids; HIV Infections; Humans; Magnetic Resonance Imaging; Male; Prednisolone; Sacroiliac Joint; Spondylarthritis

Most important news are the reimbursement of post-exposure prophylaxis for HIV, change in treatment of gonococcal infections, increase of syphilis and sexually transmitted hepatitis C infections among HIV-infected men who have sex with men. Vaccination against papillomavirus (HPV) is not discussed here. Animal and human studies have shown that 28 days post-exposure prophylaxis for HIV initiated within 72 hours after the contact at risk could reduce the risk of HIV acquisition. This prophylaxis is now reimbursed in Belgium if it is prescribed by a HIV reference center, based on the Belgian consensus for HIV post-exposure prophylaxis. A single intramuscular dose of ceftriaxone 125 mg is now the best choice for the treatment of gonococcal infection, due to the resistance more and more frequent to penicillin, tetracycline and fluoroquinolone. If a concomitant infection with Chlamydia trachomatis has not been ruled out, a single dose of azithromycin 1 g or doxycycline for 7 days will be added. Syphilis is shortly reviewed and addresses of few very useful Internet sites are given.

Topics: Anti-Bacterial Agents; Anti-HIV Agents; Belgium; Ceftriaxone; Environmental Exposure; Female; Gonorrhea; HIV Infections; Humans; Male; Reimbursement Mechanisms; Sexually Transmitted Diseases; Zidovudine

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cervical Vertebrae; Epidural Abscess; Fever; HIV Infections; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Neck Pain

Topics: Actinomycetales Infections; Ceftriaxone; Diagnosis, Differential; Doxycycline; Exudates and Transudates; Female; HIV Infections; Humans; Male; Pleural Effusion; Rhodococcus equi; Tomography, X-Ray Computed; Treatment Outcome

We report a case of severe gonococcal ophthalmia and peri-orbital cellulitis in an HIV-positive man without genital infection who was treated successfully in the outpatient department. We also highlight the importance of early diagnosis, treatment and liaison with ophthalmology in order to prevent visual complications.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Ceftriaxone; Conjunctivitis, Bacterial; Gonorrhea; HIV Infections; Humans; Male; Neisseria gonorrhoeae; Treatment Outcome

Pneumonia remains a concern for persons with long-standing HIV infection. We present a case of a 43-year-old HIV-infected woman with bilateral pneumonia whose presentation suggested the cause was a bacterial pathogen. A chest of radiograph and CT scan of the chest revealed infiltrates and adenopathies, but this did not help in the differential diagnosis. A Gram stain of a sputum specimen revealed gram-positive filamentous rods, and infection with Nocardia asteroides was diagnosed. The patient was started on a regimen of ceftriaxone and trimethoprim/sulfamethoxazole and experienced significant improvement within a few days.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Female; HIV Infections; Humans; Nocardia asteroides; Nocardia Infections; Pneumonia, Bacterial; Radiography; Sputum; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Sexually transmitted diseases (STDs), especially HIV infection, gonococcal infection and genital chlamydial infections are increasing all over the world. UNAIDS recently reported that the number of HIV/AIDS patients had been increasing and the highest prevalence was found in African countries, followed by Caribbean, Asian and Eastern European countries. HIV infection has also been gradually increasing in Japan. In non-HIV STDs, genital chlamydial infections are increasing worldwide also. On the contrary, gonococcal infections have been decreasing in many countries except Asian countries. N. gonorrhoeae has been changing in its infecting sites. The pharynx is the most important infecting site, because gonococcal infection in the pharynx may be one of the causes of the wide spread of N. gonorrhoeae. Antimicrobial-resistant N. gonorrhoeae has wide distribution throughout the world. For example, penicillin-resistant N. gonorrhoeae is prevalent in various part of the world, and fluoroquinolone-resistant N. gonorrhoeae is prevalent mainly in Asia. In addition to penicillin, tetracycline and fluoroquinolone resistance, N. gonorrhoeae acquired resistance to almost all of the cephalosporins except for ceftriaxone and cefodizime in Japan. Although there is no resistant strain to ceftriaxone, cefodizime and spectinomycin, 1.0 g single dose of ceftriaxone is considered to be the most suitable regimen for the treatment of gonococcal infection including the pharyngeal infection, because of the 100% elimination rate of N. gonorrhoeae from the urethra, cervix and pharynx obtained in a recent study.

Topics: Anti-Bacterial Agents; Ceftriaxone; Chlamydia Infections; Drug Resistance, Bacterial; Gonorrhea; HIV Infections; Humans; Japan; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Pharynx; Sexually Transmitted Diseases

To determine the prevalence of urethritis pathogens amongst male symptomatic urethritis (MUS) patients, genital ulcer (GUS) patients without urethritis symptoms and men requesting HIV testing at a voluntary counselling and testing (VCT) clinic.. A prospective study was conducted in Johannesburg, South Africa. Men from the three groups were screened for urethritis pathogens using molecular tests. Culture for Neisseria gonorrhoeae and, initially, trichomoniasis was performed. Antimicrobial susceptibility testing was undertaken for ciprofloxacin on all gonococcal isolates; ciprofloxacin resistant isolates were screened for ceftriaxone resistance.. 664 participants were recruited (438 MUS, 76 GUS and 158 VCT) over 2 years. Gonorrhoea was detected in 62.3% MUS, 15.8% GUS and 3.2% VCT participants. Chlamydial infection was detected in 19.3% MUS, 13.2% GUS and 8.2% VCT participants. Trichomoniasis was detected in 4.9% MUS, 19.7% GUS and 3.8% VCT participants. Mycoplasma genitalium infection was detected in 14.4% MUS, 13.2% GUS and 7.0% VCT participants. Ciprofloxacin resistance increased from 13.0% in the first year to 26.3% in the second year; all resistant isolates were susceptible to ceftriaxone.. Urethritis pathogens, including Trichomonas vaginalis, should be covered in syndromic management treatment of genital ulcers in the absence of clinical urethritis. Consideration should be given to adding metronidazole to existing MUS treatment. Ciprofloxacin can no longer be relied upon to treat presumptive gonococcal infections in South Africa.

Topics: Ceftriaxone; Ciprofloxacin; Counseling; Drug Resistance, Microbial; Gonorrhea; HIV Infections; Humans; Male; Mycoplasma Infections; Patient Acceptance of Health Care; Prospective Studies; South Africa; Syndrome; Trichomonas Infections; Urethritis

Ceftriaxone can be associated with catastrophic immune hemolysis in pediatric patients, particularly those with underlying diseases such as sickle cell disease and human immunodeficiency virus infection. We designed a study to screen for ceftriaxone-induced RBC antibodies in these 2 pediatric populations. The prevalence of anticeftriaxone antibody was 12.5% (8 of 64). Two of these 8 patients with the antibody experienced hemolysis; 1 case was fatal.

Topics: Adult; Anemia, Sickle Cell; Autoantibodies; Ceftriaxone; Erythrocytes; Hemolysis; HIV Infections; Humans; Infant; Infant, Newborn

Atypical presentations of cryptococcal infection have been described as clinical manifestations of immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients following commence of antiretroviral therapy (ART). The authors describe a patient presenting with cryptococcal meningoradiculitis two weeks after initiation of ART. In patients with advanced HIV disease, immune reconstitution induced by ART can precipitate onset of atypical clinical manifestations in those patients with latent cryptococcal infection of the central nervous system.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Anti-HIV Agents; Anti-Retroviral Agents; Ceftriaxone; Ciprofloxacin; Female; HIV Infections; Humans; Lamivudine; Meningitis, Cryptococcal; Nevirapine; Radiculopathy; Stavudine

We describe 3 symptomatic cases of neurologic syphilis that occurred after the administration of the usual therapy for primary or secondary syphilis in human immunodeficiency virus (HIV)-infected patients. We discuss the difficulty of diagnosing neurosyphilis, the need for lumbar puncture, and risk factors of relapse. Because HIV infection may alter the natural history and response of neurologic syphilis to treatment, scrupulous follow-up and repeated cycles of therapy are warranted.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; HIV Infections; Humans; Male; Middle Aged; Neurosyphilis; Penicillin G Benzathine; Recurrence; Syphilis

Nontyphoidal Salmonella (NTS) is recognized as a common cause of bacteremia in malaria-endemic Africa but its importance as a cause of pneumonia is uncertain. We report a case of pneumonia caused by NTS confirmed by culture of lung aspirate from a consolidated left lung in a 16 month-old HIV-uninfected girl who had been admitted to the hospital 1 month previously with severe malaria. She did not respond to first-line antibiotic therapy for benzylpenicillin and gentamicin but improved with ceftriaxone therapy.

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Gentamicins; HIV Infections; Hospitalization; Humans; Infant; Lung; Malaria; Malawi; Penicillin G; Pneumonia, Bacterial; Salmonella; Salmonella Infections

This work investigates the incidence and clinical features of syphilitic uveitis in patients infected with human immunodeficiency virus (HIV).. We retrospectively reviewed syphilitic uveitis in patients coinfected with HIV that presented at a referral center between July 2001 and November 2003.. Twelve patients (20 eyes) were included. The ocular manifestations of syphilis led to the discovery of HIV-1 seropositivity in three patients. All patients were male and homosexual. One patient has been previously treated for syphilis with benzathine penicillin G. One patient presented with anterior uveitis and 11 patients had panuveitis or posterior uveitis. Necrotizing retinitis was noted in seven eyes (35%), posterior placoid chorioretinitis in six eyes (30%) and optic nerve involvement in five eyes (25%). Of nine patients with available cerebrospinal fluid (CSF) studies, seven (77.8%) had CSF abnormalities. Eleven patients were treated with intravenous penicillin G and one with intravenous ceftriaxone sodium. One patient required a second course of antibiotics to control uveitis. Ocular inflammation decreased and visual acuity improved in all nine patients for whom follow-up was available after treatment.. Manifestations of syphilitic uveitis in HIV-infected patients are multiple, with high frequencies of posterior uveitis, posterior placoid chorioretinitis, necrotizing retinitis and optic nerve involvement. Syphilitic uveitis in HIV-infected patients seems to have a more severe course and may relapse despite high-dose intravenous penicillin therapy.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Chorioretinitis; Eye Infections, Bacterial; Fluorescein Angiography; HIV Infections; Homosexuality; Humans; Incidence; Male; Middle Aged; Penicillin G; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Risk Factors; Syphilis; Uveitis

A 23-year-old man presented with disturbance of consciousness and convulsion. Two weeks prior to his admission, he had general arthralgia, retro-orbital pain, and body temperature increase to 40 degrees C. These symptoms persisted for two weeks. He was admitted to the hospital because of general convulsion, followed by disturbance of consciousness. On admission, he was deeply lethargic. Cerebrospinal fluid obtained on admission showed pleocytosis (247/mm3) and an increased level of protein. Electroencephalogram obtained on admission disclosed diffuse slow waves. Enhanced cranial MR image did not show any abnormal lesions in the cerebral parenchyma. The patient was diagnosed as having meningoencephalitis and the treatment consisting of aciclovir, CTRX, and methylprednisolone was undertaken. A test for human immunodeficiency virus (HIV) antibody was found to be positive on the second day of hospitalization. A Western blot was positive with bands at gp160 and P24 confirming HIV infection. Antibody titers of paired acute and convalescent sera including HSV, EBV, CMV, mumps, measles, and Japanese encephalitis did not show any significant increase. The patient became alert on the 3rd day of hospitalization. Electroencephalogram obtained on the 10th day of hospitalization was normal. Western blot, which was obtained 4 months later, was positive with bands at gp120, p68, p55, p52, gp41, p40, p34, p18, including gp160 and P24. He was diagnosed as having primary HIV infection. Meningoencephalitis was attributed to acute primary HIV infection. Acute HIV infection should be considered as an etiology of meningoencephalitis.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Blotting, Western; Ceftriaxone; HIV Antibodies; HIV Infections; Humans; Male; Meningoencephalitis

Angio-oedema may be hereditary or acquired and is characterised by episodes of potentially life threatening localised tissue oedema and swelling resulting from deficiency of compliment pathway C1 esterase inhibitor. Acquired angio-oedema is about ten times less frequent than the hereditary type and has been associated with immune-deficiency disorders, malignancies and exposure to specific medications and food substances. We present a case of seven year old, human immune-deficiency virus positive girl, who developed gross swelling of the tongue and neck while on treatment for pneumococcal meningitis with ceftriaxone. Difficulties in arriving at a definitive diagnosis of angio-oedema in a resource poor country are discussed and alternative diagnostic options proposed.

Topics: AIDS-Related Opportunistic Infections; Angioedema; Anti-Bacterial Agents; Ceftriaxone; Child; Fatal Outcome; Female; HIV Infections; Humans; Meningitis, Pneumococcal

Syphilitic chorioretinitis is a rare manifestation of secondary syphilis. The Authors report a case of a patient tested positive for human immune deficiency virus. A 26-Year-old man presented with a history of suddenly blurred vision in the right eye. Because of a central scotoma, visual acuity was reduced to counting fingers. Slit-lamp examination found one-plus anterior chamber cells and one-plus vitreous cells. Results of ophthalmoscopic examination showed a large yellow lesion in the macular area with a papillar edema and peripheral vasculitis. Serum and cerebrospinal fluid were positive for syphilitic serology. Visual acuity improved to 20/20 after three courses of intravenous ceftriaxone (2g/day for 15 days). The fundus lesion resolved almost completely, resulting in slight pigmentary changes in the macular area. This case report highlights the need for syphilitic serology in cases of uveitis in immunocompromised patients.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Choroid Diseases; HIV Infections; Humans; Immunocompromised Host; Male; Retinal Diseases; Syphilis; Visual Acuity

Topics: Adult; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Gonorrhea; HIV Infections; HIV-1; Humans; Knee Joint; Male; Neisseria gonorrhoeae; Treatment Outcome

After a precipitous increase in the incidence of infectious syphilis in the United States during the late 1980s and early 1990s, the rate of new cases has declined so dramatically that a program initiated by the Centers for Disease Control and Prevention (CDC) to achieve elimination appears to stand a good chance of succeeding. In the fall of 2000, the CDC convened an advisory group to examine the recent medical literature regarding syphilis treatment. Published literature in peer-reviewed journals and abstracts from relevant scientific meetings that have appeared since the last STD Treatment Guidelines meeting in 1997 were reviewed. Where applicable, unpublished data from studies in progress were also discussed. Expert opinion was sought. Through all these efforts, it appears that the azalide azithromycin and the third-generation cephalosporin ceftriaxone should find more definitive roles in the treatment of syphilis. None will eclipse the continued primacy of penicillin for this purpose.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Databases, Factual; Ethylenediamines; HIV Infections; Humans; Incidence; Neurosyphilis; Outcome Assessment, Health Care; Penicillins; Syphilis; United States

The emergence of antibiotic resistance in Streptococcus pneumoniae poses a particular threat to HIV-infected patients. These patients are at increased risk of invasive pneumococcal disease and may respond poorly to pneumococcal vaccination. We describe an HIV-infected patient with recurrent aortic valve endocarditis due to the same serotype of S. pneumoniae (19A) despite appropriate treatment with penicillin and immunoprophylaxis. The pneumococcus responsible for the second episode of endocarditis was susceptible to cefotaxime (MIC of 0.06 microg/ml), but was no longer susceptible to penicillin (MIC of 0.25 microg/ml). The patient was treated successfully with 4 weeks of intravenous ceftriaxone.

Topics: Aortic Valve; Bacterial Vaccines; Ceftriaxone; Echocardiography; Endocarditis, Bacterial; Heart Valve Diseases; HIV Infections; Humans; Male; Middle Aged; Penicillin G; Penicillin Resistance; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Recurrence; Streptococcus pneumoniae

A 14-year-old girl with perinatally acquired human immunodeficiency virus infection had fatal intravascular hemolysis after intravenous administration of ceftriaxone. Laboratory studies confirmed the presence of an antibody against ceftriaxone in the serum and on the patient's red blood cells. No evidence of sepsis, glucose-6-phosphate dehydrogenase deficiency or anaphylaxis was found.

Topics: Adolescent; AIDS-Related Opportunistic Infections; Anemia, Hemolytic; Antibodies; Ceftriaxone; Cephalosporins; Fatal Outcome; Female; Hemolysis; HIV Infections; Humans

Outpatient i.v. antibiotic therapy is well developed in the United States, largely because of pressures from third-party payers to reduce costs of medical care. We have developed an outpatient i.v. antibiotic programme in Oxford, that has evolved from a desire to provide high quality i.v. therapy to AIDS patients with cytomegalovirus retinitis. We describe the rationale of the service and report on our first two years' experience. We treated 67 consecutive patients (eight with HIV infection) at home with i.v. antibiotics. This resulted in a saving of 2275 hospital days for those patients without HIV infection. HIV positive patients received 69 months of home i.v. therapy. Minor intravascular catheter complications occurred in only five patients (7.5%). The only serious complications were three episodes of catheter-related sepsis (4.5%), all occurring in AIDS patients who had lines in for more than six months. We have shown that home i.v. antibiotic therapy can be delivered safely to patients with a wide variety of infectious problems using the existing network of community nurses in the National Health Service. Essential components to the programme include a multidisciplinary team working between the hospital and community and a written shared care protocol. Such a programme can result in reduced lengths of hospital stay and patient, community nurse and physician satisfaction.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cost-Benefit Analysis; Cytomegalovirus Retinitis; Ganciclovir; Gentamicins; HIV Infections; Home Care Services; Home Infusion Therapy; Humans; Outcome Assessment, Health Care; United Kingdom; Vancomycin

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; CD4 Lymphocyte Count; Ceftriaxone; Cephalosporins; Female; Gentamicins; Gram-Negative Bacterial Infections; HIV Infections; Humans; Microbial Sensitivity Tests; Netilmicin; Pneumonia, Bacterial; Rhizobium; Stavudine

To evaluate the effect of ceftriaxone in treating latent syphilis or asymptomatic neurosyphilis in patients infected with the human immunodeficiency virus (HIV).. Follow-up study of patients treated at two HIV-based clinics during 16 months from 1989 to 1991.. Patients were those in whom a clinical diagnosis of latent syphilis or asymptomatic neurosyphilis was made, who received all recommended doses of antimicrobial therapy, and who returned for follow-up visits for 6 or more months.. Forty-three patients were treated with ceftriaxone, 1 to 2 g daily for 10 to 14 days. Thirteen underwent lumbar puncture before treatment; 7 (58%) had documented neurosyphilis (pleocytosis in 5, elevated protein levels in 6, VDRL reactive in cerebrospinal fluid [CSF] in 7), and 6 had documented latent syphilis (entirely normal CSF). The remaining 30 were said to have presumed latent syphilis. There was no relation between the diagnosis and the selected dosage of ceftriaxone. Response rates were similar in those who had documented neurosyphilis and documented or presumed latent syphilis. Overall, 28 patients (65%) responded to therapy, 5 (12%) were serofast, 9 (21%) had a serologic relapse, and 1 (2%) who experienced progression to symptomatic neurosyphilis was a therapeutic failure. Thirteen patients received benzathine penicillin for presumed latent syphilis; results were similar to those observed after ceftriaxone therapy, with 8 (62%) responders, 1 (8%) serofast, 2 (15%) relapses, and 2 (15%) failures. CD4 cell counts in responders were not different from those who failed to respond.. Even in the absence of neurologic symptoms, half of the HIV-infected persons who have serologic evidence of syphilis may have neurosyphilis. Although ceftriaxone achieves high serum and CSF levels, 10 to 14 days of treatment with this drug were associated with a 23% failure rate in HIV-infected patients who had latent syphilis or asymptomatic neurosyphilis. Three doses of benzathine penicillin did not have a significantly higher relapse rate and may provide appropriate therapy, at least for documented latent syphilis in persons co-infected with HIV. Studies comparing ceftriaxone with 10 to 14 doses of procaine penicillin are needed to determine the most cost-effective treatment for asymptomatic neurosyphilis or presumed latent syphilis in this group of patients.

Topics: Adult; Ceftriaxone; Female; HIV Infections; Humans; Male; Neurosyphilis; Penicillin G Benzathine; Syphilis Serodiagnosis; Syphilis, Latent; Treatment Outcome

Topics: Cefixime; Cefotaxime; Ceftriaxone; Gonorrhea; HIV Infections; Humans; Sexually Transmitted Diseases