ro13-9904 and Hemorrhage

Deafness is a common and often permanent neurological sequel of Streptococcus (S.) suis meningitis. Suppurative labyrinthitis, rather than direct auditory nerve infection, has been found to be the site responsible for deafness. Neuroimaging is important to localise the site involved in hearing loss and to assess the feasibility of a cochlear implantation. S. suis is very sensitive to penicillin. Although a relapse of S. suis meningitis is uncommon, it can occur despite an adequate duration of appropriate antibiotic therapy. We describe a patient with S. suis meningitis, who developed permanent deafness from haemorrhagic labyrinthitis, as shown on magnetic resonance imaging. She suffered a relapse despite a seven-week course of intravenous antibiotics. A review on six cases of relapse reported in the literature shows that relapses occurred despite two to four weeks of antibiotics being administered to the patients. The clinical implications and treatment of relapse are discussed.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Cochlea; Cochlear Implants; Female; Hearing Loss; Hemorrhage; Humans; Labyrinthitis; Magnetic Resonance Imaging; Meningitis, Bacterial; Recurrence; Streptococcal Infections; Streptococcus suis

Topics: Acute Disease; Adrenal Gland Diseases; Adrenal Insufficiency; Anti-Bacterial Agents; Antiphospholipid Syndrome; Ceftriaxone; Exanthema; Fever; Fludrocortisone; Hemorrhage; Heparin; Humans; Hydrocortisone; Lyme Neuroborreliosis; Male; Middle Aged; Radiography; Shock; Thrombocytopenia; Thrombophilia

In leptospirosis, severe pulmonary hemorrhagic syndrome has replaced Weil's disease as the main cause of mortality, with rates of up to 75%. Four men, all farmers, were admitted to the intensive care unit between August 2009 and July 2010 with a diagnosis of acute respiratory distress syndrome. All patients presented with fever, hemoptysis, bilateral pulmonary infiltrates in chest radiographs, and thrombocytopenia and had compatible epidemiological history with leptospirosis; 3 patients had anemia, 3 had renal failure, 2 had increased creatine kinase, whereas bilirubin was slightly increased in only 1 patient. Leptospirosis was diagnosed serologically in all cases. Empirical therapy with ceftriaxone was administered immediately to all patients, while implementation of ARDSnet protective mechanical ventilation approach combined with an early goal-directed hemodynamic approach led to a relatively low mortality rate (25%). Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II and Sepsis-Related Organ Failure Assessment scoring systems were unable to predict the outcome of the patients with leptospirosis-associated severe pulmonary hemorrhagic syndrome.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Hemorrhage; Humans; Leptospirosis; Lung; Lung Diseases; Male; Middle Aged; Radiography; Respiration, Artificial; Respiratory Distress Syndrome; Retrospective Studies

Topics: Adolescent; Anti-Infective Agents; Azithromycin; Bronchoscopy; Ceftriaxone; Factor VIII; Hemophilia A; Hemorrhage; Humans; Lung Diseases; Male; Pulmonary Alveoli; Radiography; Sulfamethoxazole; Treatment Outcome; Trimethoprim

Topics: Actinobacillus Infections; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Ciprofloxacin; Drug Therapy, Combination; Edema; Endocarditis, Subacute Bacterial; Fingers; Gentamicins; Hand Dermatoses; Heart Valve Prosthesis; Hemorrhage; Humans; Male; Middle Aged; Nail Diseases; Rheumatic Heart Disease; Ultrasonography

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Bronchoscopy; Ceftriaxone; Drug Therapy, Combination; Floxacillin; Hemorrhage; Humans; Leptospira; Leptospirosis; Lung Diseases; Male; Pneumonia, Bacterial; Radiography, Thoracic