ro13-9904 and Hepatitis-B--Chronic

A 61-year-old man with chronic hepatitis B and dyslipidemia visited the emergency department with a fever and severe headache. He was diagnosed with bacterial meningitis after a lumbar puncture, and blood culture revealed Parvimonas micra bacteremia. Although he had a history of extraction of a molar two weeks before symptom onset, there was no evidence of abscess formation on physical examination or imaging studies. He was successfully treated with oral metronidazole for 12 days after 9 days of treatment with IV ceftriaxone and vancomcycin. This is the first report of primary bacterial meningitis caused by this organism, which indicates that this organism is capable of being a bacterial meningitis pathogen.

Topics: Anti-Bacterial Agents; Bacteremia; Bacteria, Anaerobic; Ceftriaxone; Dyslipidemias; Firmicutes; Gram-Positive Bacterial Infections; Hepatitis B, Chronic; Humans; Male; Meningitis, Bacterial; Metronidazole; Middle Aged; Treatment Outcome; Vancomycin

We report here a case of recurrent paratyphoid fever A with hepatitis A co-infection in a patient with chronic hepatitis B. A 26-year-old male patient, who was a hepatitis B virus carrier, was co-infected with Salmonella enterica serovar Paratyphi A and hepatitis A virus. The recurrence of the paratyphoid fever may be ascribed to the coexistence of hepatitis B, a course of ceftriaxone plus levofloxacin that was too short and the insensitivity of paratyphoid fever A to levofloxacin. We find that an adequate course and dose of ceftriaxone is a better strategy for treating paratyphoid fever. Furthermore, the co-infection of paratyphoid fever with hepatitis A may stimulate cellular immunity and break immunotolerance. Thus, the administration of the anti-viral agent entecavir may greatly improve the prognosis of this patient with chronic hepatitis B, and the episodes of paratyphoid fever and hepatitis A infection prompt the use of timely antiviral therapy.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Coinfection; Drug Resistance, Bacterial; Hepatitis A; Hepatitis A virus; Hepatitis B, Chronic; Humans; Levofloxacin; Male; Paratyphoid Fever; Recurrence; Salmonella paratyphi A