ro13-9904 and Hypotension

Typhoid fever is usually a mild clinical disease, but it can have potentially serious complications. Here, we describe a case of an adolescent male who presented with severe illness and multi-organ involvement from typhoid fever. He required follow-up after discharge but eventually recovered. Clinicians should be aware of the spectrum of clinical manifestations as early recognition will improve monitoring and management of typhoid disease.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Confusion; Humans; Hypotension; Male; Meningism; Pancytopenia; Paratyphoid Fever; Pneumonia; Salmonella typhi; Typhoid Fever

Topics: Adult; Anti-Bacterial Agents; Cardiotonic Agents; Ceftriaxone; Cerebrospinal Fluid; Confusion; Female; Headache; Humans; Hypotension; Milrinone; Neisseria meningitidis; Norepinephrine; Purpura Fulminans; Vasoconstrictor Agents

A previously healthy man presented with fever for 2 days and rapidly progressive purpuric rash for 1 day. He progressed into hypotension, disseminated intravascular coagulation and refractory shock despite resuscitation and early antibiotic commencement. Blood culture grew

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Disseminated Intravascular Coagulation; Fatal Outcome; Gram-Positive Bacteria; Humans; Hypotension; Male; Pneumococcal Infections; Purpura Fulminans; Resuscitation; Shock, Septic; Streptococcus pneumoniae; Time Factors

The aim of this study is to investigate predictive factors for intensive care unit (ICU) admission among patients with severe leptospirosis.. This is a retrospective study with all patients with severe leptospirosis admitted to a tertiary hospital. Patients were divided in ICU and ward groups. Demographical, clinical and laboratory data of the groups were compared as well as acute kidney injury (AKI) severity, according to the RIFLE criteria (R = Risk, I = Injury, F = Failure, L = Loss, E = End-stage kidney disease).. A total of 206 patients were included, 83 admitted to ICU and 123 to ward. Mean age was 36 ± 15.8 years, with 85.9% males. Patients in ICU group were older (38.8 ± 15.7 vs. 34.16 ± 15.9 years, p = 0.037), had a shorter hospital stay (4.13 ± 3.1 vs. 9.5 ± 5.2 days, p = 0.0001), lower levels of hematocrit (29.6 ± 6.4 vs. 33.1 ± 8.6%, p = 0.003), hemoglobin (10.2 ± 2.4 vs. 11.6 ± 1.9 g/dL, p < 0.0001), and platelets (94,427 ± 86,743 vs. 128,896 ± 137,017/mm(3), p = 0.035), as well as higher levels of bilirubin (15.0 ± 12.2 vs. 8.6 ± 9.5 mg/dL, p = 0.001). ICU group also had a higher frequency of severe AKI (RIFLE-"Failure": 73.2% vs. 54.2%, p < 0.0001) and a higher prevalence of dialysis requirement (57.3% vs. 27.6%, p < 0.0001). Mortality was higher among ICU patients (23.5% vs. 5.7%, p < 0.0001). Independent predictors for ICU admission were tachypnea (p = 0.027, OR = 13, CI = 1.3-132), hypotension (p = 0.009, OR = 5.27, CI = 1.5-18) and AKI (p = 0.029, OR = 14, CI = 1.3-150). Ceftriaxone use was a protective factor (p = 0.001, OR = 0.13, CI = 0.04-0.4).. Independent risk factors for ICU admission in leptospirosis include tachypnea, hypotension and AKI. Ceftriaxone was a protective factor for ICU admission, suggesting that its use may prevent severe forms of the disease.

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Ceftriaxone; Cross-Sectional Studies; Female; Humans; Hypotension; Intensive Care Units; Length of Stay; Leptospirosis; Male; Middle Aged; Odds Ratio; Retrospective Studies; Risk Factors; Severity of Illness Index; Survival Rate

Topics: Anti-Bacterial Agents; Ceftriaxone; Fever; Humans; Hypotension; Leptospirosis; Male; Middle Aged; Travel

Acute generalized exanthematous pustulosis is a rare condition characterized by sterile pustules on erythematous and edematous tissue. Mostly drug induced, this condition can also be caused by other factors. Cases due to vancomycin are rare. A 67-year-old woman with cellulitis of the left lower extremity was admitted with marked bilateral lymphedema of the lower extremities and diffuse erythema of the left lower extremity from foot to knee. She was given clindamycin and then vancomycin. On day 5, her condition worsened, with erythema involving the entire back. Although treatment with clindamycin and vancomycin was discontinued, acute generalized exanthematous pustulosis developed. After successful treatment of other complications, the skin condition improved. Because vancomycin is frequently used, clinicians should be aware of the possibility of acute generalized exanthematous pustulosis. Because the pustulosis decreases after withdrawal of the causative drug, being able to diagnose and differentiate the abnormality from other conditions is prudent.

Topics: Acute Generalized Exanthematous Pustulosis; Aged; Anti-Bacterial Agents; Ceftriaxone; Cellulitis; Chronic Disease; Clindamycin; Erythema; Female; Fluid Therapy; Humans; Hypotension; Lower Extremity; Lymphedema; Multiple Organ Failure; Obesity, Morbid; Vancomycin; Vasoconstrictor Agents

Necrotizing fasciitis is a true surgical emergency. This study was undertaken to determine whether clinical indicators could be used to initiate early surgery, and to compare the characteristics observed on initial examination of necrotizing fasciitis in patients who died and those who survived.. We retrospectively reviewed the medical records of 143 patients with surgically confirmed necrotizing fasciitis of the extremities over a period of 3.5 years at a tertiary hospital of southwest Taiwan. Differences in mortality, patient characteristics, laboratory findings, and hospital course were compared between patients who died and those who survived, and between patients with Gram-positive infections and those with Gram-negative infections.. A patient with a fungal infection died. Nine of the 58 patients in the Gram-positive group (15.5%) and 12 of the 60 cases in the Gram-negative group (20%) died. Hence a total of 22 patients died, giving a mortality rate of 15.4%. Hypotension, lower counts of total and segmented leukocytes, higher counts of banded leukocytes, and lower levels of serum albumin were significantly associated with mortality. Monomicrobial infections had a stake of 70.6%, and Vibrio spp were the predominant causative agents (26.6%).. Hypotensive shock, severe hypoalbuminemia, and increased counts of banded leukocytes can be considered the clinical and laboratory risk indicators to initiate early surgery and to predict mortality for all types of necrotizing fasciitis. The clinical characteristics of Gram-negative infections were more fulminant than those of Gram-positive infections.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ceftriaxone; Fasciitis, Necrotizing; Female; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Hospitals; Humans; Hypotension; Leukocyte Count; Leukocytes; Male; Medical Records; Middle Aged; Mycoses; Retrospective Studies; Risk Factors; Serum Albumin; Taiwan; Vibrio; Young Adult

Topics: Anti-Bacterial Agents; Bacteremia; Borrelia; Cardiopulmonary Resuscitation; Cardiovascular Agents; Ceftriaxone; Child; Combined Modality Therapy; Cytokines; Doxycycline; Endotoxins; Female; Humans; Hypotension; Positive-Pressure Respiration; Pulmonary Edema; Relapsing Fever; Shock, Cardiogenic; Tachycardia; Unconsciousness

Spinal epidural abscess (SEA) is a rare infectious disease. However, if left unrecognized and untreated, the clinical outcome of SEA can be devastating.. To report a rare clinical presentation of a cervicothoracolumbar SEA with cerebral salt wasting (CSW).. Case report.. Clinical history, physical and laboratory findings, and magnetic resonance imaging studies of a patient with cervicothoracolumbar SEA and CSW.. We report the case of a 15-year-old boy with cervicothoracolumbar SEA complicated with CSW and treated with conservative methods.. In conclusion, CSW can be seen at the follow-up period of the SEA and the clinicians must be aware of this entity.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Cervical Vertebrae; Epidural Abscess; Gentamicins; Humans; Hyponatremia; Hypotension; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Sepsis; Staphylococcal Infections; Thoracic Vertebrae; Vancomycin

A case of childhood enteric fever complicated by transient dysautonomia and cerebellitis is reported. The child was treated with intravenous antibiotics, and the complications were managed conservatively. Dysautonomia and cerebellitis resolved by day 5 and day 8 after admission, respectively. Results of a neurologic examination at the end of 6 months were normal. Dysautonomia complicating the course of childhood enteric fever is previously unreported.

Topics: Anti-Bacterial Agents; Ataxia; Autonomic Nervous System; Ceftriaxone; Cerebellar Diseases; Cerebellum; Child; Gait Disorders, Neurologic; Humans; Hypotension; Male; Ofloxacin; Primary Dysautonomias; Salmonella typhi; Tachycardia; Treatment Outcome; Typhoid Fever