ro13-9904 and Leukocytosis

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

Evaluation of children with clinically suspected neuroborreliosis (NB) is difficult. With a prospective study design we wanted to characterize children with signs and symptoms indicative for NB, investigate clinical outcome and, if possible, identify factors of importance for recovery.. Children being evaluated for NB (n = 177) in southeast Sweden were categorized into 3 groups: "confirmed neuroborreliosis" (41%) with Borrelia antibodies in the cerebrospinal fluid, "possible neuroborreliosis" (26%) with pleocytosis but no Borrelia antibodies in the cerebrospinal fluid, and "not determined" (33%) with no pleocytosis and no Borrelia antibodies in the cerebrospinal fluid. Antibiotic treatment was given to 69% of children. Patients were followed during 6 months and compared with a matched control group (n = 174).. Clinical recovery at the 6-month follow-up (n = 177) was generally good and no patient was found to have recurrent or progressive neurologic symptoms. However, persistent facial nerve palsy caused dysfunctional and cosmetic problems in 11% of patients. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls. Influence on daily life was reported to the same extent in patients and controls. Consequently, persistent headache and fatigue at follow-up should not be considered as attributable to NB. No prognostic factors could be identified.. Clinical recovery was satisfactory in children being evaluated for NB although persistent symptoms from facial nerve palsy occurred. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls.

Topics: Adolescent; Anti-Bacterial Agents; Borrelia burgdorferi; Ceftriaxone; Child; Child, Preschool; Doxycycline; Enzyme-Linked Immunosorbent Assay; Facial Paralysis; Female; Humans; Immunoglobulin M; Leukocytosis; Lyme Neuroborreliosis; Male; Prognosis; Prospective Studies; Statistics, Nonparametric; Sweden; Treatment Outcome

This prospective multicenter study was conducted to define more clearly clinical and laboratory criteria that predict a strong probability of occult bacteremia and to evaluate the effect of empiric broad spectrum antimicrobial treatment of these children. Children 3 to 36 months old with fever > or = 40 degrees C (104 degrees F) or, > or = 39.5 degrees C (103 degrees F) with white blood cells (WBC) > or = 15 x 10(9)/liter, and no focus of infection had blood cultures obtained and were randomized to treatment with oral amoxicillin/potassium clavulanate or intramuscular ceftriaxone. Sixty of 519 (11.6%) study patients had positive blood cultures: Streptococcus pneumoniae, 51; Haemophilus influenzae b, 6; Neisseria meningitidis, 2; and Group B Streptococcus, 1. Subgroups of high risk were identified as fever > or = 39.5 degrees C and WBC > or = 15 x 10(9)/liter, 55 of 331 or 16.6% positive with increasing incidence of positive culture with increasing increments of degrees of leukocytosis to WBC > or = 30 x 10(9)/liter where 9 of 21 or 42.9% were positive. Subgroups of significantly lower risk were identified as fever > or = 39.5 degrees C and WBC < 15 x 10(9)/liter, 5 of 182 or 2.7% positive and those with WBC < 10 x 10(9)/liter, 0 of 99 or 0.0% positive. Children with positive cultures who received ceftriaxone were nearly all afebrile after 24 hours whereas a significant number who received amoxicillin/potassium clavulanate remained febrile. In the 459 culture-negative children more amoxicillin/potassium clavulanate-treated children developed diarrhea and had less improvement in clinical scores after 24 hours than ceftriaxone-treated children.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Female; Fever; Follow-Up Studies; Haemophilus Infections; Humans; Infant; Injections, Intramuscular; Leukocytosis; Male; Meningococcal Infections; Multivariate Analysis; Pneumococcal Infections; Prospective Studies; Regression Analysis; Treatment Outcome

A man in his 70s presented to hospital in early summer with a 5-week history of progressive lower back and right thigh pain, sensory deficit and right leg weakness. There had been limited response to analgesics in the community. Primary investigations on admission revealed no cause for his symptoms. Five days into admission, history emerged of a possible tick bite with subsequent rash sustained 3 months earlier, raising the possibility of neuroborreliosis leading to radiculopathy. Cerebrospinal fluid demonstrated a lymphocytic pleocytosis. An elevated

Topics: Ceftriaxone; Humans; Leukocytosis; Low Back Pain; Lyme Neuroborreliosis; Male; Radiculopathy

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Contrast Media; Cranial Nerve Diseases; Diplopia; Female; Gadolinium; Humans; Immunoglobulin G; Leukocytosis; Meningitis, Bacterial; Oligoclonal Bands; Paralysis; Prednisolone

Topics: Abdominal Pain; Administration, Intravenous; Anti-Bacterial Agents; Borrelia; Ceftriaxone; Cranial Nerves; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Exanthema; Gastroesophageal Reflux; Hematopoietic Stem Cell Transplantation; Humans; Leukocytosis; Lyme Neuroborreliosis; Lymphoma, Mantle-Cell; Magnetic Resonance Imaging; Male; Middle Aged; Spinal Cord

Topics: Abdominal Pain; Administration, Intravenous; Anti-Bacterial Agents; Borrelia; Brain; Ceftriaxone; Cranial Nerves; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Exanthema; Hematopoietic Stem Cell Transplantation; Humans; Leukocytosis; Lyme Neuroborreliosis; Lymphoma, Mantle-Cell; Magnetic Resonance Imaging; Male; Middle Aged; Spinal Cord

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiviral Agents; Behcet Syndrome; Brain Stem; Ceftriaxone; Dexamethasone; Humans; Leukocytosis; Magnetic Resonance Imaging; Male; Meningoencephalitis; Treatment Outcome

Topics: Adenosine Deaminase; Adult; Ampicillin; Anti-Bacterial Agents; Antitubercular Agents; Azathioprine; Biomarkers; Ceftriaxone; Cerebrospinal Fluid; Colitis, Ulcerative; Diagnosis, Differential; Drug Therapy, Combination; Humans; Immunocompromised Host; Immunosuppressive Agents; Leukocytosis; Listeria monocytogenes; Male; Meningitis, Listeria; Tuberculosis, Meningeal

The clinical management of late stage Borreliosis can be difficult due to various associated symptoms and signs and cumbersome microbiological tests. We report a case of successful antibiotic treatment of Borreliosis-associated pseudolymphomatous infiltrates in bone marrow and lymph nodes, which were diagnosed by bone marrow trephine biopsy and positron emission tomography.

Topics: Agricultural Workers' Diseases; Anti-Bacterial Agents; Antibodies, Bacterial; Bone Marrow Examination; Borrelia burgdorferi; C-Reactive Protein; Ceftriaxone; Fibrinogen; Humans; L-Lactate Dehydrogenase; Leukocytosis; Lyme Disease; Lymph Nodes; Male; Middle Aged; Positron-Emission Tomography; Pulmonary Emphysema; Radiography, Thoracic; Spleen; Treatment Outcome