ro13-9904 and Multiple-Organ-Failure

Leptospirosis is a zoonotic disease of worldwide distribution caused by infection with

Topics: Administration, Intravenous; Adult; Anti-Bacterial Agents; Ceftriaxone; Critical Care; Diagnosis, Differential; Environmental Exposure; Fluid Therapy; Humans; Ill-Housed Persons; Kidney Function Tests; Leptospira interrogans; Liver Function Tests; Male; Multiple Organ Failure; Thrombocytopenia; Treatment Outcome; Weil Disease

A 34-year-old HIV-positive man with a history of chronic substance abuse was admitted with dual infection of Streptococcus pneumoniae and Listeria monocytogenes. Combined bacteraemia with S. pneumoniae and L. monocytogenes is very rare. To the best of our knowledge, this is the first such case documented at our institution and in South Africa. Ampicillin should be added to antibiotic regimens to improve patient outcome if L. monocytogenes infection is suspected. Co-infections that occur with L. monocytogenes may have conflicting antibiotic treatment options. This case report emphasises the need for a good relationship between the local microbiology pathologist and physician to select appropriate antibiotic treatment before definitive results are available.

Topics: Adult; Ampicillin; Anemia; Anti-Bacterial Agents; Blood Transfusion; CD4 Lymphocyte Count; Ceftriaxone; Coinfection; Fatal Outcome; HIV; HIV Seropositivity; Humans; Listeria monocytogenes; Listeriosis; Male; Multiple Organ Failure; Pneumonia, Pneumococcal; Respiration, Artificial; Streptococcus pneumoniae

Hemolytic uremic syndrome (HUS) is one of the most common causes of acute renal failure in children, with the majority of cases caused by an infection with Shiga toxin-producing Escherichia coli (STEC). Whereas O157 is still the predominant STEC serotype, non-O157 serotypes are increasingly associated with STEC-HUS. However, little is known about this emerging and highly diverse group of non-O157 serotypes. With supportive therapy, STEC-HUS is often self-limiting, with occurrence of chronic sequelae in just a small proportion of patients.. In this case report, we describe a 16-month-old boy with a highly severe and atypical presentation of STEC-HUS. Despite the presentation with multi-organ failure and extensive involvement of central nervous system due to extensive thrombotic microangiopathy (suggestive of atypical HUS), fecal diagnostics revealed an infection with the rare serotype: shiga toxin 2d-producing STEC O80:H2.. This report underlines the importance of STEC diagnostic tests in all children with HUS, including those with an atypical presentation, and emphasizes the importance of molecular and serotyping assays to estimate the virulence of an STEC strain.

Topics: Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Biopsy; Blood Culture; Ceftriaxone; Escherichia coli Infections; Hemolytic-Uremic Syndrome; Humans; Infant; Liver; Magnetic Resonance Imaging; Male; Midazolam; Multiple Organ Failure; Real-Time Polymerase Chain Reaction; Resuscitation; Serotyping; Shiga Toxin 2; Shiga-Toxigenic Escherichia coli; Thrombotic Microangiopathies; Virulence

We describe a case of pneumonia and empyema thoracis caused by trimethoprim-sulfamethoxazole-susceptible, but imipenem-resistant Nocardia abscessus in a cancer patient. The isolate was confirmed to the species level by 16S rRNA sequencing analysis. The patient did not respond to antibiotic therapy, including ceftriaxone and imipenem, and died of progressing pneumonia and multiple organ failure.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Empyema, Pleural; Hemangiosarcoma; Humans; Imipenem; Immunocompromised Host; Male; Middle Aged; Multiple Organ Failure; Nocardia; Nocardia Infections; Pneumonia; RNA, Ribosomal, 16S; Trimethoprim, Sulfamethoxazole Drug Combination

Drug-induced immune haemolytic anaemia (DIIHA) is caused by various drugs or their metabolites. Cephalosporins are associated with haemolytic anaemia but multi-organ failure is rarely described.. We report the case of a 57-year-old female who was diagnosed with neuroborreliosis and treated with ceftriaxone. The patient developed severe DIIHA. Massive intravascular haemolysis led to shock and acute renal failure, necessitating mechanical ventilation and dialysis. Treatment with ceftriaxone was discontinued and glucocorticoids were prescribed. The patient recovered slowly but fully.. Ceftriaxone-induced immune haemolytic anaemia is a rare but potentially fatal condition.

Topics: Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Female; Fluid Therapy; Glucocorticoids; Humans; Middle Aged; Multiple Organ Failure

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

Stress-induced cardiomyopathy, a reversible left ventricular dysfunction, has been reported following anaphylaxis; this clinical circumstance seems to be linked to elevated levels of circulating catecholamines. We present a 36-year-old woman diagnosed as stress-induced cardiomyopathy following ceftriaxone-induced anaphylaxis. After anaphylactic reaction, the patient initially presented with cardiogenic shock, and subsequently developed multiple organ failure. She recovered basically by multiple organ supportive therapies including intra-aortic balloon pump and continuous veno-venous hemofiltration. This case provides a unique opportunity to observe the triggering of stress-induced cardiomyopathy, and also it provides evidence to support the role of catecholamine in the pathogenesis of this disease.

Topics: Adult; Anaphylaxis; Ceftriaxone; Cephalosporins; Female; Humans; Multiple Organ Failure; Takotsubo Cardiomyopathy

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Fatal Outcome; Female; Humans; Infant; Meningococcal Infections; Multiple Organ Failure; Neisseria meningitidis; Purpura Fulminans

Topics: Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Child; Humans; Male; Multiple Organ Failure; Saudi Arabia

Multi-organ failure syndrome (MOFS) is a rare life threatening complication of sickle cell disease. It is precipitated by severe vaso-occlusive episodes. We report a Saudi boy with sickle cell anemia, who developed acute MOFS following anaphylaxis to ceftriaxone administration. He had a dramatic recovery after red blood cell exchange transfusion and peritoneal dialysis.

Topics: Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Humans; Male; Multiple Organ Failure; Saudi Arabia

The mortality and morbidity of salmonella infections is seriously underestimated. Salmonella myocarditis is an unusual complication of salmonella sepsis in adults. Cases that do occur may be associated with high morbidity and mortality. We present a rare case of salmonella myocarditis with multi-organ failure in a previously healthy young adult man who was brought to the emergency room with fever, diarrhea, shortness of breath, and altered sensorium, discovered to have acute pulmonary edema and respiratory compromise for which he was assisted with mechanical ventilation for 8 days. Blood culture grew Salmonella typhi. Biochemically he exhibited myocardial, hepatic, and muscular enzymatic surge with renal failure, features of rhabdomyolysis, and disseminated intravascular coagulation. The patient showed a progressive improvement on treatment with ceftriaxone for 2 weeks in addition to decongestive therapy. He was discharged in good condition afterward.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Multiple Organ Failure; Myocarditis; Pulmonary Edema; Rhabdomyolysis; Salmonella typhi; Treatment Outcome; Typhoid Fever

To describe a case of a ceftriaxone-induced hemolytic anemia and hepatitis leading to multiple organ failure and death in an adolescent with hemoglobin SC disease and to review the previous cases of this rare and potentially fatal disorder in children.. Case report and literature review.. Intensive care unit.. Adolescent with hemoglobin SC.. Emergency treatment.. After 4 days of ceftriaxone therapy, the adolescent experienced an acute hemolytic reaction (hemoglobin decreased to 5 g/dL with hemoglobinuria) and severe hepatitis (all enzymes increasing dramatically including aminoaspartate transferase >20,000 IU/L). Renal failure and ultimately multiple organ failure ensued, and the patient died on hospital day 19. Direct antiglobulin tests on red cells obtained from the patient on hospital day 2 showed microscopic agglutination with polyspecific and anticomplement (C3) antiglobulin reagents. Plasma samples showed macroscopic agglutination reactions when incubated in the presence of ceftriaxone, many days after cessation of ceftriaxone, indicating the continued presence of ceftriaxone-dependent antibodies.. Drug reactions leading to hemolysis are relatively uncommon, and a total of ten cases of ceftriaxone-induced hemolytic anemia have been reported in children. The present case describes an adolescent who ultimately died on hospital day 19 from multiple organ failure, although the presentation of this case seems atypical in several respects. Children with clinical syndromes that place them at risk for hemolysis and children who frequently require broad spectrum antibiotics present unique diagnostic challenges, and the possibility that hemolytic syndromes may be due to ceftriaxone must be considered.

Topics: Adolescent; Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Chemical and Drug Induced Liver Injury; Fatal Outcome; Female; Hemoglobin SC Disease; Humans; Multiple Organ Failure

Neisseria meningitidis, a ubiquitous Gram-negative diplococcus, is responsible for a spectrum of clinical manifestations. This is illustrated by the history of three patients recently admitted to our hospital. Because of the possibly rapid and dramatic evolution, awareness for meningococcal diseases remains obligatory. Adequate antibiotic treatment instituted as soon as the diagnosis is suspected and early application of aggressive supportive care can lead to more favourable outcome.

Topics: Adult; Ceftriaxone; Cephalosporins; Fatal Outcome; Female; Humans; Male; Meningococcal Infections; Middle Aged; Multiple Organ Failure; Neisseria meningitidis