ro13-9904 and Opportunistic-Infections

In this article we review the available data concerning meningitis caused by Capnocytophaga canimorsus. The clinical presentation of this rare condition is described with the emphasis on associated conditions and management issues. Two additional cases, illustrating the difficulties in recognizing this rare disease, are presented. Reviewing a total of 28 reported cases, a preceding bite-incident by a cat or dog, or close contact with these animals, was described in the majority of cases (89%). Patients had a median age of 58 years; splenectomy and alcohol abuse were noted in, respectively, 18% and 25% of patients. Only in one case immune suppressive drug use was reported. The diagnosis C. canimorsus meningitis should be considered in healthy and immunocompromised adults, especially after splenectomy, who present with symptoms attributable to meningitis and a history of recent exposure to dogs or cats. The possibility of this condition has implications for both the diagnostic work-up and the treatment of the patient.

Topics: Alcohol-Related Disorders; Animals; Bites and Stings; Capnocytophaga; Cats; Ceftriaxone; Dexamethasone; Diagnosis, Differential; Dogs; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Humans; Male; Meningitis, Bacterial; Middle Aged; Opportunistic Infections; Risk Factors; Splenectomy

Stroke-associated infections occur frequently and are associated with unfavorable outcome. Previous cohort studies suggest a protective effect of beta-blockers (BBs) against infections. A sympathetic drive may increase immune suppression and infections.. This study is aimed at investigating the association between BB treatment at baseline and post-stroke infection in the Preventive Antibiotics in Stroke Study (PASS), a prospective clinical trial.. We performed an exploratory analysis in PASS, 2,538 patients with acute phase of stroke (24 h after onset) were randomized to ceftriaxone (intravenous, 2 g per day for 4 days) in addition to stroke unit care, or standard stroke unit care without preventive antibiotic treatment. All clinical data, including use of BBs, was prospectively collected. Infection was diagnosed by the treating physician, and independently by an expert panel blinded for all other data. Multivariable analysis was performed to investigate the relation between BB treatment and infection rate.. Infection, as defined by the physician, occurred in 348 of 2,538 patients (14%). Multivariable analysis showed that the use of BBs at baseline was associated with the development of infection during clinical course (adjusted OR (aOR) 1.61, 95% CI 1.19-2.18; p < 0.01). BB use at baseline was also associated with the development of pneumonia (aOR 1.56, 95% CI 1.05-2.30; p = 0.03). Baseline BB use was not associated with mortality (aOR 1.14, 95% CI 0.84-1.53; p = 0.41) or unfavorable outcome at 3 months (aOR 1.10, 95% CI 0.89-1.35; p = 0.39).. Patients treated with BBs prior to stroke have a higher rate of infection and pneumonia.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Drug Administration Schedule; Female; Humans; Immunocompromised Host; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Opportunistic Infections; Pneumonia, Bacterial; Prospective Studies; Risk Factors; Stroke; Time Factors; Treatment Outcome; Urinary Tract Infections

Systemic antibiotics are routinely prescribed for severe acute malnutrition (SAM). However, there is no consensus regarding the most suitable regimen. In a therapeutic feeding centre in Khartoum, Sudan, a randomised, unblinded, superiority-controlled trial was conducted, comparing once daily intramuscular injection with ceftriaxone for 2 days with oral amoxicillin twice daily for 5 days in children aged 6-59 months with SAM.. Commencing with the first measured weight gain (WG) following admission, the risk difference and 95% confidence interval (95% CI) for children with a WG > or = 10 g/kg/day were calculated over a 14-day period. The recovery rate and case fatality ratio (CFR) between the two groups were also calculated.. In an intention-to-treat analysis of 458 children, 53.5% (123/230) in the amoxicillin group and 55.7% (127/228, difference 2.2%, 95% CI -6.9-11.3) in the ceftriaxone group had a WG > or = 10 g/kg/day during a 14-day period. Recovery rate was 70% (161/230) in the amoxicillin group and 74.6% (170/228) in the ceftriaxone group (p=0.27). CFR was 3.9% (9/230) and 3.1% (7/228), respectively (p=0.67). Most deaths occurred within the 1st 2 weeks of admission.. In the absence of severe complications, either ceftriaxone or amoxicillin is appropriate for malnourished children. However, in ambulatory programmes, especially where there are large numbers of admissions, ceftriaxone should facilitate the work of medical personnel.

Topics: Administration, Oral; Age Factors; Amoxicillin; Anthropometry; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Drug Administration Schedule; Female; Humans; Infant; Infant Nutrition Disorders; Injections, Intramuscular; Length of Stay; Male; Opportunistic Infections; Treatment Outcome; Weight Gain

Clinical efficacy of 3rd generation cephalosporins i.e. oral cefpodoxime and parenteral ceftriaxone was studied in the treatment of children with oncohematologic pathology. Cefpodoxime proved to be efficient in cases of moderate infectious complications in regard to the respiratory tracts. The oral administration of the drug provided its usage in outpatients. Ceftriaxone had a favourable effect in the treatment of children with more severe processes as a rule at the background of agranulocytosis and a lower immune response often with a tendency to generalization. No side effects of the cephalosporins were observed.

Topics: Administration, Oral; Agranulocytosis; Anemia, Aplastic; Cefpodoxime; Ceftizoxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Hematologic Neoplasms; Humans; Injections, Intraperitoneal; Opportunistic Infections; Respiratory Tract Infections; Treatment Outcome

In this open label prospective multicenter trial, 420 patients with neutropenia < 1000/microliter, fever > 38.5 degrees C and hematological malignancies were treated with ceftriaxone. Acute leukemia (n = 238) and high-grade lymphoma patients (n = 182) from 35 centers were enrolled. Between February 1992 and January 1996, patients were treated with 2 g ceftriaxone i.v. per day either as monotherapy (n = 135), or in combination with aminoglycosides (n = 235), glycopeptides (n = 37), or other antimicrobial agents (n = 13). Patients' median age was 54 years (range 15 to 97) with a median Karnofsky-performance-score of 6.0. The median neutrophil counts were 400/microliter. Fever was of unknown origin (FUO) in 268 (63.8%) of patients. Clinically defined infections (CDI) were diagnosed in 152 (36.2%) cases, including 74 (17.8%) episodes with pneumonia. Response to the initial approach with ceftriaxone was observed in 56.2% of febrile episodes, including 93 (68.8%) treatment courses with ceftriaxone alone. Concerning defervescence of fever ceftriaxone monotherapy was successful as compared to ceftriaxone in combination. Analysis revealed a low risk characterized by higher neutrophil counts (> or = 500/microliter; p < 0.0001), better Karnofsky-performance-score (> or = 7; p = 0.01), duration of neutropenia (< or = 5 days; p = 0.008) from start of antimicrobial treatment and duration of neutropenia per cycle (< or = 10 days; p = 0.0016). At the end of the observation, an overall response was obtained in 88.3% of the patients (n = 371) without statistical difference between patients treated with ceftriaxone alone or in combination. Once daily ceftriaxone either alone or in combination was effective in patients with hematological malignancies. Monotherapy was effective in a low risk group characterized by neutrophil counts (> or = 500/microliter), a Karnofsky-performance-score (> or = 7) and a duration of neutropenia (< or = 5 days) at the commencement of treatment.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Ceftriaxone; Drug Administration Schedule; Drug Therapy, Combination; Female; Fever of Unknown Origin; Hematologic Neoplasms; Humans; Infusions, Intravenous; Leukemia; Lymphoma, Non-Hodgkin; Male; Middle Aged; Neutropenia; Opportunistic Infections; Prospective Studies; Treatment Outcome

The high prevalence of Bacillus species in nature and the detection of these bacteria as contaminant in cultures may lead diagnostic dilemma, however they should still be considered as a pathogen particularly in case of repeated positive cultures from patients with risk factors. Bacillus pumilus is a bacteria, though rarely, been reported as the causative agent of various infections such as sepsis, endocarditis, skin infections and food poisoning in human. In this report, a sepsis case in an immunocompetent patient caused by B.pumilus was presented. A 38-year-old female patient was admitted to emergency service of our hospital with the complaints of headache, dizziness and diarrhea. She had not any risk factors except a history of heart valve replacement operation two years ago. In physical examination, she had abdominal retention, high fever and hypotension, together with the high levels of sedimentation rate (ESR) and C-reactive protein (CRP). The patient was hospitalized with the preliminary diagnosis of sepsis. Three sets of blood samples at two different periods were taken for the culture. All blood culture vials had a positive signal at the second day of incubation in BD BACTEC™ 9050 system, therefore subcultures were performed in sheep blood agar, chocolate agar and MacConkey agar, and incubated in aerobic and anaerobic conditions. Beta-haemolytic, gray-colored large colonies were isolated from anaerobic culture at the end of 18-24 hours incubation, and Gram staining from colonies showed gram-positive rods. The isolate was identified as B.pumilus with 99% accuracy rate by using BD Phoenix™ 100 identification system. This result was also confirmed by MALDI-TOF based VITEK® MS system and 16S rRNA sequencing by Illumina MiSeq® platform. Antibiotic susceptibility test performed by BD Phoenix™ 100 system and the isolate was found to be resistant against penicillin, while it was susceptible to vancomycin, erythromycin, clindamycin, levofloxacin, and trimethoprim-sulfamethoxazole. Initial treatment of patient was started with intravenous ceftriaxone and metronidazole empirically. Hypotension and fever returned to normal levels at the second and third days of the treatment, respectively. Metronidazole treatment was stopped at seventh day, and treatment was completed to 14 day with ceftriaxone alone. At the end of the treatment course, general condition of the patient was completely good, ESR and CRP were also decreased to normal levels. In conclusion, alth

Topics: Adult; Anti-Bacterial Agents; Bacillaceae Infections; Bacillus pumilus; Blood Sedimentation; C-Reactive Protein; Ceftriaxone; Female; Heart Valve Prosthesis Implantation; Humans; Metronidazole; Opportunistic Infections; Sepsis

Severe falciparum malaria may be complicated by prolonged haemolysis and recurrent fever after parasite clearance. However, their respective etiologies are unclear and challenging to diagnose. We report the first case of severe falciparum malaria followed by prolonged haemolytic anaemia and rhinomaxillary mucormycosis in a previously healthy adult male.. A 30-year old Bangladeshi man was admitted with severe falciparum malaria complicated by hyperlactataemia and haemoglobinuria. Prior to admission he was treated with intravenous quinine and upon admission received intravenous artesunate and empiric ceftriaxone. Thirty hours later the peripheral parasitaemia cleared with resolution of fever and haemoglobinuria. Despite parasite clearance, on day 3 the patient developed recurrent fever and acute haemolytic anaemia requiring seven blood transfusions over six days with no improvement of his haemoglobin or haemoglobinuria. On day 10, he was treated with high-dose dexamethasone and meropenem with discontinuation of the ceftriaxone. Two days later the haemoglobinuria resolved. Ceftriaxone-induced haemolysis was the suspected final diagnosis. On day 16, the patient had progressively worsening right-sided facial pain and swelling; a necrotic ulceration of the hard palate was observed. Rhinomaxillary mucormycosis was diagnosed supported by microscopy findings. The patient initially responded to treatment with urgent surgical debridement, itraconazole, followed by two weeks of amphotericin B deoxycholate, however was subsequently lost to follow up.. This case highlights the range of potential alternative aetiologies of acute, prolonged haemolysis and recurrent fever following parasite clearance in severe falciparum malaria. It emphasizes the importance of a high degree of suspicion for alternative causes of haemolysis in order to avoid unnecessary treatments, including blood transfusion and steroids. It is critical to consider and identify common invasive bacterial and rare opportunistic co-infections as a cause of fever in severe malaria patients remaining febrile after parasite clearance to promote antimicrobial stewardship and prompt emergency care.

Topics: Adult; Anemia, Hemolytic; Antimalarials; Ceftriaxone; Coinfection; Humans; Malaria, Falciparum; Male; Maxillary Diseases; Mucormycosis; Opportunistic Infections; Parasitemia; Rhinitis; Severity of Illness Index

Topics: Aged; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Carcinoma, Small Cell; Ceftriaxone; Cisplatin; Combined Modality Therapy; Cranial Irradiation; Etoposide; Fatal Outcome; Female; Humans; Immunocompromised Host; Lung Neoplasms; Opportunistic Infections; Pneumonia, Pneumocystis; Pneumonia, Staphylococcal; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

Yokenella regensburgei belongs to the Enterobacteriaceae and shares some biochemical characteristics with Hafnia alvei. A few case reports have suggested that it is an opportunistic pathogen, but there is no strong evidence to support its clinical importance. Until recently, it was difficult to accurately differentiate between Y. regensburgei and H. alvei by use of routine identification techniques. Here, we present a case of soft tissue infection and bacteremia caused by Y. regensburgei, which was successfully treated by intravenous administration of ceftriaxone for three weeks, and review the previous literature.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Diagnosis, Differential; Enterobacteriaceae; Enterobacteriaceae Infections; Hafnia alvei; Humans; Immunocompromised Host; Infusions, Intravenous; Leg; Male; Opportunistic Infections; Soft Tissue Infections; Taiwan; Treatment Outcome

Osteomyelitis is an inflammation of the bone caused by infecting organisms. We present here the first case of osteomyelitis of the distal femur caused by Salmonella typhimurium in a patient with Crohn's disease. The infection was successfully treated with a combination of antibiotics and surgical treatment.

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Ceftriaxone; Combined Modality Therapy; Crohn Disease; Femur; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Opportunistic Infections; Osteomyelitis; Postoperative Care; Postoperative Complications; Radionuclide Imaging; Salmonella Food Poisoning; Salmonella Infections; Salmonella typhimurium

Nocardia is a serious opportunistic infection in renal transplant recipients and nocardial brain abscess in these patients has a high mortality. In addition to antimicrobial therapy, treatment usually involves craniotomy and excision of the abscess. We describe a renal transplant recipient maintained on cyclosporine and prednisone developing Nocardia Asteroides brain abscess. After stereotactic aspiration of the abscess, successful treatment was achieved by triple therapy with trimethoprim sulfamethoxazole (TMP/SMX), ceftriaxone and amikacin. The allograft function remained stable. Long-term prophylaxis with TMP/SMX is necessary to prevent the relapse of nocardia.

Topics: Amikacin; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Once-a-day ceftriaxone and amikacin was administered in case of fever to 46 neutropenic patients attending day hospital for hematologic malignancies. All patients were admitted to a short-term ward for infective complications, but were discharged in the event of prompt disappearance of fever and of clinical signs of infection continuing their therapy either by daily reporting to the hospital, or at home. Response to the initial empiric therapy was obtained in 37 cases (76%). Twenty-four patients who promptly responded to therapy completed their treatment on an outpatient basis, their mean number of days of hospitalization being reduced to 4.6 versus a mean of 9.6 days in the overall patient population being considered. Since the outpatient treatment accounted for 21% of the antibiotic therapy administered, the above treatment may result in cost containment and better quality of life for patients, provided that these data are confirmed by prospective randomized studies.

Topics: Adolescent; Adult; Aged; Amikacin; Antineoplastic Combined Chemotherapy Protocols; Ceftriaxone; Day Care, Medical; Drug Therapy, Combination; Female; Fever; Hematologic Diseases; Humans; Male; Middle Aged; Neoplasms; Neutropenia; Opportunistic Infections; Pilot Projects

Topics: Adult; Ceftriaxone; Glottis; Haemophilus Infections; Haemophilus influenzae; Humans; Laryngitis; Male; Opportunistic Infections