ro13-9904 and Pain

Meningococcal infection is a multifaceted disease including acute polyarthritis. This presentation should be known by clinicians in order to prevent delay in treatment. We report what we believe to be the first case of an association of parvovirus B19 and meningococcal polyarthritis in a young adult.. A 19-year-old Caucasian woman presented to our hospital with fever, intense leg pain, and a transient rash. A physical examination showed asymmetric polyarthritis and no neurological abnormalities. A parvovirus B19 polymerase chain reaction performed using a blood sample and knee fluid aspirate came back positive, but serology was negative for immunoglobulin M and positive for immunoglobulin G. A blood culture was positive for serotype C meningococcus; a polymerase chain reaction performed for Neisseria meningitidis was positive in joint fluid but negative in blood samples (performed after antibiotic treatment had begun). Our patient was treated with ceftriaxone for 15 days, associated with analgesic therapy. Hydroxychloroquine treatment was introduced 5 months after the onset of polyarthritis because of persisting inflammatory arthralgia.. To the best of our knowledge, this is the first case report of polyarthritis caused by concomitant meningococcal and parvovirus B19 infections. This unusual presentation of meningococcal disease may have resulted from the persistent parvovirus B19 infection. Our experience with this case illustrates the need for a systematic approach to the diagnosis of febrile acute polyarthritis. Only long-term follow-up will reveal if this infectious polyarthritis will evolve towards an autoimmune rheumatism.

Topics: Analgesia; Anti-Bacterial Agents; Antibodies, Viral; Arthritis; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Meningococcal Infections; Pain; Pain Measurement; Parvoviridae Infections; Parvovirus B19, Human; Phlebitis; Polymerase Chain Reaction; Treatment Outcome; Young Adult

Spondylodiscitis is an unusual diagnosis among children and consequent abscess formation is even rarer. A 6-year-old girl with fever, hip pain, and refusal to walk was evaluated. The neurologic examination was normal. Recurrent joint pain with cold weather, iron for anemia without improvement, and decreased intervertebral spaces raised the use of ceftriaxone, oxacillin, and external immobilization. Hemoglobin sickle cell disease, spondylodiscitis with paravertebral collections, and epidural abscess were documented. She was fully recovered. The treatment was conservative because there was no neurologic deficit. We add to the literature 1 case of spondylodiscitis with epidural abscess that was successfully treated with antibiotics alone.

Topics: Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Child; Discitis; Epidural Abscess; Female; Humans; Lower Extremity; Oxacillin; Pain; Pain Management; Radiography; Remission Induction

Pain is one of the presenting symptoms in acute neuroborreliosis. Classically, acute neuroborreliosis--also known in Europe as Bannwarth's syndrome--is a combination of radicular pain, cranial neuritis and peripheral radiculitis and inflammatory changes of the CSF. The prognosis following antibiotic therapy is favorable. At least in its early stages, however, the diagnosis neuroborreliosis might be missed or mistaken. Thus, targeted assessment of typical signs is needed to expedite examination of the CSF which then permits definitive diagnosis.

Topics: Adult; Analgesics; Anti-Bacterial Agents; Borrelia burgdorferi Group; Cefotaxime; Ceftriaxone; Complex Regional Pain Syndromes; Diagnosis, Differential; Headache; Humans; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Pain; Radiculopathy; Time Factors; Tomography, X-Ray Computed

We report an unusual case of Streptococcus pneumoniae sacroiliitis in a previously healthy 31-year-old woman. Six cases of pneumococcal sacroiliitis have been reported; the only two cases in adults occurred in young women in the preantibiotic era. Our patient had fever and a depressed level of consciousness, with subsequent right buttock and thigh pain. Blood cultures revealed S pneumoniae, and a bone scan showed increased tracer activity in the right sacroiliac joint. Although the cerebrospinal fluid white blood cell count was only 3/microL, culture of cerebrospinal fluid grew S pneumoniae. Our patient was successfully treated with a 6-week course of intravenous antibiotics (penicillin G after an initial week of ceftriaxone), followed by 2 weeks of oral penicillin therapy.

Topics: Administration, Oral; Adult; Arthritis, Infectious; Bacteremia; Buttocks; Ceftriaxone; Cephalosporins; Consciousness; Drug Therapy, Combination; Female; Fever; Humans; Injections, Intravenous; Pain; Penicillin G; Penicillins; Pneumococcal Infections; Sacroiliac Joint; Streptococcus pneumoniae; Thigh

It is controversial whether additional antibiotic treatment will improve cognitive function in patients with post-treatment chronic Lyme disease (PTCLD).. To determine whether antibiotic therapy improves cognitive function in two randomized double-blind placebo-controlled studies of patients with PTCLD.. A total of 129 patients with a physician-documented history of Lyme disease from three study sites in the northeast United States were studied. Seventy-eight were seropositive for IgG antibodies against Borrelia burgdorferi, and 51 were seronegative. Patients in each group were randomly assigned to receive IV ceftriaxone 2 g daily for 30 days followed by oral doxycycline 200 mg daily for 60 days or matching IV and oral placebos. Assessments were made at 90 and 180 days after treatment. Symptom severity was measured from the cognitive functioning, pain, and role functioning scales of the Medical Outcomes Study (MOS). Memory, attention, and executive functioning were assessed using objective tests. Mood was assessed using the Beck Depression Inventory and Minnesota Multiphasic Personality Inventory.. There were no significant baseline differences between seropositive and seronegative groups. Both groups reported a high frequency of MOS symptoms, depression, and somatic complaints but had normal baseline neuropsychological test scores. The combined groups showed significant decreases in MOS symptoms, higher objective test scores, and improved mood between baseline and 90 days. However, there were no significant differences between those receiving antibiotics and placebo.. Patients with post-treatment chronic Lyme disease who have symptoms but show no evidence of persisting Borrelia infection do not show objective evidence of cognitive impairment. Additional antibiotic therapy was not more beneficial than administering placebo.

Topics: Administration, Oral; Affect; Aged; Ceftriaxone; Chronic Disease; Cognition Disorders; Depression; Double-Blind Method; Doxycycline; Drug Therapy, Combination; Female; Humans; Infusions, Intravenous; Lyme Neuroborreliosis; Male; Middle Aged; Neuropsychological Tests; Pain; Sensation Disorders; Treatment Failure

To determine whether post Lyme syndrome (PLS) is antibiotic responsive.. The authors conducted a single-center randomized double-masked placebo-controlled trial on 55 patients with Lyme disease with persistent severe fatigue at least 6 or more months after antibiotic therapy. Patients were randomly assigned to receive 28 days of IV ceftriaxone or placebo. The primary clinical outcomes were improvement in fatigue, defined by a change of 0.7 points or more on an 11-item fatigue questionnaire, and improvement in cognitive function (mental speed), defined by a change of 25% or more on a test of reaction time. The primary laboratory outcome was an experimental measure of CSF infection, outer surface protein A (OspA). Outcome data were collected at the 6-month visit.. Patients assigned to ceftriaxone showed improvement in disabling fatigue compared to the placebo group (rate ratio, 3.5; 95% CI, 1.50 to 8.03; p = 0.001). No beneficial treatment effect was observed for cognitive function or the laboratory measure of persistent infection. Four patients, three of whom were on placebo, had adverse events associated with treatment, which required hospitalization.. Ceftriaxone therapy in patients with PLS with severe fatigue was associated with an improvement in fatigue but not with cognitive function or an experimental laboratory measure of infection in this study. Because fatigue (a nonspecific symptom) was the only outcome that improved and because treatment was associated with adverse events, this study does not support the use of additional antibiotic therapy with parenteral ceftriaxone in post-treatment, persistently fatigued patients with PLS.

Topics: Adult; Aged; Antigens, Bacterial; Antigens, Surface; Bacterial Outer Membrane Proteins; Bacterial Vaccines; Borrelia burgdorferi; Ceftriaxone; Chronic Disease; Cognition Disorders; Double-Blind Method; Fatigue; Female; Humans; Lipoproteins; Lyme Disease; Lyme Neuroborreliosis; Male; Middle Aged; Neuropsychological Tests; Pain; Psychomotor Performance; Severity of Illness Index; Treatment Outcome

The pharmacokinetics and tolerability of 1-g doses of ceftriaxone diluted in sterile water, 1% lidocaine, or buffered lidocaine were investigated. No difference in bioequivalence was noted between the three treatments. No difference in peak creatine kinase values was seen. By use of a quantitative pain scale, injection of ceftriaxone with the water diluent was significantly more painful than that with either of the other two diluents. No difference in injection pain was noted for lidocaine or buffered lidocaine.

Topics: Adult; Buffers; Ceftriaxone; Cephalosporins; Chemistry, Pharmaceutical; Female; Humans; Injections, Intramuscular; Lidocaine; Male; Middle Aged; Pain; Therapeutic Equivalency

To compare the pain associated with ceftriaxone sodium injections by using two different diluents, ie, lidocaine hydrochloride and sterile water.. Prospective study of adolescents who were culture positive for gonorrhea. Random selection of the diluent used for the intramuscular ceftriaxone therapy.. Urban, hospital-based adolescent medicine service.. Thirty-nine adolescents and young adults, predominantly of black or Hispanic backgrounds, ranging in age between 14 and 23 years (mean age, 17.6 years; median age, 17 years), of whom 27 were females.. Pain predictions were elicited from the adolescents before treatment. Pain ratings were obtained at five time intervals after the injections. All ratings were obtained by using a visual analog scale.. No pain prediction differences before the injection were noted between the two groups. Individual t tests showed significant pain differences between the two groups at the time after the injection and at 10- and 20-minute and 6-hour intervals. Repeated-measures analysis of variance models showed that the diluent effect on pain was significant.. Lidocaine can reduce the amount of pain of an intramuscular injection of ceftriaxone when compared with sterile water as a diluent. These findings have implications not only for the treatment of gonorrhea but also for other situations where intramuscular injections utilizing a diluent may be necessary.

Topics: Adolescent; Adult; Ceftriaxone; Female; Gonorrhea; Humans; Injections, Intramuscular; Lidocaine; Male; Pain; Pain Measurement; Pharmaceutical Vehicles; Water

The effects of 1% lidocaine as a diluent on the pharmacokinetics and tolerance of ceftriaxone administered intramuscularly were investigated in 12 adult volunteers. Each subject received two 0.5-g doses of ceftriaxone (one in water and the other in 1% lidocaine) at least 1 week apart in a randomized crossover fashion. Plasma and urine samples were collected serially and assayed for ceftriaxone content by high-performance liquid chromatography. The mean peak plasma concentration, time to attain the peak, area under the plasma curve from time zero to infinity, and elimination half-life were 45 micrograms/ml, 2.5 h, 578 micrograms . h/ml, and 7.1 h, respectively, after intramuscular administration of ceftriaxone in water diluent. The corresponding mean values in 1% lidocaine diluent were 42 micrograms/ml, 3 h, 577 micrograms . h/ml, and 7.0 h. The pharmacokinetic data suggested that 1% lidocaine does not alter either the elimination parameters or the bioavailability of intramuscularly administered ceftriaxone. The intensity and frequency of pain at the injection site were reduced considerably by the coadministered lidocaine.

Topics: Adult; Cefotaxime; Ceftriaxone; Excipients; Humans; Injections, Intramuscular; Kinetics; Lidocaine; Male; Middle Aged; Pain

The subcutaneous (SC) route provides an alternative to the IV or oral route for drug administration in the elderly. The benefits of SC administration have been proven for hydration but are still debated for antibiotics because tolerance remains uncertain, especially in the frail geriatric population. Here, we aimed to improve current knowledge concerning the tolerance profile of ceftriaxone SC administration at both the systemic and cutaneous level, as well as in terms of pain.. This was a prospective descriptive study of SC ceftriaxone tolerance in a geriatric department. We included all patients over 75 years of age who received a prescription for SC ceftriaxone in our hospital over a 5 month period.. We evaluated the systemic and local tolerance of SC ceftriaxone. Nurses were asked about their perceptions concerning its use.. Among 117 patients, 57% presented with pain and 60% with a mild local adverse effect, such as the formation of oedema in one-third of patients, induration or transient erythema. Finally, there were no serious local adverse effects and two systemic adverse effects were observed (one diarrhoea and one Clostridioides difficile colitis). Pain was mainly related to the skin breach and oedema formation.. We did not find any worrying signs concerning the use of SC ceftriaxone but this study shows that its wide use must consider pain management, which is often overlooked.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Drug-Related Side Effects and Adverse Reactions; Humans; Injections, Subcutaneous; Pain; Prospective Studies

Ceftriaxone (CFX) is a β-lactam antibiotic with analgesic properties. However, its role in the formalin-induced nociception remains unknown. The purpose of this study was to investigate the antinociceptive effect of CFX in the 1% formalin test in rats. Formalin induced a typical nociceptive response (flinching behavior) of two phases. Local peripheral pretreatment (20 min) with CFX (400-800 μg/paw) slightly attenuated the flinching behavior in phase 2, but not phase 1. Acute intraperitoneal pretreatment (20 min) also reduced phase 2 of the formalin test. In both cases, CFX induced a dose-dependent antinociception. We also tested the effect of CFX 1 day after its administration and in two schedules of repeated administration. One-day pretreatment with CFX (50-400 mg/kg, ip) induced a dose-dependent antinociceptive effect in formalin-treated rats. Repeated administration (daily during 3 or 7 days) with CFX (50-400 mg/kg, ip) diminished formalin-induced nociception. Results suggest that local or systemic as well as single or repeated administration of CFX reduces formalin-induced nociception.

Topics: Analgesics; Animals; Anti-Bacterial Agents; Ceftriaxone; Drug Administration Schedule; Female; Formaldehyde; Injections, Intraperitoneal; Nociception; Pain; Rats, Wistar

About 50% of patients with cancer develop bone metastasis mainly presenting with distressing, drug-resistant pain.. The study evaluated efficacy and safety of combined cementoplasty and bony radiofrequency ablation in palliation of intractable pain and disability in cancer patients with bony metastases.. The study included 30 adult patients suffering from localized bony metastases causing refractory moderate to severe pain. Radiofrequency bony ablation performed followed by cementoplasty were done under computed tomography (CT) guidance with conscious sedation and local anesthesia. Final CT check was done to ensure adequate lesion filling and to exclude any cement leakage. Pain, hemodynamic variables, and neurological status were checked for a minimum of 2 h before discharge. The patients were followed up weekly in the pain clinic. The primary outcome measures pain severity and daily opioid consumption. The secondary outcome measures were quality of life and the degree of disability, and procedure-related adverse outcomes.. Pain score, daily morphine consumption, and Oswestry Disability Index score decreased significantly after 1 day, and 1, 4 and 12  weeks. None of the patients had serious complications during the postoperative follow up visits. Only 4 patients (13.3%) experienced discomfort during, and few days after the procedure, 3 patients (10%) suffered from local infection, and 2 patients (6.7%) reported cement leakage.. Combined radiofrequency ablation and cementoplasty is a safe and effective pain relief modality in patients suffering from extraspinal painful bone metastases with improvement of the quality of life.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Catheter Ablation; Ceftriaxone; Cementoplasty; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Pain; Pain Management; Palliative Care; Tomography, X-Ray Computed; Treatment Outcome

We report a rare case of syphilitic meningomyelitis presenting with visceral crisis and possessing characteristic imaging findings.. The patient, a 50-year-old woman, complained of pain in the upper abdomen and back. She then developed numbness in both lower extremities and weakness in the left lower limb.. Magnetic resonance imaging (MRI) of the spinal cord revealed the candle guttering sign and irregular enhancement at the T6 level. Rapid plasma reagin test of the cerebrospinal fluid yielded a titer of 1:8. Thus, the patient was diagnosed with syphilitic meningomyelitis.. She was treated with ceftriaxone and dexamethasone after the failure of penicillin treatment.. She could perform the activities of daily living, and her pain completely disappeared.. A patient with syphilitic meningomyelitis can present with visceral crisis caused by the involvement of the posterior nerve roots or the posterior horn, which usually occurs in patients with tabes dorsalis. Considering the non-specific symptoms and MRI features, we should be aware that abdominal pain may be a symptom of myelopathy, and syphilitic meningomyelitis ought to be taken into account in a patient with longitudinally extensive myelitis.

Topics: Abdominal Pain; Anti-Bacterial Agents; Anti-Inflammatory Agents; Back Pain; Ceftriaxone; Dexamethasone; Female; Humans; Hypesthesia; Lower Extremity; Middle Aged; Pain; Stomach; Tabes Dorsalis

A 9-year-old boy admitted to a district general hospital with a 1-week history of fever and a 2-day history of right hip pain. Initial workup revealed raised inflammatory markers and unremarkable imaging studies. After clinical review, there was minimal improvement of the patient's condition 5 days after presentation; therefore, an MRI of the pelvis/hips was carried out, which supported a clinical diagnosis of right-sided infective sacroiliitis. Infective sacroiliitis is rare and only represents 1%-2% of septic arthritis in children. The condition still remains a diagnostic challenge first due to poor localisation of symptoms with referred pain to the hip, thigh and lower back and second due to a lack of awareness by non-specialist clinicians. Early diagnosis is a key to avoid sequelae such as an abscess, degenerative changes of the sacroiliac joint and can be achieved by a thorough clinical examination, monitoring inflammatory markers and MRI.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Child; Diagnosis, Differential; Hip; Humans; Magnetic Resonance Imaging; Male; Movement Disorders; Pain; Rare Diseases; Sacroiliac Joint; Sacroiliitis; Treatment Outcome

The β-lactam antibiotic ceftriaxone stimulates glutamate transporter GLT-1 expression and is effective in neuropathic and visceral pain models. This study examined the effects of ceftriaxone and its interactions with different analgesics (ibuprofen, celecoxib, paracetamol, and levetiracetam) in somatic and visceral pain models in rodents.. The effects of ceftriaxone (intraperitoneally/intraplantarly), analgesics (orally), and their combinations were examined in the carrageenan-induced paw inflammatory hyperalgesia model in rats (n = 6-12) and in the acetic acid-induced writhing test in mice (n = 6-10). The type of interaction between ceftriaxone and analgesics was determined by isobolographic analysis.. Pretreatment with intraperitoneally administered ceftriaxone (10-200 mg/kg per day) for 7 days produced a significant dose-dependent antihyperalgesia in the somatic inflammatory model. Acute administration of ceftriaxone, via either intraperitoneal (10-200 mg/kg) or intraplantar (0.05-0.2 mg per paw) routes, produced a significant and dose-dependent but less efficacious antihyperalgesia. In the visceral pain model, significant dose-dependent antinociception of ceftriaxone (25-200 mg/kg per day) was observed only after the 7-day pretreatment. Isobolographic analysis in the inflammatory hyperalgesia model revealed approximately 10-fold reduction of doses of both drugs in all examined combinations. In the visceral nociception model, more than 7- and 17-fold reduction of doses of both drugs was observed in combinations of ceftriaxone with ibuprofen/paracetamol and celecoxib/levetiracetam, respectively.. Ceftriaxone exerts antihyperalgesia/antinociception in both somatic and visceral inflammatory pain. Its efficacy is higher after a 7-day pretreatment than after acute administration. The two-drug combinations of ceftriaxone and the nonsteroidal analgesics/levetiracetam have synergistic interactions in both pain models. These results suggest that ceftriaxone, particularly in combinations with ibuprofen, celecoxib, paracetamol, or levetiracetam, may provide useful approach to the clinical treatment of inflammation-related pain.

Topics: Acetaminophen; Analgesics; Analgesics, Non-Narcotic; Animals; Anti-Bacterial Agents; Ceftriaxone; Celecoxib; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Synergism; Drug Therapy, Combination; Hyperalgesia; Ibuprofen; Inflammation; Levetiracetam; Male; Pain; Piracetam; Pyrazoles; Rats; Rats, Wistar; Sulfonamides

Cervical nerve root injury commonly leads to radicular pain. Normal sensation relies on regulation of extracellular glutamate in the spinal cord by glutamate transporters. The goal of this study was to define the temporal response of spinal glutamate transporters (glial glutamate transporter 1 [GLT-1], glutamate-aspartate transporter [GLAST], and excitatory amino acid carrier 1) following nerve root compressions that do or do not produce sensitivity in the rat and to evaluate the role of glutamate uptake in radicular pain by using ceftriaxone to upregulate GLT-1. Compression was applied to the C7 nerve root. Spinal glutamate transporter expression was evaluated at days 1 and 7. In a separate study, rats underwent a painful root compression and were treated with ceftriaxone or the vehicle saline. Glial glutamate transporter expression, astrocytic activation (glial fibrillary acidic protein [GFAP]), and neuronal excitability were assessed at day 7. Both studies measured behavioral sensitivity for 7 days after injury. Spinal GLT-1 significantly decreased (P < 0.04) and spinal GLAST significantly increased (P = 0.036) at day 7 after a root injury that also produced sensitivity to both mechanical and thermal stimuli. Within 1 day after ceftriaxone treatment (day 2), mechanical allodynia began to decrease; both mechanical allodynia and thermal hyperalgesia were attenuated (P < 0.006) by day 7. Ceftriaxone also reduced (P < 0.024) spinal GFAP and GLAST expression, and neuronal hyperexcitability in the spinal dorsal horn, restoring the proportion of spinal neurons classified as wide dynamic range to that of normal. These findings suggest that nerve root-mediated pain is maintained jointly by spinal astrocytic reactivity and neuronal hyperexcitability and that these spinal modifications are associated with reduced glutamate uptake by GLT-1.

Topics: Animals; Astrocytes; Ceftriaxone; Excitatory Amino Acid Transporter 2; Male; Neurons; Pain; Pain Measurement; Pain Threshold; Radiculopathy; Rats; Rats, Sprague-Dawley; Spinal Cord; Up-Regulation

Pelvic inflammatory disease (PID) is a common clinical syndrome with highest rates in adolescents, but no studies have singularly focused on this population in relationship to established guidelines for diagnosis and treatment. The study objective was to assess knowledge of diagnosis and treatment criteria for PID within an adolescent population and to compare factors associated with adherence to Centers for Disease Control and Prevention guidelines in outpatient settings.. Data were collected as part of a retrospective chart review of evaluation, diagnosis, and treatment of sexually transmitted infections in adolescent women in an outpatient setting. Participant charts were eligible for review if they were 12 to 21 years of age and were given an International Classification of Diseases, Ninth Revision/chart diagnosis of PID. Two primary outcome variables were utilized: meeting PID diagnosis guidelines (no/yes) and correct treatment for subject meeting criteria with guidelines (no/yes). The study controlled for race, age, medical venue, and current/past infection with gonorrhea/chlamydia.. Subjects (n = 150) were examined for the primary outcome variables; 78% (117/150) met at least 1 criterion for PID diagnosis. Nearly 75% (111/150) had cervical motion tenderness, 34% (51/150) adnexal tenderness, and 5% (7/150) had uterine tenderness; nearly 11% (16/150) were positive for all 3 criteria. Symptoms associated with PID were compared for subjects meeting diagnosis criteria versus subjects not meeting diagnosis criteria: abdominal pain and vomiting were significantly associated with PID diagnosis at P < 0.05.. Our findings show that PID diagnosis/treatment often does not follow guidelines in the adolescent population. Pelvic inflammatory disease and cervicitis appear to be confused by providers in the diagnosis process, and educational tools may be necessary to increase the knowledge base of practitioners in regard to PID.

Topics: Adolescent; Anti-Bacterial Agents; Arkansas; Ceftriaxone; Centers for Disease Control and Prevention, U.S.; Child; Diagnosis, Differential; Diagnostic Errors; Doxycycline; Ethnicity; Female; Guideline Adherence; Humans; International Classification of Diseases; Levofloxacin; Metronidazole; Ofloxacin; Outpatient Clinics, Hospital; Pain; Pelvic Inflammatory Disease; Practice Guidelines as Topic; Recurrence; Retrospective Studies; Sexually Transmitted Diseases; Symptom Assessment; United States; Uterine Cervicitis; Young Adult

Topics: Acetamides; Adolescent; Anti-Bacterial Agents; Ceftriaxone; Electrodiagnosis; Electromyography; Female; Fever; Humans; Linezolid; Meningococcal Infections; Mononeuropathies; Neisseria meningitidis; Neural Conduction; Neurologic Examination; Oxazolidinones; Pain; Sepsis; Sural Nerve

Topics: Aged, 80 and over; Anecdotes as Topic; Anti-Bacterial Agents; Ceftriaxone; Diplopia; Facial Paralysis; Female; Humans; Lyme Neuroborreliosis; Pain; Quality of Life

Glutamatergic pathways mediate transmission of pain. Strategies to reduce glutamatergic neurotransmission may have beneficial effects to mitigate nociception. Recent work revealed that overexpression of the astrocytic glutamate transporter (GLT-1) by transgenic or pharmacologic approaches produced a diminished visceral nociceptive response to colonic distension. The purpose of this study was to determine the effect of GLT-1 overexpression on the visceromotor response to bladder distension. Increased glutamate uptake activity produced by 1-wk ceftriaxone (CTX) treatment attenuated 60-64% the visceromotor response to graded bladder distension compared with vehicle-treated mice. One-hour pretreatment with selective GLT-1 antagonist dihydrokainate reversed the blunted visceromotor response to bladder distension produced by 1-wk CTX, suggesting that GLT-1 overexpression mediated the analgesic effect of CTX. Moreover, sensitization of the visceromotor response to bladder distension produced by local bladder irritation (acrolein) was also attenuated by 1-wk CTX treatment. A model of cross-organ sensitization of bladder visceromotor response to distension was next studied to determine whether increased expression of GLT-1 can mitigate colon to bladder sensitization. Intracolonic trinitrobenzene sulfonic acid (TNBS) administered 1 h before eliciting the visceromotor response to graded bladder distension produced a 75-138% increase in visceromotor response compared with animals receiving intracolonic vehicle. In marked contrast, animals treated with 1-wk CTX + intracolonic TNBS showed no enhanced visceromotor response compared with the 1-wk vehicle + intracolonic vehicle group. The study suggests that GLT-1 overexpression attenuates the visceromotor response to bladder distension and both local irritant-induced and cross-organ-sensitized visceromotor response to bladder distension.

Topics: Analysis of Variance; Animals; Blotting, Western; Ceftriaxone; Colon; Electromyography; Excitatory Amino Acid Transporter 2; Female; Kainic Acid; Mice; Pain; Pain Perception; Urinary Bladder

We present a case of pyogenic pubic symphysitis presenting in the third trimester with progressive suprapubic pain, fever and massive vulvar oedema. This case demonstrates a rare, but important cause of sepsis in pregnancy, which, if not recognised and treated promptly, may result in significant morbidity.

Topics: Adult; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Edema; Female; Fever; Gentamicins; Humans; Infant, Newborn; Metronidazole; Pain; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third; Pubic Symphysis; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Vulvar Diseases

Visceral hypersensitivity is the leading complaint of functional bowel disorders. Central sensitization mediated by glutamate receptor activation is implicated in pathophysiology of visceral pain. The glial glutamate transporter EAAT2 is the principal mediator of glutamate clearance to terminate glutamate-mediated responses. Transgenic mice overexpressing human EAAT2 (EAAT2 mice), which exhibited a twofold enhanced glutamate uptake, showed 39% less writhing response to intraperitoneal acetic acid than nontransgenic littermates. Moreover, EAAT2 transgenic mice showed a 53-64% reduction in visceromotor response (VMR) to colorectal distension (CRD) in assessments of the response to graded increase in pressures. Corroborating the involvement of enhanced glutamate uptake, wild-type mice treated for 1 wk with ceftriaxone, an EAAT2 expression activator, showed a 49-70% reduction in VMR to CRD. Moreover, systemic pretreatment with the selective EAAT2 transporter blocker dihydrokainate reversed the ceftriaxone-blunted nociceptive response to CRD. However, the enhanced VMR to CRD produced by intracolonic ethanol was not significantly attenuated by 1-wk ceftriaxone pretreatment. The data suggest that enhanced glutamate uptake provides protective effects against colonic distension-induced nociception and represents an exciting new mechanistic approach leading to better therapeutic options to visceral pain disorders.

Topics: Acetic Acid; Animals; Behavior, Animal; Ceftriaxone; Colon; Disease Models, Animal; Ethanol; Excitatory Amino Acid Transporter 2; Glutamate Plasma Membrane Transport Proteins; Humans; Hyperalgesia; Kainic Acid; Mice; Mice, Transgenic; Pain; Pain Measurement; Pain Threshold; Pressure; Up-Regulation

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Diabetes Complications; Fournier Gangrene; Humans; Male; Pain; Pain Management; Scrotum; Treatment Outcome

We report a rare case of pyomyositis of the iliacus muscle in a 29-year-old woman. After 2 weeks of adequate treatment, secondary septic sacroiliitis occurred, a complication that had not been described previously. Pyomyositis of the iliacus muscle must be considered in the differential diagnosis of acute pain in the hip region.

Topics: Adult; Ceftriaxone; Cloxacillin; Female; Hip; Humans; Ilium; Magnetic Resonance Imaging; Osteitis; Pain; Pyomyositis; Sacroiliac Joint; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Ceftriaxone; Chronic Disease; Clinical Trials as Topic; Cognition Disorders; Data Interpretation, Statistical; Drug Administration Schedule; Humans; Lyme Neuroborreliosis; Pain; Placebo Effect; Risk Assessment; Time; Treatment Failure

Herein, we present a case of a parkinsonism-hyperpyrexia syndrome (PHS) in a 58-year-old man with a 10-year history of Parkinson's disease. The patient presented with a 2-week history of fever and increasing confusion, in the context of a number of changes to his medication regimen. On presentation, he was noted to be febrile with autonomic instability, diaphoresis and marked rigidity. He was disoriented and responding to visual hallucinations. Investigations revealed an elevated creatine kinase and a provisional diagnosis of PHS was made. After the patient failed to respond during a 2-week period to supportive measures, electroconvulsive therapy (ECT) treatment was commenced. A good response to eight bilateral ECT treatments was achieved, with resolution of his confusional state and associated psychotic phenomena. We discuss the nosological and management issues associated with this case and discuss the role of ECT as a treatment modality in this condition.

Topics: Acetaminophen; Acyclovir; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Anxiety Agents; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiparkinson Agents; Antiviral Agents; Anxiety; Carbidopa; Ceftriaxone; Cervical Vertebrae; Depression; Dexamethasone; Diazepam; Doxepin; Electroconvulsive Therapy; Humans; Levodopa; Male; Middle Aged; Neuroleptic Malignant Syndrome; Oxycodone; Pain; Parkinson Disease; Selegiline; Spinal Injuries

Topics: Abdomen; Aged; Amoxicillin; Anti-Bacterial Agents; Aortitis; Ceftriaxone; Fever; Humans; Male; Pain; Salmonella Infections; Thailand

Topics: Adult; Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Endocarditis, Bacterial; Gammaproteobacteria; Humans; Injections, Intravenous; Male; Pain; Prosthesis-Related Infections

Topics: Ceftriaxone; Chronic Disease; Cognition Disorders; Convalescence; Double-Blind Method; Doxycycline; Drug Evaluation; Fatigue; Humans; Lyme Neuroborreliosis; Pain; Sleep Wake Disorders; Treatment Outcome

Streptococcus pneumoniae is a common cause of infection in the pediatric population, as well as an important cause of septic arthritis. The increased prevalence of drug-resistant S pneumoniae in North America has renewed interest in the use of pneumococcal vaccines. We describe the case of a child with isolated acute septic arthritis caused by infection with penicillin-resistant S pneumoniae.

Topics: Acute Disease; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Cephalosporins; Combined Modality Therapy; Debridement; Drainage; Edema; Elbow Joint; Humans; Infant; Leukocyte Count; Male; Microbial Sensitivity Tests; Nafcillin; Pain; Penicillin Resistance; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Prevalence; Streptococcus pneumoniae

Having affirmed that a dose of 2 g ceftriaxone (CTRX) administered subcutaneously (SC) to healthy volunteers was well absorbed, the same dose administered to eight patients first intravenously (days 1 to 3), then SC (days 4 to 6). Plasma levels obtained after SC administration are similar to those obtained after IV administration and are consistent with drug therapeutic efficacy. The poor tolerance of CTRX when administered SC represents a very important limiting factor on the administration of a 2 g dose via this path.

Topics: Adult; Aged; Aged, 80 and over; Ceftriaxone; Drug Tolerance; Female; Humans; Injections, Subcutaneous; Male; Middle Aged; Necrosis; Pain