ro13-9904 and Syndrome

In chronic persistent asthma and severe acute exacerbations of bronchial asthma, infectious agents are the predominant triggers that drive disease and airway pathobiology. In acute exacerbations of bronchial asthma (AEBA) including near fatal and fatal asthma, viral agents, particularly human rhinovirus-C, respiratory syncytial virus and influenza A appear to be the more prevalent and recurring threats. Both viral, and to a lesser extent bacterial agents, can play a role, and co-infection may also be present and worsen prognosis in hospitalized patients, placing a portion at risk for critical asthma syndrome. During severe acute exacerbations, infectious agents must be treated empirically, but the initial treatment regimens can vary and viral coverage may also vary based on seasonality and patient age. Early treatment with ceftriaxone and azithromycin, along with oseltamivir in winter months, should be initiated with all cases of severe exacerbations where infection is suspected, and definitely in critical asthma syndrome until infection is excluded by appropriate diagnostic testing. In this manuscript we will outline the impact of the major viral agents on severe asthma including the data from the 2009 H1N1 influenza pandemic. The role of bacterial infections in acute exacerbations of asthma will also be reviewed as well as the benefit of empiric antibiotics and the role of macrolides in both acute and chronic asthma.

Topics: Animals; Asthma; Azithromycin; Bacterial Infections; Ceftriaxone; Coinfection; Critical Illness; Disease Progression; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Oseltamivir; Seasons; Syndrome

The diagnostic criteria of active neuroborreliosis include inflammatory changes of the cerebrospinal fluid (CSF) and an elevated specific Borrelia CSF-to-serum antibody index, indicating intrathecal Borrelia antibody production. Patients with neuroborreliosis are usually treated with intravenous ceftriaxone for 2-3 weeks. In case of allergy, doxycycline may be used. Treatment efficacy is detected by the improvement of the neurological symptoms and the normalization of the CSF pleocytosis. The measurement of serum and CSF antibodies is not suitable for follow-up, because they frequently persist. Post-Lyme disease (PLD) syndrome is characterized by persistent complaints and symptoms after previous treatment for Lyme borreliosis, e.g., musculoskeletal or radicular pain, dysaesthesia, and neurocognitive symptoms that are often associated with fatigue. There is no formal definition of the PLD syndrome, and its pathogenesis is unclear. Recent controlled studies do not support the use of additional antibiotics in these patients, but recommend primarily symptomatic strategies.

Topics: Adult; Antibodies, Bacterial; Borrelia burgdorferi; Ceftriaxone; Chronic Disease; Humans; Lyme Neuroborreliosis; Syndrome

We present a case of a 75-year-old woman with Austrian syndrome: pneumonia, meningitis and endocarditis all due to

Topics: Aged; Agranulocytosis; Anti-Bacterial Agents; Ceftriaxone; Comorbidity; COVID-19; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Humans; Meningitis, Bacterial; Pandemics; Pneumococcal Infections; SARS-CoV-2; Streptococcus pneumoniae; Syndrome

Tropical infections form 20-30% of ICU admissions in tropical countries. Diarrheal diseases, malaria, dengue, typhoid, rickettsial diseases and leptospirosis are common causes of critical illness. Overlapping clinical features makes initial diagnosis challenging. A systematic approach involving (1) history of specific continent or country of travel, (2) exposure to specific environments (forests or farms, water sports, consumption of exotic foods), (3) incubation period, and (4) pattern of organ involvement and subtle differences in manifestations help in differential diagnosis and choice of initial empiric therapy. Fever, rash, hypotension, thrombocytopenia and mild derangement of liver function tests is seen in a majority of patients. Organ failure may lead to shock, respiratory distress, renal failure, hepatitis, coma, seizures, cardiac arrhythmias or hemorrhage. Diagnosis in some conditions is made by peripheral blood smear examination, antigen detection or detection of microbial nucleic acid by PCR. Tests that detect specific IgM antibody become positive only in the second week of illness. Initial therapy is often empiric; a combination of intravenous artesunate, ceftriaxone and either doxycycline or azithromycin would cover a majority of the treatable syndromes. Additional antiviral or antiprotozoal medications are required for some specific syndromes. Involving a physician specializing in tropical or travel medicine is helpful.

Topics: Artesunate; Azithromycin; Ceftriaxone; Child; Communicable Diseases; Critical Care; Dengue; Diagnosis, Differential; Doxycycline; Exanthema; Female; Fever; Geography; Humans; Intensive Care Units; Leptospirosis; Malaria; Male; Nervous System Diseases; Pregnancy; Shock, Hemorrhagic; Syndrome; Travel; Tropical Medicine; Typhoid Fever

Hoigne's syndrome is characterized by the development of acute clinical manifestations which are mainly psycho-sensorial. Classically, these features immediately follow the injection of procaine penicillin G.. We report a 59-year-old man who presented with psycho-organic manifestations that occurred just after the intravenous injection of ceftriaxone; to our knowledge, this is the first case of Hoigne's syndrome reported after an injection of this antibiotic.. The pathophysiologic basis of this syndrome is still unknown. It is important to keep in mind its clinical characteristics, which may mimic immuno-allergic symptoms. It should be differentiated from anaphylactic manifestations because Hoigne's syndrome allows the continuation of the treatment.

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Drug Hypersensitivity; Humans; Injections, Intravenous; Male; Middle Aged; Syndrome

Kounis syndrome has been known as allergenic angina and/or allergenic myocardial infarction following an allergic reaction. Probable allergic insults usually include drugs, latex, and food. Although ceftriaxone administration has been associated with various allergic reactions such as urticaria, angioedema, erythema, rash and anaphylactic shock, as far as we know, there is no published report that has shown an association between ceftriaxone use and Kounis syndrome. Here, we describe the first report of allergic vasospasm, culminating in acute inferior myocardial infarction, probably as the result of an acute allergenic reaction, after ceftriaxone use.

Topics: Adult; Angina Pectoris; Anti-Bacterial Agents; Ceftriaxone; Coronary Angiography; Coronary Vasospasm; Drug Hypersensitivity; Electrocardiography; Humans; Male; Myocardial Infarction; Nitroglycerin; Syndrome; Vasodilator Agents

Otits media is a common problem. Some of its complications that were seen frequently in the preantibiotic era are rare today. We report a case of an 8 year boy who presented with earache, retro-orbital pain and diplopia secondary to a sixth nerve palsy--Gradenigo's syndrome. In this syndrome infection from the middle ear spreads medially to the petrous apex of the temporal bone. Work-up includes CT scan of the temporal bones. Timely management with intravenous antibiotics (+ surgery) is needed to prevent intra-cranial complications.

Topics: Abducens Nerve Diseases; Anti-Bacterial Agents; Ceftriaxone; Child; Cranial Nerve Injuries; Diplopia; Earache; Facial Nerve Diseases; Humans; Male; Mastoiditis; Syndrome; Temporal Bone; Tomography, X-Ray Computed; Treatment Outcome

The association of an acute coronary syndrome with mast cell activation secondary to allergen exposure is known as the Kounis syndrome. We present two cases of the Kounis syndrome: (i) one was misdiagnosed as acute ST elevation myocardial infarction and treated with thrombolytics; (ii) the second diagnosis was made after a recurrence two months after the first incident.

Topics: Acute Coronary Syndrome; Adult; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Coronary Angiography; Coronary Stenosis; Coronary Vasospasm; Diagnosis, Differential; Drug Hypersensitivity; Female; Humans; Male; Mast Cells; Myocardial Infarction; Recurrence; Syndrome

Topics: Aged, 80 and over; Anti-Infective Agents; Aza Compounds; Azithromycin; Bile Duct Diseases; Ceftriaxone; Fluoroquinolones; Humans; Male; Moxifloxacin; Quinolines; Syndrome

Topics: Aged; Ampicillin; Anti-Bacterial Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Ceftriaxone; Drug Eruptions; Drug Therapy, Combination; Eosinophilia; Female; Humans; Methylprednisolone; Sulbactam; Sulfasalazine; Syndrome

Lemierre syndrome is a distinct clinical syndrome comprising oropharyngeal sepsis and fever, internal jugular vein thrombosis and remote septic metastases caused by Fusobacterium species. The mortality rate was historically high and although use of antibiotics led to a dramatic fall in incidence, a resurgence has been seen recently. A 14-year-old male developed Lemierre syndrome after tonsillitis. There was extensive leptomeningitis, especially over the clivus, causing 6th and 12th cranial nerve palsies, a clinical feature termed the 'clival syndrome'. He also developed an epidural abscess in the cervical spine, which was unsafe for surgical drainage. Conservative treatment with an extended course of antibiotics and anticoagulation for jugular vein thrombosis led to a good recovery. A 15-year-old female developed Lemierre syndrome after a persistent sore throat lasting 7 weeks. She had palsy of the 12th cranial nerve from clival osteomyelitis. She was treated with a 6-week course of antibiotics and anticoagulants leading to almost full recovery at 3-month review. Awareness of the potential neurological complications of Lemierre syndrome and prompt management are crucial in reducing morbidity and mortality in this 'forgotten disease'.

Topics: Acyclovir; Adolescent; Anti-Infective Agents; Antiviral Agents; Bacteremia; Ceftriaxone; Cranial Nerve Diseases; Diagnosis, Differential; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Jugular Veins; Magnetic Resonance Imaging; Male; Oropharynx; Syndrome; Venous Thrombosis

We report the case of a 39-year old patient with septicemia treated for pharyngitis with antibiotics since a few days. She wasn't able to swallow her antibiotics anymore because of dysphagia. Radiologic examination revealed pulmonary infiltrates and Vena iugularis interna-thrombosis. These findings and anamnesis led to the diagnosis of Lemierre syndrome inspite of lacking detection of bacteria. After changing the antibiotic therapy and start of anticoagulation further course of illness was favorable. The long duration of hospitalization was indepted to high morbidity typically seen in Lemierre syndrome.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anticoagulants; Ceftriaxone; Clindamycin; Deglutition Disorders; Diagnosis, Differential; Drug Therapy, Combination; Female; Fever of Unknown Origin; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Jugular Veins; Pneumonia, Bacterial; Sepsis; Syndrome; Thrombosis; Tomography, X-Ray Computed; Tonsillitis; Ultrasonography

Topics: Aged, 80 and over; Anti-Bacterial Agents; Catheters, Indwelling; Ceftriaxone; Female; Humans; Proteus Infections; Proteus mirabilis; Syndrome; Urinary Catheterization; Urinary Tract Infections

To determine the prevalence of urethritis pathogens amongst male symptomatic urethritis (MUS) patients, genital ulcer (GUS) patients without urethritis symptoms and men requesting HIV testing at a voluntary counselling and testing (VCT) clinic.. A prospective study was conducted in Johannesburg, South Africa. Men from the three groups were screened for urethritis pathogens using molecular tests. Culture for Neisseria gonorrhoeae and, initially, trichomoniasis was performed. Antimicrobial susceptibility testing was undertaken for ciprofloxacin on all gonococcal isolates; ciprofloxacin resistant isolates were screened for ceftriaxone resistance.. 664 participants were recruited (438 MUS, 76 GUS and 158 VCT) over 2 years. Gonorrhoea was detected in 62.3% MUS, 15.8% GUS and 3.2% VCT participants. Chlamydial infection was detected in 19.3% MUS, 13.2% GUS and 8.2% VCT participants. Trichomoniasis was detected in 4.9% MUS, 19.7% GUS and 3.8% VCT participants. Mycoplasma genitalium infection was detected in 14.4% MUS, 13.2% GUS and 7.0% VCT participants. Ciprofloxacin resistance increased from 13.0% in the first year to 26.3% in the second year; all resistant isolates were susceptible to ceftriaxone.. Urethritis pathogens, including Trichomonas vaginalis, should be covered in syndromic management treatment of genital ulcers in the absence of clinical urethritis. Consideration should be given to adding metronidazole to existing MUS treatment. Ciprofloxacin can no longer be relied upon to treat presumptive gonococcal infections in South Africa.

Topics: Ceftriaxone; Ciprofloxacin; Counseling; Drug Resistance, Microbial; Gonorrhea; HIV Infections; Humans; Male; Mycoplasma Infections; Patient Acceptance of Health Care; Prospective Studies; South Africa; Syndrome; Trichomonas Infections; Urethritis

We present the clinical, radiological and pathological features of a case of a cranial hypertrophic pachymeningitis that developed in the course of mastoiditis and petrous apex inflammation and responded to immunosuppressive therapy only. Documented by the development of clinical findings, magnetic resonance imaging, cerebrospinal fluid changes, histopathology findings, by otosurgical intervention and finally by the insertion of a ventriculo-peritoneal shunt, the case illustrates a gradual development of pachymeningitis with consequent hydrocephalus and intracranial hypertension. We consider this disease development an example of immune-induced proliferative fibrotic changes in meninges.

Topics: Abducens Nerve Diseases; Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid; Chloramphenicol; Drug Therapy, Combination; Humans; Hydrocephalus; Hypertrophy; Immunoglobulin G; Immunosuppressive Agents; Magnetic Resonance Imaging; Male; Mastoiditis; Meninges; Meningitis; Methotrexate; Methylprednisolone; Middle Aged; Otitis Media; Petrous Bone; Syndrome; Trigeminal Nerve Diseases

This report documents a 47-year-old male who developed acute deficits of the IX, X, XI, XII cranial nerves and Horner's symptoms, consistent with Villaret's syndrome. Neuroimaging studies demonstrated an osteolytic lesion in the skull base involving the clivus and jugular foramen. The patient recovered after the antibiotic treatment for proteus mirabilis infection. We suggest that Villaret's syndrome can be a rare presentation of skull base osteomyelitis.

Topics: Ceftriaxone; Cranial Nerve Diseases; Horner Syndrome; Humans; Male; Middle Aged; Osteomyelitis; Proteus Infections; Proteus mirabilis; Skull Base; Syndrome

Topics: Anti-Bacterial Agents; Atlanto-Axial Joint; Ceftriaxone; Epidural Abscess; Humans; Joint Instability; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Radiography; Spinal Diseases; Syndrome

Topics: Acetazolamide; Brain; Ceftriaxone; Child; Drug Therapy, Combination; Female; Heparin, Low-Molecular-Weight; Humans; Intracranial Pressure; Lyme Disease; Magnetic Resonance Imaging; Pseudotumor Cerebri; Sinus Thrombosis, Intracranial; Syndrome; Venous Thrombosis

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Drug Therapy, Combination; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Kidney Diseases; Liver Abscess; Lung Diseases; Metronidazole; Nafcillin; Penicillins; Sepsis; Syndrome

In general, meningopolyradiculitis (Bannwarth's syndrome, stage 2 of neuroborreliosis) follows a predictable monophasic self-limiting course. In contrast, we report the case of a patient with an untreated meningopolyradiculitis which evolved into acute schizophrenia-like psychosis due to persistent infection with Borrelia burgdorferi. The psychosis resolved within 1 week of treatment with ceftriaxone. This case shows that the usually benign monophasic meningopolyradiculitis may progress to severe CNS complications, which may have implications on current pathophysiological beliefs.

Topics: Acute Disease; Antibodies, Bacterial; Borrelia burgdorferi Group; Ceftriaxone; Chronic Disease; Diagnosis, Differential; Encephalitis; Humans; Immunoglobulin G; Lyme Disease; Male; Meningitis; Middle Aged; Neurocognitive Disorders; Polyradiculopathy; Schizophrenia; Syndrome

We document the case of a young woman with bilateral nonluetic, interstitial keratitis, vestibuloauditory problems, and bilateral recurrent facial palsies, who had strongly positive serologic tests of Lyme borreliosis. To our knowledge, this is the first reported case of positive serologic tests for Borrelia burgdorferi in a patient with Cogan's syndrome.

Topics: Adult; Antibodies, Bacterial; Ceftriaxone; Enzyme-Linked Immunosorbent Assay; Facial Paralysis; Female; Hearing Loss; Hearing Loss, Bilateral; Humans; Keratitis; Lyme Disease; Penicillins; Serologic Tests; Syndrome

Topics: Adult; Arthritis, Infectious; Ceftriaxone; Female; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillinase; Pregnancy; Pregnancy Complications, Infectious; Skin Diseases, Infectious; Syndrome