zithromax and Respiratory-Distress-Syndrome

Previous studies have evaluated treatment efficacy of various antibiotics for patients with mild-to-moderate scrub typhus (ST). However, the efficacy of different antibiotics for treating severe ST remains uncertain.. A retrospective study of patients with severe ST was undertaken in China. The treatment efficacy rates of doxycycline, azithromycin and chloramphenicol were compared, using treatment failure and time to defervescence as primary outcomes.. In total, 876 patients with severe ST who initially received doxycycline, azithromycin or chloramphenicol were recruited. The treatment failure rate did not differ significantly between patients receiving doxycycline and patients receiving azithromycin (6.0% vs 11.4%; P=0.109). However, a higher treatment failure rate was observed for chloramphenicol compared with doxycycline (14.6% vs 6.0%; P=0.004). No significant difference in time to defervescence was observed between patients receiving doxycycline, azithromycin or chloramphenicol. Further subgroup analysis revealed a higher risk of treatment failure for chloramphenicol compared with doxycycline in patients with acute kidney injury, pneumonia and shock; and a higher risk of treatment failure for azithromycin compared with doxycycline in patients with meningitis. Significant correlation was found between azithromycin resistance and meningitis (P=0.009), and between chloramphenicol resistance and acute respiratory distress syndrome (ARDS) (P<0.001) using Cramer's V correlation coefficient. Multi-variate Cox regression analysis revealed significant associations between time to defervescence and presence of ARDS, shock, myocarditis, meningitis and acute kidney injury.. Azithromycin and doxycycline were found to have significant therapeutic effects in patients with severe ST. In contast, chloramphenicol was less efficacious for the treatment of these patients.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Azithromycin; Chloramphenicol; Doxycycline; Humans; Respiratory Distress Syndrome; Retrospective Studies; Scrub Typhus

A 23-year-old primigravida at 20 weeks of gestation presented to our hospital with undifferentiated febrile illness and severe acute respiratory distress syndrome. She was intubated in the emergency department and transferred to the intensive care unit. Initial treatment included ventilatory care, vasopressor support and broad-spectrum antibiotics. Based on a positive PCR assay for scrub typhus, she was treated with intravenous doxycycline and azithromycin. Despite reduction in fever, her oxygenation further declined. Following a risk-benefits assessment, we decided to ventilate her in prone position for 8 hours a day for three consecutive days using a checklist-based protocol. Her oxygenation indices and lung compliance markedly improved over this period, and she was extubated a day later. She was eventually discharged home after 1 week.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Doxycycline; Female; Humans; Pregnancy; Respiratory Distress Syndrome; Scrub Typhus; Young Adult

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Age Factors; Angiotensin-Converting Enzyme Inhibitors; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Antiviral Agents; Azithromycin; Bromhexine; Coronavirus Infections; COVID-19; Cytokines; Expectorants; Humans; Hydroxychloroquine; Hypertension; Inflammation; Interferon beta-1a; Interleukin-1; Interleukin-12; Interleukin-6; Lymphohistiocytosis, Hemophagocytic; Obesity; Pandemics; Pneumonia, Viral; Pulmonary Disease, Chronic Obstructive; Respiratory Distress Syndrome; Risk Factors; Smoking; Tumor Necrosis Factor-alpha

Topics: Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Betacoronavirus; C-Reactive Protein; Coronavirus Infections; COVID-19; COVID-19 Drug Treatment; Disease Progression; Enzyme Inhibitors; Female; Hospitalization; Humans; Hydroxychloroquine; Intensive Care Units; Interleukin 1 Receptor Antagonist Protein; Lung; Male; Middle Aged; Pandemics; Pneumonia, Viral; Respiratory Distress Syndrome; SARS-CoV-2; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Azithromycin; Betacoronavirus; Chloroquine; Combined Modality Therapy; Coronavirus Infections; COVID-19; Fatal Outcome; Female; Humans; Infant; Morocco; Multiple Organ Failure; Nasopharynx; Pandemics; Pneumonia, Viral; Respiration, Artificial; Respiratory Distress Syndrome; SARS-CoV-2; Tomography, X-Ray Computed

While the COVID-19 epidemic occurred since December 2019, as of end April 2020, no treatment has been validated or invalidated by accurate clinical trials. Use of hydroxychloroquine has been popularised on mass media and put forward as a valid treatment option without strong evidence of efficacy. Hydroxychloroquine (HCQ) has its own side effects, some of which are very serious like acute haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient patients. Side effects may be worse than the disease itself. Belgian national treatment guidelines recommend the use of HCQ in mild to severe COVID-19 disease. As opinions, politics, media and beliefs are governing COVID-19 therapy, performance of randomised controlled blinded clinical trials became difficult. Results of sound clinical trials are eagerly awaited. We report a case of acute haemolysis leading to admission in intensive care unit and renal failure in a patient with uncovered G6PD deficiency.

Topics: Aged; Azithromycin; Betacoronavirus; Blood Transfusion; Continuous Renal Replacement Therapy; Coronavirus Infections; COVID-19; Drug Therapy, Combination; Enzyme Inhibitors; Glucosephosphate Dehydrogenase Deficiency; Haptoglobins; Hemolysis; Humans; Hydroxychloroquine; Hypoxia; Male; Nasopharynx; Pandemics; Pneumonia, Viral; Respiratory Distress Syndrome; SARS-CoV-2; Severe acute respiratory syndrome-related coronavirus

Invasive aspergillosis is a well-known complication of severe influenza pneumonia with acute respiratory distress syndrome (ARDS). However, recent studies are reporting emergence of aspergillosis in severe COVID-19 pneumonia, named as COVID-19-associated pulmonary aspergillosis (CAPA).. A retrospective observational study was conducted in patients with severe COVID-19 pneumonia from February 2020 to April 2020. Patients ≥18 years of age with clinical features and abnormal chest imaging with confirmed COVID-19 by RT-PCR for SARS-CoV-2 were included. CAPA was diagnosed based on clinical parameters, radiological findings and mycological data. Data were recorded on a structured proforma, and descriptive analysis was performed using Stata ver 12.1.. A total of 147 patients with confirmed COVID-19 and 23 (15.6%) patients requiring ICU admission were identified. Aspergillus species were isolated from tracheal aspirates of nine (39.1%) patients, and of these, five patients (21.7%) were diagnosed with CAPA and four (17.4%) had Aspergillus colonisation. The mean age of patients with CAPA was 69 years (Median age: 71, IQR: 24, Range: 51-85), and 3/5 patients were male. The most frequent co-morbid was diabetes mellitus (4/5). The overall fatality rate of COVID-19 patients with aspergillosis was 44% (4/9). The cause of death was ARDS in all three patients with CAPA, and the median length of stay was 16 days (IQR: 10; Range 6-35 days).. This study highlights the need for comparative studies to establish whether there is an association of aspergillosis and COVID-19 and the need for screening for fungal infections in severe COVID-19 patients with certain risk factors.

Topics: Aged; Aged, 80 and over; Azithromycin; Coronavirus Infections; COVID-19; Diabetes Complications; Female; Humans; Hydroxychloroquine; Invasive Pulmonary Aspergillosis; Male; Middle Aged; Nasopharynx; Pakistan; Pandemics; Pneumonia, Viral; Respiratory Distress Syndrome; Retrospective Studies; Risk Factors

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Humans; Male; Pandemics; Piperacillin; Psittacosis; Respiratory Distress Syndrome; Tazobactam

At the end of December 2019, the Health Commission of the city of Wuhan, China, alerted the World Health Organization (WHO) to a pneumonia cluster in the city. The cause was identified as being a new virus, later named SARS-CoV-2. We can distinguish three clinical phases of the disease with a distinct pathogenesis, manifestations and prognosis. Here, we describe the case of a 45-year-old male, successfully treated for Coronavirus disease (COVID-19). The patient was feeling sick in early April 2020; he had a fever and pharyngodynia. When he came to our COVID hospital, his breathing was normal. The nasopharyngeal swab specimen turned out positive. High-resolution computed tomography (HRCT) showed mild interstitial pneumonia. The patient was admitted to our department and treated with hydroxychloroquine, ritonavir, darunavir, azithromycin and enoxaparin. On day seven of the disease, the patient's respiratory condition got worse as he was developing acute respiratory distress syndrome (ARDS). He was given tocilizumab and corticosteroids and was immediately treated with non-invasive mechanical ventilation (NIMV). His condition improved, and in the ensuing days, the treatment gradually switched to a high-flow nasal cannula (HFNC); after 18 days, the patient's clinical condition was good.The successful results we have been able to obtain are closely associated with avoidance of invasive ventilation that may lead to intensive care unit (ICU)-related superinfections. In our opinion, it is fundamental to understand that COVID-19 is a systemic disease that is a consequence of an overwhelming inflammatory response, which can cause severe medical conditions, even in young patients.

Topics: Adrenal Cortex Hormones; Antibodies, Monoclonal, Humanized; Azithromycin; China; Coronavirus Infections; COVID-19; Darunavir; Disease Progression; Enoxaparin; Humans; Hydroxychloroquine; Male; Middle Aged; Noninvasive Ventilation; Pandemics; Pneumonia, Viral; Respiratory Distress Syndrome; Ritonavir

Topics: Adult Stem Cells; Angiotensin-Converting Enzyme 2; Azithromycin; Blood Component Transfusion; COVID-19; Extracorporeal Membrane Oxygenation; Humans; Hydroxychloroquine; Ivermectin; Plasma; Recombinant Proteins; Respiratory Distress Syndrome; SARS-CoV-2

Scrub typhus is a re-emerging mite-borne rickettsiosis, which continues to be underdiagnosed, with lethal consequences. The present study was conducted to determine the seasonality, clinical presentation and predictors of mortality in patients with scrub typhus at a tertiary care teaching hospital in northern India.. Scrub typhus was suspected in patients attending the hospital as per the standard case definition and serological evidence was obtained by performing an IgM ELISA.. A total of 284 patients with scrub typhus from urban and rural areas were seen, predominantly from July to November. The most common clinical presentation was a bilateral community-acquired pneumonia (CAP), which resembled pneumonia due to atypical pathogens and often progressed to acute respiratory distress syndrome (ARDS). An acute undifferentiated febrile illness (AUFI) or a febrile illness associated with altered sensorium, aseptic meningitis, shock, abdominal pain, gastrointestinal bleeding or jaundice was also seen. Eschars were seen in 17 per cent of patients, and thrombocytopenia, transaminitis and azotaemia were frequent. There were 24 deaths (8.5%) caused predominantly by ARDS and multi-organ dysfunction. The mortality in patients with ARDS was high (37%). ARDS [odds ratio (OR)=38.29, 95% confidence interval (CI): 9.93, 147.71] and acute kidney injury (OR=8.30, 95% CI: 2.21, 31.21) were the major predictors of death.. The present findings indicate that scrub typhus may be considered a cause of CAP, ARDS, AUFI or a febrile illness with multisystem involvement, in Uttarakhand and Uttar Pradesh, especially from July to November. Empiric therapy of CAP may include doxycycline or azithromycin to ensure coverage of underlying unsuspected scrub typhus.

Topics: Adult; Azithromycin; Community-Acquired Infections; Doxycycline; Female; Humans; India; Male; Middle Aged; Orientia tsutsugamushi; Pneumonia; Respiratory Distress Syndrome; Scrub Typhus

After taking azithromycin and prednisone for lower respiratory symptoms, this patient developed a rash. The way it spread provided a diagnostic clue.

Topics: Azithromycin; Exanthema; Humans; Male; Middle Aged; Practice Guidelines as Topic; Prednisone; Prurigo; Respiratory Distress Syndrome; Treatment Outcome

Azithromycin is a member of macrolides, utilized in the treatment of infections. Independently, these antibiotics also possess anti-inflammatory and immunomodulatory properties. Phospholipase A2 isotypes, which are implicated in the pathophysiology of inflammatory lung disorders, are produced by alveolar macrophages and other lung cells during inflammatory response and can promote lung injury by destructing lung surfactant. The aim of the study was to investigate whether in lung cells azithromycin can inhibit secretory and cytosolic phospholipases A2, (sPLA2) and (cPLA2), respectively, which are induced by an inflammatory trigger. In this respect, we studied the lipopolysaccharide (LPS)-mediated production or secretion of sPLA2 and cPLA2 from A549 cells, a cancer bronchial epithelial cell line, and alveolar macrophages, isolated from bronchoalveolar lavage fluid of ARDS and control patients without cardiopulmonary disease or sepsis. Pre-treatment of cells with azithromycin caused a dose-dependent decrease in the LPS-induced sPLA2-IIA levels in A549 cells. This inhibition was rather due to reduced PLA2G2A mRNA expression and secretion of sPLA2-IIA protein levels, as observed by western blotting and indirect immunofluorescence by confocal microscopy, respectively, than to the inhibition of the enzymic activity per se. On the contrary, azithromycin had no effect on the LPS-induced production or secretion of sPLA2-IIA from alveolar macrophages. The levels of LPS-induced c-PLA2 were not significantly affected by azithromycin in either cell type. We conclude that azithromycin exerts anti-inflammatory properties on lung epithelial cells through the inhibition of both the expression and secretion of LPS-induced sPLA2-IIA, while it does not affect alveolar macrophages.

Topics: Azithromycin; Case-Control Studies; Cell Line, Tumor; Humans; Lipopolysaccharides; Lung; Macrophages, Alveolar; Organ Specificity; Phospholipases A2; Respiratory Distress Syndrome; Respiratory Mucosa

Lung diseases caused by surfactant protein C (SFTPC) mutations are inherited as autosomal traits with variable penetrance and severity or as sporadic disease caused by a de novo mutation on one allele. Here, we report the case of a child surviving with a homozygous surfactant protein C mutation after aggressive clinical management unlike his six siblings who died in infancy. This presentation raises the suspicion of an autosomal recessive inheritance that is discussed in this report.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Azithromycin; Consanguinity; Genes, Recessive; Homozygote; Humans; Hydroxychloroquine; Infant; Lung; Male; Methylprednisolone; Microscopy, Electron; Mutation, Missense; Oxygen Inhalation Therapy; Pedigree; Phenotype; Pulmonary Alveolar Proteinosis; Pulmonary Surfactant-Associated Protein C; Radiography; Respiration, Artificial; Respiratory Distress Syndrome; Siblings; Treatment Outcome

Babesiosis is a tick-borne illness caused by the intraerythrocytic parasite Babesia microti. Adult respiratory distress syndrome (ARDS) is a complication of B. microti infection and generally presents later in the course of the disease. We present a case of babesiosis presenting with ARDS. A 59-year-old male with history of hypertension and atrial fibrillation presented with one day of progressive shortness of breath. The patient returned from a trip to Massachusetts one day prior. On arrival to the emergency department (ED) the patient was noted to be febrile with tachycardia, tachypnea, and hypoxia and was intubated for respiratory failure. A computed tomography angiography (CTA) was negative for pulmonary embolism and showed bilateral infiltrates. The Berlin criteria for severe ARDS were met. Tick-borne illness was suspected and Wright-Giemsa stained thin blood smear confirmed the diagnosis of babesiosis. The patient was treated with atovaquone and azithromycin for seven days and was successfully extubated on day four of hospitalization. He continued to clinically improve and was discharged home four days later. The case highlights the importance of physicians being aware of the manifold ways in which babesiosis can manifest.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Atovaquone; Azithromycin; Babesiosis; Diagnosis, Differential; Humans; Intubation, Intratracheal; Male; Massachusetts; Middle Aged; Respiratory Distress Syndrome; Tomography, X-Ray Computed

A middle-aged woman presented with fever of 1-month duration along with bilateral knee joint pain, swelling and difficulty in walking for 2 weeks. The patient's Typhidot test was positive for IgM antibodies. Her Widal test was negative, and blood culture and synovial fluid culture were sterile. She was started on ceftriaxone, to which her fever initially responded. However, after 4 days of treatment her disease course was complicated by relapse of fever and acute respiratory distress syndrome (ARDS). This settled with respiratory support and addition of azithromycin. Following recovery from ARDS and fever, her persistent knee arthritis responded to intra-articular methyl prednisolone instillation.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Arthritis; Azithromycin; Female; Humans; Knee Joint; Middle Aged; Prednisolone; Respiratory Distress Syndrome; Typhoid Fever

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Female; Follow-Up Studies; Humans; Pneumonia, Mycoplasma; Radiography, Thoracic; Respiratory Distress Syndrome; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

14-membered ring macrolides have been reported to have anti-inflammatory effects and to decrease neutrophil infiltration into the airways in chronic lower respiratory tract diseases. This study investigated the potential inhibitory effects of macrolide antibiotics on bleomycin-induced acute lung injury. Four drugs were studied: two 14-membered ring macrolides, clarithromycin (CAM) and roxithromycin (RXM); a 15-membered ring macrolide, azithromycin (AZM); and a 16-membered ring macrolide, josamycin (JM). Their effects were compared with macrolide untreated, pretreated, and post-treated groups. An acute lung injury was inhibited by pretreatment with CAM or RXM, which significantly ameliorated the bleomycin-induced increases in the total cell and neutrophil counts in bronchoalveolar lavage (BAL) fluids and the wet lung weight. The pretreatment with CAM or RXM also suppressed inflammatory cell infiltration and interstitial lung edema in the histopathological study. These inhibitory effects were associated with a decreased KC concentration in the BAL fluid and a decreased number of apoptotic cells in the lungs. Posttreatment with CAM or RXM had no marked inhibitory effects. Pretreatment with AZM was much less effective, and JM showed no inhibitory effects. These findings suggest that 14-membered ring macrolides have different effects on inflammatory lung disease than 15- and 16-membered ring macrolides and may be therapeutic agents for acute lung injury and pulmonary fibrosis.

Topics: Animals; Anti-Bacterial Agents; Antibiotics, Antineoplastic; Apoptosis; Azithromycin; Bleomycin; Bronchoalveolar Lavage Fluid; Chemokine CXCL1; Chemokines, CXC; Chemotactic Factors; Clarithromycin; Disease Models, Animal; Dose-Response Relationship, Drug; Growth Substances; In Situ Nick-End Labeling; Intercellular Signaling Peptides and Proteins; Josamycin; Lung; Male; Mice; Mice, Inbred ICR; Pulmonary Edema; Respiratory Distress Syndrome; Roxithromycin; Time Factors; Treatment Outcome