11/219. Gemifloxacin: survival of the fittest.The incidence of penicillin resistance in pneumococci is increasing in the USA, having risen from <5% before 1989 to >35% in 1997. There has also been a shift in the ratio of intermediate to high-level resistance from 3 or 4:1 to 2 or 1:1. Multidrug resistance and resistance to macrolides and fluoroquinolones in pneumococci is also a matter of concern. The implications for empirical treatment of respiratory tract infections are considerable. The potential of quinolones with activity against respiratory pathogens including pneumococci must be preserved by careful antimicrobial prescribing.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
12/219. Ligneous conjunctivitis in a girl with severe type I plasminogen deficiency.BACKGROUND: Ligneous conjunctivitis is a rare form of chronic recurrent pseudomembranous disease and may be associated with systemic membranous pathological changes. Recently ligneous conjunctivitis has been linked to severe type I plasminogen deficiency. We report on a patient with plasminogen deficiency and severe bilateral ligneous conjunctivitis. A new treatment approach and its outcome in this patient are described. CASE REPORT: We present the case of a 9-month-old Turkish girl with massive swelling of the eyelids and hard white pseudomembranes on both lids. The conjunctival smear was positive for streptococcus pneumoniae. The clinical diagnosis was: ligneous conjunctivitis with superinfection. Histological investigation showed fibrin as major component of the pseudomembranes. The coagulation analyses revealed decreased plasminogen activity (<5%; normal 80-120%) and decreased plasminogen antigen (<0.4 mg/dl; normal 6-25 mg/dl). The failure of surgical therapy led to the attempt at treatment with intravenous lys-plasminogen. A significant improvement of the ocular symptoms occurred; stabilization with no recurrent pseudomembranes could be achieved for 6 months after treatment. DISCUSSION: The initial amelioration of symptoms in our patient after systemic replacement therapy confirms the etiological importance of plasminogen deficiency in the development of ligneous conjunctivitis. Curative treatment of ligneous conjunctivitis is still not available. However, intravenous application of plasminogen offers new possibilities in therapy, although long-term treatment seems necessary.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
13/219. Breakthrough pneumococcal bacteremia in patients being treated with azithromycin and clarithromycin.streptococcus pneumoniae strains have exhibited decreasing susceptibility to penicillins and macrolides during the past several years. We reviewed the medical charts of all patients with pneumococcal bacteremia who were admitted to a university hospital over a period of 1 year, to identify failures of outpatient therapy. Of 41 patients admitted with pneumococcal bacteremia, 4 had previously taken either azithromycin or clarithromycin for 3-5 days. All 4 had pneumococcal strains that exhibited low-level resistance to macrolide antibiotics. Among pneumococci, low-level resistance to macrolides can lead to clinical failure, and resistance to macrolides should be considered during the selection of empiric therapy for patients with presumed pneumococcal infections.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
14/219. Recurrent penicillin-resistant pneumococcal sepsis after matched unrelated donor (MUD) transplantation for refractory T cell lymphoma.patients who undergo splenectomy and recipients of allogeneic marrow (alloBMT) or peripheral stem cell transplantation are at increased risk of overwhelming infection from encapsulated organisms such as streptococcus pneumoniae, Haemophilus influenzae and neisseria meningitidis. As prophylaxis against these pathogens splenectomised patients are immunised and may also receive antibiotics for life. We report relapsing overwhelming sepsis caused by penicillin-resistant pneumococcus in a patient who was immunised and received prophylactic phenoxymethylpenicillin for 8 months following splenectomy and matched unrelated donor (MUD) marrow transplantation for refractory T cell lymphoma. No obvious focus of sepsis was found during any of the three episodes and S. pneumoniae serogroup 6, subtype 6B was isolated from blood cultures on each occasion. He was treated with i.v. cephalosporins, as the organisms were resistant to penicillin with a minimum inhibitory concentration (MIC) of 2.0, and there was complete resolution of symptoms each time. In the light of recurrent sepsis with this penicillin-resistant organism the decision was made to give prophylactic levofloxacin for the next 12 months. This case illustrates that the choice of prophylactic regimen and the treatment of sepsis in immunocompromised patients remain difficult and challenging issues.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
15/219. Renal transplantation after streptococcus pneumoniae-associated hemolytic uremic syndrome.Of the several causes of nondiarrheal hemolytic uremic syndrome (HUS), infection with streptococcus pneumoniae is infrequent, but important, because of its unique pathogenesis. A comprehensive literature review found 37 well-documented cases of S pneumoniae-associated HUS (SP-HUS), only 2 of which progressed to end-stage renal disease (ESRD). We report the third such child, and the first to receive a renal transplant following SP-HUS. Her course illustrates several unique characteristics of SP-HUS common to previous patients reported in the literature, including a greater duration of oligoanuria compared with cases not progressing to ESRD, the significant adverse effect of unwashed blood products, and a possible influence of female gender on outcome. Clinicians caring for children with SP-HUS should be aware of these differences and modify therapy appropriately to avoid known risk factors for poor outcome, specifically the use of unwashed blood products.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
16/219. Pneumococcal pyomyositis.pyomyositis is most commonly caused by staphylococcus aureus. A 25-month-old child developed infection of the biceps brachialis muscle caused by streptococcus pneumoniae. The child had no underlying immune or anatomic defect.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
17/219. Impaired IgG responses in a child with homozygous C2 deficiency and recurrent pneumococcal septicaemia.Homozygous deficiency of the second component of complement (C2) is the most common inherited deficiency of complement. Although C2 deficiency has been detected in asymptomatic individuals, patients usually present with either autoimmune disease or recurrent pyogenic infection, particularly due to encapsulated bacteria such as streptococcus pneumoniae, haemophilus influenzae type b and neisseria meningitidis. Interestingly, infection is the most common mode of presentation of C2 deficiency in young children (1). An association between C2 deficiency and IgG subclass deficiency has also been previously described. We now report a female child with C2 deficiency that presented at the age of 3 mo with recurrent pneumococcal septicaemia. Although IgG subclass levels were normal, specific IgG responses to vaccination against S. pneumoniae and H. influenzae were significantly impaired.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
18/219. Ruptured mycotic thoracoabdominal aortic aneurysms: a report of three cases and a systematic review.We report three cases of ruptured mycotic thoracoabdominal aortic aneurysms (TAAAS) and a review of the literature. escherichia coli and streptococcus pneumoniae (2 patients) were the responsible organisms. Surgical management consisted of wide debridement of necrotic tissue and in situ repair with a Dacron graft. Antibiotics were administered intravenously in the hospital and continued orally after discharge for at least 6 weeks, until clinical and laboratory parameters were normalized. A review of the literature showed that Gram-negative microorganisms are found in 47% of mycotic TAAAs. A trend toward increased mortality for these organisms, compared with Gram-positive microorganisms, was observed (P =.09). Lifelong antimicrobial therapy is controversial. No difference in survival or recurrence rate was found between series advocating lifelong therapy and those suggesting prolonged (6 weeks to 12 months) therapy (median follow-up period, 18 and 19 months, respectively). In situ repair with synthetic material can be successful if prompt confirmation of infection is obtained, all possibly infected tissue is resected, and antibiotic therapy based on sensitivity data is administered for a prolonged period. A short-term survival rate as high as 82% can be expected with this strategy, but data on long-term survival rates are limited. polytetrafluoroethylene-expanded grafts, homografts, and antibiotic-bonded grafts may offer advantages over Dacron grafts, but data are insufficient to draw conclusions. Careful long-term follow-up is an important element of the treatment of these patients. We suggest antibiotic treatment until biochemical parameters of inflammation (white cell count, erythrocyte sedimentation rate, or c-reactive protein) return to normal and a computerized tomography scan every 3 months for 1 year, then annually.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
19/219. Pneumococcal endocarditis of subacute evolution.With the development of penicillin, streptococcus pneumoniae has become an uncommon cause of bacterial endocarditis in adults. Subacute manifestation of pneumococcal endocarditis has been reported a few times in the literature, but most reports define the disease as acute, severe, and having a high mortality rate. We report the case of a 58-year-old male with subacute bacterial endocarditis due to streptococcus pneumoniae. We stress the low frequency of this agent as a cause of endocarditis and the atypical evolution of this case. The pathophysiology, clinical manifestations and evolution, and the therapeutical options for this type of infection are also discussed.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
20/219. Isolated septic arthritis caused by penicillin-resistant streptococcus pneumoniae.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.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
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