Meningococcal meningitis in two patients with primary antibody deficiency treated with replacement intravenous immunoglobulin

The current treatment of primary antibody deficiency (PAD) is the early recognition of the condition and replacement immunoglobulin combined with prompt treatment of infections and complications. The route of administration (intravenous or subcutaneous), dose and frequency of administration of immunoglobulin still vary between centres and countries. Most infections in patients with PAD are reduced but not entirely prevented by replacement immunoglobulin, with sinopulmonary infections accounting for the bulk of the remainder. Although there have been reports of meningitis in patients with PAD before replacement treatment, we describe the first two cases of bacterial meningitis (group B Neisseria meningitidis) on adequate immunoglobulin replacement and discuss the involvement of potential cofactors.     

La cryptococcose neuroméningée au cours de l’infection à VIH à Bangui, à l’ère du traitement antirétroviral

The cryptococcal neuromeningitis is the most common fungal meningitis infections in the course of HIV/AIDS. This is the number two of opportunist infection of the central nervous system. The authors post the outcomes of a retrospective study conducted related to 122 cases of cryptococcal neuromeningitis observed over for four years ago, in Bangui in the Central African Republic, this at time when antiretroviral treatment has been avaible, corresponding to a prevalence of 6.5%. These infections very aften occur more in female folk, and to patients whose average age is 35 years old, ranging from 18 to 69 years old. The clinical symptoms often found had been headache (98,3.%), fever (95.0%), the impairing of the overall condition of the patient (86.7%) and neck stiffness (85.9%). It makes sense to notice that comorbidity case alowgwith tuberculosis, intestinal candidiasis, bacterial pneumonia and Kaposi’s diseases were found out. The screening of the cerebrospinal fluid showed a sound cell count and even low count in 12.2% of cases. Direct examination of cerebrospinal fluid with India ink helps in diagnosis of 97.5% of cases, and the culture carried out from 74 patients was in any case positive. This culture allowed the diagnosis of three patients whose examination along side with India ink has been negative. The CD4 cell count was less than 100/mm³ in 97.7% of cases. The rate of the fatality cases has been 66.4%, it has been badly impacted by a CD4 count <50/mm³ and the lack of antiretroviral therapy. Despite the establishment of a national antiretroviral treatment program to do influence the frequency of opportunistic infections whose cryptococcal neuromeningitis, this condition is still present although it is declining. The clinical variability of this disease requires early diagnosis to avoid delayed treatment corollary of a very high mortality as we have observed.     

Zoonotic babesiosis

Zoonotic babesiosis has received increased attention recently, due mainly to the interest in tickborne zoonotic diseases generated by the emergence of Lyme borreliosis and to increased awareness of diagnostic and treatment difficulties associated with co-infection cases. The vast majority of European cases have been caused by Babesia divergeas in splenectomised patients, and although rare, this disease is very dangerous, requiring aggressive treatment. The use of atovaquone, a recently developed anti-protozoan agent for human treatment, may be considered in future cases. Most human babesiosis caused by B. microti have occurred in the north-eastern states of the USA and can affect spleen-intact as well as asplenic patients. The majority of infections are subclinical or follow a mild chronic course, but dangerous acute infections can occur in immunocompromised patients. The role of B. microti in apparently unresponsive cases of Lyme borreliosis and treatment of co-infections require further investigation. The zoonotic potential of B. microti in Europe is still unresolved, but the vector competence of Ixodes ricinus for at least some European (and American) strains has been demonstrated.     

Systemic and deep-seated infections caused byArcanobacterium haemolyticum

Arcanobacterium haemolyticum has been implicated mainly in non-streptococcal pharyngitis and wound infections. Rarely, it has been reported to cause systemic infection, often in combination with other pathogens. Two cases of systemic and deep-seated infections caused byArcanobacterium haemolyticum are reported, and the literature is reviewed. Sixteen cases of bacteremia and seven cases of non-bacteremic deep-seated have been published previously. Eight of the bacteremic and two of the non-bacteremic cases occurred in younger, apparently healthy immunocompetent patients. Six patients had infections of the central nervous system. The optimal treatment of infections caused byArcanobacterium haemolyticum is not known. Although in vitro susceptibility tests have demonstrated tolerance ofArcanobacterium haemolyticum to penicillin, penicillins with or without aminoglycosides have been the most widely used antibiotics, in most cases with success.     

Bell's palsy may have relations to bacterial infection

Bell's palsy is the most common acute facial paralysis with its causes still unclear. At present, the most widely accepted causes are viral infections, trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. Unclear causes lead to unidentified treatments. Most therapeutic methods are simply symptomatic treatment. Fortunately, the pathomechanism of Bell's palsy is relative clear, involving herpes simplex virus (HSV) reactivation within the geniculate ganglion, followed by inflammation and entrapment of the nerve in the bony foramen. This makes symptomatic treatment possible. But the therapeutic effects are not quite satisfactory. Therefore, novel etiological and therapeutic concepts are urgently needed. According to our clinical observation and some facts that do not favor the viral infections theory, we can conclude that all Bell's palsy is not related to viral infections, some even may have relations to bacterial infection. As far as blood routine examination is concerned, though lymphocyte increasing can be seen in most patients with Bell's palsy, there are cases with normal lymphocyte but increased neutrophil. Also, antibiotic treatment in these patients could accelerate recovery to some extent. These results indicate that Bell's palsy in these patients may be caused by bacterial infection.     

SARS-CoV-2 and dengue virus co-infection: Epidemiology,pathogenesis, diagnosis,treatment, and management

SARS-CoV-2 and dengue virus co-infection cases have been on the rise in dengue-endemic regions as coronavirus disease 2019 (COVID-19) spreads over the world, posing a threat of a co-epidemic. The risk of comorbidity in co-infection cases is greater than that of a single viral infection, which is a cause of concern. Although the pathophysiologies of the two infections are different, the viruses have comparable effects within the body, resulting in identical clinical symptoms in the case of co-infection, which adds to the complexity. Overlapping symptoms and laboratory features make proper differentiation of the infections important. However, specific biomarkers provide precise results that can be utilised to diagnose and treat a co-infection, whether it is simply COVID-19, dengue, or a co-infection. Though their treatment is distinguished, it becomes more complicated in circumstances of co-infection. As a result, regardless of whatever infection the first symptom points to, confirmation diagnosis of both COVID-19 and dengue should be mandatory, particularly in dengue-endemic regions, to prevent health deterioration in individuals treated for a single infection. There is still a scarcity of concise literature on the epidemiology, pathophysiology, diagnosis, therapy, and management of SARS-CoV-2 and dengue virus co-infection. The epidemiology of SARS-CoV-2 and dengue virus co-infection, the mechanism of pathogenesis, and the potential impact on patients are summarised in this review. The possible diagnosis with biomarkers, treatment, and management of the SARS-CoV-2 and dengue viruses are also discussed. This review will shed light on the appropriate diagnosis, treatment, and management of the patients suffering from SARS-CoV-2 and dengue virus co-infection.     

Antimicrobial treatment concepts for orthopaedic device-related infection

Successful management of orthopaedic device-related infections requires combined surgical and antimicrobial therapy. Because of the heterogeneity of clinical situations, controlled trials are lacking. Although rational concepts for surgical treatment have been published, many aspects of antimicrobial therapy are still not well documented. In this review, some of these knowledge gaps are discussed, and rational arguments for initial parenteral treatment are presented. In addition, the interpretation of data regarding bone penetration is discussed. Whereas rifampin is now a standard combination partner in the treatment of staphylococcal infections, its role against other microorganisms is still unclear. Finally, in view of the increasing prevalence of methicillin-resistant staphylococci and their decreasing susceptibility to vancomycin, data are provided on linezolid and daptomycin, which can potentially be used in bone and joint infections.     

REVIEW ARTICLE: Chlamydia trachomatis,a Hidden Epidemic: Effects on Female Reproduction and Options for Treatment

Citation Carey AJ, Beagley KW. Chlamydia trachomatis, a hidden epidemic: effects on the female reproduction and options for treatment. Am J Reprod Immunol 2010 The number of genital tract Chlamydia trachomatis infections is steadily increasing worldwide, with approximately 50–70% of infections asymptomatic. There is currently no uniform screening practice, current antibiotic treatment has failed to prevent the increased incidence, and there is no vaccine available. We examined studies on the epidemiology of C. trachomatis infections, the effects infections have on the female reproductive tract and subsequent reproductive health and what measures are being taken to reduce these problems. Undetected or multiple infections in women can lead to the development of severe reproductive sequelae, including pelvic inflammatory disease and tubal infertility. There are two possible paradigms of chlamydial pathogenesis, the cellular and immunological paradigms. While many vaccine candidates are being extensively tested in animal models, they are still years from clinical trials. With no vaccine available and antibiotic treatment unable to halt the increased incidence, infection rates will continue to increase and cause a significant burden on health care systems.     

Rapid diagnosis of bacteremic pneumococcal infections in adults by using the Binax NOW Streptococcus pneumoniae urinary antigen test: a prospective,controlled clinical evaluation

The diagnosis of severe pneumococcal infections is inadequate, relying heavily on culture of Streptococcus pneumoniae from blood or other normally sterile fluids, and is severely limited by prior administration of antibiotics. We evaluated prospectively the Binax NOW S. pneumoniae urinary antigen test, a rapid immunochromatographic assay, for the diagnosis of bacteremic pneumococcal infections in hospitalized adult patients. Antigen was detected in 88 of 107 cases overall, resulting in a test sensitivity of 82% (95% confidence interval [95% CI], 74 to 89%). Antigen detection was greater in those with pneumonia (67 of 77 [87%]) than in those without pneumonia (21 of 30 [70%]) (P = 0.04). Urinary antigen was also detected in 3 of 106 adult patients with community-acquired septicemic infections caused by other organisms, giving a test specificity of 97% (95% CI, 92 to 99%). For 45 pneumococcal bacteremia patients with a positive test on treatment day 1, urinary antigen excretion was monitored for the first week of antibiotic treatment. Antigen was still detectable in 83% (29 of 35 tested; 95% CI, 66 to 93%) on treatment day 3. Detection of urinary antigen is a valuable, sensitive, and rapid test for the early diagnosis of bacteremic pneumococcal infections in adult patients, even after antibiotic treatment has commenced.     

Chlamydia trachomatis in subfertile women undergoing uterine instrumentation. Screen or treat?

Women who undergo uterine instrumentation are considered at risk for pelvic infections by Chlamydia trachomatis, which may derive either from ascending endocervical infections or from reactivation of micro-organisms persisting in the genital tract after previous chlamydia infections. Women presenting at fertility clinics frequently undergo uterine instrumentation (e.g. hysterosalpingography and laparoscopy with hydrotubation). Studies in subfertile women using DNA amplification techniques have shown that the prevalence of endocervical chlamydia infections is low (1.8%). In contrast, in 30-60% of subfertile women chlamydia IgG antibodies can be found in serum, indicating previous chlamydia infections. It has been demonstrated that, several years after chlamydia infections, viable micro-organisms may still be present in the upper genital tract. Therefore, subfertile women with chlamydia antibodies should be considered at risk for reactivation of persistent chlamydia infections after uterine instrumentation, even after exclusion of endocervical chlamydia infections. Moreover, in subfertile women without chlamydia antibodies, the presence of viable micro-organisms in the genital tract cannot be excluded. As a consequence, prophylactic antibiotics before uterine instrumentation should be considered in all subfertile women, instead of endocervical screening for C. trachomatis and treatment of positive cases only.     

Clinical, pathologic and epidemiologic features of infection with Scedosporium prolificans: four cases and review

Objective: To describe the features of infection with Scedosporium prolificans and to investigate the possibility of a common source of infection.
Methods: S.prolificans caused invasive infections in four patients at Liverpool Hospital from 1994 to 1997, prompting a pathologic and epidemiologic investigation. Blood cultures were processed by either the BACTEC NR660 or VITAL systems. MIC testing was performed with Etest strips. Strain differentiation of isolates from three of the patients and two soil samples from the home of one of the patients was performed by allozyme electrophoresis.
Results: The four cases represented disseminated infections that arose during prolonged neutropenia, and progressed relentlessly despite treatment, including in one case high-dose liposomal amphotericin B. In two cases, VITAL blood culture bottles contained mycelia of S. prolificans without the reader having signaled. An autopsy was performed in three of the cases. Angio-invasion, tissue necrosis and multiple abscesses were found in each patient. Multiple air samples from the ward were negative for S. prolificans . The organism was grown from two samples of pot plant soil from the home of one patient. Allozyme electrophoresis performed on isolates from three cases and pot plant soil indicated that all strains were unrelated. Furthermore, two patients appeared to harbor at least two different strains of S. prolificans .
Conclusions: S. prolificans causes disseminated infection in neutropenic patients. Antifungal treatment, including high-dose liposomal amphotericin B, is ineffective in overcoming these infections. Genetic techniques discriminated all strains and suggested that an outbreak had not occurred. Multiple strains of S. prolificans were isolated from two patients, indicating the possibility of mixed infections occurring.     

医院内真菌感染的病原种类和耐药性分析

目的研究某教学医院侵袭性真菌感染的发病率、耐药性和病原分布特点,为临床医师合理用药提供科学依据。方法回顾分析2008-2010年住院患者真菌培养的检出率、标本来源、菌种分布及其对常见抗真菌药物的耐药性。结果医院内侵袭性真菌感染近3年的检出率19.32%,2008-2010年真菌检出率呈逐年上升的趋势,2008与2009年、2009与2010年差异有统计学意义（χ2=7.61、69.33,P〈0.05）;感染部位以呼吸道最多,其次为泌尿道;检出的真菌种类以假丝酵母菌属为主,约占99.78%,且白色假丝酵母菌居多,占49.04%。白假丝酵母菌和热带假丝酵母菌对三唑类药物敏感性仍较好,光滑假丝酵母菌及其他两种真菌则对三唑类药物耐药率较高,所有菌株对两性霉素B均较敏感。结论白色假丝酵母菌仍是医院内侵袭性真菌感染的主要病原菌,临床应根据药物敏感试验结果合理使用抗生素,防止侵袭性真菌的发生,延缓其耐药性的进一步发展。     

Rapidly growing non-tuberculous mycobacteria infection of prosthetic knee joints: A report of two cases

Non-tuberculous mycobacteria (NTM) cause prosthetic knee joint infections in rare cases. Infections with rapidly growing non-tuberculous mycobacteria (RGNTM) are difficult to treat due to their aggressive clinical behavior and resistance to antibiotics. Infections of a prosthetic knee joint by RGNTM have rarely been reported. A standard of treatment has not yet been established because of the rarity of the condition.In previous reports, diagnoses of RGNTM infections in prosthetic knee joints took a long time to reach because the condition was not suspected, due to its rarity. In addition, it is difficult to identify RGNTM in the lab because special identification tests are needed. In previous reports, after treatment for RGNTM prosthetic infections, knee prostheses could not be re-implanted in all cases but one, resulting in arthrodesis or resection arthroplasty; this was most likely due to the aggressiveness of these organisms. In the present report, two cases of prosthetic knee joint infection caused by RGNTM (Mycobacterium abscessus) are described that were successfully treated, and in which prosthetic joints were finally reimplanted in two-stage revision surgery.     

Selective IgG subclass deficiencies in patients with recurrent sinopulmonary infections: report of two cases

Two patients with recurrent sinopulmonary infections and normal total serum immunoglobulin levels were found to have selective deficiencies in IgG subclasses. The serum of one patient contained abnormally low IgG2 and IgG4; and the other was deficient in IgG4. Both patients responded to the treatment with high dose intravenous immunoglobulin. The experiences on these two cases strongly suggest that IgG subclasses should be checked in patients with recurrent sinopulmonary infections in face of normal total immunoglobulins.     

近年病原微生物实验室获得性感染病例分析及其控制策略的初步研究

目的分析研究2000--2009年文献报道的引起全球病原微生物实验室获得性感染病例的病原微生物种类、感染途径、发生原因并初步探讨病原微生物实验室获得性感染预防控制策略。方法选择PubMed、Embase、Biosis以及涵盖SCIE、SSCI、CPCI-S和CPCI—SSH的WebofScience作为数据源,以Laboratory—acquired（associated）infections为检索词,检索2000—2009年发表的有关实验室获得性感染文献后,对获取信息和数据进行整理、分析、研究。结果近10年来引起实验室获得性感染病例的病原微生物有19种,其中细菌15种,占78．9％;病毒4种,占21．1％。报道病例83例,其中细菌性病例60例,占72．3％;病毒性病例23例,占27．7％。感染途径以摄人和吸人性感染为主,分别占32．5％和31．3％,感染主要原因为意外事故,占47．O％。结论近年来,病原微生物实验室获得性感染病例仍时有发生,感染的主要原因为意外事故,暴露出实验室工作人员安全意识和规范操作方面的缺陷。实验室工作人员注重安全意识,遵守安全操作规程,仍是预防控制实验室获得性感染发生的关键。     

Chronic urticaria: assessment of current treatment

Chronic urticaria is heterogenous, long-persisting and has a severe impact on quality of life and daily work. Effective treatment is essential but remains a confounding problem. This review summarizes available treatment strategies for chronic urticaria and their strength of evidence. Besides treatment of identified triggering factors such as chronic persistent bacterial infections (e.g., with Helicobacter pylori, streptococci, staphylococci or yersinia), standard treatment consists of nonsedating H1-antihistamines. Most patients require increasing (off-label) dosages that should be taken daily and regularly, however, this still fails in a third of cases. Reliable alternatives in the world literature are rare and the level of evidence is low. Certain subgroups may display benefit from additional treatment with cyclosporine A, cysteinyl leukotriene receptor antagonists, chloroquine, dapsone or other alternatives. A practicable step-wise treatment approach is given to optimize and individualize the treatment of patients with chronic urticaria.     

Mycology in the Philippines, revisited.

The warm tropical climate of the Philippines and its interaction with cultural practices, occupation and immune responsiveness contribute to the increased susceptibility of Filipinos to fungal infections. An investigation to determine the prevalence of fungal infections in dermatology training institutions over a 4-year period was conducted. The results showed that fungal infections rank as the second leading cause of consultation with a prevalence of 12.98%. Pityriasis versicolor (25.34%), tinea corporis (22.63%), tinea cruris (16.7%) and tinea pedis (16.38%) were the most frequently encountered cases. Fungal culture yield is low and Candida sp. is the most common isolate, obtained predominantly from specimens taken from the oral mucosa and nails. Candidiasis is still the most common opportunistic infection followed by coccidioidomycosis, cryptococcosis and aspergillosis. Imidazoles are the most commonly prescribed systemic and topical treatment by Filipino dermatologists. Initial data collected would serve as reference for future research and may be used to compare with epidemiologic data obtained from other Asian countries.     

Infections caused by carbapenem-resistant Klebsiella pneumoniae among patients in intensive care units in Greece: a multi-centre study on clinical outcome and therapeutic options

Infections due to carbapenem-resistant Klebsiella pneumoniae (CR-KP) have emerged as a public health problem worldwide given their spread dynamics and the limited therapeutic options. Our aim was to study the clinical outcome of patients with CR-KP infections in relation to antimicrobial treatment. CR-KP infections that occurred in a 10-month period (September 2009 to June 2010) in patients admitted to 19 intensive care units all over Greece were studied. A total of 127 CR-KP infections were reported. Central venous catheter bacteraemia was the most frequent infection, followed by ventilator-associated pneumonia (39 (30.7%) and 35 (27.6%) cases, respectively). Resistance to colistin, tigecycline, gentamicin and amikacin was detected in 20%, 33%, 21% and 64% of isolates, respectively. Regarding treatment, 107 cases received active treatment, including 1 or ≥2 active antibiotics in 65 (60.7%) and 42 (39.3%) cases, respectively. The most frequent combination was colistin plus aminoglycoside and tigecycline plus aminoglycoside (17 and 11 cases, respectively). Forty-eight (45.2%) of the cases that received active treatment were considered clinical failures, with 23.5% mortality at 14 days. Logistic regression analysis revealed that age ≤55 years, non-immunocompromised patients and patients who received colistin had higher successful response rates, while patients ≤55 years old had lower mortality rates at 14 days after the introduction of active treatment. CR-KP infections are associated with a significant clinical failure rate. Colistin remains a valuable antimicrobial agent for treating these infections, while the rise of resistance to the last available antibiotics further limits treatment options.     

Prophylaxis and treatment for invasive fungal infections in solid organ transplant recipients]

Solid organ transplantation is becoming increasingly common in Japan. Despite invasive fungal infections being less common than bacterial and viral infections, fungal infections still result in a higher mortality rate. Empiric and pre-emptive therapy plays an important role in management of invasive fungal infections, because successful treatment is difficult after a definite diagnosis of an invasive disease, especially invasive aspergillosis. Given this situation, to improve outcome, high risk patients need to be identified and antifungal prophylaxis is mandatory in preventing the development of the disease. However, antifungal prophylaxis for solid organ transplant recipients remains controversial. New antifungal agents might change the choice of fungal prevention and treatment.     

Results of bacteriophage treatment of suppurative bacterial infections. VI. Analysis of treatment of suppurative staphylococcal infections

Analysis of phage therapy results was carried out on 273 cases of spontaneous and postoperative septic staphylococcal infections. The treatment appeared effective in 254 (93.0%) cases. Detailed analysis of the results obtained in particular disease categories revealed that staphylococcal bacteriophages may be efficiently applied in the treatment of suppurative staphylococcal infections resistant to antibiotics.