Central skull base osteomyelitis: a rare but life-threatening disease.

We present the case of a 70-year-old non-diabetic patient who presented to the emergency department with unrelenting otalgia. A severe otitis externa (OE) and mastoiditis were treated with broad spectrum antibiotics and surgical drainage. No bacteria was isolated from surgical samples. Because the otalgia persisted, a magnetic resonance (MR) was performed and showed an infiltrating process at the skull base. Biopsies failed to prove malignancy or granulomatosis. The patient's neurological state deteriorated. The suspicion of a skull base osteomyelitis (SBO) was raised and proven by CT-guided biopsies that grew Pseudomonas aeruginosa. Meropenem and ciprofloxacin, given for 8 weeks, lead to a fast clinical improvement and a full recovery. SBO is uncommon, often complicating severe OE. Pseudomonas aeruginosa is the main pathogen. Prompt diagnosis and adequate antibiotherapy are required to lower mortality and morbidity. The diagnosis may be delayed because of unawareness and large differential diagnosis including solid neoplasic tumours, malignant hemopathies and granulomatosis.

About three cases of ulceroglandular tularemia, is this the re-emergence of Francisella tularensis in Belgium?

Tularemia is a zoonosis caused by Francisella tularensis that can be transmitted by several ways to human being and cause different clinical manifestations. We report three clinical cases of tularemia with ulceroglandular presentation in young males acquired during outdoor activities in Southern Belgium. Confirmation of the diagnosis was established by serology. Only three cases of tularemia have been reported in Belgium between 1950 and 2012 by the National Reference Laboratory CODA-CERVA (Ref Lab CODA-CERVA) but re-emergence of tularemia is established in several European countries and F. tularensis is also well known to be present in animal reservoirs and vectors in Belgium. The diagnosis of tularemia has to be considered in case of suggestive clinical presentation associated with epidemiological risk factors.

Evaluation of the appropriateness of intravenous amoxicillin/clavulanate prescription in a teaching hospital.

BACKGROUND: Despite the implementation of strategies aiming at improving antimicrobial utilisation, inappropriate use remains an increasing problem with important consequences on both antibiotic resistance and hospital costs. OBJECTIVE: To evaluate the appropriateness of prescribing the intravenous amoxicillin/clavulanate combination (Augmentin). METHODS: Prospective observational five-week study in a Belgian teaching hospital. Patients receiving prophylactic or therapeutic intravenous amoxicillin/clavulanate were enrolled. Data were collected by a pharmacist and the appropriateness of antibiotic treatment was analysed in collaboration with an infectious disease specialist according to local recommendations. The primary outcome measure was the appropriateness of indication, dosage, intravenous to oral switch and duration of therapy. RESULTS: One hundred and six patients were evaluated. The most common indications for amoxicillin/clavulanate prescriptions were: respiratory tract infections (38%), surgical/interventional prophylaxis (28%) and intra-abdominal infections (11%). Overall, 43% of intravenous amoxicillin/clavulanate prescriptions were fully appropriate. Indication for use was appropriate in 87% and dosage in 74% of cases. In contrast, the timing of intravenous to oral switch and duration of therapy were inappropriate in 64% and 53% of cases, respectively. CONCLUSIONS: This study identified two main areas for improving amoxicillin/clavulanate prescribing: (1) the intravenous to oral switch, which is often too late or nonexistent and (2) the duration of therapy, which is too long particularly in respiratory tract infections. The results have been presented to clinicians and specific interventions for optimisation are being discussed and implemented.

Clinical, virological and epidemiological assessment of 2009 influenza A (H1N1) pandemic in a Belgian university hospital.

BACKGROUND: Recommendations were applied before and during the Belgian pandemic (2009) H1N1 influenza wave at a university hospital (420 beds), for optimizing isolation processes and therapeutic management of possible and confirmed infected cases. METHODS: All patients presenting to the Emergency Department (ED) between August 1st and December 31st 2009 were screened for ILI symptoms, and were isolated for clinical assessment in case of positive screening. Patients categorized as possible influenza cases and who required hospitalization were isolated in dedicated wards. Specific diagnostic algorithms were implemented. Medical charts were retrospectively reviewed and matched with results of the microbiology laboratory. Patient's characteristics were analyzed, the contribution of laboratory diagnosis on therapy and lengh of stay (LOS) in isolation was also assessed. RESULTS: 310 patients out of 6068 had a positive screening for ILI, of these, 265 were retained as possible influenza cases and 139 required hospitalization. Twenty-eight children (8 requiring hospitalization) and 20 hospitalized adult patients had confirmed influenza infection. Five adult patients were admitted to the intensive care unit (ICU), 3 requiring extracorporeal membrane oxygenation (ECMO). There was no death related to the new influenza strain. The majority of confirmed patients were diagnosed during the Belgian epidemic wave, with a sensitivity of antigen detection of 50% in children and 35% in adults comparatively to real-time PCR (RT-PCR). CONCLUSIONS: The impact of (2009) H1N1 pandemic influenza remained limited, except for ICU patients requiring ECMO. Implementation of screening, isolation, and virological diagnosis processes led to significant improvement of patient management.

Campylobacter fetus cellulitis in an immunocompromised patient: case report and review of the literature.

Campylobacter fetus is an opportunist Gram-negative bacillus. The most frequent clinical manifestation is bacteriemia but it can also be responsable for soft tissue infections, endovascular infections, meningitis, peritonitis and thrombophlebitis. Campylobacter fetus cellulitis has been described, but rarely identified in subcutaneous puncture samples. We report a case of an immunocompromised patient with Campylobacter fetus bacteriemia associated with a soft tissue infection whose subcutaneous puncture also revealed the bacteria.

Infected abdominal aortic aneurysm treated by in situ replacement with cryopreserved arterial homograft.

Infected abdominal aortic aneurysms are uncommon but not rare (1-3% of all abdominal aortic aneurysms). This life-threatening disease can lead to rapid uncontrolled sepsis and/or aortic rupture. We report one case that underlines two notions. Firstly computed tomography is effective to detect early stages of the pathology providing complete depiction of the anatomical abnormalities. Secondly infected aortic aneurysm can be successfully treated by antibiotherapy and in situ replacement with cryopreserved arterial homograft.