Unusual accumulation of a wide array of antimicrobial resistance mechanisms in a patient with cytomegalovirus-associated hemophagocytic lymphohistiocytosis: a case report.

BACKGROUND: Infections with multidrug-resistant organisms (MDRO) pose a serious threat to patients with dysregulated immunity such as in hemophagocytic lymphohistiocytosis (HLH), but such infections have rarely been comprehensively characterized. Here, we present a fatal case of HLH secondary to cytomegalovirus (CMV) infection complicated by both anti-viral drug resistance and sepsis from multiple MDROs including pandrug-resistant superbug bacteria. CASE PRESENTATION: A previously healthy, six-year-old boy presented with a 45-day history of fever prior to a diagnosis of hemophagocytic lymphohistiocytosis and hemorrhagic colitis, both associated with CMV. On hospital admission, the patient was found to be colonized with multiple, multidrug-resistant (MDR) bacteria including vancomycin-resistant enterococci (VRE) and carbapenamase-producing organisms (CPO). He eventually developed respiratory, urine and bloodstream infections with highly drug-resistant, including pandrug-resistant bacteria, which could not be controlled by antibiotic treatment. Antiviral therapy also failed to contain his CMV infection and the patient succumbed to overwhelming bacterial and viral infection. Whole genome sequencing (WGS) of the MDR bacteria and metagenomic analysis of his blood sample revealed an unusual accumulation of a wide range of antimicrobial resistance mechanisms in a single patient, including antiviral resistance to ganciclovir, and resistance mechanisms to all currently available antibiotics. CONCLUSIONS: The case highlights both the risk of acquiring MDR superbugs and the severity of these infections in HLH patients.

Epidemiology of neonatal meningitis in Qatar.

OBJECTIVE: Neonatal meningitis is responsible for thousands of neonatal deaths annually all over the world. Our study was conducted to determine the epidemiology, management and best preventive measures for neonatal meningitis in Qatar. METHODS: A retrospective study reviewed the records of bacterial meningitis patients under the age of one month. The study was carried out at Hamad Medical Hospital, the only hospital that provides health care at Qatar and the study period was between January 1998 to December 2000. RESULTS: Thirteen patients were included. Sixty percent of patients had early onset meningitis. Causative organisms were group B Streptococcus pneumoniae, Klebsiella pneumonia, Pseudomonas species, Neisseria meningitidis, Staphylococcus epidermidis and Flavibacterium meningococcus septicum. A bacterial resistance to the usual combination of ampicillin and gentamicin were noticed (as initial treatment before culture sensitivity results), which affected negatively on some patients. Complications of cerebral palsy, mental retardation and epilepsy occurred in 3 patients (23%). None of the patients died during the study period. CONCLUSION: Emphasis is placed on the importance of correct early diagnosis and appropriate antibiotic therapy. It is suggested that the identification and appropriate treatment of any maternal bacterial infection is an important measure in preventing neonatal sepsis and meningitis.

Clinical presentation of acute bacterial meningitis in Qatar.

OBJECTIVE: To study the changes in the epidemiology of bacterial meningitis in the era of the Hemophilus influenzae (H. influenzae) type b vaccine and pneumoccous resistance. METHODS: Retrospective study which included patients admitted to Hamad Medical Corporation, Doha, Qatar between January 1998 through to December 2000 with positive cerebrospinal fluid culture. RESULTS: Thirty-seven patients with culture proven bacterial meningitis were described. Streptococcus pneumoniae (S. pneumoniae) and H. influenzae were the most common organisms, accounting for 30% and 24% of cases. Fever, neck stiffness, vomiting, and bulging fontanel were the most frequent presenting features. Fifty four percent of S. pneumoniae isolates were resistant to penicillin, and 22% of H. influenzae were resistant to ampicillin, but both were sensitive to ceftriaxone. No cases of Listeria monocytogenes meningitis were diagnosed. Morbidity was 32%, and mortality 5%. Poor outcome was associated with altered mental status on admission. CONCLUSION: Bacterial meningitis is a serious illness in our community with significant morbidity and mortality. Streptococcus pneumoniae and H. influenzae are the most frequent pathogens causing meningitis in our community. As there is no bacterial resistance (S. pneumoniae and H. influenzae) reported against ceftrixone, we recommend ceftriaxone alone as empiric therapy for patients with no comorbid conditions presenting with community acquired bacterial meningitis. A continuous surveillance for changes in the microbiology of organisms causing bacterial meningitis or their sensitivity in our community is essential to update these recommendations.

Epidemiology of neonatal meningitis in Qatar.

OBJECTIVE: Neonatal meningitis is responsible for thousands of neonatal deaths annually all over the world. Our study was conducted to determine the epidemiology, management and best preventive measures for neonatal meningitis in Qatar. METHODS: A retrospective study reviewed the records of bacterial meningitis patients under the age of one month. The study was carried out at Hamad Medical Hospital, the only hospital that provides health care at Qatar and the study period was between January 1998 to December 2000. RESULTS: Thirteen patients were included. Sixty percent of patients had early onset meningitis. Causative organisms were group B Streptococcus pneumoniae, Klebsiella pneumonia, Pseudomonas species, Neisseria meningitidis, Staphylococcus epidermidis and Flavibacterium meningococcus septicum. A bacterial resistance to the usual combination of ampicillin and gentamicin were noticed (as initial treatment before culture sensitivity results), which affected negatively on some patients. Complications of cerebral palsy, mental retardation and epilepsy occurred in 3 patients (23%). None of the patients died during the study period. CONCLUSION: Emphasis is placed on the importance of correct early diagnosis and appropriate antibiotic therapy. It is suggested that the identification and appropriate treatment of any maternal bacterial infection is an important measure in preventing neonatal sepsis and meningitis.