Empyema thoracic in a neonate co-infected with SARS-CoV-2 and staphylococcus arouse successfully treated with fibrinolysis: a brief report.

BACKGROUND: Empyema as a rare cause of respiratory distress in neonatal period has not yet been reported after Corona virus disease 2019 (COVID-19) and even rarely in the context of bacterial infections is age group. CASE PRESENTATION: The first neonate of quadruplets, resulting from Cesarean-Section of a 30-year-old mother without a history of previous illness, born at 34 weeks of gestation with a birth weight of 1600 gram. All four newborns were hospitalized; while the first one underwent nasal continuous positive airway pressure (N-CPAP) with a positive end-expiratory pressure of 6 and fractional inspired oxygen of 0.6, due to respiratory distress, noting a respiratory score of five out of 12.She was resuscitated one hour later due to bradycardia and underwent ventilator support. She received a single dose of pulmonary surfactant, intravenous paracetamol, and phenobarbital due to respiratory distress syndrome, Pectus Ductus Arteriosus, and unilateral clonic movements, respectively. In the lack of positive blood culture, she extubated two days later and breast-feeding was started. On day eight, she underwent high flow nasal cannula. On day 12, she suddenly developed respiratory distress, mottling, and abdominal distension, leading to N-CPAP and re-evaluation. The nasopharyngeal sampling for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) real time Polymerase chain reaction and the blood culture for staphylococcus aurous became positive. A large volume pleural effusion including septa and loculation in right hemi-thorax on chest computerized tomography scan and ultrasound was seen, necessitating to thoracotomy, which was not possible due to her general condition. Remdesivir was started and antibiotics changed to a more broad-spectrum coverage. Chest tube was inserted and Alteplase was injected for three consecutive days with beneficial effects. She had no problem for six-month follow up. CONCLUSION: This was a case of empyema thoracic in the context of SARS-CoV-2 and Staphylococcus arouses co-infection. In our experience, it can be treated by chest drainage and fibrinolysis in neonatal period.

[Rapidly fatal streptococcal toxic shock syndrome due to Streptococcus agalactiae in a patient with chronic myeloid leukemia and cirrhosis].

A 72-year-old woman with chronic myeloid leukemia (CML) and cirrhosis complicated with blood blisters on her right upper arm and ascites was admitted. She presented with shock vital on admission. Initial gram staining of blood cultures showed gram-positive cocci in chains, suggesting streptococcal toxic shock syndrome (STSS). Amputation of the right upper arm was performed owing to necrotizing fasciitis. Despite continued antibiotic therapy and systemic management, the blood blisters rapidly spread to the skin of the whole body, and she died 41 h after admission. Blood and fluid cultures from the blisters showed group B streptococci. Reports of patients with leukemia complicated with STSS are rare, and all cases have followed fatal courses. Particularly in this case, various risk factors, such as neutropenia due to tyrosine kinase inhibitor, neutrophil dysfunction due to cirrhosis, and elderly CML, overlapped. In the future, we believe that the lives of patients with leukemia complicated with STSS may be saved by establishing treatment methods and determining the detailed pathogenesis of STSS.

Microbiological monitoring of continuous positive airway pressure and resuscitation equipment in very-low birth weight infants.

BackgroundTo investigate the colonization of respiratory equipment and the rate of respiratory infections of very-low birth weight (VLBW) infants.MethodsThe prospective study includes 26 VLBW infants on continuous airway pressure (CPAP) from September until December 2012. Swabs from respiratory equipment and colonization/infections were evaluated.ResultsA total of 603 swabs was cultured with 298 isolates; 59% of cultures from CPAP equipment (n=337; 95% confidence interval (CI; 54;64)) and 19% from ambu bags (n=51; 95% CI (14;24)) were positive. Overall, 181/201 CPAP prongs and masks hosted 221 microorganisms. Colonization on days 3 and 7 were 93% and 87%, respectively, with an increase in pathogens and a decrease in skin flora (79% vs. 68%). Comparing the 58 paired swab results from days 3 and 7 showed an increase in Gram-negative bacteria (P=0.014). Eighteen infants had positive weekly screening results, with similar colonization of CPAP equipment, dominated by Enterobacteriacae. Pneumonia was diagnosed in two infants.ConclusionOf the CPAP equipment close to the patient, 90% was colonized with microorganisms increasing during 1 week of CPAP. The pathogens were dominated by gastrointestinal bacteria, and persisted over weeks. Frequent cleaning did not prevent pneumonia, although pneumonia rates were rare.

Agricultural anaerobic digestion power plants in Ireland and Germany: policy and practice.

The process of anaerobic digestion (AD) is valued as a carbon-neutral energy source, while simultaneously treating organic waste, making it safer for disposal or use as a fertilizer on agricultural land. The AD process in many European nations, such as Germany, has grown from use of small, localized digesters to the operation of large-scale treatment facilities, which contribute significantly to national renewable energy quotas. However, these large AD plants are costly to run and demand intensive farming of energy crops for feedstock. Current policy in Germany has transitioned to support funding for smaller digesters, while also limiting the use of energy crops. AD within Ireland, as a new technology, is affected by ambiguous governmental policies concerning waste and energy. A clear governmental strategy supporting on-site AD processing of agricultural waste will significantly reduce Ireland's carbon footprint, improve the safety and bioavailability of agricultural waste, and provide an indigenous renewable energy source. © 2016 Society of Chemical Industry.

A Case of IVIG-Induced Aseptic Chemical Meningitis.

Intravenous immunoglobulin (IVIG) is a commonly used and generally well-tolerated medication. Common side effects include flu-like symptoms such as fevers, headaches, myalgia, fatigue, and nausea. One of the more rare side effects is aseptic meningitis, with a reported incidence rate of around 0.067 percent of all IVIG infusions. In this paper, we describe a 47-year-old female patient with a history of myasthenia gravis who presented with a headache, neck pain, and neck stiffness while undergoing IVIG infusions for a myasthenia crisis. On admission day, the patient was afebrile with stable vital signs. A physical examination revealed nuchal rigidity and tenderness with no focal neurological deficits. Cerebrospinal fluid (CSF) cytology noted an elevated white blood cell (WBC) count of 1,138 cells/µL with a neutrophil predominance (96 percent). CSF red blood cell count was unremarkable at 1 cell/µL. The patient's IVIG infusions were stopped, suspecting chemical meningitis. Given the markedly elevated CSF WBC count with neutrophil predominance, she was started on vancomycin and ceftriaxone to also cover for bacterial meningitis. The patient's meningeal signs and symptoms significantly improved 24 hours after admission. Given the clear temporal relationship to IVIG administration and the rapid improvement of symptoms, IVIG-induced aseptic meningitis is strongly suspected. The patient's antibiotics were discontinued. Forty-eight hours after stopping IVIG and 24 hours after discontinuing antibiotics, her meningitis symptoms completely resolved with the use of analgesics alone. The patient was then discharged uneventfully. CSF viral and bacterial studies, including a gram stain and cultures, did not result in anything noteworthy. Our case presents an interesting diagnostic dilemma where drug-induced (IVIG) aseptic meningitis mimics bacterial meningitis clinically and on CSF analysis. The clear temporal relationship to IVIG administration and the rapid resolution of symptoms upon stopping the drug can aid in the diagnosis of this rare event and help doctors avoid the use of unnecessary antibiotic therapy.

High-throughput sequencing of cerebrospinal fluid for diagnosis of chronic Propionibacterium acnes meningitis in an allogeneic stem cell transplant recipient.

BACKGROUND: A 40-year-old man with chronic myelogenous leukemia presented multiple times over a period of 3 years with episodes of confusion, wide-based gait and falls because of recurrent hydrocephalus despite repeated therapeutic lumbar punctures. These problems occurred in the context of persistent cerebrospinal fluid (CSF) pleocytosis and leptomeningeal enhancement. Extensive diagnostic workups and therapeutic trials had failed to identify a clinically plausible cause or produce any significant improvement in the CSF and neuroimaging abnormalities. METHODS: We used high-throughput metagenomic shotgun sequencing to identify microbes in 2 CSF samples collected from the patient during his illness. These results were compared to sequence data from 1 CSF sample collected during treatment and 5 control CSF samples from other patients. RESULTS: We found sequences representing 53% and 67% of the Propionibacterium acnes genome in 2 CSF samples collected from the patient during his illness. Directed antimicrobial therapy was administered for 6 weeks with resolution of CSF and neuroimaging abnormalities. Sequencing of a sample obtained during treatment demonstrated that the P. acnes levels were decreased to background levels. After insertion of a ventriculo-peritoneal shunt, the patient returned to baseline status. CONCLUSIONS: High-throughput metagenomic shotgun sequencing revealed P. acnes as the cause of chronic meningitis that had eluded conventional attempts at diagnosis. Treatment directed at this organism resulted in cure of the infection and clinical improvement.

Gravity predominates over ventilatory pattern in the prevention of ventilator-associated pneumonia.

OBJECTIVE: In the semirecumbent position, gravity-dependent dissemination of pathogens has been implicated in the pathogenesis of ventilator-associated pneumonia. We compared the preventive effects of a ventilatory strategy, aimed at decreasing pulmonary aspiration and enhancing mucus clearance versus the Trendelenburg position. DESIGN: Prospective randomized animal study. SETTING: Animal research facility, University of Barcelona, Spain. SUBJECTS: Twenty-four Large White-Landrace pigs. INTERVENTIONS: Pigs were intubated and on mechanical ventilation for 72 hours. Following surgical preparation, pigs were randomized to be positioned: 1) in semirecumbent/prone position, ventilated with a duty cycle (TITTOT) of 0.33 and without positive end-expiratory pressure (control); 2) as in the control group, positive end-expiratory pressure of 5 cm H2O and TITTOT to achieve a mean expiratory-inspiratory flow bias of 10 L/min (treatment); 3) in Trendelenburg/prone position and ventilated as in the control group (Trendelenburg). Following randomization, Pseudomonas aeruginosa was instilled into the oropharynx. MEASUREMENTS AND MAIN RESULTS: Mucus clearance rate was measured through fluoroscopic tracking of tracheal markers. Microspheres were instilled into the subglottic trachea to assess pulmonary aspiration. Ventilator-associated pneumonia was confirmed by histological/microbiological studies. The mean expiratory-inspiratory flow in the treatment, control, and Trendelenburg groups were 10.7 ± 1.7, 1.8 ± 3.7 and 4.3 ± 2.8 L/min, respectively (p < 0.001). Mucus clearance rate was 11.3 ± 9.9 mm/min in the Trendelenburg group versus 0.1 ± 1.0 in the control and 0.2 ± 1.0 in the treatment groups (p = 0.002). In the control group, we recovered 1.35% ± 1.24% of the instilled microspheres per gram of tracheal secretions, whereas 0.22% ± 0.25% and 0.97% ± 1.44% were recovered in the treatment and Trendelenburg groups, respectively (p = 0.031). Ventilator-associated pneumonia developed in 66.67%, 85.71%, and 0% of the animals in the control, treatment, and Trendelenburg groups (p < 0.001). CONCLUSIONS: The Trendelenburg position predominates over expiratory flow bias and positive end-expiratory pressure in the prevention of gravity-dependent translocation of oropharyngeal pathogens and development of ventilator-associated pneumonia. These findings further substantiate the primary role of gravity in the pathogenesis of ventilator-associated pneumonia.

[Treatment approaches for bronchopulmonary infection in myasthenia gravis patients].

Nineteen patients with bronchopulmonary infection and myasthenia gravis were enrolled in the study. The microbiological analysis of the specimens of phlegm and bronchial secretion revealed both grampositive and gramnegative bacteria. All the isolates were susceptible to the antibiotic used (cefoperazone/sulbactam). Intravenous immunoglobulins (IvIgs) were used to increase the treatment efficacy, to opsonize the infection foci and to decrease the hospitalization terms. The antibiotic therapy and simultaneous use of intravenous immunoglobulins provided higher clinical efficacy in 16 out of 19 patients (84.2%).

Clostridium acetobutylicum

A species of gram-positive bacteria in the family Clostridiaceae, used for the industrial production of SOLVENTS.

Una especie de bacteria gram-positiva de la familia Clostridiaceae, usada para la producción industrial de SOLVENTES.

Espécie de bactéria Gram-positiva (família Clostridiaceae) utilizada na produção industrial de SOLVENTES.

Clostridium bifermentans

A species of gram-positive bacteria in the family Clostridiaceae that ferments both CARBOHYDRATES and AMINO ACIDS.

Una especie de bacteria gram-positiva de la familia Clostridiaceae que fermenta los CARBOHIDRATOS y AMINOÁCIDOS.

Espécie de bactéria Gram-positiva (família Clostridiaceae) que fermentam CARBOIDRATOS e AMINOÁCIDOS.

Clostridium sordellii

A species of gram-positive bacteria in the family Clostridiaceae, found in INTESTINES and SOIL.

Una especie de bacteria gram-positiva de la familia Clostridiaceae, encontrada en INTESTINOS y SUELO.

Espécie de bactéria Gram-positiva (família Clostridiaceae) encontrada nos INTESTINOS e SOLOS.

Clostridium tertium

A species of gram-positive bacteria in the family Clostridiaceae, causing BACTEREMIA in humans and ANIMALS.

Una especie de bacteria gram-positiva de la familia Clostridiaceae, que causa BACTERIEMIA en seres humanos y ANIMALES.

Espécie de bactéria Gram-positiva (família Clostridiaceae) causadora de BACTEREMIA em humanos e ANIMAIS.

Clostridium tetanomorphum

A species of gram-positive bacteria in the family Clostridiaceae. Its glutamate mutase is commonly used in research.

Una especie de bacteria gram-positiva de la familia Clostridiaceae. Su glutamato mutasa se utiliza comúnmente en la investigación.

Espécie de bactéria Gram-positiva (família Clostridiaceae). Sua glutamato mutase é frequentemente utilizado em pesquisas.

Streptococcus thermophilus

A species of thermophilic, gram-positive bacteria found in MILK and milk products.

Una especie de bacteria termofílica, gram-positiva que se encuentra en la LECHE y productos lácteos.

Espécie de bactéria Gram-positiva termofílica encontrada no LEITE e em produtos lácteos.

Clostridium butyricum

Type species of the genus CLOSTRIDIUM, a gram-positive bacteria in the family Clostridiaceae. It is used as a source of PROBIOTICS.

Tipo de especie del género CLOSTRIDIUM, bacteria gram-positiva de la familia Clostridiaceae. Se utiliza como fuente de PROBIOTICOS.

Bactéria representante do gênero CLOSTRIDIUM (família Clostridiaceae), Gram-positiva, utilizada como fonte de PROBIÓTICOS.

Clostridium cellulolyticum

A species of gram-positive bacteria in the family Clostridiaceae. It is a cellulolytic, mesophilic species isolated from decayed GRASS.

Una especie de bacteria gram-positiva de la familia Clostridiaceae. Es una especie celulolítica, mesofílica aislada de PASTO podrido.

Espécie de bactéria (família Clostridiaceae) Gram-positiva, celulolítica e mesofílica, isolada de GRAMA em decomposição.

Clostridium symbiosum

A species of gram-positive bacteria in the family Clostridiaceae. Its GLUTAMATE DEHYDROGENASE is commonly used in research.

Una especie de bacteria gram-positiva de la familia Clostridiaceae. Su GLUTAMATO DEHIDROGENASA se utiliza comúnmente en la investigación.

Espécie de bactéria (família Clostridiaceae) Gram-positiva, muito usada em pesquisa devido à GLUTAMATO DESIDROGENASE.

Butyrivibrio

A species of anaerobic bacteria, in the family Lachnospiraceae, found in RUMINANTS. It is considered both gram-positive and gram-negative.

Una especie de bacterias anaerobias, en la familia Lachnospiraceae, encontrada en RUMIANTES. Está considerada a la vez grampositiva y gramnegativa.

Espécie de bactérias anaeróbias da família Lachnospiraceae, encontrada em RUMINANTES. É considerada tanto Gram-positiva como Gram-negativa.

Staphylococcus hyicus

A species of gram-positive bacteria in the family STAPHYLOCOCCACEAE. It is an important opportunistic pathogen in swine.

Especie de bacteria grampositiva en la familia STAPHYLOCOCCACEAE. Es un importante patógeno oportunista en cerdos.

Espécie de bactéria Gram-positiva da família STAPHYLOCOCCACEAE. É um parasita oportunista importante em suínos.

Staphylococcus saprophyticus

A species of gram-positive bacteria in the family STAPHYLOCOCCACEAE. It commonly causes urinary tract infections in humans.

Especie de bacteria grampositiva en la familia STAPHYLOCOCCACEAE. Es causa común de infecciones en el tracto urinario en el hombre.

Espécie de bactéria Gram-positiva da família STAPHYLOCOCCACEAE. Comumente causa infecções do trato urinário em humanos.