A 56-Year-Old Woman with Chronic Hepatitis C Liver Disease and Meningitis due to Streptococcus equi subsp. Zooepidemicus.

Streptococcus equi subsp. zooepidemicus (S. equi subsp. zooepidemicus), which carries the Lancefield group C antigen, is an uncommon human pathogen. It is considered an opportunistic commensal of the equine upper respiratory tract and causes invasive infections in immunocompromised hosts, following close contact to infected horses. Meningitis caused by S. equi subsp. zooepidemicus is a rare infectious disease with high rates of complications. We present the case of a 56-year-old female with acutely altered mental status following three days of fever and vomiting. For several months, she was taking care of horses. The most relevant preexisting illnesses were chronic hepatitis C infection and traumatic paraplegia due to spinal cord injury 30 years ago. Laboratory evaluation on admission revealed leukocytosis, hyponatremia, and elevated C-reactive protein. Cerebral CT scan showed diffuse cerebral edema. Whereas cerebrospinal fluid real-time PCR assay for common pathogens was negative, cultures showed S. equi subsp. zooepidemicus. She recovered fully after intravenous administration of ceftriaxone for four weeks. This is one of only few reported cases of S. equi subsp. zooepidemicus meningitis and the first case in chronic hepatitis C infection. Our case supports the necessity for extended microbiological examination especially in immunocompromised patients if PCR examination for common pathogens is negative.

The accuracy of the oxygen washout technique for functional residual capacity assessment during spontaneous breathing.

BACKGROUND: Measurement of functional residual capacity (FRC) is of considerable interest for monitoring patients with lung injury. The lack of instruments has impeded routine bedside FRC measurement. Recently, a simple automated method for FRC assessment by O2 washout has been introduced. We designed this study to evaluate the accuracy of FRC measurement using the O2 washout technique. METHODS: The LUFU system (Draeger, Luebeck, Germany) estimates FRC by O2 washout, a variant of multiple breath nitrogen washout. This technique uses a sidestream O2-analyzer to calculate FRC from end-inspired and end-expired O2 concentrations during fast changes of Fio2. We measured FRC in 23 healthy, spontaneously breathing volunteers in the sitting position using three techniques: 1) helium dilution (FRC-He), 2) body plethysmography (FRC-bp), 3) oxygen washout (FRC-O2). RESULTS: FRC-O2 (mean 4.1 +/- 1.1 L, range 2.4-6.9 L) corresponds with FRC-He (mean 4.0 +/- 1.0 L, range 2.4-6.2 L; bias of FRC-O2: -0.2 +/- 0.4 L) and FRC-bp (mean 4.2 +/- 1.0 L, range 2.8-6.1 L; bias of FRC-O2: 0.1 +/- 0.6 L). CONCLUSIONS: The bias and precision of the O2 washout technique using the LUFU system were clinically acceptable when compared with FRC-He and FRC-bp for FRC assessment in spontaneously breathing volunteers.