Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) bacteraemia: a series of 12 cases at Prince Sultan Military Medical City KSA.

The aim of this study was to describe the epidemiological data, clinical features and outcome of patients with Elizabethkingia meningoseptica bacteraemia and to report the antimicrobial susceptibility pattern. All patients with E. meningoseptica bacteraemia were retrospectively recruited at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia, between June 2013 and May 2019. Epidemiological data, clinical features and patient outcome, as well as antimicrobial susceptibilities of E. meningoseptica, were collected from patient electronic medical records. Twelve patients (eight male and four female) with E. meningoseptica bacteraemia were included in the study. Eleven patients acquired the infection from the hospital, five of whom were in the intensive care unit. All patients had one or more underlying medical conditions or interventions, including chronic illness (eight cases), major surgery (three cases), pulmonary fibrosis (one case), sickle-cell anaemia (one case) and end-stage renal disease (one patient on haemodialysis). Eleven patients had a prolonged stay in the hospital (≥3 months), and nine patients had received prolonged antibiotic therapy. Three patients had polymicrobial bacteraemia, including Serratia marcescens (two cases) and Enterococcus faecalis (one case). All E. meningoseptica isolates were susceptible to trimethoprim/sulfamethoxazole, piperacillin/tazobactam and moxifloxacin but showed a high degree of resistance to ß-lactam antibiotics, aminoglycosides and carbapenems. These findings have important implications for the clinician selecting optimal antimicrobial regimens for patients with risk factors for E. meningoseptica infection.

Outcome of mucormycosis after treatment: report of five cases.

Mucormycoses are serious infections caused by filamentous fungi of the order Mucorales. They occur most often in immunocompromised patients. We report five cases of mucormycosis in patients hospitalized in the Infectious Diseases Department in Sousse - Tunisia between 2000 and 2013. They were 4 males and one female, mean age 60 years. Three patients were diabetic and one patient had acute leukemia. The locations of mucormycosis were rhinocerebral, rhino-orbital, auricular, pulmonary and cutaneous. The Mucorales isolated were Rhizopus arrhizus in 3 cases and Lichteimia in 2 cases. All patients were treated with amphotericin B and 2 patients had, in addition, surgical debridement. Two patients died and 2 kept peripheral facial paralysis.

Eosinophilic fasciitis and toxic thyroid adenoma--a novel association.

Eosinophilic fasciitis is characterized by skin induration, peripheral blood eosinophilia, hypergammaglobulinaemia and thickening, fibrosis and inflammatory cell infiltration of the fascia. There have been several reports of illness particularly haematological disorders in patients with eosinophilic fasciitis. However, their association with thyroid disorders has rarely been described and includes autoimmune thyroiditis rather than toxic thyroid adenoma. We describe a case of a 53-year-old woman with simultaneous association of eosinophilic fasciitis and subclinical hyperthyroidism caused by toxic thyroid adenoma. Corticosteroids, antithyroid drugs and radioiodine therapy were started, with a good follow-up

[Chemotherapy-induced febrile neutropenia: about 200 episodes. Clinical, microbiological and therapeutic characteristics]. / Les neutropénies fébriles chimio-induites : à propos de 200 épisodes. Profil clinique, microbiologique et thérapeutique.

Cytotoxic chemotherapy suppresses the haematopoietic system, febrile neutropenia is the most serious haematological toxicity associated with the risk of life-threatening infections. We present a retrospective study of 200 episodes of febrile neutropenia in 128 patients treated in department of medical oncology. The aim of this study was to determinate the clinical, therapeutic and evolutive characteristics in patients treated essentially for solid tumors. Among these patients, 72% of them have at least two episodes, the median age was 34 years with extremes six and 75 years. It has been noticed that 26.3% of patients have diabetes, the dominate neoplasm was solid tumors in 79.7%, 65% of patients have received preventive colony-stimulating factors, 83% have received preventive buccal disinfection with antifungic. The median duration of hospitalisation was 12 days, the median delay of febrile neutropenia was 10 days with extremes two and 31 days, median duration of febrile neutropenia was 5.45 days with extremes one and 24 days. Among these cases, 9.45% of them have nadir zero, 68% of patients have clinical documented infections, ORL in 47% of cases. According to the study, 12% of cases have documented microbiological fever, the sites was urinary in 33% of cases, blood in 33% of cases, derm in 30% of cases. The microbe was staphylococcus negative coagulase in 37.5% essentially in blood and derm, the Escherichia coli in 20.8% essentially in urinary and blood. First line antibiotherapy was cefotaxim associated with amikacine in 93.5%, second line antibiotherapy was association of imipenam and amikacine in 82% of cases. Among these cases,7% of them have received anti-staphylococcus, and antifungic treatment in 50% of cases. The thermic defervescence was obtained in median delay of 2.8 days. We have noted nine deaths (22% of cases). Recent surveys indicate that neutropenia remains a prevalent problem associated with substantial morbidity, mortality and costs. The colony-stimulating have used effectively in a variety of clinical settings to prevent or treat febrile neutropenia and to assist patients receiving dose-intensive chemotherapy.

[Abdominal actinomycosis: four cases]. / Actinomycose abdominale: à propos de quatre cas.

The abdominal actinomycosis (AA) is a rare and often unrecognised suppurative chronic illness. It is caused by an anaerobic Gram positive bacteria, Actinomyces israelii. Abdominal actinomycosis is responsible for pseudotumoral syndrome often leading, to a large and mutilating surgery whereas a prolonged treatment by antibiotics would have permitted to cure the disease. The diagnosis is obtained generally from anatomopathologic exam. We report four cases of abdominal actinomycosis being revealed by a pseudotumoral syndrome. The diagnosis was only made after surgery. In spite of an active treatment by antibiotics during several months, two of our patients had a relapse of the infectious process. These four observations confirm the diagnostic and therapeutic difficulties previously reported by other authors.

Regression of skin lesions of Kyrle's disease with metronidazole in a diabetic patient.

We describe here in a case of a 41-year-old man, with diabetes mellitus, who presented manifestations of Kyrle's disease. Administration of metronidazole, 500 mg twice daily for 1 month, resulted in complete regression of skin lesions with no recurrence during 12 months of follow-up. This successful antibiotic treatment is to support the role of infectious agents (anaerobic bacteria) in the pathogenesis of Kyrle's disease.

Pott's puffy tumor. A case report.

Pott's puffy tumor is an infrequent entity characterized by a subperiosteal abscess associated with frontal bone osteomyelitis. It is usually seen as a complication of frontal sinusitis. This common condition is usually not diagnosed initially and is easily confused with neoplasms, skin and soft-tissue infection, and infected haematoma. Although Pott's puffy tumor is more commonly described in children, it should also be included in the differential diagnosis of swelling on the forehead in adults. This report describes the case of a 25-year-old man with Pott's puffy tumor resulting from frontal sinusitis, complicated by frontal brain abscess, and a subdural empyema. It was successfully treated with abscess drainage and prolonged use of antibiotics. To the best of our knowledge, only 13 cases of Pott's puffy tumor have been previously reported in adults. Particularities of this disease are reported here.