Probiotic intake unmasking a gastro-pleural fistula.

OBJECTIVE: Gastropleural fistula represents a rare clinical event often resulting in an iatrogenic complication of gastrointestinal surgery. Clinical presentation is insidious, patients complain of chronic and non-specific respiratory symptoms and may be conservatively treated for lung infections for several months until detailed tests finally reveal the correct diagnosis. PATIENTS AND METHODS: We describe a case of a healthy patient with an unexpected diagnosis of empyema due to a gastropleural fistula. RESULTS: A 51-year-old man with a past history of splenectomy for cyst was admitted because of high fever and cough. A chest radiography and CT-scan revealed a left-side pneumonia complicated with pleural empyema. Broad spectrum empirical antibiotics and pleural drainage did not significantly improve the clinical picture. While the need for a surgical complex thoracic approach becomes a collective awareness, questions about causes of empyema and its unfavorable evolution in our patient did not initially find a common satisfactory answer. It was only by the identification of probiotics bacteria in the pleural fluid that a gastropleural fistula was suspected, and then, it was confirmed by CT-scan and by digestive endoscopy. A combined thoraco-abdominal surgical treatment was therefore scheduled, leading to progressive improvement till total healing. CONCLUSIONS: Although gastropleural fistula is rare, it is necessary to include this pathological condition in the differential diagnosis of a persistent complicated pneumonia, because early diagnosis and, consequently, surgical management, may significantly impact on the prognosis of these patients. In our case, the detection of probiotics bacteria in the pleural fluid helped us to suspect and to look for the fistula.

Invasive Trichosporon infection in solid organ transplant patients: a report of two cases identified using IGS1 ribosomal DNA sequencing and a review of the literature.

Trichosporon species are rare etiologic agents of invasive fungal infection in solid organ transplant (SOT) recipients. We report 2 well-documented cases of Trichosporon inkin invasive infection in SOT patients. We also conducted a detailed literature review of Trichosporon species infections in this susceptible population. We gathered a total of 13 cases of Trichosporon species infections. Any type of organ transplantation can be complicated by Trichosporon infection. Bloodstream infections and disseminated infections were the most common clinical presentations. Liver recipients with bloodstream or disseminated infections had poor prognoses. Although the most common species was formerly called Trichosporon beigelii, this species name should no longer be used because of the changes in the taxonomy of this genus resulting from the advent of molecular approaches, which were also used to identify the strains isolated from our patients. Antifungal susceptibility testing highlights the possibility of multidrug resistance. Indeed, Trichosporon has to be considered in cases of breakthrough infection or treatment failure under echinocandins or amphotericin therapy. Voriconazole seems to be the best treatment option.

Enterococcus cecorum empyema thoracis successfully treated with cefotaxime.

We report the first case of Enterococcus cecorum empyema thoracis and spontaneous bacterial peritonitis in a 44-year-old man with underlying cirrhosis. The patient responded to cefotaxime (MIC, 0.25 microg/ml) treatment and drainage of the empyema. Susceptibility of E. cecorum to expanded-spectrum cephalosporins could be due to its production of types of penicillin-binding proteins similar to those produced by Streptococcus species rather than to those produced by Enterococcus species (as predicted by phylogenetic analysis of the 16S rRNA gene sequences).

Use of imipenem in the treatment of pulmonary nocardiosis.

A case of pulmonary nocardiosis with empyema in a 55-year-old man with macroglobulinemic lymphoma is presented. Treatment with imipenem followed by oral trimethoprim-sulfamethoxazole (TMP-SMX) resolved his symptoms and cleared the roentgenographic abnormalities. This case illustrates the clinical potential of imipenem against Nocardia.

Respiratory infections: established therapy and its limitations.

Factors influencing the selection of an antibiotic include the findings of susceptibility tests, the relative ability of various agents to reach the site of infection, and the difficulties of treating resistant microorganisms. After a brief review of these factors and the characteristics of piperacillin, established therapies for acute bronchitis, chronic bronchitis, bacterial pneumonias, pleurisy and empyema, bronchiectasis, lung abscess, and cystic fibrosis are outlined. New therapies for various lower respiratory tract infections, aspiration or decubitus pneumonia, and infections in patients with cystic fibrosis, and in immunocompromised patients are discussed, as are the advantages and disadvantages of aerosol administration or endotracheal instillation of antibiotics.

[Mezlocillin in the antibiotic therapy of severe bacterial infections in visceral surgery]. / Mezlocillin in der antibiotischen Therapie schwerer bakterieller Infektionen in der Viszeralchirurgie.

Fifty-six patients suffering from severe and very severe bacterial infections received additional antibacterial treatment with mezlocillin following abdominal or chest surgery. There were 18 intestinal-peritoneal infections, 15 pleuropulmonary infections, seven patients with sepsis, six localized abscesses and ten patients receiving perioperative application. In 36 patients treatment had to be initiated before the pathogens had been identified. Twenty patients received mezlocillin alone and 37 in combination with an aminoglycoside. The clinical course and laboratory data were recorded while the patients were receiving antibiotic therapy. In 43 of the 56 patients, most of whom were suffering from mixed infections caused by anaerobes and aerobes or from fecal infections, a cure without complications could be achieved. In six patients a generalized infection was reduced to a local one which could be cured. Eight patients died, six of their surgical primary disease and two of septic complications. Apart from four instances of phlebitis at the site of the infusion, no side-effects resulted from our antibiotic therapy.