ABSTRACT
Histoplasmosis is an endemic fungal infection caused by the dimorphic fungus, Histoplasma capsulatum, which is treated with intravenous amphotericin B and oral itraconazole as first-line and second-line therapy. We report a case of a man in his early 70s treated with methotrexate and infliximab for rheumatoid arthritis who developed disseminated histoplasmosis. The patient was unable to absorb itraconazole due to intractable diarrhoea and developed a severe, anaphylactoid reaction or an immune reconstitution inflammatory syndrome when treated with liposomal amphotericin B. He was subsequently treated with isavuconazole and steroids and made a full recovery.A literature review revealed other cases of histoplasmosis which were treated with isavuconazole including both primary pulmonary and disseminated presentations. Cases of blastomycosis which were treated with isavuconazole are also reviewed including those with severe immunocompromised statuses including solid-organ transplant and tumour necrosis factor-alpha antagonist recipients. Our report describes the potential role of isavuconazole in cases of histoplasmosis where first-line and second-line therapies have failed or are contraindicated (excluding meningitis).
Subject(s)
Histoplasmosis , Male , Humans , Histoplasmosis/diagnosis , Histoplasmosis/drug therapy , Itraconazole , Triazoles/therapeutic use , Nitriles/therapeutic useABSTRACT
The in vitro activity of 13 antimicrobials against clinical isolates of Gemella morbillorum showed good susceptibility to clindamycin, all beta-lactams agents studied except cefoxitin (MIC90, 4 µg/ml) and fluoroquinolones. There was 36% metronidazole resistance.
Subject(s)
Anti-Infective Agents , Gemella , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/pharmacology , Clindamycin , beta-LactamsABSTRACT
Bulleidia extructa is a rarely recognized anaerobic Gram-positive bacterium with an oral and gastroenterological ecological niche. It is difficult to isolate due to slow growth in culture and usually requires identification techniques such as 16S rRNA gene sequencing or matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). While most often isolated from infections related to the oral cavity (gingivitis, periodontitis, brain and lung abscess), it has also been recovered from cases of prosthetic joint hip infections after unprophylaxed dental procedures.
Subject(s)
Bacteria, Anaerobic/genetics , Firmicutes/genetics , Gram-Positive Bacteria/genetics , Mouth/microbiology , Prostheses and Implants/adverse effects , Prostheses and Implants/microbiology , Stomatognathic Diseases/microbiology , Humans , RNA, Ribosomal, 16S , Sequence Analysis, DNAABSTRACT
Necrotizing soft tissue infections occur after traumatic injuries, minor skin lesions, nonpenetrating injuries, natural childbirth, and in postsurgical and immunocompromised patients. Infections can be severe, rapidly progressive, and life threatening. Survivors often endure multiple surgeries and prolonged hospitalization and rehabilitation. Despite subtle nuances that may distinguish one entity from another, clinical approaches to diagnosis and treatment are highly similar. This review describes the clinical and laboratory features of necrotizing soft tissue infections and addresses recommended diagnostic and treatment modalities. It discusses the impact of delays in surgical debridement, antibiotic use, and resuscitation on mortality, and summarizes key pathogenic mechanisms.
Subject(s)
Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/therapy , Soft Tissue Infections/diagnosis , Soft Tissue Infections/therapy , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Clostridium/isolation & purification , Coinfection/microbiology , Combined Modality Therapy , Debridement/methods , Fasciitis, Necrotizing/microbiology , Female , Gas Gangrene/diagnosis , Gas Gangrene/therapy , Hospitalization , Humans , Magnetic Resonance Imaging/methods , Male , Soft Tissue Infections/microbiology , Streptococcal Infections/diagnosis , Streptococcal Infections/therapy , Streptococcus pyogenes/isolation & purification , Tomography, X-Ray Computed/methodsABSTRACT
The objective of this study was to determine the pharmacodynamic (PD) activity of moxifloxacin against four selected Bacteroides fragilis strains (three strains with low MICs and one strain with a high MIC) and two Escherichia coli strains (one strain with a low MIC and one strain with a high MIC) in a pharmacokinetic (PK) in vitro model in pure cultures as well as in mixed cultures. PK/PD assays of moxifloxacin were carried out with an initial maximum concentration of 4.0 mg l-1 and a half-life of 13 h. The E. coli strain with the low MIC was rapidly killed in both pure and mixed cultures in the in vitro PK/PD model, while the E. coli strain with the high MIC was not killed. None of the B. fragilis strains were rapidly killed in pure or mixed cultures. The bacterial numbers of the B. fragilis strains with low MICs were reduced by about one to two logs after 12 h in pure cultures. The presence of an E. coli strain with a low or a high MIC in the mixed culture reduced this effect even further.
