Subject(s)
Anti-Bacterial Agents/administration & dosage , Cephalosporins/administration & dosage , Daptomycin/administration & dosage , Endocarditis/drug therapy , Heart Defects, Congenital/drug therapy , Heart Valve Diseases/drug therapy , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/drug therapy , Aged , Aortic Valve/microbiology , Bicuspid Aortic Valve Disease , Endocarditis/microbiology , Heart Defects, Congenital/microbiology , Heart Valve Diseases/microbiology , Humans , Male , Microbial Sensitivity Tests , Microbial Viability/drug effects , Staphylococcal Infections/microbiology , Treatment Outcome , CeftarolineABSTRACT
Legionnaire's disease (LD) manifests most commonly as an atypical community acquired pneumonia (CAP) with systemic extrapulmonary manifestations. Disorders associated with impaired cell mediated immunity (CMI) are particularly predisposed to LD. Hairy cell leukemia (HCL) is a rare B-cell lymphoproliferative leukemia associated with decreased CMI. LD has only rarely been reported in HCL. We present a most interesting case of persistent LD in a elderly male with HCL who required prolonged antibiotic therapy.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Legionnaires' Disease/complications , Leukemia, Hairy Cell/drug therapy , Levofloxacin/therapeutic use , Aged , Chronic Disease , Community-Acquired Infections/complications , Community-Acquired Infections/drug therapy , Humans , Leukemia, Hairy Cell/complications , Male , Pneumonia, Bacterial/complications , Pneumonia, Bacterial/drug therapy , Treatment OutcomeABSTRACT
For chronic bacterial prostatitis, there are few oral antibiotics available that are active against common uropathogens and are able to penetrate the non-inflamed prostate at therapeutic concentrations. Oral options to treat chronic prostatitis due to Gram-negative bacillary multidrug-resistant organisms are even more limited. We report a case of persistent extended-spectrum ß-lactamase (ESBL)-positive Escherichia coli chronic prostatitis refractory to antibiotic therapy. Prolonged courses of fosfomycin failed to eradicate the infection. Re-treatment with high-dose fosfomycin again failed to clear the infection. After repeated courses of fosfomycin, the ESBL-positive E. coli remained susceptible to fosfomycin. Transrectal ultrasound revealed prostatic calcifications that were thought to be the reason for antibiotic failure. Following transurethral resection of the prostate (TURP) to remove the prostatic calcifications, the prostatic calcifications remained and the infection persisted. Although the patient's ESBL-positive E. coli was resistant to doxycycline, he was treated with a combination of fosfomycin plus doxycycline. Treatment with fosfomycin and doxycycline rapidly cured his chronic prostatitis.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Doxycycline/administration & dosage , Escherichia coli Infections/drug therapy , Escherichia coli/isolation & purification , Fosfomycin/administration & dosage , Prostatitis/drug therapy , Drug Therapy, Combination/methods , Escherichia coli/enzymology , Escherichia coli Infections/microbiology , Humans , Male , Middle Aged , Prostatitis/microbiology , Treatment Outcome , beta-Lactamases/metabolismSubject(s)
Anti-Infective Agents, Urinary/adverse effects , Delirium/etiology , Neurotoxicity Syndromes/diagnosis , Thienamycins/adverse effects , Aged, 80 and over , Anti-Infective Agents, Urinary/therapeutic use , Diagnosis, Differential , Humans , Male , Meropenem , Neurotoxicity Syndromes/physiopathology , Thienamycins/therapeutic use , Treatment Outcome , Urinary Tract Infections/drug therapy , Urinary Tract Infections/urineSubject(s)
Endocarditis, Bacterial/microbiology , Heart Valve Prosthesis/microbiology , Q Fever/diagnosis , Anti-Bacterial Agents/therapeutic use , Doxycycline/therapeutic use , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/pathology , Female , Humans , Middle Aged , Q Fever/drug therapyABSTRACT
Diagnostic efforts are usually centered on malaria in febrile travelers returning from the tropics. However, by focusing on malaria other important diagnostic considerations are easily overlooked. Patients returning from malarial areas are also exposed to other tropical diseases which have features in common with malaria, e.g., typhoid fever, dengue fever, chikungunya fever. However, there are a few key findings that clinically differentiate these infections from malaria. We present a case of a traveler with fever returning from India without localizing signs with persistent monocytosis initially thought to have malaria.