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1.
BMC Infect Dis ; 19(1): 991, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752720

RESUMO

BACKGROUND: Male urethritis is primary sexually transmitted. Northern Territory (NT) has the highest rates of gonococcal infection in Australia and local guidelines recommend empiric treatment with azithromycin and ceftriaxone for all men presenting with urethritis. As gonococcal drug resistance is a growing concern, this study aims to improve empiric use of ceftriaxone through examining local patterns of male urethritis, comparing cases of gonococcal urethritis (GU) to controls with non-gonococcal urethritis (NGU). METHODS: A retrospective study was undertaken of all men with symptomatic urethritis presenting to Darwin sexual health clinic from July 2015 to July 2016 and aetiology of urethritis in this population was described. Demographic, risk profile, and clinical features of GU cases were compared to NGU controls. RESULTS: Among n = 145 men, the most common organisms identified were Chlamydia trachomatis (23.4%, SE 3.5%) and Neisseria gonorrhoeae (17.2%, SE 3.1%). The main predictors of GU were any abnormalities on genital examination (aOR 10.4, 95% CI 2.1 to 50.8) and a history of urethral discharge (aOR 5.7, 95% CI 1.4 to 22.6). Aboriginal patients (aOR 3.0, 95% CI 0.9 to 9.6) and those over 30 years of age (aOR 1.4, 95% CI 0.3 to 7.0) were more likely to have GU in the unadjusted analysis, but not in the adjusted model. CONCLUSION: This is the first study looking at patterns of male urethritis in urban NT and the results support a move towards adopting national guidelines to use ceftriaxone for empiric management of syndromic urethritis only in high-risk patients. In addition to traditional demographic risk factors, clinical features remain an important component of risk stratification.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Uretrite/epidemiologia , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Azitromicina/uso terapêutico , Estudos de Casos e Controles , Ceftriaxona/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/efeitos dos fármacos , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Gonorreia/tratamento farmacológico , Gonorreia/microbiologia , Humanos , Masculino , Neisseria gonorrhoeae/efeitos dos fármacos , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Northern Territory/epidemiologia , Estudos Retrospectivos , Uretrite/diagnóstico , Uretrite/tratamento farmacológico , Uretrite/microbiologia
2.
BMC Infect Dis ; 19(1): 927, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684875

RESUMO

BACKGROUND: Capnocytophaga canimorsus is a gram-negative bacterium and an oral commensal in dogs and cats, but occasionally causes serious infections in humans. Septicemia is one of the most fulminant forms, but diagnosis of C. canimorsus infection is often difficult mainly because of its very slow growth. C. canimorsus infective endocarditis (IE) is rare and is poorly understood. Since quite a few strains produce ß-lactamase, antimicrobial susceptibility is pivotal information for adequate treatment. We herein report a case with C. canimorsus IE and the results of drug susceptibility test. CASE PRESENTATION: A 46-year-old man had a dog bite in his left hand 3 months previously. The patient was referred to our hospital for fever (body temperature > 38 °C), visual disturbance, and dyspnea. Echocardiography showed aortic valve regurgitation and vegetation on the leaflets. IE was diagnosed, and we initially administered cefazolin and gentamycin assuming frequently encountered microorganisms and the patient underwent aortic valve replacement. C. canimorsus was detected in the aortic valve lesion and blood cultures. It was also identified by 16S ribosome DNA sequencing. Ceftriaxone were started and continued because disk diffusion test revealed the isolate was negative for ß-lactamase and this case had cerebral symptoms. The patient successfully completed antibiotic treatment following surgery. CONCLUSIONS: We diagnosed C. canimorsus sepsis and IE by extended-period blood cultures and 16S ribosome DNA sequencing by polymerase chain reaction, and successfully identified its drug susceptibility.


Assuntos
Mordeduras e Picadas/complicações , Capnocytophaga/patogenicidade , Endocardite Bacteriana/etiologia , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/terapia , Animais , Antibacterianos/uso terapêutico , Hemocultura , Capnocytophaga/genética , Cefazolina/uso terapêutico , Ceftriaxona/uso terapêutico , Cães , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/terapia , Gentamicinas/uso terapêutico , Infecções por Bactérias Gram-Negativas/microbiologia , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase/métodos , Sepse/tratamento farmacológico , beta-Lactamases
3.
BMC Infect Dis ; 19(1): 891, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651255

RESUMO

BACKGROUND: Enterococcus hirae is rarely identified in humans and may be a commensal pathogen in psittacine birds. We present the fifth known case of E. hirae endocarditis. CASE PRESENTATION: A 64-year-old Caucasian female presented with fever, hypotension, atrial fibrillation with rapid ventricular response, and a two-week history of lightheadedness. Her previous medical history included COPD, recurrent DVT, atrial fibrillation (on warfarin), hypertension, hypothyroidism, and Hodgkin's lymphoma. Physical exam was notable for expiratory wheezes and a 2/6 systolic ejection murmur at the right sternal border. 2D echocardiogram revealed severe aortic stenosis. The patient underwent right and left heart catheterization, where she was found to have severe aortic stenosis and mild pulmonary hypertension. She subsequently underwent minimally invasive aortic valve replacement with a bovine pericardial valve, bilateral atrial cryoablation, and clipping of the left atrial appendage. Her aortic valve was found to have a bicuspid, thickened appearance with calcifications, multiple small vegetations, and a root abscess beneath the right coronary cusp. With a new suspicion of infective endocarditis, the patient was placed on broad-spectrum IV antibiotics. Intra-operative blood cultures were negative. A tissue culture from the aortic valve vegetations identified Enterococcus hirae susceptible to ampicillin through MALDI-TOF. Antibiotic treatment was then switched to IV ampicillin and ceftriaxone; she declined aminoglycoside treatment due to toxicity concerns. The patient had an uncomplicated postoperative course and was discharged with 6 weeks of antibiotics. To date, she continues to be followed with no signs of relapsing disease. CONCLUSIONS: To our knowledge, this case constitutes the fifth known case of E. hirae endocarditis, and the second case to have been identified with MALDI-TOF and treated with ampicillin and ceftriaxone. This case reinforces the efficacy of ampicillin and ceftriaxone for the treatment of E. hirae endocarditis.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/terapia , Streptococcus faecium ATCC 9790/patogenicidade , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Doenças das Valvas Cardíacas/microbiologia , Aminoglicosídeos/uso terapêutico , Ampicilina/uso terapêutico , Animais , Bovinos , Ceftriaxona/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/etiologia , Streptococcus faecium ATCC 9790/efeitos dos fármacos , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/microbiologia , Doenças das Valvas Cardíacas/terapia , Próteses Valvulares Cardíacas , Humanos , Pessoa de Meia-Idade , Substituição da Valva Aórtica Transcateter
6.
BMC Infect Dis ; 19(1): 796, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31510926

RESUMO

BACKGROUND: The number of new rickettsial species are rapidly increasing, and increasing numbers of Rickettsia raoultii (R. raoultii) infection cases have been detected in humans. However, neurological abnormalities caused by R. raoultii are rarely reported, especially in northwestern China. CASE PRESENTATION: A 36-year-old Kazakh shepherd with an attached tick on part temporalis, presented with right eyelid droop, lethargy, fever, headache, fever (38.0-41.0 °C) and erythematous rash. The examination of cerebrospinal fluid (CSF) showed cerebrospinal pressure of 200 mm H2O, leukocyte count of 300.0 × 106/L, adenosine deaminase of 2.15 U/L, and total protein concentration of 0.93 g/L. The diagnosis of R. raoultii infection was confirmed by six genetic markers, and semi-quantified by enzyme-linked immunosorbent assay for rickettsial antigen. The patient gradually recovered after treatment with doxycycline and ceftriaxone. R. raoultii DNA was found both in a tick detached from this patient and in 0.18% (2/1107) of blood samples collected from local shepherds. CONCLUSIONS: This is the first reported case with neurological abnormalities caused by R. raoultii in northwestern China. It is vital to detect rickettsial agents both in blood and CSF for tick bite patients with neurological abnormalities. Public health workers and physicians should pay attention to neurological abnormalities caused by Rickettsia.


Assuntos
Doenças do Sistema Nervoso/diagnóstico , Infecções por Rickettsia/diagnóstico , Rickettsia/metabolismo , Picadas de Carrapatos/diagnóstico , Adenosina Desaminase/líquido cefalorraquidiano , Adulto , Animais , Antígenos de Bactérias/análise , Antígenos de Bactérias/imunologia , Ceftriaxona/uso terapêutico , China , DNA Bacteriano/sangue , Doxiciclina/uso terapêutico , Humanos , Contagem de Leucócitos , Masculino , Doenças do Sistema Nervoso/etiologia , Filogenia , RNA Ribossômico 16S/metabolismo , Rickettsia/classificação , Rickettsia/genética , Infecções por Rickettsia/complicações , Infecções por Rickettsia/tratamento farmacológico , Picadas de Carrapatos/complicações , Carrapatos/genética
7.
BMJ Case Rep ; 12(8)2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31399414

RESUMO

Streptococcus agalactiae (group B streptococcus or GBS) is the most common cause of bacterial meningitis in infants, but is rarely the cause in adults. Across all non-pregnant adults it comprises 7% of bacterial meningitis cases, with a mortality rate of 56% in the elderly. Therefore, while rare, GBS should be a part of a patient's differential when initiating antibiotics in adults with chronic illnesses. We report a 78-year-old diabetic female admitted to the hospital with suspected meningitis. Lumbar puncture revealed grossly purulent cerebrospinal fluid (CSF) and she was started on antibiotics for empiric treatment of expected Streptococcus pneumoniae Thirty-one hours post-sampling, the CSF culture results returned positive for beta haemolytic GBS and treatment was altered accordingly. The case was complicated by concomitant periodic lateralising epileptiform discharges which were treated simultaneously. After 14 days of hospitalisation, the patient was discharged to a skilled nursing facility for further recovery.


Assuntos
Meningites Bacterianas/diagnóstico , Infecções Estreptocócicas/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Ceftriaxona/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Eletroencefalografia , Feminino , Humanos , Levetiracetam/uso terapêutico , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/tratamento farmacológico , Convulsões/complicações , Convulsões/tratamento farmacológico , Infecções Estreptocócicas/líquido cefalorraquidiano , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus agalactiae/isolamento & purificação
8.
Indian J Med Microbiol ; 37(1): 120-122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424023

RESUMO

Primary amoebic meningoencephalitis is rare but fatal disease encountered in immunocompetent individuals. Here, we present a case of a previously healthy 8-month-old female child, who presented with features of meningoencephalitis of 2 days' duration. Rapidly moving trophozoites of amoeba were observed in cerebrospinal fluid, which were confirmed to be Naegleria fowleri on polymerase chain reaction. Broad-spectrum antimicrobial therapy with ceftriaxone, vancomycin, amphotericin B and acyclovir was initiated. However, the patient deteriorated and left the hospital against medical advice. The isolation of N. fowleri in this case demands for increased awareness for prompt diagnosis and management in view of its high mortality.


Assuntos
Amebíase/diagnóstico , Amebicidas/uso terapêutico , Infecções Protozoárias do Sistema Nervoso Central/diagnóstico , Meningoencefalite/parasitologia , Naegleria fowleri/isolamento & purificação , Aciclovir/uso terapêutico , Amebíase/tratamento farmacológico , Anfotericina B/uso terapêutico , Ceftriaxona/uso terapêutico , Infecções Protozoárias do Sistema Nervoso Central/tratamento farmacológico , Infecções Protozoárias do Sistema Nervoso Central/parasitologia , Líquido Cefalorraquidiano/parasitologia , Feminino , Humanos , Lactente , Meningoencefalite/diagnóstico , Meningoencefalite/tratamento farmacológico , Naegleria fowleri/genética , Trofozoítos/isolamento & purificação , Vancomicina/uso terapêutico
9.
Zhonghua Er Ke Za Zhi ; 57(8): 592-596, 2019 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-31352743

RESUMO

Objective: To investigate the clinical characteristics of invasive Haemophilus influenzae (HI) infection in children. Methods: The clinical manifestations, laboratory examinations and treatment outcomes of 84 children with HI infection confirmed by bacterial culture in 7 tertiary children's hospitals from 2014 to 2018 were analyzed retrospectively. Results: Among the 84 cases, 50 were males. The age was 1.54 years (ranged from 5 days to 13 years).Twenty cases (24%) had underlying diseases and 48 cases (57%) had not received antibiotics before collecting specimens. Eighty-two cases (98%) had fever and 75 cases (89%) had clear infection foci, among which 31 cases (37%) had meningitis and 27 cases (32%) had pneumonia. Blood culture was positive in 62 cases (74%), cerebrospinal fluid culture was positive in 10 cases (12%), blood culture and cerebrospinal fluid culture were both positive in 11 cases (13%). Antibiotics susceptibility test showed that 27% (22/82) of all HI strains produced ß-lactamases and 48% (37/77) strains were resistant to ampicillin. The drug resistance rates to cefuroxime, ampicillin-sulbactam, trimethoprim-sulfamethoxazole and azithromycin were 25% (20/80) , 20% (9/45) , 71% (44/62) and 19%(11/58), respectively. All strains were sensitive to meropenem, levofloxacin and ceftriaxone. After sensitive antibiotic therapy, 83% (70/84) of all patients were cured and improved, the mortality rate and loss of follow-up rate were 13% (11/84) and 4% (3/84) respectively. Conclusions: Meningitis and pneumonia are common presentation of invasive HI infections in children. Mortality in HI meningitis children is high and the third generation of cephalosporins, such as ceftriaxone can be used as the first choice for the treatment of invasive HI infection.


Assuntos
Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/tratamento farmacológico , Haemophilus influenzae/isolamento & purificação , Adolescente , Cefalosporinas/farmacologia , Cefalosporinas/uso terapêutico , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Infecções por Haemophilus/epidemiologia , Haemophilus influenzae/efeitos dos fármacos , Humanos , Lactente , Masculino , Meningite/epidemiologia , Testes de Sensibilidade Microbiana , Pneumonia/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , beta-Lactamases/metabolismo
11.
BMJ Case Rep ; 12(7)2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31345833

RESUMO

We describe an unusual case of a 58-year-old man with type 2 diabetes mellitus (T2DM) developing sepsis secondary to a prevertebral neck abscess. Following cross-sectional imaging, the patient underwent surgical drainage. Salmonella sandiego was isolated from urine, blood and pus cultures. Salmonella species neck infections represent a rare cause of focal salmonellosis, though have been reported in the literature. This is the first reported case of S. sandiego causing neck abscess. The case highlights an atypical presentation of salmonellosis, with the surprising finding of a neck abscess on cross-sectional imaging without evidence of co-existing significant discitis or osteomyelitis.


Assuntos
Abscesso/microbiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Pescoço/microbiologia , Infecções por Salmonella/diagnóstico , Salmonella enterica/isolamento & purificação , Sepse/diagnóstico , Abscesso/terapia , Ceftriaxona/uso terapêutico , Ciprofloxacino/uso terapêutico , Drenagem , Humanos , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Infecções por Salmonella/tratamento farmacológico , Sepse/complicações , Sepse/terapia , Resultado do Tratamento
12.
Cir Cir ; 87(4): 410-415, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264979

RESUMO

Objective: To assess compliance of antibiotic prophylaxis in surgery for acute appendicitis in children and its effect on surgical site infection. Methods: We carried out a prospective cohort study to evaluate compliance of antibiotic prophylaxis in appendectomies in children. An assessment of the level of compliance with prophylaxis was made, as well as the causes of non-compliance. The effect of non-compliance of antibiotic prophylaxis on the incidence of surgical site infection was studied with the adjusted relative risk (RR) with a backstep logistic regression model. Results: The study included a total of 412 patients. Antibiotic prophylaxis was indicated in 348 patients, and administered in 95.7% of cases, with an overall protocol compliance of 90.7%. The principal cause of non-compliance was time of initiation. Cumulative incidence of surgical site infection was 2.7%. No relationship was found between inadequate prophylaxis compliance and infection (RR: 1.01; 95% confidence interval: 0.95-1.11; p = 0.61). Conclusions: Compliance of antibiotic prophylaxis was high, but could be improved. No relationship was found between prophylaxis compliance and surgical site infection rate.


Assuntos
Antibioticoprofilaxia , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Fidelidade a Diretrizes/estatística & dados numéricos , Infecção da Ferida Cirúrgica/prevenção & controle , Doença Aguda , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Ampicilina/uso terapêutico , Antibioticoprofilaxia/estatística & dados numéricos , Cefazolina/uso terapêutico , Ceftriaxona/uso terapêutico , Criança , Pré-Escolar , Intervalos de Confiança , Esquema de Medicação , Feminino , Gentamicinas/uso terapêutico , Humanos , Incidência , Modelos Logísticos , Masculino , Adesão à Medicação/estatística & dados numéricos , Metronidazol/uso terapêutico , Estudos Prospectivos , Infecção da Ferida Cirúrgica/epidemiologia
13.
Am J Health Syst Pharm ; 76(11): 804-809, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31361811

RESUMO

PURPOSE: There are limited data on the effect of ceftriaxone on methotrexate clearance, with results of some studies indicating altered methotrexate pharmacokinetics with the administration of ceftriaxone. We describe 2 possible cases demonstrating an interaction between methotrexate and ceftriaxone, resulting in profound neutropenia. SUMMARY: The decision to continue methotrexate therapy in the setting of surgery or during treatment of an active infection continues to be a topic of debate due to perceived negative effects on the healing process. Methotrexate is typically administered at a lower dose for inflammatory arthritis than for hematologic indications, thus having less immunosuppression potential. However, if methotrexate is continued during treatment of infection, drug interactions along with effects on the healing process should be considered. Ceftriaxone is commonly considered safe for long-term therapy due to its favorable adverse effect and drug interaction profile. Ceftriaxone is partially eliminated via organic anion transporters in the kidneys, leading to potential competition with methotrexate clearance in the renal tubules. Clinicians using these drugs concurrently should be aware of the potential for development of neutropenia and monitor patients receiving this combination closely. CONCLUSION: Two patients receiving ceftriaxone therapy in the setting of a joint infection developed profound neutropenia after resuming oral methotrexate therapy for inflammatory arthritis.


Assuntos
Artrite Infecciosa/tratamento farmacológico , Artrite Psoriásica/tratamento farmacológico , Ceftriaxona/farmacologia , Metotrexato/farmacologia , Neutropenia/induzido quimicamente , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Artrite Infecciosa/imunologia , Artrite Infecciosa/microbiologia , Artrite Psoriásica/imunologia , Ceftriaxona/uso terapêutico , Relação Dose-Resposta a Droga , Interações de Medicamentos , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Humanos , Imunossupressores/farmacologia , Imunossupressores/uso terapêutico , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Propionibacterium acnes/isolamento & purificação , Staphylococcus aureus/isolamento & purificação
14.
BMJ Case Rep ; 12(6)2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167768

RESUMO

We present a case of a 23-year-old man coming with palpitations, found to be in atrial fibrillation (AF). He was initially managed with metoprolol for rate-controlled therapy-reverted to normal sinus rhythm and discharged home. He returned a few days later-this time in varying degrees of atrioventricular block including transient complete heart block. He was empirically started on intravenous ceftriaxone for suspected Lyme carditis, which subsequently led to the resolution of high-degree heart block. Lyme immunoglobulin G (IgG) and IgM returned positive. Follow-up ECG after the course of antibiotic exhibited normal sinus rhythm. AF is a rare presentation of Lyme disease but still exists. It should be considered in terms of appropriate treatment, especially in Lyme-endemic areas.


Assuntos
Fibrilação Atrial/diagnóstico , Bloqueio Atrioventricular/diagnóstico , Doença de Lyme/diagnóstico , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Bloqueio Atrioventricular/tratamento farmacológico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Doença de Lyme/tratamento farmacológico , Doença de Lyme/imunologia , Masculino , Resultado do Tratamento , Adulto Jovem
15.
Int J Antimicrob Agents ; 54(2): 149-153, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31173864

RESUMO

Ceftriaxone is an empirical antibiotic commonly used to treat pneumonia. However, its use to treat infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) is controversial given limited evidence of its clinical efficacy. The objective of this study was to compare the clinical efficacy of ceftriaxone with either ceftaroline or ceftobiprole in the treatment of pneumonia caused by MSSA. A systematic review and meta-analysis of randomised controlled trials (RCTs) comparing clinical cure in patients with pneumonia who received ceftriaxone versus those who received either ceftaroline or ceftobiprole was conducted. Patients who received ceftriaxone plus vancomycin were excluded. The PubMed, Embase and Cochrane Library databases as well as clinical trial registries were searched up to 8 June 2018. Risk differences (RDs) with 95% confidence intervals (CIs) were estimated using a random-effects model and assessing for heterogeneity (I2). A total of five RCTs met the inclusion criteria; four used ceftaroline and one used ceftobiprole. Four studies included adults and one included paediatric patients. The adult studies included non-intensive care unit patients with mild-to-moderate community-acquired pneumonia. Clinical cure was statistically lower with ceftriaxone (RD, -28.5%, 95% CI -53.5% to -3.4%; P = 0.026; I2 = 16.321%) than with ceftaroline or ceftobiprole. In conclusion, ceftriaxone use was associated with higher clinical failure of MSSA pneumonia compared with ceftaroline or ceftobiprole. This supports the notion that ceftriaxone is not an ideal agent for the treatment of MSSA infections and adds new evidence against its use for MSSA pneumonia.


Assuntos
Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Cefalosporinas/uso terapêutico , Pneumonia Estafilocócica/tratamento farmacológico , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Staphylococcus aureus/efeitos dos fármacos , Resultado do Tratamento , Adulto Jovem
16.
Folia Med Cracov ; 59(1): 5-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31180072

RESUMO

Lyme disease is an emerging problem in Poland. Analysis has been undertaken of the medical documentation of 86 patients hospitalized in the Infectious Diseases Department, University Hospital in Cracow in 2013-2016, suspected of Lyme arthritis. It has especially considered medical history including potential exposure to the infection, detailed characteristics of the symptoms, diagnostic challenges and results of the treatment. Only some patients had a history of erythema migrans and not all of them recalled tick-bite. The majority of the patients had affected large joints, especially knee joints, and polyarthritis was rarely observed. Symptoms were resolved completely or partially after antibiotic treatment in most patients. The diagnosis of Lyme arthritis in areas endemic for Lyme disease is still a diagnostic challenge in patients with other rheumatic diseases, including osteoarthritis.


Assuntos
Artrite Infecciosa/tratamento farmacológico , Eritema Migrans Crônico/tratamento farmacológico , Doença de Lyme/tratamento farmacológico , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/fisiopatologia , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Eritema Migrans Crônico/diagnóstico , Eritema Migrans Crônico/etiologia , Feminino , Articulações do Pé , Articulação da Mão , Articulação do Quadril , Hospitalização , Hospitais Universitários , Humanos , Articulação do Joelho , Doença de Lyme/complicações , Doença de Lyme/diagnóstico , Doença de Lyme/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Polônia , Articulação do Ombro , Picadas de Carrapatos , Resultado do Tratamento
17.
Rev Soc Bras Med Trop ; 52: e20190009, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31188917

RESUMO

Murine typhus is a flea-borne disease caused by Rickettsia typhi, which was first detected in Mexico in 1927. It was not until 1996 that the first systematized study involving this pathogen was conducted in two coastal states of Mexico. We now report the first confirmed case of murine typhus in the state of Campeche, which occurred in a male patient who exhibited fever, thrombocytopenia, hyperbilirubinemia, and a rash. Furthermore, the patient reported having had previous contact with Rickettsia reservoirs.


Assuntos
Tifo Endêmico Transmitido por Pulgas/diagnóstico , Adulto , Ceftriaxona/uso terapêutico , Doxiciclina/uso terapêutico , Exantema , Febre , Humanos , Masculino , México , Reação em Cadeia da Polimerase , Rickettsia typhi , Trombocitopenia , Tifo Endêmico Transmitido por Pulgas/sangue , Tifo Endêmico Transmitido por Pulgas/tratamento farmacológico
20.
BMJ Case Rep ; 12(4)2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036741

RESUMO

The incidence of Lyme disease in the USA is 8 per 100 000 cases and 95% of those occur in the Northeastern region. Cardiac involvement occurs in only 1% of untreated patients. We describe the case of a 46-year-old man who presented with chest pressure, dyspnoea, palpitations and syncope. He presented initially with atrial fibrillation with rapid ventricular response, a rare manifestation of Lyme carditis. In another hospital presentation, he had varying degrees of atrioventricular block including Mobitz I second-degree heart block. After appropriate antibiotic treatment, he made a full recovery and his ECG normalised. The authors aim to urge physicians treating patients in endemic areas to consider Lyme carditis in the workup for patients with atrial fibrillation and unexplained heart block, as the associated atrioventricular nodal complications may be fatal.


Assuntos
Fibrilação Atrial/etiologia , Bloqueio Atrioventricular/etiologia , Doença de Lyme/diagnóstico , Miocardite/diagnóstico , Administração Intravenosa , Antibacterianos/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Western Blotting/métodos , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Eletrocardiografia , Humanos , Doença de Lyme/complicações , Doença de Lyme/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Doenças Raras , Síncope/etiologia , Resultado do Tratamento
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