Cases Of Septicemia Research Articles

Antibacterial mechanism of gold nanoparticles on Streptococcus pneumoniae.

Streptococcus pneumoniae is a causal agent of otitis media, pneumonia, meningitis and severe cases of septicemia. This human pathogen infects elderly people and children with a high mortality rate of approximately one million deaths per year worldwide. Antibiotic-resistance of S. pneumoniae strains is an increasingly serious health problem; therefore, new therapies capable of combating pneumococcal infections are indispensable. The application of gold nanoparticles has emerged as an option in the control of bacterial infections; however, the mechanism responsible for bacterial cell lysis remains unclear. Specifically, it has been observed that gold nanoparticles are capable of crossing different structures of the S. pneumoniae cells, reaching the cytosol where inclusion bodies of gold nanoparticles are noticed. In this work, a novel process for the separation of such inclusion bodies that allowed the analysis of the biomolecules such as carbohydrates, lipids and proteins associated with the gold nanoparticles was developed. Then, it was possible to separate and identify proteins associated with the gold nanoparticles, which were suggested as possible candidates that facilitate the interaction and entry of gold nanoparticles into S. pneumoniae cells.

Haematological Parameters in Early Diagnosis of Clinically Suspected Neonatal Septicemia

Neonatal septicemia is a life-threatening yet treatable condition. It is one of the major health problems throughout the world. Blood culture is the gold standard for diagnosis of neonatal septicemia and should be performed in all cases of suspected septicemia prior to starting antibiotics. But in the present study, the use of the haematological parameters was evaluated to determine the early diagnosis of neonatal septicemia. It was carried out in the neonatal unit of Mandalay Children’s Hospital from September 2012 to August 2013. Out of 68 cases of clinically suspected neonatal septicemia, bacterial pathogens were isolated from 33 cases. Early onset neonatal septicemia was more common than late onset. Among 33 cases of culture-proven neonatal septicemia, septicemia is not likely in 1 case (3%) while borderline for septicemia and septicemia in 6 cases (18.2%) is very likely in 26 cases (78.8%) according to haematological scoring system (HSS). HSS assigns a score of one for each of seven haematological parameters. Out of the seven haematological parameters, immature to total neutrophil ratio (I:T) and immature to mature neutrophil ratio (I:M) were the most reliable test for the neonatal septicemia. Thrombocytopenia had low sensitivity. The haematolgical parameters are simple, quick, cost effective and readily available. The sensitivity, specificity and the predictive values of haematological parameters could be enhanced by combination of these parameters rather than the use of single parameter.

Neonatal septicemia: Blood culture bacterial isolates and their antimicrobial susceptibility pattern

Abstract Introduction: Neonatal septicemia is defined as “a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first four weeks of life”. Blood culture is the gold standard method for diagnosis of septicemia. Isolation of organism in blood culture and its antimicrobial sensitivity pattern carries a great role. Aim: To provide prevalence and antimicrobial susceptibility pattern of bacteria isolated from suspected cases of neonatal septicemia at a tertiary care hospital, Valsad. Materials and Mathods: Retrospective study is conducted at a tertiary care hospital, Valsad from January 2017 to June 2018. Processing of blood culture samples, Isolation and identification of bacteria were done using standard microbiology techniques. Antimicrobial susceptibility testing was performed using modified Kirby-Bauer disk diffusion method as per Clinical laboratory Standard Institute guideline. ATCC E. coli 25922, ATCC S. aureus 25923, ATCC P. aeruginosa 27853 were used as standard strains. Results: Out of 452 blood cultures, organisms were isolated in 127(28.09%). Commonly isolated bacteria are Coagulase Negative Staphylococci (42.52%) followed by Klebsiella spp. (18.11%), Acinetobacter spp. (15.75%), Enterococcus spp. (9.45%) and others (Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa). Coagulase Negative Staphylococci strains have highest sensitivity to Vancomycin (100%), Linezolid (100%), Teicoplanin (100%), followed by Chloramphenicol (92.6%), Levofloxacin (90.7%), Cefoxitin (83.3%), and Tetracycline (77.8%). 16.7% isolates were Methicillin Resistant Staphylococci (MRS). Klebsiella spp. strain have highest sensitivity to Meropenem (73.9%), Imipenem (73.9%) and Amikacin (69.6%) followed by Chloramphenicol (65.2%), Tetracycline (60.9%) and Piperacillin Tazobactum (52.2%). 78.3% strains were Extended spectrum Beta-Lactamase (ESBL) producers. Conclusion: Antimicrobial resistances are growing among bacteria an

Neonatal sepsis due to coagulase negative Staphylococci: a study from Kashmir valley, India

Background: Neonatal sepsis is a leading cause of neonatal mortality and morbidity. Early diagnosis and treatment with appropriate antibiotics are important to improve the prognosis of neonatal sepsis. Coagulase-negative Staphylococci (CoNS) have emerged as prominent pathogens in the neonatal intensive care unit. These infections are rarely fatal, but they cause significant morbidity, especially among very low birth weight infants. This study was done to know the prevalence of Coagulase-negative Staphylococci in neonatal sepsis and to determine their antibiotic susceptibility pattern.Methods: A prospective study was conducted on blood samples of suspected neonatal septicaemia between August 2017 and May 2018 received at Department of Microbiology, Government Medical College, Srinagar. Blood culture was done by automated blood culture system, (BacT/Alert) and identification and antibiotic susceptibility was done by VITEK2 method.Results: Out of 356 neonates screened, there were 185 (53.4%) positive blood cultures. Among the culture positive cases, 107 (57.83%) were male and 78 (42.16%) were female. Early Onset Septicaemia cases (130 [70.27%]) were found to be three times higher than late onset Septicaemia (55 [29.72%]). Coagulase-negative Staphylococci (CoNs) (30.27%) were the most common organisms isolated followed by Acinetobacter sp (15.1%), Klebsiella sp (5.4%) S. aureus (4.8%) and E. coli (4.8%). All the isolates of CoNS were sensitive to linezolid and vancomycin and tigecycline. Methicillin resistance was seen in 84% isolates.Conclusions: Present study highlights the emergence of Coagulase-negative Staphylococci (CoNS) as predominant cause of neonatal septicaemia. Most of the isolates were resistant to methicillin which is alarming and a cause for concern.

Biological characterization of Pasteurella multocida present in the Saiga population

BackgroundThis study provides biochemical and molecular genetic characteristics of P. multocida isolated from dead saigas in 1988, 2010–2015 on the territory of the Republic of Kazakhstan.ResultsBacteriological samples taken from carcasses of saiga antelope during mortality events recorded in West Kazakhstan in both 2010 and 2011 and in Kostanay in 2012 and 2015 confirmed the presence of P. multocida, according to morphological and biochemical characterisation. Only in the event of 2015 was the agent proven to be the causative agent of the disease observed, haemorrhagic septicaemia. In the other mortality events it is not certain if the organism was a primary aetiology or an incidental finding as confirmatory pathological investigation was not undertaken. The implemented phylogenetic analysis of ribosomal RNA 16S gene allowed us to identify Pasteurella strains isolated in 2010–2015 as P. multocida subspecies multocida. Capsular typing by PCR showed that the studied strains isolated from dead saiga in 2010, 2011, 2012 and 2015 belonged to serotype B. MLST analysis showed that these strains of P. multocida are of the capsule type B and form one clonal grouping with isolates ST64, ST44, ST45, ST46, ST44, ST47 which isolated from cases of hemorrhagic septicemia of animals in Hungary, Burma, Sri Lanka, Pakistan and Spain. Sixteen virulence genes of the five strains of P. multocida, isolated from saigas were studied using multiplex PCR. ptfA, ompA, ompH, oma87, plpB, fimA, hsf-2, pfhA, exbB, tonB, hgbA, fur, nanB, nanH and pmHAS genes were detected in all strains. The toxA gene was not identified in the studied strains. The phylogenies of these isolates is compared across saiga populations and years and the 2015 isolate was compared to that of an isolate from a disease outbreak in 1988 and the findings suggest that these isolated bacteria are stable commensals, opportunistically pathogenic, being phylogenetically uniform with very little genetic variation notable over the last 4 decades.ConclusionIsolation, phenotypic and genetic characterization of the P. multocida isolates inform understanding of the epidemiology of infection in saigas and predict virulent potential of these opportunistic bacteria.

Neonatal sepsis due to glycopeptide resistant Enterococcus faecium from colonized maternal gut- rare case evidence

BackgroundVancomycin-resistant enterococcal infections in the neonatal ICU are growing global problems. We report a case of neonatal septicemia by multidrug-resistant vancomycin-resistant Enterococcus faecium (VRE), the source of infection being the mother’s gut.Case presentationA newborn male child admitted to the neonatal intensive care unit (NICU) was diagnosed to have mild meconium aspiration syndrome, early onset neonatal septicemia, and bacteremia by multidrug and vancomycin-resistant Enterococcus faecium. Screening of gut flora of the baby and the mother were carried out to trace the source of infection. Stool cultures of the mother and the baby yielded Vancomycin-Resistant Enterococcus faecium. All three isolates of Enterococcus faecium had similar antibiogram, harbored the vanA gene and similar pulsed-field gel electrophoresis pattern. Baby responded to the 1 week therapy with oral linezolid suspension 20 mg/kg/day, 1 ml/t.d.s. No VRE was isolated from baby on a repeat stool culture 1 week after the linezolid therapy. He was discharged with the advice for the continuance of linezolid for seven more days.ConclusionIsolation of MDR-VRE from the blood culture of the baby and stool specimens of the mother and the baby with the same antibiogram profile and clonal similarities reveals that maternal gut colonization was responsible for neonatal sepsis. Optimal infection control measures and the development of guidelines for monitoring VRE colonization in pregnant women might be useful in reducing the occurrence of neonatal sepsis.

Bacterial Profile and Antimicrobial Susceptibility in Neonatal sepses, Al -Alwyia Pediatric Teaching Hospital in Baghdad

Background: Neonatal septicemia is a major health problem in developing countries furthermore data on bacteriological profile in early onst sepses (EOS) and late neonatal sepsis (LOS) are lacking in context of continuous change in bacteriological profile and increasing resistant strains. Objectives: The study done to determine the pattern of organisms implicated in neonatal septicemia in a neonatal care unit and to measure the degree of bacterial resistance to some antibiotics.
 Type of the study : cross –sectional study.
 Methods: Confirmed cases of neonatal septicemia admitted at Al-Alwyia pediatric teaching hospital for the period from January 2011- January 2012 were included which constitute 107 case. Blood samples were obtained, incubated and Subculture was done on blood agar and MacConkey Agar routinely after 48 hours and 7 days and in between if visible turbidity appeared. Bacterial isolates and antibiotic sensitivity were identified by standard conventional methods.
 Results EOS constituted 29.9%(32 case) of confirmed neonatal sepsis , while LOS constituted 70.1% (75case) .Eescehrichia coli (E. coli) constitutes 37% of EOS followed by Klebsella pneumonia and Staphylocoocus species (which constitute 12.5% for each of them ) were the most common microorganisms, while for LOS: E.coli constituted 38.7 % of LOS followed by Staphylocoocus species 17.3% and Klebsella pneumonia 10.7%. Gram negative (G negative) bacteria predominated over gram positive (G positive) bacteria in both EOS (81.2%) and LOS (74.7%) . Staphylocoocus species predominates G positive sepsis in both EOS and LOS. Group B streptococci are not identified in the study sample. Microorganisms tested shows highly resistant to amoxicillin or ampicillin and to gentamycin.For amoxicillin or ampicillin higher resistant (100%) were encourted with pseudomonas, proteus and Enterobacter. For cefotaxime high rate of resistance encountered with klebsella (71.4%) compared to 40% resistant in pseudomonas. Amikacin also shows varied degree of resistant for E. coli(22% ) and klebsella (41%) , pseudomonas(10%) ,and Enterobacter (16.7%) .for Staphylococcus aureus, proteus and citrobacter no resistance was encountered to amikacin and the sensitivity was 100% in tested isolates .
 Conclusions: G negative bacteria is more common in EOS and LOS with predominant of E. coli in two categories .Resistant strains to commonly used antibiotics is a common finding. Guidelines in treatment of neonatal sepsis should be frequently reviewed taking in consideration antimicrobial resistance . Due to magnitude of problem, preventive measures for EOS and LOS should be considered.

Aeromonas Infections in Patients with Liver Cirrhosis in Japan

Aeromonas species are recognized as opportunistic pathogens that cause serious problems in patients with liver cirrhosis (LC). In this article, 25 case reports of Aeromonas infections in patients with LC in Japan are reviewed and summarized. Among the 25 cases, cases of septicemia or skin and soft tissue infections have been relatively well reported. In total, the 1-month mortality rate was 68% (17/25), whereas the overall survival rate was 32% (8/25). In particular, among 16 cases with skin and soft tissue infections, 12 (75%) died within the first 4 days after admission, regardless of the administration of antimicrobial agents and/or lower limb amputation, indicating extremely poor short-term prognosis.

Burkholderia cepacia complex bacteremia in pediatric intensive care unit in a tertiary care hospital in North India

Introduction: Burkholderia cepacia complex (BCC) is a nonfermentative Gram-negative bacillus, now increasingly recognized as an important human pathogen causing hospital-acquired infections. Furthermore, it is a rare cause of sepsis in pediatric age group. Objective: The study aimed to determine the pattern of BCC infection in pediatric intensive care unit (PICU), to explore the antibiotic sensitivity profile, and to identify the source of BCC if any within the PICU. Materials and Methods: The study was conducted in the Department of Microbiology and Pediatrics, JNMC, AMU, Aligarh, for a period of 8 months from January 2017 to August 2017. Matrix-assisted laser desorption/ionization-time-of-flight (MALDI-TOF) was done in the Department of Microbiology, PGI, Chandigarh. All the blood cultures received in the enteric laboratory were screened. The isolates were then identified by standard biochemical techniques, and antimicrobial sensitivity was determined by Kirby–Bauer disc diffusion method as per the Clinical and Laboratory Standards Institute guidelines. Identity was confirmed by MALDI-TOF. As the increasing number of BCC infections was being reported, additional samples were collected from the PICU to identify the source. Results: The study involved 35 cases of blood culture-proven septicemia due to BCC among patients admitted in PICU. The first clustering of cases was noted in January 2017 affecting 6 babies. Six months later in August 2017, a second cluster of cases was noted affecting 24 babies. BCC was isolated in 35 samples. Among 30 patients, 20 were infants (including 13 neonates). Ceftriaxone (100%), minocycline (95%), chloramphenicol (85%), and co-trimoxazole (84.6%) were the most effective drugs followed by levofloxacin (79.1%), meropenem (71.4%), and ceftazidime (48.3%). None of the isolates was found to be sensitive to colistin, polymyxin B, cefepime, and tobramycin. BCC was also isolated from samples of Diurese-Nierenszintigraphie (DNS) and injection fentanyl used in PICU which could have possibly served as a source for further infection. Conclusion: BCC is an important cause of bacteremia with high fatality. It possesses the intrinsic resistance to many potent antibiotics. Proper and timely identification can help reduce the mortality, and implementation of infection control measures is essential.

Multidrug-resistant Acinetobacter septicemia in neonates: A study from a teaching hospital of Northern India

BACKGROUND:Acinetobacter species are typical nosocomial pathogens causing infections and high mortality, almost exclusively in compromised hospitalized patients. Acinetobacter sp. are intrinsically less susceptible to antibiotics and have propensity to acquire resistance. Multidrug-resistant (MDR) Acinetobacter sp. blood infection in the neonatal intensive care unit patients create a great problem in hospital settings.AIMS:A prospective data analysis was performed over a one year period of all neonates admitted with sepsis who developed Acinetobacter infection and their antibiotic susceptibility pattern was carried out.MATERIALS AND METHODS:Blood samples of infected neonates were collected aseptically and cases of Acinetobacter septicemia were identified. Speciation of Acinetobacter species was done. Various risk factors were identified and their drug-sensitivity test was performed.RESULTS:The incidence of neonatal septicemia due to Acinetobacter species was 13.7% (49/357). Predominant species isolated was Acinetobacter baumannii (98%). The major symptoms were lethargy and poor feeding. The major signs were tachypnea, intercostal retraction, and respiratory distress. The major fetal risk factors were low birth weight and prematurity. High degree of resistance was observed to the various antibiotics used. Majority of the isolates (95.9%) were MDR while 93.68% were resistant to carbapenems as well as extensively drug resistant. However, all the strains were sensitive to colistin.CONCLUSION:MDR Acinetobacter septicemia in neonatal patients is becoming alarmingly frequent and is associated with significant mortality and morbidity. Therefore, rational antibiotic use is mandatory along with an effective infection control policy in neonatal intensive care areas of each hospital to control Acinetobacter infection and improve outcome.

Early diagnosis and evaluation of neonatal septicemia by hematological scoring system

Background: Neonatal septicemia is a major health problem. Morbidity and mortality in the neonatal period are mostly due to neonatal septicemia. Objective: The present study was undertaken to highlight the importance of hematological scoring system (HSS) in the early diagnosis and evaluation of neonatal septicemia and to correlate these hematological parameters with blood culture and C-reactive protein. Materials and Methods: This study was prospective and was done over the period of 1 year including 100 clinically suspected neonatal septicemia cases admitted in neonatal intensive care unit. Hematological parameters were measured in all cases. Culture positivity was taken as the criterion for definitive diagnosis. Specificity, sensitivity, positive predictive value, negative predictive value, and P value were calculated for each hematological parameter. Results: Of 100 clinically suspected neonates with sepsis studied, 19% were culture positive, 63.2% were male, 84.2% were term neonates, and 84.2% were low birth weight neonates (

Infections Associated With Hospitalization Over One Year Period

Abstract The aim of this study was to identify the bacterial species circulating in various wards of the Emergency Clinical Hospital Constanta, involved in infections associated with hospitalization. Clinical specimens were obtained during 2016 year period. Identification of species and sensitivity tests were performed on VITEK 2 System. There were isolated 163 bacterial strains suspected to be responsible for infections associated with hospitalization. Surgery wards had the most important number of cases, 49% of all. The second most affected ward was neonatology (11%), as many as gynecology (5%) and pediatrics (6 %) together. According to the site of the infection, digestive are majoritary (42.94%), followed by surgical wounds (16.56%) and respiratory infections (15.33%). Septicemia cases (11.04%) are important due to the severity. Distribution on months varies between a minimum number of cases in January (5) and a maximum of cases in April (19).Gram-negative bacilli were the most frequently involved (49%). The most frequent species was Acinetobacter baumanii (28 cases), followed by Pseudomonas aeruginosa (15) and E.coli (7). Anaerobic bacteria (Clostridium difficile) are the second most important group (32% of the cases), followed by Gram positive cocci (15%) mostly staphylococci. Multidrug resistance was diagnosed in most Acinetobacter baumanii strains. A special attention must be given to associations of bacteria, that even though are in small number (2% of the cases), are more difficult to be treated.

Clinical and bacteriological profile of neonatal sepsis with emerging resistance patterns

Background: The present study was designed to evaluate the clinical spectrum, bacteriological profile, antibiotic sensitivity pattern and mortality due to neonatal septicemia in neonates admitted in neonatal units attached to the SMS Medical College, Jaipur.Methods: In born and out born babies of postnatal age up to 28 days who were bacteriological proven cases of septicemia were subjected to history, clinical examination and laboratory evaluation and data were analyzed statistically.Results: Out of 150 cases 67.33% neonates were preterm and 77.33% were low birth weight neonates. Gram negative organisms were most common cause of septicemia (66.6%), Both the Gram negative and Gram positive organisms were sensitive to piperacillin-tazobactam, linezolid, fosfomycin, teicoplanin, polymyxin B, colistin, ofloxacin. Both the Gram negative and Gram positive organisms were resistant against cephalosporins, ampicillin, Amoxyclav, cotrimoxazole. Gram negative isolates were most sensitive to Polymyxin B (70%) and had the highest resistance to cefepime (36%). Gram-positive organisms were most sensitive to vancomycin (84%) and linezolid (82%). Highest resistance was noted from Amoxyclav (52%).Conclusions: Preterm (<37 week) and low birth weight (<2500gm) neonates are considered as major susceptible causes of neonatal sepsis. Proper hygiene and hand washing, early detection of sepsis and judicial use of antibiotics to prevent multidrug resistance is needful in our setup.

Leukotriene receptor antagonists for eczema.

Leukotriene receptor antagonists for eczema.

Fulminant Septicemia from Aeromonas hydrophilia in a Nonmobile Diabetic Patient.

We report an unusual case of Aeromonas hydrophilia septicemia in a nonmobile diabetic patient secondary to contaminated well water used for bathing with a portal of entry through chronic forefoot and heel ulcers. To date, there are no documented cases similar to this patient's presentation. Aeromonas hydrophilia is commonly distributed among aquatic environments and tends to be found during warmer months. It is a rare cause of disease but can be life threatening and deadly, as in our case, in immunocompromised individuals. As podiatric physicians, we must remain diligent and have a high index of suspicion to identify patients at risk for this rare but serious infection and administer treatment aggressively to limit morbidity and mortality.

A randomized placebo-controlled phase II study of clarithromycin or placebo combined with VCD induction therapy prior to high-dose melphalan with stem cell support in patients with newly diagnosed multiple myeloma

BackgroundThe objective of this randomized placebo-controlled study was to investigate the efficacy and safety of clarithromycin in combination with bortezomib–cyclophosphamide–dexamethasone (VCD) in patients with newly diagnosed multiple myeloma eligible for high-dose therapy.MethodsPatients were randomized to receive tablet clarithromycin 500 mg or matching placebo tablet twice daily during the first 3 cycles of VCD induction therapy. Primary endpoint was to compare the rate of very good partial response (VGPR) or better response after three cycles of VCD combined with clarithromycin or placebo.ResultsThe study was prematurely stopped for safety reasons after the inclusion of 58 patients (36% of the planned study population). The patients were randomly assigned to clarithromycin (n = 27) or placebo (n = 31). VGPR or better response after the VCD induction therapy was obtained in 12 patients (44.4%, 95% CI 25.5–64.7) and in 16 patients (51.6%, 33.1–69.8) (p = 0.59) in the clarithromycin group and the placebo group, respectively. Seven patients (25.9%) in the clarithromycin group developed severe gastrointestinal complications (≥ grade 3) comprising pain, neutropenic enterocolitis, paralytic ileus or peptic ulcer. These complications occurred in only one patient in the placebo group. Septicemia with Gram negative bacteria was observed in 5 patients in the clarithromycin group in contrast to one case of pneumococcal septicemia in the placebo group. Patient-reported QoL were negatively affected in the clarithromycin group compared to the placebo group.ConclusionThe study was prematurely stopped due to serious adverse events, in particular serious gastrointestinal complications and septicemia. The response data do not suggest any effect of clarithromycin when added to the VCD regimen. The combination of clarithromycin and bortezomib containing regimens is toxic and do not seem to offer extra anti-myeloma efficacy.Trial registration EudraCT (no. 2014-002187-32, registered 7 October 2014, https://www.clinicaltrialsregister.eu/ctr-search/trial/2014-002187-32/DK) and ClinicalTrials.gov (no NCT02573935, retrospectively registered 12 October 2015, https://www.clinicaltrials.gov/ct2/show/NCT02573935?term=Gregersen&cntry=DK&rank=9)

Emerging Resistance in Cases of Septicemia with Special Reference to Vancomycin

Introduction: Blood Stream Infections increase the mortality rate, prolonging hospital stay in ICU, posing a challenge to the skill of not only the clinician but also to the microbiologist. Easy availability and indiscriminate use of antibiotics is leading to antimicrobial resistance. Objective: To review the spectrum of organisms isolated and their antibiotic sensitivity pattern in the Intensive Care Unit to minimize the risk of morbidity and mortality. Method: 235 suspected cases of septicemia from ICU were taken; co morbid illness and outcome were noted. Blood culture and their antibiotic susceptibility profile were done. Results: Of the 235 suspected cases, 47 (20%) were culture positive with Gram Negative Organisms predominant (70.21%) over Gram Positive Organism (27.65%). Klebsiella species was the most common organism isolated (38.29%). Of the 13 GPC, 38.46% cases showed Vancomycin resistance. Conclusion: Gram Negative Organisms were most common etiological agents with Klebsiella being most predominant. The rate of Vancomycin resistance from isolated organisms was high. Mortality rate was high (17.02%).

Management of acute meningococcal septicaemia in Al-Nasser Paediatric Hospital: a retrospective cohort study

BackgroundAcute meningococcal septicaemia is a fulminant disease, and mortality and long-term morbidity can be very high if not treated appropriately. We aimed to evaluate case fatality rate of all children admitted with acute meningococcal septicaemia. MethodsWe did a retrospective cohort study of all paediatric cases of acute meningococcal septicaemia admitted to Al-Nasser Paediatric Hospital, the largest paediatric hospital in the Gaza Strip. Acute meningococcal septicaemia was diagnosed clinically and confirmed on the basis of results from skin smears and blood cultures, and meningitis was diagnosed clinically and confirmed by bacteriological examination of cerebrospinal fluid. Sociodemographic and clinical data and outcome information were obtained from hospital records. Outcome measures were predicted mortality using Paediatric Risk of Mortality score III (PRISM-III), actual mortality, and standardised mortality ratio (SMR). FindingsBetween Jan 1, 2009, and Sept 31, 2015, 240 children were admitted with acute meningococcal septicaemia. 113 (47%) children were boys, and the average age was 3·15 years (SD 2·6). The number of admitted children with acute meningococcal septicaemia decreased from 47–59 cases per year in 2009–11, to 21–22 cases per year in 2012–15. Similarly, there were fewer deaths in 2012–15 (n=14) than in 2009–11 (n=35). The total mortality predicted by PRISM-III was 25·6%, whereas the actual overall mortality was 21% (standardised mortality ratio 0·814; n=49). 41 (82%) children died within 24 h of admission, 69 (29%) children received corticosteroid, 85 (35%) children received inotropic medications, and 46 (19%) children required mechanical ventilation for a median of 24 h (IQR 6–48]. Acute meningococcal septicaemia was associated with meningitis in 75 (31%) children. The most common complications were multiorgan failure (22 [9%] children), skin necrosis or scarring (13 [5%]), convulsions or seizures (13 [5%]), and disseminated intravascular coagulopathy (ten [4%]). Mortality was independently associated with age (odds ratio per 1-year decreased age 1·06, 95% CI 1·03–1·10; p=0·0006), shock (3·83, 1·32–11·70; p=0·015), absence of meningitis on presentation (9·55, 3·25–28·07; p=0·0013), and mechanical ventilation (9·85; 4·31–22·54; p<0·0001). InterpretationThe mortality and morbidity associated with meningococcemia are improving but remain high. Timely identification of acute meningococcal septicaemia in primary care as well as in emergency departments is crucial. FundingNone.

Fusobacterium Septicemia with Liver and Lung Abscesses Due to Diverticulitis

The Fusobacterium species is known for its association with septic thrombophlebitis of the internal jugular vein (Lemierre's syndrome). Lemierre's syndrome is associated with septic emboli to the liver and lungs, often causing multiple abscesses. We present a unique case of Fusobacterium septicemia in which the bacteria invaded the portal vein through the gastrointestinal mucosa due to diverticulitis and spread hematogenously to the liver and lungs, causing abscesses. It was treated successfully with 6 weeks of antibiotics. Physicians should be aware of this rare pathogen and suspect its presence in severe pharyngitis or culture-negative liver abscess.

Assessment of neonatal septicemia cases in pediatric department

Background: Neonatal septicemia is the chief cause of morbidity and mortality in the neonatal period. The present study was conducted to assess neonatal septicemia cases in pediatric department. Materials & Methods: The present study was conducted in department of Pediatrics. It comprised of 84 babies with gestational age >32 weeks and/or birth weight >1500 g. Babies were divided into 2 groups of 42 each. Group I received 7 days antibodies coverage and group II received 14 days. All were monitored for clinical signs and symptoms, blood cultures etc Results: Gestation in weeks in group I was 35.4 and in group II was 35.2, birth weight was 2018.4 grams in group I and in group II was 1984.6 grams, early onset sepsis was seen in 16 in group I and 20 in group II, gram + organisms were seen in 15 in group I and 19 in group II and S. aureus was evident in 6 in group I and 8 in group II. There was treatment failure in 7 in group I and 2 in group II. The difference was significant (P< 0.05). Conclusion: It was observed that 14 days antibiotic coverage provide slight better results as compared to 7 days antibiotic course.