Clinical Presentation Of Infection Research Articles

Deep vein thrombosis as a rare complication of scrub typhus

Scrub typhus is a common re-emerging, acute febrile infectious disease, caused by orientia tsutsugamushi, transmitted by bite of chiggers of trombiculid mite. The clinical presentation of infection can vary from mild symptoms to severe multi organ failure, shock, encephalopathy, meningoencephalitis, DIC and various thromboembolic complications. We describe a rare hematological complication of deep vein thrombosis (DVT) caused by scrub typhus in a 61-year-old female. Vasculitis and perivasculitis with endothelial dysfunction could be considered as the main pathologic mechanism causing this complication.

Vaccination against coronavirus disease 2019 (COVID-19)

Die klinischen Präsentationen von Infektionen mit SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) sind sehr heterogen, und das Risiko für einen schweren Verlauf steigt mit zunehmendem Alter deutlich an. Ältere Erwachsene sind deshalb eine wichtige Zielgruppe für Impfungen. In Europa sind derzeit 2 mRNA-Impfstoffe, 2 adenovirale Vektorimpfstoffe und ein Proteinimpfstoff für ältere Erwachsene zugelassen. Die Immunogenität und klinische Wirksamkeit dieser Impfstoffe waren in den ersten Zulassungsstudien bei älteren Erwachsenen ähnlich oder nur geringfügig niedriger als in jüngeren Altersgruppen. Allerdings nehmen die Konzentration neutralisierender Antikörper und der Schutz vor Infektion im Laufe der Zeit deutlich ab und sind gegen Virusvarianten, besonders gegen Omicron, stark reduziert. Der Schutz vor schwerer Krankheit und Hospitalisierung ist jedoch langlebiger und nach 3 Impfdosen im Schema 2 + 1 auch für Omicron gegeben. Weitere Auffrischungsimpfungen sind derzeit für Risikopatienten, insbesondere für ältere Erwachsene, empfohlen. Bezüglich der konkreten, aktuell gültigen Empfehlungen für verschiedene Alters- und Risikogruppen wird auf die Bekanntmachungen der nationalen Impfgremien verwiesen.Alle derzeit verfügbaren Impfstoffe beruhen auf der ursprünglichen Virusvariante. Impfstoffe, die an die neuen Virusvarianten angepasst sind, werden derzeit erprobt, und ein zeitnaher Wechsel zu diesen Impfstoffen ist wahrscheinlich. Allerdings schreitet auch die Veränderung der Viruspopulationen voran, sodass voraussichtlich eine kontinuierliche Weiterentwicklung der Impfstoffe notwendig sein wird.

Neonatal SARS-CoV-2 Infection: Practical Tips.

The recent viral pandemic in Wuhan, Hubei, China has led to the identification of a new species of beta-coronavirus, able to infect humans, the 2019-nCoV, later named SARS-CoV-2. SARS-CoV-2 causes a clinical syndrome named COVID-19, which presents with a spectrum of symptoms ranging from mild upper respiratory tract infection to severe pneumonia, with acute respiratory distress syndrome and frequent death. All age groups are susceptible to the infection, but children, especially infants, seem to be partially spared, having a more favorable clinical course than other age groups. There is currently no clear evidence showing vertical transmission and intrauterine SARS-CoV-2 infection in fetuses of women developing COVID-19 pneumonia in late pregnancy, and even if transmission is possible, the SARS-CoV2 positivity of the mother does not require delivery by caesarean section, does not contraindicate the management of the infant in rooming-in and allows breastfeeding. This review provides an overview on the biology of the virus, on the pathogenesis of the infection, with particular attention to pregnancy and neonatal age, on the clinical presentation of infection in newborns and young infants and summarizes the international recommendations currently available on the clinical care of neonates with SARS-CoV2 infection or at risk of catching the virus. The main objective of the review is to provide an update especially focused to the clinical management of COVID-19 infection in the perinatal and neonatal age.

Effect of Salicylic Acid 3% + Benzoic Acid 6% (Whitfield’s Ointment), Clotrimazole 1% Cream, and Systemic Terbinafine on Mild-to-Moderate Tinea Corporis: A Randomized Comparative Study

Abstract Introduction The various epidemiological studies conducted on dermatophytic infection in different parts of India have concluded that there is a rising prevalence of dermatophytosis, with change in clinical presentation of infection. Although most of the therapeutic interventions show sufficient effect, there is a need for objective high-quality randomized comparative study to evaluate the effects of intervention, which can provide reliable evidence for clinical practice. Therefore, keeping this need in mind, we undertook this research work. To date, to the best of our knowledge, the inclusion of body surface area (BSA) as a tool for the evaluation of clinical improvement in dermatophytosis infection has not been considered. Objective The aim of this study was to assess the effect of topical antifungal as a monotherapy in naive and in combination with systemic antifungal drug in relapse cases of mild-to-moderate tinea corporis, to study and compare the efficacy of Clotrimazole 1% and Whitfield’s ointment as a monotherapy in mild-to-moderate cases of tinea corporis, and to study and compare the efficacy of combination of systemic terbinafine with Whitfield’s ointment and with clotrimazole 1% in mild-to-moderate relapsed cases of tinea corporis. Materials and Methods A total of 102 patients with mild-to-moderate tinea corporis who fulfilled the inclusion and exclusion criteria were enrolled. The naive patients for monotherapy and relapsed cases for a combination of systemic and topical antifungal drugs were randomly distributed. Results Predominance of males than females and the duration of disease for more than 6 weeks were observed. There was a significant reduction of infection in all the groups after 4 weeks, but early response was observed with clotrimazole as a monotherapy and in combination of clotrimazole with systemic drug. Conclusion Topical drugs as a monotherapy in naive and in combination of topical and systemic antifungal drug in relapsed cases were effective, but to achieve zero BSA, treatment for more than 4 weeks is required.

Innate Lymphocyte Th1 and Th17 Responses in Elderly Hospitalised Patients with Infection and Sepsis.

Background: the role of innate immunity in human sepsis must be fully clarified to identify potential avenues for novel immune adjuvant sepsis therapies. Methods: A prospective observational study was performed including patients with sepsis (septic group), infection without sepsis (infection group), and healthy controls (control group) in the setting of acute medical wards and intensive care units in a 1000-bed university hospital. A total of 42 patients with sepsis, 30 patients with infection, and 30 healthy controls were studied. The differentiation states of circulating mucosal associated invariant T (MAIT) cells and Natural Killer T (NKT) cells were characterised as naive (CD45RA+, CD197+), central memory (CD45RA−, CD197+), effector memory (CD45RA−, CD197−), or terminally differentiated (CD45RA+, CD197−). The differentiation states of circulating gamma-delta T lymphocytes were characterised as naive (CD45RA+, CD27+), central memory (CD45RA−, CD27+), effector memory (CD45RA−, CD27−), or terminally differentiated (CD45RA+, CD27−). The expression of IL-12 and IL-23 receptors, the transcription factors T-Bet and RORγt, and interferon-γ and IL-17a were analysed. Results: MAIT cell counts were lower in the septic group (p = 0.002) and the infection group (p < 0.001) than in the control group. The MAIT cell T-Bet expression in the infection group was greater than in the septic group (p = 0.012). The MAIT RORγt expression in the septic group was lower than in the control group (p = 0.003). The NK cell counts differed in the three groups (p < 0.001), with lower Natural Killer (NK) cell counts in the septic group (p < 0.001) and in the infection group (p = 0.001) than in the control group. The NK cell counts increased in the septic group in the 3 weeks following the onset of sepsis (p = 0.028). In lymphocyte stimulation experiments, fewer NK cells expressed T-Bet in the septic group than in the infection group (p = 0.002), and fewer NK cells expressed IFN-γ in the septic group than in the control group (p = 0.002). The NKT cell counts were lower in the septic group than both the control group (p = 0.05) and the infection group (p = 0.04). Fewer NKT cells expressed T-Bet in the septic group than in the infection group (p = 0.004). Fewer NKT cells expressed RORγt in the septic group than in the control group (p = 0.003). Fewer NKT cells expressed IFN-γ in the septic group than in both the control group (p = 0.002) and the infection group (p = 0.036). Conclusion: The clinical presentation of infection and or sepsis in patients is linked with a mosaic of changes in the innate lymphocyte Th1 and Th17 phenotypes. The manipulation of the innate lymphocyte phenotype offers a potential avenue for immune modulation in patients with sepsis.

Recurrent mucocutaneous infections caused by PVL-positive Staphylococcus aureus strains: a challenge in clinical practice.

Recurrent mucocutaneous infections caused by PVL-positive Staphylococcus (S.) aureus strains represent an increasing problem in Germany. Although there have been several outbreaks at day care centers and in urban communities in recent years, there are currently no diagnostic algorithms or treatment recommendations for these particular infections in Germany. We performed a literature search in the PubMed/MEDLINE database with the goal of developing an algorithm for diagnosis and treatment of these infections. National and international recommendations were also considered. Panton-Valentine leukocidin (PVL) is a pore-forming protein produced by certain S.aureus strains. Both methicillin-susceptible (MSSA) and methicillin-resistant S.aureus (MRSA) strains may carry the lukS-lukF gene responsible for PVL production. The clinical presentation of infections caused by PVL-positive S.aureus ranges from isolated recurrent abscesses to extensive furunculosis. Despite adequate treatment of primary infections, approximately 40% of patients develop recurrent disease. The choice of treatment regimen is guided by the clinical presentation of the infection. In addition, some scientific literature recommends bacteriological screening of patients and their contacts, followed by decolonization of affected individuals. The present article focuses on the pathogenesis and risk factors of recurrent mucocutaneous infections caused by PVL-positive S.aureus strains and proposes a diagnostic and therapeutic algorithm for optimal patient care.

A218 LISTERIA MONOCYTOGENES MENINGITIS IN A NEWLY DIAGNOSED PATIENT WITH INFLAMMATORY BOWEL DISEASE: A CASE REPORT

Abstract Background Anti-Tumor Necrosis Factor (TNF) is a frequently utilized therapy in the treatment of Inflammatory Bowel Disease (IBD). Opportunistic infections are a known but an infrequently encountered complication. Listeria monocytogenes (LM) is an aerobic gram-positive intracellular bacillus. Clinical presentation of infection is host dependent, ranging from self-limited illnesses in immunocompetent individuals to life-threatening sepsis and meningitis in the immunocompromised. TNF plays a crucial role in host’s defense against LM. Although published in adults, few case reports have documented invasive LM in children receiving infliximab (IFX), an anti-TNF agent used in IBD therapy. Aims Describe an adolescent with IBD-unclassified (IBD-U) in whom LM sepsis and meningitis was diagnosed after induction therapy with intravenous (IV) IFX. Methods Case report and literature review. Results A 15-year-old girl presented with 2-week history of progressive abdominal pain, bloody diarrhea, urgency, nocturnal stooling, tenesmus, and weight loss. She had been afebrile, with no history of exposures. Examination revealed pallor and tenderness in the right and left lower quadrants. Investigations showed elevated white cell count (WBC), platelets, inflammatory markers, and low albumin. Abdominal ultrasound showed thickening of the descending and sigmoid colon. Stool multiplex PCR was negative. Colonoscopy showed Mayo 3 pancolitis. The terminal ileum was not intubated and endoscopy was normal. She was diagnosed with IBD-U. Due to poor response to high dose IV steroids, IV IFX (after documenting normal vaccination titers) was given with good clinical response and no adverse effects; she was discharged on tapering prednisone. She re-presented 3 days later with fever, severe headaches, photophobia, and neck stiffness. Her IBD remained quiescent. She had consumed a cold meat sandwich 10 days prior. Antibiotics were started as investigations showed leukocytosis and very high inflammatory markers. Brain MRI showed pus in the lateral ventricles. Cerebrospinal fluid (CSF) analysis showed WBC 1832 x106/L, low glucose, and high protein. Blood and CSF cultures detected LM. She defervesced within 24 hours and completed a 21-day course of Ampicillin monotherapy. 2-month follow up showed IBD in continuous remission on IFX with no neurological sequalae, and a normal brain MRI. Conclusions This is the youngest patient with IBD reported with invasive listeriosis secondary to IFX and adds to 3 cases in children. It highlights the importance of vigilance when evaluating IBD patients with fever during IFX-based therapy. Physicians should be reminded of such patients’ immunocompromised state and their high risk of acquiring opportunistic infections. It is unclear if listeriosis avoidance precautions, currently recommended in pregnant women, should be adopted in patients receiving anti-TNF therapy. Funding Agencies None

Pediatric Odontogenic Infections and Prescription Antibiotic Use

Objectives: In the past several years worldwide, the discussion has developed about antibiotic resistance. Dentists, although a small percentage of the prescribers of antibiotics, can play a role in reducing antibiotic use and therefore help address this growing problem. Highly variable prescription practices illustrate the dentist’s contribution to the overuse of antibiotics. An investigation into antibiotic use and subsequent effects on clinical presentation odontogenic infections. Described are the variances in the clinical presentation of subjects who received antibiotics and those that had no antimicrobial therapy before presentation in the hospital setting. Methods: A retrospective chart review was conducted for subjects who presented with odontogenic infections to a children’s hospital emergency department. Variables collected were: pre-hospital antibiotic use, vital signs on admission, site of infection, quality of infection, and dental involvement. Results: 112 subjects: 73 male and 39 females. 49 received pre-hospital antibiotics while 63 did not have previous antibiotic therapy. Pre-hospital antimicrobials consisted of 10 different types of antibiotic therapies. No significance was found between the two groups and the clinical presentation of infection or admission vital signs. Conclusion: High variability of antibiotic use for orofacial infections was observed including the type of antimicrobial utilized and prescribing provider (non-dentist). This study provided information correlating patient physiology and the lack of clinical impact by pre-hospital antibiotic use. Due to high variability in providers' type administering antibiotic prescriptions and irregular drug and dosage practices, detailed practice guidelines and antibiotic stewardship programs should be augmented for assistance concerning odontogenic infection treatments.

A Case Series of Staphylococcus lugdunensis Infection in Cancer Patients at an Academic Cancer Institute in the United States.

BackgroundStaphylococcus lugdunensis is a coagulase-negative staphylococcus (CoNS) that is a part of the normal human skin flora. Even though it belongs to CoNS family, it can cause severe and destructive infections in a similar fashion to Staphylococcus aureus. Skin and soft tissue infections (SSTI), bacteremia and endocarditis are amongst the most common clinical presentations. Diagnosis and clinical presentation of infections caused by S. lugdunensis in cancer patients is limited.Materials and MethodsWe performed a retrospective chart review of 24 patients who had cultures positive for S. lugdunensis. Out of 24 patients, 14 patients were diagnosed with a true infection and 10 other patients were considered to be colonized with this pathogen. We analyzed clinical manifestation, treatment and response to therapy.ResultsSSTI was the most common presentation in our study patients. All patients diagnosed with SSTI had a prior surgery or an invasive procedure at the affected site. Five urinary tract infections (UTIs), one catheter-associated bloodstream infection, and a deep pelvic abscess were other reported infections in our study. We observed that S. lugdunensis remains susceptible to a variety of antibiotics, with all isolates susceptible to vancomycin and linezolid and most remain susceptible to fluoroquinolone and trimethoprim/ sulfamethoxazole. All 14 patients received antibiotics and improved.ConclusionIn our case series, SSTI was common and diagnosed in 50% of the patients with clinically significant isolates for S. lugdunensis. This is consistent with prior studies indicating that S. lugdunensis is a significant pathogen in SSTIs. UTI was the second most common infection type in our patient population.

Bartonella Species, an Emerging Cause of Blood-Culture-Negative Endocarditis.

Since the reclassification of the genus Bartonella in 1993, the number of species has grown from 1 to 45 currently designated members. Likewise, the association of different Bartonella species with human disease continues to grow, as does the range of clinical presentations associated with these bacteria. Among these, blood-culture-negative endocarditis stands out as a common, often undiagnosed, clinical presentation of infection with several different Bartonella species. The limitations of laboratory tests resulting in this underdiagnosis of Bartonella endocarditis are discussed. The varied clinical picture of Bartonella infection and a review of clinical aspects of endocarditis caused by Bartonella are presented. We also summarize the current knowledge of the molecular basis of Bartonella pathogenesis, focusing on surface adhesins in the two Bartonella species that most commonly cause endocarditis, B. henselae and B. quintana. We discuss evidence that surface adhesins are important factors for autoaggregation and biofilm formation by Bartonella species. Finally, we propose that biofilm formation is a critical step in the formation of vegetative masses during Bartonella-mediated endocarditis and represents a potential reservoir for persistence by these bacteria.

Development of Hepatic Abscesses Following International Travel

A 19 year-old woman presented to the emergency department with a one-week history of progressively worsening right-sided abdominal, shoulder, and rib pain. Her occupational history included service in the navy's culinary department with recent 5-month travel to Oman, Bahrain, Jordan, and Spain. Vital signs were significant for a temperature of 103.1 degrees Fahrenheit and tachycardia to 132. She had exquisite tenderness of the right upper abdominal quadrant with mild guarding. The patient noted recent ingestion of authentic foods from the countries which she visited. She was admitted to the general internal medicine inpatient service. While in the emergency department, right upper quadrant ultrasound was performed. CT of the abdomen and pelvis was later ordered for further characterization of hepatic findings on ultrasound. Empiric therapy with IV metronidazole and ciprofloxacin was initiated. Blood and urine cultures were drawn. Interventional Radiology was consulted for CT-guided aspiration of liver findings on imaging. Initial CBC showed a leukocytosis of 21.5K with 81% neutrophils. Alkaline phosphatase was 146 and INR 1.8. Right upper quadrant imaging demonstrated heterogenous liver parenchyma with multiple cystic lesions in the right hepatic lobe, with the largest measuring 1.3 cm. CT scan of the abdomen confirmed diffusely distributed, peripherallyenhancing cysts in the posterior right hepatic lobe. Extrahepatic biliary ductal prominence was present measuring 4mm in largest diameter. CT-guided aspiration of the largest cystic lesion was performed. Gram stain showed numerous RBCs, few WBCs, and no organisms. Serum serology for Brucella returned positive. Brucellosis is one of the most widespread zoonoses worldwide. Humans may contract the infection through the ingestion of unpasteurized milk, cheese, raw or undercooked meat as well as through the entry of the bacteria through skin lesions, conjunctiva, or by inhalation. The clinical presentation of infection is broad, ranging from asymptomatic to fatal. Gastrointestinal involvement may lead to pancreatitis, cholecystitis, ileitis, colitis, spontaneous peritonitis, splenic or hepatic abscesses, or hepatitis. The take home message for this case demonstrates the importance of recognizing gastrointestinal involvement by Brucella organisms and also acknowledgement of travel history and occupational exposure when presented with new onset abdominal pain.

Adverse consequences of neonatal antibiotic exposure.

Antibiotics have not only saved lives and improved outcomes, but they also influence the evolving microbiome. This review summarizes reports on neonatal infections and variation in antibiotic utilization, discusses the emergence of resistant organisms, and presents data from human neonates and animal models demonstrating the impact of antibiotics on the microbiome, and how microbiome alterations impact health. The importance of antibiotic stewardship is also discussed. Infections increase neonatal morbidity and mortality. Furthermore, the clinical presentation of infections can be subtle, prompting clinicians to empirically start antibiotics when infection is a possibility. Antibiotic-resistant infections are a growing problem. Cohort studies have identified extensive center variations in antibiotic usage and associations between antibiotic exposures and outcomes. Studies of antibiotic-induced microbiome alterations and downstream effects on the developing immune system have increased our understanding of the mechanisms underlying the associations between antibiotics and adverse outcomes. The emergence of resistant microorganisms and recent evidence linking antibiotic practice variations with health outcomes has led to the initiation of antibiotic stewardship programs. The review encourages practitioners to assess local antibiotic use with regard to local microbiology, and to adopt steps to reduce infections and use antibiotics wisely.

Viral Infections in Renal Transplant Recipients in Belarus

The presented study had its aim in establishing the prevalence and etiological structure of post-transplant viral complications and the kinetics of infection development. Two groups of recipients were examined: Group 1 comprised patients without any clinical signs of infection (n=84) monitored for a year, Group 2 included recipients with a clinical presentation of infection (n=92). 591 blood samples and 446 urine samples from 196 patients (20 donors and 176 renal transplant recipients) were analyzed. All donor-recipient pairs were tested for CMV, EBV, and HSV-1, 2. Latent viral infection reactivation was detected by the presence of viraemia (DNAemia) induced by CMV, EBV, HSV-1, 2, HHV-6, VZV, PVB19, or viruria (DNAuria) induced by BKV. The percentage of Group 1 patients with viral DNA detected amounted to 41.9% for CMV, 30.4% for EBV, 17.4% for BKV, 5.6% for HHV-6, 1.9% for AdV, and 1.7% for PVB19. HSV-1, 2 and VZV infections in this group were not observed. The rate of CMV, EBV, and BKV infection reactivation, determined by the viraemic patients percentage, increased with time and peaked 1, 1.5 and 2 months after transplantation for EBV, BKV, and CMV, respectively. Three to six months after transplantation, the percentage of patients with active CMV, EBV, or BKV infection decreased significantly; and later on, viraemia was only occasional finding in Group 1 patients. Examination of Group 2 patients revealed that the predominant etiological agents of post-transplant viral complications were CMV (24.4%), EBV (18.8%), and BKV (17.6%). The current study is the first complex investigation into the etiological structure and activation kinetics of viral infections in renal transplant recipients in Belarus. The results have major implications for early prevention of potential viral complications and adjustment of the therapy regimens for kidney transplant recipients currently in use.

Comorbidity and high viral load linked to clinical presentation of respiratory human bocavirus infection.

Human bocavirus (HBoV) is a new parvovirus associated with acute respiratory tract infection (ARTI). In order to evaluate HBoV significance as an agent of acute respiratory disease, we screened 1,135 respiratory samples from children and adults with and without symptoms during two complete calendar years. HBoV1 prevalence in patients with ARTI was 6.33 % in 2011 and 11.64 % in 2012, including neonatal and adult patients. HBoV1 was also detected in 3.77 % of asymptomatic individuals. The co-detection rate was 78.1 %. Among children, 87 % were clinically diagnosed with lower respiratory infection (no significant differences between patients with and without coinfection), and 31 % exhibited comorbidities. Pediatric patients with comorbidities were significantly older than patients without comorbidities. Patients with ARTI had either high or low viral load, while controls had only low viral load, but there were no clinical differences between patients with high or low viral load. In conclusion, we present evidence of the pathogenic potential of HBoV1 in young children with ARTI. Since patients with HBoV1-single infection are not significantly different from those with coinfection with respect to clinical features, the virus can be as pathogenic by itself as other respiratory agents are. Furthermore, an association between high HBoV1 load and disease could not be demonstrated in this study, but all asymptomatic individuals had low viral loads. Also, children with comorbidities are susceptible to HBoV1 infection at older ages than previously healthy children. Thus, the clinical presentation of infection may occur depending on both viral load and the particular interaction between the HBoV1 and the host.

Rate of co-colonization with serotypes of strep pneumonia isolated from nasopharyngeal swab

Background: Extended Spectrum Beta Lactamases (ESBLs) that mediate resistance to 3rd generation cephalosporins are now observed worldwide. Numerous types of ESBLs exist and can be found in nosocomial infections with Klebsiella pneumoniae strains in hospitals in Nigeria. However, there is no information available on the detection and prevalence of beta-lactamases of Klebsiella pneumoniae in clinical samples in Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. Methods & Materials: In this analytical cross sectional study, between January2012and January2013,600 isolateswere received from different clinical samples. Susceptibility of the isolates to different antibiotics was determined by disk diffusion method using NCCLS guidelines. The MICs of ceftazidime was determined using broth dilution assay. Isolates showing MICs≥ 4 g/ml for ceftazidime were phenotypically confirmed for ESBL production using double disc synergy method. The positive ESBL isolates were subjected to Polymerase Chain Reaction (PCR) to study the target genes. Demographic datawere assessed and all datawere analyzed accordingly. Results: Patient’s mean age was 65±26.36 year. Three hundred and twenty six (54.3%) cases were females and Two hundred and eighty two (45.6%) cases were males. Clinical presentation of infection were 189 cases of respiratory infection (31.5%), 129 cases of septicaemia (21.5%), 117 cases of wound infection (19.5%), 96 cases of UTI, (16%), 36 cases of STI (6%) and 33 cases of meningitis (5.5%). All the isolates were sensitive to imipenem. Resistance to ceftazidime and cefotaxime were 43.5% and 46.2% respectively. Frequency of 375 (62.5%) cases of positive ESBL was recorded. The prevalence of SHV, CTX-M and TEM genes among these isolates were 32% (n=120), 36% (n=135) and 32% (n=120) respectively. There was no significant correlation between ESBL positivity, age, ward and clinical presentation. Conclusion: The incidence of ESBL producing isolates of Klebsiella pneumonia is high in OAUTHC, Ile–Ife, Nigeria. These are associated with multiple drug resistance and pose a special therapeutic challenge. Routine evaluation of ESBL producing pathogens in the hospital can help clinicians in empirical treatment of high risks patients with serious nosocomial infection.

Onset of an Outbreak of Bipolaris hawaiiensis Fungal Endophthalmitis after Intravitreal Injections of Triamcinolone

To report a series of cases with fungal endophthalmitis occurring after intravitreal injection of triamcinolone derived from a single lot prepared by a compounding pharmacy. Retrospective, observational case series. Seventeen eyes treated with triamcinolone obtained from a single lot subsequently found to be contaminated with Bipolaris hawaiiensis. A retrospective chart review in a single retina practice was performed for 15 patients (n= 17 eyes) who received intravitreal injections of triamcinolone obtained from a single compounding pharmacy. Medical records and cytologic and microbiologic results were reviewed from December 2011 through January2013. Visual acuity; presence of vitreous cell, anterior chamber cell, or both; and fungal detection in samples obtained by vitreous needle aspiration or vitreous biopsy. Fungal endophthalmitis developed in 82% (14/17) of eyes after intravitreal triamcinolone obtained from the same lot. Median onset was 83 days (range, 6-322 days). Preinjection visual acuity ranged from 20/20 to counting fingers (median, 20/50). Median visual acuity at last follow-up was 20/400 (range, 20/30-no light perception). The most common signs and symptoms included decreased vision (57% [8/14]), vitreous cell (64% [9/14]), and anterior chamber cell (50% [7/14]). Fungus was detected by cytologic or culture examination in 7% (1/14) from initial vitreous tap. By comparison, vitreous samples obtained by pars plana vitrectomy (PPV) resulted in fungus-positive cytologic results in 43% (6/14) of eyes and positive culture results in 36% (5/14) of eyes. All culture-positive specimens (100% [5/5]) were identified as B.hawaiiensis. Overall, fungal infection was confirmed in 57% (8/14) of eyes by either cytologic or microbiologic analysis. Fungal endophthalmitis resulting from B.hawaiiensis developed in a series of eyes after intravitreal injections of triamcinolone obtained from a single compounding pharmacy. Clinical presentation of infection can be delayed up to 10 months. Vitreous tap may be inadequate, and direct vitreous biopsy by PPV may be preferred to identify fungal endophthalmitis and facilitate prompt diagnosis and treatment.

Mediastinal histoplasmosis presenting as dysphagia: a case report with literature review.

Histoplasmosis is an endemic infection of the Ohio and Mississippi River valleys. Clinical presentation of infection in immunocompetent hosts ranges from asymptomatic to minor flu-like symptoms; however, disseminated infection can occur in immunocompromised patients. Esophageal involvement in the form of dysphagia secondary to mediastinal histoplasmosis is rarely reported in the literature. We present a young female who complained of dysphagia and was found to have an esophageal stricture on barium esophagogram. Endoscopy revealed a submucosal nodule stricture situated 29cm from the incisors. She underwent thoracotomy for lymph node removal. Histologic findings of the removed lymph node showed caseating granuloma with macrophages. The clinical findings together with the laboratory evaluation and biopsy features were suggestive of mediastinal histoplasmosis as the cause of the dysphagia.

15 Clinical Presentation of Infection in Catheter-Dependent Hemodialysis Patients

15 Clinical Presentation of Infection in Catheter-Dependent Hemodialysis Patients

Musculoskeletal infection in children

Purpose of reviewMusculoskeletal infection in children is evolutionary. Theemergence of new causative organisms, the developmentof antibiotic resistance among common organisms and anincreased incidence of unusual clinical presentations ofinfection contribute to this evolution. Early, accuratediagnosis and prompt initiation of appropriate treatmentremain central principles in the evaluation and treatment ofacute orthopedic infections. This review summarizes therecent literature regarding musculoskeletal infection inchildren.Recent findingsKingellakingaehasbeenidentifiedasacausativeorganismof septic arthritis and osteomyelitis in children between theages of 6 months and 2 years. Improved culture techniquesallow more reliable detection of this gram-negativecoccobacillus, which is otherwise difficult to isolate. Thereis a rising incidence of community-acquiredmethicillin-resistant Staphylococcusaureusasthecauseofinvasive musculoskeletal infection in children. Specificgenetically encoded virulence factors may play a role in theoccurrence of complications of chronic osteomyelitis anddeep venous thrombosis in some children. Thedifferentiation of septic arthritis from transient synovitis maybe facilitated by an evidence-based clinical predictionalgorithm. Variation of population characteristics fromregion to region may limit the application of such guidelinesin general practice. Careful clinical judgment remainsnecessary.SummaryImproved methods of evaluation of musculoskeletalinfection including culture techniques for isolating Kingellakingae, genetic mapping of community-acquiredmethicillin-resistant S. aureus virulence factors, andmagnetic resonance imaging to evaluate pelvic pyomyositismay lead to more accurate diagnosis and earlyadministration of appropriate treatment for invasivemusculoskeletal infections in children.Keywordschildren, musculoskeletal infection, osteomyelitis,pyomyositis, septic arthritis

Surgical Site Infection in the Elderly Population

Surgical site infections (SSIs) account for 11% of nosocomial infections among older patients. This report reviews the available data and presents medical and surgical perspectives on the epidemiology, outcomes, and prevention of SSI in the elderly population. The risk for SSI does not seem to increase after the age of 65 years. Several risk factors for SSI are similar among elderly patients and younger patients, but financial factors and factors related to health services may differ between the groups. The clinical presentation of infection and the pathogens that cause infection are similar among elderly patients and younger patients. However, the mortality rate, the duration of hospitalization, and the costs associated with hospital care are greater for elderly patients with SSI than for younger patients with SSI. Several modalities for SSI prevention have been well studied in the general surgical population but have not been specifically evaluated in the elderly surgical population. Insights and opinions pertaining to modalities for SSI prevention in the elderly population and areas of import for future research are discussed.