Course Of Azithromycin Research Articles

Azithromycin in severe malaria bacterial co-infection in African children (TABS-PKPD): a phase II randomised controlled trial

BackgroundAfrican children with severe malaria are at increased risk of non-typhoidal salmonellae co-infection. Broad-spectrum antibiotics are recommended by guidelines but the optimal class and dose have not been established. We investigated the optimal dose of oral dispersible azithromycin and whether simple clinical criteria and point-of-care biomarkers could target antibiotics to those at greatest risk of bacterial co-infection.MethodsWe conducted a phase I/II trial in Ugandan children with severe malaria comparing a 5-day course of azithromycin: 10, 15 and 20 mg/kg of azithromycin (prescribed by weight bands) spanning the dose-range effective for other salmonellae infection. We generated relevant pharmacokinetic (PK) data by sparse sampling during dosing intervals and investigated associations between azithromycin exposure and potential mechanisms (PK-pharmacodynamics) using change in C-reactive protein (CRP), a putative marker of sepsis, at 72 h (continuous) and microbiological cure (7-day) (binary), alone and as a composite with 7-day and 90-day survival. To assess whether clinical or biomarkers could identify those at risk of sepsis, a non-severe malaria control was concurrently enrolled.ResultsBetween January 2020 and January 2022, 105 cases were randomised azithromycin doses: 35 to 10 mg/kg, 35 to 15 mg/kg and 35 to 20 mg/kg. Fifty non-severe malaria controls were concurrently enrolled. CRP reduced in all arms by 72 h with a mean reduction of 65.8 mg/L (95% CI 57.1, 74.5) in the 10 mg/kg arm, 64.8 mg/L (95% CI 56.5, 73.1; p = 0.87) in the 20 mg/kg arm and a smaller reduction 51.2 mg/L (95% CI 42.9, 59.5; p = 0.02) in the 15 mg/kg arm. Microbiological cure alone outcome was not analysed as only one pathogen was found among cases. Three events contributed to the composite outcome of 7-day survival and microbiological cure, with no events in the 15 mg/kg arm. The odds ratio comparing 20 vs 10 mg/kg was 0.50 (95% CI 0.04, 5.79); p = 0.58. Due to the low number of pathogens identified, it was not possible to identify better methods for targeting antibiotics including both the cases and controls.ConclusionsWe found no evidence for an association between systemic azithromycin exposure and reduction in CRP. Further work is needed to better identify children at highest risk from bacterial co-infection.Trial registrationISRCTN49726849 (registered on 27th October 2017).

Three Days of Oral Azithromycin Versus Five Days of Oral Clarithromycin in the Treatment of Campylobacter Enterocolitis in Children: A Prospective Study.

This study aimed to compare the efficacy and tolerability of azithromycin and clarithromycin in pediatric Campylobacter enterocolitis. A prospective, randomized, controlled trial was conducted at a single center. Patients with confirmed Campylobacter enterocolitis were randomly assigned to receive either a 3-day course of azithromycin or a 5-day course of clarithromycin. Symptoms were monitored daily, and changes in laboratory markers (WBC counts, CRP levels, and stool calprotectin) were compared. A total of 29 pediatric patients were included, with 14 patients in the azithromycin group and 15 patients in the clarithromycin group. The median age of patients in the azithromycin group was 10.0 years (interquartile range [IQR]: 5.0-13.0), and in the clarithromycin group, the median age was 9.0 years (IQR: 7.0-13.0) (p = 0.793). The median time to clinical resolution was 3.0 days (IQR: 2.0-3.0) in the azithromycin group and 2.0 days (IQR: 2.0-3.0) in the clarithromycin group (p = 0.132). There were no significant differences in the duration of individual symptoms, including fever, vomiting, and abdominal pain. The length of hospital stay was also similar, with a median stay of 4 days (IQR: 3.0-5.0) in both groups (p = 0.394). Both antibiotics were well-tolerated, with no significant adverse events or treatment discontinuation reported. Clarithromycin was found to be as effective as azithromycin in treating pediatric Campylobacter enterocolitis, with similar clinical outcomes and improvements in laboratory markers.

Legionella Pneumophila Presenting as a Rare Cause of Acute Thrombocytopenia: A Case Report and Review of Literature.

Legionella pneumophila can cause a wide spectrum of clinical manifestations, ranging from a mild flu-like illness to fulminant multi-organ involvement, characterised by severe pneumonia, diarrhoea, encephalopathy, shock, hepatic dysfunction and renal failure. Very rarely, it can be associated with haematologic conditions such as thrombotic thrombocytopenic purpura (TTP), haemolytic uraemic syndrome (HUS) and immune thrombocytopenic purpura (ITP). We report a rare case of L. pneumophila causing ITP and review previously published cases of thrombocytopenia associated with Legionellosis in the literature. A 53-year-old male presented with fevers, chills, a productive cough and severe haemoptysis. Blood work was remarkable for leukocytosis, severe thrombocytopenia and hyponatraemia. Computed tomography (CT) imaging showed left lower lobe lung consolidation, and a peripheral blood smear showed giant platelets consistent with ITP. Legionella urine antigen testing returned positive. He was treated with intravenous immunoglobin, steroid taper and a ten-day course of azithromycin, which led to normalisation of his platelet count and resolution of the pneumonia. L. pneumophila can lead to complement-mediated destruction of platelets resulting in ITP. Antibodies against L. pneumophila can also cross-react with the enzyme ADAMTS13, inhibiting its function and resulting in TTP and HUS. Additionally, L. pneumophila can infect vascular endothelial cells causing their death and stimulating release of von Willebrand factor (vWF) multimers into the bloodstream, promoting thrombosis and platelet consumption. It is important for internists to consider L. pneumophila in the differential for any patient presenting with pneumonia and severe thrombocytopenia. Earlier detection and intervention can lead to prevention of critical bleeding and better outcomes. Legionella pneumophila is rarely associated with different haematologic disorders resulting in severe bleeding diathesis as well as thrombosis.It is important for internists to consider Legionella pneumophila in the differential diagnosis for any patient presenting with pneumonia and severe thrombocytopenia.Earlier detection and intervention can lead to prevention of critical bleeding and better outcomes.

Compound heterozygous CFTR variants (Q1352H and 5T; TG13) in a Chinese patient with cystic fibrosis

Cystic fibrosis (CF) is an autosomal recessive inherited disease caused by variants of cystic fibrosis transmembrane conductance regulation (CFTR) gene. This report presents a case of a Chinese boy diagnosed with CF, attributed to the presence of two specific CFTR gene variations: 4056G > C (NM_000492.4) (p.Gln1352His, legacy: Q1352H) and c.1210-34TG[13]T[5] (NM_000492.4)(legacy: 5T; TG13). A ten-year-old boy was admitted to the hospital due to recurrent pneumonia, cough, and intermittent fever for seven years. Lung auscultation revealed rales, and a lung CT scan indicated parenchymal transformation with infection in both lungs. Whole Exome Sequencing (WES) identified two CFTR gene variants, Q1352H and 5T; TG13, which were significantly associated with clinical phenotype. Following a two-year course of azithromycin combined with inhalation therapy with budesonide, the patient experienced no further episodes of respiratory infections. Moreover, significant improvements were observed in pulmonary function, pulmonary infection, and bronchiectasis. The occurrence of combined variations, Q1352H and 5T; TG13, in the CFTR gene is rare and specific to Chinese populations. WES proves to be a valuable diagnostic tool for detecting CFTR gene variants.

Latency Antibiotics in Preterm Prelabor Rupture of Membranes: A Comparison of Azithromycin Regimens.

Treatment with antibiotics at the time of preterm prelabor rupture of membranes (PPROM) has been shown to prolong pregnancy. Due to the recurrent shortage of erythromycin, azithromycin has been substituted in the traditional regimen; however, there are little data on optimal dosing. The objective of this study was to determine whether there is a difference in latency from onset of PPROM to delivery in patients who received a single dose of azithromycin compared with a 5-day course. This was a single-center, multisite, retrospective, IRB approved analysis of patients admitted with a diagnosis of PPROM. Patients were included if rupture occurred between 22 0/7 and 33 6/7 weeks of gestation and received either a single dose or a 5-day course of azithromycin along with a beta lactam. A total of 376 patients were reviewed with 296 patients included in the final analysis. There was no statistical difference in the primary outcome of latency days in patients who received the 5-day versus the single-dose course (4 vs 5 days, P = 0.641). There was a significantly higher rate of histologic chorioamnionitis in the single-dose course of azithromycin (46.4% vs 62.6%, P = 0.006). There was no difference in latency for patients who received a 5-day course of azithromycin versus a single dose for the treatment of PPROM. A higher rate of histologic chorioamnionitis was observed in those who received the single-day course. Prospective follow-up studies are needed to confirm these findings.

Legionella associated rhabdomyolysis: a case report

BackgroundInfections have been recognized as an uncommon cause of rhabdomyolysis, with evidence indicating a worse prognosis when compared to rhabdomyolysis caused by other etiologies. Diseases caused by Legionella pneumophila can present variably, ranging from mild to severe illness, as is sometimes the case with pneumonia. In particular, the triad of Legionnaire’s disease, rhabdomyolysis, and acute kidney injury is associated with a significant increase in the morbidity and mortality, with most patients requiring initiation of renal replacement therapy such as hemodialysis. While the exact mechanism of both the muscle and kidney injury in this setting remains unknown, several hypotheses exist, with some research suggesting multiple yet distinct processes occurring in both target organs.Case presentationIn this case report, we describe a 53-year-old African American man who presented with Legionella pneumophila pneumonia complicated by rhabdomyolysis and acute kidney injury. He was treated with aggressive fluid resuscitation and a 2-week course of azithromycin. His clinical status improved without necessitating renal replacement therapy or mechanical ventilation. We postulate that early recognition and treatment were key to his recovery. He was discharged 10 days later without recurrence of rhabdomyolysis at the time of this report.ConclusionWhile there are several well-established and more common causes of rhabdomyolysis, clinicians should recognize Legionella sp. as an etiology, given its association with significant morbidity and mortality.

A Needs Assessment for Infectious Diseases Consultation in Community Hospitals.

Infectious diseases (ID) consultations have been demonstrated to improve patient outcomes in the treatment of severe infections. However, ID consultation is often unavailable to patients that live in rural communities. Little is known regarding the treatment of infections in rural hospitals with no coverage from an ID specialist. We characterized the outcomes of patients cared for in hospitals without coverage from an ID physician. Patients aged 18years or older admitted to eight community hospitals without access to ID consultation during a 6.5-month period were assessed. All patients had received at least three days of continuous antimicrobial therapy. The primary outcome was the need for transfer to a tertiary facility for ID services. The secondary outcome was the characterization of antimicrobials received. Antimicrobial courses were evaluated independently by two board-certified ID physicians. 3706 encounters were evaluated. Transfers for ID consultation occurred in 0.01% of patients. The ID physician would have made modifications in 68.5% of patients. Areas for improvement included treatment of chronic obstructive pulmonary disease exacerbations, broad-spectrum treatment of skin and soft tissue infection, long courses of azithromycin, and management of Staphylococcus aureus bacteremia, including choice and length of therapy, as well as obtaining echocardiography. Patients evaluated received 22,807days of antimicrobial therapy. Patients hospitalized in community hospitals are rarely transferred for ID consultation. Our work demonstrates a need for ID consultation in community hospitals, identifying opportunities to enhance patient care by modifying antimicrobial regimens to improve antimicrobial stewardship and avoid inappropriate antimicrobials. Efforts to expand the ID workforce to include coverage at rural hospitals will likely improve antibiotic utilization.

Abstract #1377584: Brain on Fire: A Case of Hashimoto's Encephalitis in a 29-Year-Old Female

A 29-year-old female presents to the hospital for insomnia, hallucination, and bizarre behavior. The patient had been feeling well until approximately three days early when she became psychotic after fasting from food for three days. She began having auditory and visual hallucinations and then started having seizures. Initially, the patient was admitted to a hospital in another city where she was diagnosed with Autoimmune Encephalitis for which she received IVIg. Brain MRI showed questionable T2 changes around the fourth ventricle on the left during hospital admission. The patient was discharged home after her symptoms improved. However, she was brought to our hospital for psychiatric consultation as her condition deteriorated. Upon arrival at Larkin Community Hospital, the patient was hemodynamically stable, breathing room air, and continued to complain of having delusions and hallucinations. Initial Vital Signs: BP: 122/74 mmHg, HR: 70 bpm, RR: 18, T: 98°F. weight 56.2 kg, BMI 24.21. She was in nonacute distress, although anxious with pressured speech. She was cooperative and able to follow commands and track the examiner. Her NIH Stroke Scale/Score (NIHSS) was 0 and Glasgow Coma Scale (GCS) was 15. She denied using illicit drugs, smoking, and alcohol. Neurology decided to repeat LP CSF r/o NMDA Antibody encephalitis and started empirically a 5-day course of azithromycin to cover for streptococcal infections while awaiting further results. Thyroglobulin antibodies were ordered to rule out Steroids Responsive Encephalopathy and it came back elevated (91.2). She was started on Solu-Medrol 500mg IV daily for 3 days which was increased to 1000mg IV daily to complete 5 days. Even though, she developed tachycardia in the 120s; she started feeling much better as well as improved her symptoms. “Steroid-responsive encephalopathy associated with autoimmune thyroiditis” (SREAT) is an uncommon condition that is associated with Hashimoto thyroiditis. It is also called Hashimoto encephalopathy (HE). This condition was originally described in 1966 by Brain et al1. HE is a rare disorder with an approximate prevalence of 2/100,0002. It affects women more often than men. This diagnosis is typically made when a patient has encephalopathy associated with antithyroid (anti-thyroid peroxidase [TPO]) and/or anti-thyroglobulin (TG) antibodies, when other causes have been excluded. The symptoms typically seen include subacute onset of confusion with altered level of consciousness, seizures, and myoclonus. Based on the literature review of 251 cases of SREAT by Laurent et al3, SREAT has various presentations including coma to isolated psychiatric disorder. This disorder is thought to be immune mediated as opposed to being the result of an altered thyroid state on the nervous system. In most of the reported cases of SREAT, the patients are euthyroid during the presentation of symptoms. However, the exact mechanism of SREAT is still unknown. The diagnosis is made after excluding other toxic, infectious, and metabolic causes of encephalopathy with examination of cerebrospinal fluid and neuroimaging.

Azithromycin alters spatial and temporal dynamics of airway microbiota in idiopathic pulmonary fibrosis.

High bacterial burden in the lung microbiota predicts progression of idiopathic pulmonary fibrosis (IPF). Azithromycin (AZT) is a macrolide antibiotic known to alter the lung microbiota in several chronic pulmonary diseases, and observational studies have shown a positive effect of AZT on mortality and hospitalisation rate in IPF. However, the effect of AZT on the lung microbiota in IPF remains unknown. We sought to determine the impact of a 3-month course of AZT on the lung microbiota in IPF. We assessed sputum and oropharyngeal swab specimens from 24 adults with IPF included in a randomised controlled crossover trial of oral AZT 500 mg 3 times per week. 16S rRNA gene amplicon sequencing and quantitative PCR (qPCR) were performed to assess bacterial communities. Antibiotic resistance genes (ARGs) were assessed using real-time qPCR. AZT significantly decreased community diversity with a stronger and more persistent effect in the lower airways (sputum). AZT treatment altered the temporal kinetics of the upper (oropharyngeal swab) and lower airway microbiota, increasing community similarity between the two sites for 1 month after macrolide cessation. Patients with an increase in ARG carriage had lower bacterial density and enrichment of the genus Streptococcus. In contrast, patients with more stable ARG carriage had higher bacterial density and enrichment in Prevotella. AZT caused sustained changes in the diversity and composition of the upper and lower airway microbiota in IPF, with effects on the temporal and spatial dynamics between the two sites.

399: A CASE OF SEVERE BABESIOSIS REQUIRING EXCHANGE TRANSFUSION

Introduction: Babesiosis is an infection caused by a protozoan that infects human erythrocytes. In the United States, Babesia microti is the most commonly isolated strain transmitted by tick vector (Ixodes scapularis). The severity of infection usually depends on host immune status and Babesia species, ranging from asymptomatic to life-threatening. We describe a case of severe babesiosis requiring exchange transfusion in an elderly but otherwise healthy individual. Description: A previously healthy 90-year-old man presented to the emergency department with a 1-week history of dyspnea and dark-colored urine. Patient reported a tick bite two months prior for which he was empirically treated with doxycycline. On admission, he was afebrile, blood pressure was 130/69 mmHg, heart rate was 84 bpm, and respiratory rate was 22 breaths/min. Physical exam was unremarkable. Labs were notable for serum creatinine 2.70mg/dl, total bilirubin 3.2mg/dl, direct bilirubin 1.6mg/dl, AST 125U/L, ALT 66U/L, hemoglobin 10.1g/dl, and platelets 44k/µL. Peripheral smear showed babesia species without Anaplasma and Ehrlichia, and Lyme serology was negative. Patient was started on intravenous azithromycin and atovaquone and admitted to medical ward. Later that day he became hypotensive with elevated lactate of 3.1mmol/dl. His blood pressure was minimally fluid-responsive. Further labs revealed a haptoglobin < 10, elevated lactate dehydrogenase, and parasitemia of 31.4%. Due to the hypotension with evidence of organ damage, intravascular hemolysis, and high-grade parasitemia, he was transferred to the medical intensive care unit (MICU) for exchange transfusion. In the ICU patient received two rounds of exchange red blood cell transfusion with which parasitemia decreased to 1.4% and hemolysis parameters improved. His blood smear was negative for babesia on hospital day 5 and he was discharged home to complete a 2-week course of azithromycin and atovaquone from the day of negative smear. Discussion: Babesiosis can be life-threatening, especially in elderly, asplenic, and immunocompromised patients. Our case outlines the importance of early institution of exchange transfusion in addition to appropriate antimicrobial therapy in patients with end-organ damage, intra-vascular hemolysis, and high-grade parasitemia for better outcomes.

A DELAYED DRUG RASH IN A PATIENT WITH ULCERATIVE COLITIS: INFLIXIMAB-INDUCED PSORIASIS.

<h3>Introduction</h3> Infliximab, a Tumor Necrosis Factor (TNF)-α antagonist, can rarely lead to paradoxical psoriasis even though infliximab can be used to treat psoriasis. We present a case of TNF-α-inhibitor-induced psoriasis. <h3>Case Description</h3> An 18-year-old-female with ulcerative colitis on infliximab was evaluated after developing a one-month history of generalized erythematous papules and plaques with scale (Fig 1A) sparing her face and neck. She had recently received a course of azithromycin 2 days prior and had started oral contraceptives (OCPs) a month prior. She had been on infliximab every 2 months for the last year and had received the last infusion a month prior to development of the rash. She was not on any over-the-counter medications or supplements. The rash did not improve with systemic steroids or low-dose antihistamines. A punch biopsy revealed acanthosis, parakeratosis, dilated blood vessels with surrounding mixed inflammatory infiltration with thinning of the suprapapillary epidermal plates (Fig 1B) consistent with psoriasis. She was recommended to avoid further TNF-α inhibitors and was started on ustekinumab. The psoriasis was treated with triamcinolone 0.1% cream using wet dressing technique and resolved within 2 months. The patient continued with OCPs and declined an azithromycin challenge. <h3>Discussion</h3> Most side effects from TNF-α inhibitors are observed during the first six months of use including: injection site reactions, cutaneous infections, immune-mediated complications (psoriasis and lupus), and even skin cancers. Identifying the difference between classic psoriasis and drug-induced psoriasis may be challenging due to the variable clinical and histopathological features.

A RARE CAUSE OF MULTIFOCAL PNEUMONIA AND CONSTRICTIVE PERICARDITIS: COXSACKIEVIRUS A

A RARE CAUSE OF MULTIFOCAL PNEUMONIA AND CONSTRICTIVE PERICARDITIS: COXSACKIEVIRUS A

S2009 Chronic Diarrhea Due to Campylobacter Infection in an Immunocompetent Host: A Case Report

Introduction: Campylobacter infection is a foodborne illness transmitted by ingestion of contaminated food or water. It is responsible for roughly 1.5 million infections annually in the U.S. Typical symptoms include acute diarrhea (< 2 weeks) that can be bloody or non-bloody, periumbilical pain, fever, and body aches. The enteritis is often self-limited in immunocompetent hosts. Subacute or chronic diarrhea can be observed in immunocompromised patients, but rarely in the immunocompetent host. Case Description/Methods: A 58-year-old male with a history of Korsakoff syndrome and anoxic brain injury was admitted with chronic diarrhea of 2 months, severe metabolic acidosis and acute kidney injury. Patient had 5 to 6 episodes of large volume watery diarrhea daily. There was serum leukocytosis with 17.2 K/mcL. Fecal immunochemical test was negative for blood. Stool culture was positive for Campylobacter antigen. CT abdomen showed numerous mildly enlarged mesenteric root lymph nodes without pericolonic fat stranding (Figure). Serum and stool inflammatory markers were elevated (Table). Stool testing for other infectious agents was unremarkable. Diarrhea did not improve with fasting. Patient did have underlying chronic pancreatitis due to prior alcohol abuse, but had been abstinent for 3 years. He was not previously on pancreatic enzyme and vitamin supplementation, which was started but did not improve his symptoms. Screening for celiac disease, HIV, and viral hepatitis was also unremarkable. It was concluded that in addition to chronic pancreatic insufficiency, Campylobacter was the culprit for his chronic diarrhea, which was treated with IV azithromycin for 10 days. Patient’s diarrhea resolved after completion of antibiotics. Repeat CT abdomen showed near-complete resolution of previously seen lymphadenopathy. Discussion: Chronic diarrhea due to Campylobacter infection is rare in immunocompetent hosts. Long-term Campylobacter colonization has been described in immunocompromised hosts. Colonization, or chronic campylobacteriosis, is confirmed by persistent Campylobacter-positive feces in the setting of prolonged diarrhea. It is typically treated with oral azithromycin or ciprofloxacin for 3 days. However, our patient required an intravenous administration and longer course of treatment since his symptoms were refractory to oral antibiotics. This is an uncommon case of complicated Campylobacter infection resulting in chronic diarrhea in an immunocompetent patient.Figure 1.: Left: CT Abdomen without contrast (axial) showing mesenteric lymphadenopathy, lymph node measuring 1.2cm x 2.4cm (arrow). Right: Resolution of lymphadenopathy after completion of 10-day course of azithromycin. Table 1. - Stool and serum laboratory profile of the patient Test Result Reference Range Stool Studies Stool culture Campylobacter sp Negative WBC Positive Negative Calprotectin 447 Normal < 50 mcg/g Pancreatic Elastase 1 < 15 Normal >200 mcg/g C. Difficile PCR Negative Negative Giardia antigen Negative Negative Fecal sodium 114 N/A Fecal potassium 14.0 N/A Fecal chloride 73 N/A Fecal Osmolality 437 275-295 mOsm/kg* Fecal Osmotic Gap 34 Secretory diarrhea: < 50 mOsm/kg Osmotic diarrhea: >75 mOsm/kg Fecal Fat (Qualitative) Abnormal (positive) Normal Ova and parasites Negative Negative Serum Studies WBC 17.2 4.8-10.8 K/mcL TSH 1.5 0.55-4.78 uIU/mL ESR 62 < 20 mm/hr for men over 50 years CRP 95 0-7.5 mg/L Lipase 7 22-51 U/L HIV 1 and 2 antibody Nonreactive Nonreactive Celiac panel (tTg IgA) Negative Negative Total IgA 293 47-310 mg/dL Blood cultures Negative Negative *Stool osmolality greater than 290 and up to 600 are common because of bacterial metabolism of fecal carbohydrate during storage of the stool sample.Abbreviations: WBC: white blood cells, CRP: C-reactive protein, HIV: human immunodeficiency virus, tTg: tissue transglutaminase, IgA: Immunoglobulin A.

A comparison of different antibiotic regimens for the treatment of naturally acquired shigellosis in rhesus and pigtailed macaques (Macaca mulatta and nemestrina).

Shigella spp. are common enteric pathogens in captive non-human primates. Treatment of symptomatic infections involves supportive care and antibiotic therapy, typically with an empirical choice of antibiotic. Twenty-four clinically ill, Shigella PCR-positive animals were randomly assigned to one of four treatment groups: single-dose ceftiofur crystalline free acid (CCFA), single-dose azithromycin gavage, a 5-day tapering azithromycin dose, or 7-day course of enrofloxacin. We hypothesized that all antimicrobial therapies would have similar efficacy. Animals in all groups cleared Shigella, based on fecal PCR, and had resolution of clinical signs 2 weeks after treatment. Eight out of nine clinically ill and PCR-positive animals tested negative by fecal culture. Single-dose CCFA, single-dose azithromycin, and a 5-day tapering course of azithromycin all performed as well as a 7-day course of enrofloxacin in eliminating Shigella infection. Fecal PCR may be a better diagnostic than culture for Shigella.

Effect of Azithromycin on Sciatic Nerve Injury in the Wistar Rats.

After a severe peripheral nerve injury, complete functional recovery is rare. Modulating the inflammatory response could be an effective way to enhance peripheral nerve regeneration. The present study aimed to determine the effect of azithromycin on functional recovery following sciatic nerve crush in Wistar rats. 40 male Wistar rats were used in four groups, including: the negative control, sham, and two groups of azithromycin (15 and 150mg/kg/day) (n = 10).The rats' right sciatic nerve was crushed using a non-serrated clamp. In experimental groups, animals were treated with azithromycin (15 and 150mg/kg/day) for 7 days. Then, sensory-motor functions were evaluated over eight weeks. Real-time PCR was used to measure the expression of NGF and BDNF genes. At the end of the 4th week, the sensory recovery accelerated in the azithromycin-treated rats so that the reaction times in the groups treated with 15mg/kg and 150mg/kg doses of azithromycin reached 5.14s and 6.61s, respectively, which were significantly lower than the 12s in the negative control group (P < 0.05).Eventually, the mean SFI values in the negative control and both azithromycin-treated groups recovered to preoperative levels in the 8th week, with no significant difference between the sciatic lesion groups. Findings showed a seven-day course of azithromycin administered immediately after a sciatic nerve crush could accelerate regeneration and improve motor and sensory function recovery compared to negative controls. These significant effects were observed in both the azithromycin 15mg/kg and the azithromycin 150mg/kg treatment groups. Azithromycin treatment upregulated the expression of NGF and BDNF genes in crushed sciatic nerve. Our findings suggest that a seven-day treatment of azithromycin after a sciatic nerve injury could accelerate the regeneration process and improve functional recovery.

2021 European guideline on the management of Mycoplasma genitalium infections.

Asymptomatic infections are frequent. In men, urethritis, dysuria and discharge predominate. In women, symptoms include vaginal discharge, dysuria or symptoms of PID - abdominal pain and dyspareunia. Symptoms are the main indication for diagnostic testing. Diagnosis is achievable only through nucleic acid amplification testing and must include investigation for macrolide resistance mutations. Therapy for M .genitalium is indicated if M. genitalium is detected. Doxycycline has a cure rate of 30-40%, but resistance is not increasing. Azithromycin has a cure rate of 85-95% in macrolide-susceptible infections. An extended course of azithromycin appears to have a higher cure rate, and pre-treatment with doxycycline may decrease organism load and the risk of macrolide resistance selection. Moxifloxacin can be used as second-line therapy but resistance is increasing. Uncomplicated M. genitalium infection without macrolide resistance mutations or resistance testing: Azithromycin 500 mg on day one, then 250 mg on days 2-5 (oral). Second-line treatment and treatment for uncomplicated macrolide-resistant M. genitalium infection: Moxifloxacin 400 mg od for 7 days (oral). Third-line treatment for persistent M. genitalium infection after azithromycin and moxifloxacin: Doxycycline or minocycline 100 mg bid for 14 days (oral) may cure 40-70%. Pristinamycin 1 g qid for 10 days (oral) has a cure rate of around 75%. Complicated M. genitalium infection (PID, epididymitis): Moxifloxacin 400 mg od for 14 days. MAIN CHANGES FROM THE 2016 EUROPEAN M. Due to increasing antimicrobial resistance and warnings against moxifloxacin use, indications for testing and treatment have been narrowed to primarily involve symptomatic patients. The importance of macrolide resistance-guided therapy is emphasised.

Q Fever Masquerading as Legionnaires Disease in an Endovascular Stent Infection

Abstract Background Legionellosis in the setting of preexisting endovascular prosthetic graft may represent a Coxiella burnetii infection as antibody cross-reactivity exists. Methods We present a 63-year-old man status-post endovascular aneurysm repair (EVAR) with a history of ankylosing spondylitis, chronic obstructive pulmonary disease asthma, coronary artery disease with myocardial infarction, hypertension, and hyperlipidemia who presented with clinical symptoms of legionellosis. This was confirmed with a positive urine antigen test. Results He completed a 21-day course of azithromycin for Legionella. His leukocytosis and liver function tests normalized, but he had continued lethargy and a persistently elevated erythrocyte sedimentation rate and C-reactive protein. Imaging showed a radiographically infected EVAR graft (placed 10 months prior). The EVAR was explanted and the operating room cultures grew C. burnetii. Prolonged hydroxychloroquine and doxycycline therapy were required for vascular manifestations of Coxiella as azithromycin provides inappropriate coverage. Conclusions Persistent constitutional symptoms in the setting of an EVAR require expanded investigation, especially in the setting of legionellosis.

Lady Windermere Syndrome: An Interesting Clinical and Radiological Presentation

Lady Windermere Syndrome is an uncommon pulmonary disease characteristically observed in elderly white females with chronic cough suppression and dyspnea. It is classically associated with Mycobacterium avium complex (MAC) species. An 84-year-old female was evaluated for longstanding non-productive cough and intermittent dyspnea. A chest computed tomography scan revealed densities in the right upper lobe and scattered nodular-cystic bronchiectasis. Biopsy was negative for malignancy; however, bronchioalveolar lavage studies showed presence of MAC. Patient was treated with a 12-month course of azithromycin, rifampin and ethambutol resulting in resolution of her symptoms.

EVALUATING THE EFFICACY OF HUMAN BRONCHIECTASISBASED ANTIBIOTIC THERAPY IN THE TREATMENT OF ORANGUTAN RESPIRATORY DISEASE SYNDROME.

Unique among apes, orangutans (Pongo spp.) develop a chronic respiratory disease called orangutan respiratory disease syndrome (ORDS). The authors define ORDS as intermittent bacterial infection and chronic inflammation of any region or combination of regions of the respiratory tract, including the sinuses, air sacs, cranial bones, airways, and lung parenchyma. Infection in any of these areas can present acutely but then becomes recurrent, chronic, progressive, and ultimately fatal. The closest model to this disease is cystic fibrosis (CF) in people. We hypothesized that use of a 4-8-wk course of combined oral antibiotics used in the treatment of bronchiectasis in CF patients would lead to prolonged symptomatic and computed tomography (CT) scan improvement in orangutans experiencing early signs of ORDS. Nine adult Bornean orangutans (Pongo pygmaeus, eight males, one female, 18-29 yr of age) diagnosed with early ORDS-like respiratory disease underwent CT scan before initiation of treatment. Each animal received a combined course of azithromycin (400 mg 3/wk, mean 7 mg/kg) and levofloxacin (500 mg PO q24h, mean 8.75 mg/kg) for a period of 4-8 wk. CT scan was repeated 6-14 mon after completion of antibiotic treatment. Pretreatment CT showed that six of nine animals had lower respiratory pathology (airway disease, pneumonia, or both). All six orangutans had concurrent sinusitis, mastoiditis, airsacculitis, or a combination of these conditions. Upper respiratory disease alone was observed in three animals. CT showed improvement or resolution in four of five sinusitis cases, improvement in one of two instances of mastoiditis, resolution in five of six instances of airsacculitis, improvement or resolution in six of six instance of lower airway disease (P = 0.03, 95% CI 0.54-1.0], and resolution in five of five cases of pneumonia. Resolution of pretreatment clinical signs was observed in all nine animals. Two developed signs not present at pretreatment. These results show that combination antibiotic therapy with azithromycin and levofloxacin provides improvement in clinical signs and CT evidence of ORDS-related pathology, resulting in symptom-free status in some animals for up to 33 mon.

A CASE OF VAPING-RELATED LUNG INJURY MIMICKING COVID-19

TOPIC: Tobacco Cessation and Prevention TYPE: Medical Student/Resident Case Reports INTRODUCTION: E-cigarette and vaping associated lung injury (EVALI) was first recognized in 2019 and can present with acute onset respiratory distress mimicking that of COVID-19. It is important to consider in a young patient with a significant vaping history. CASE PRESENTATION: A 19-year-old male with a history of anxiety, depression, and delusional disorder presented with worsening dyspnea, fever and productive cough, nausea, vomiting, diarrhea for 1 week. He had gone to urgent care where he had tested negative for COVID19 twice and was started on Azithromycin. He denied any exposure to COVID positive individuals but reported that his siblings' school had a recent outbreak. Vitals on admission were temperature 100.3F, Heart rate 121, Respiratory rate 24, Blood Pressure 157/97, pulse oximetry 81% on Room Air, improved after 6L supplemental oxygen. Labs significant for leukocytosis of 19.4K, normal procalcitonin, ESR >130, ferritin 443, LDH 694, CRP 358. Urine drug screen positive for THC (tetrahydrocannabinol). Urine was negative for Legionella and Strep pneumoniae. COVID testing were negative on 3 separate occasions. Chest x-ray showed mild-moderate pulmonary congestion, but no effusions. Chest CTA showed patchy parenchymal interstitial infiltrates bilaterally, suspicious for nonspecific pneumonitis/atypical viral pneumonia or pulmonary edema, but no pulmonary embolus. Blood cultures and sputum cultures negative.On further questioning, he attested to vaping and smoking marijuana through a bong; he had recently bought a new THC product off the street for vaping that contained vitamin E acetate. Given his history of vaping and his failed treatment with antibiotics, we considered EVALI. He was started on prednisone 40mg daily and 5 day course of Azithromycin and Ceftriaxone. On the 4th day of hospitalization, he showed significant clinical improvement and was no longer requiring oxygen supplementation. The patient was discharged on Day 5. Repeat chest xray 5 days after discharge showed no evidence of active disease. DISCUSSION: EVALI is a diagnosis of exclusion; it can mimic atypical and viral pneumonias, most notably COVID-19. Vitamin E acetate is the main causative agent, resulting in an acute lung injury with findings of acute fibrinous pneumonitis, diffuse alveolar damage, or organizing pneumonia. Patients are usually treated with supportive care, antibiotics, and systemic steroids. The COVID19 pandemic poses a diagnostic challenge to accurately diagnose cases of EVALI due to the similar presentation of both diseases: acute to subacute respiratory symptoms with gastrointestinal symptoms, ground-glass opacities on CT, and elevated inflammatory markers. CONCLUSIONS: Similar to COVID19, EVALI can also be fatal, and should not be overlooked as a diagnosis. A thorough history is imperative in reaching a diagnosis, and can save PPE use, and decrease hospitalization cost. REFERENCE #1: "Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products." Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 27 Nov. 2020, www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#overview. REFERENCE #2: Blount, Benjamin C., et al. "Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI." New England Journal of Medicine, vol. 382, no. 8, 2020, pp. 697–705., doi:10.1056/nejmoa1916433. REFERENCE #3: Hollingsworth, Helen. UpToDate, 9 Feb. 2021, www.uptodate.com/contents/e-cigarette-or-vaping-product-use-associated-lung-injury-evali?search=evali&source=search_result&selectedTitle=1~13&usage_type=default&display_rank=1#H4113759245. DISCLOSURES: No relevant relationships by Rebecca Greenspan, source=Web Response No relevant relationships by Areej Khan, source=Web Response No relevant relationships by Manpreet Mann, source=Web Response No relevant relationships by Krishnaveni Sirigaddi, source=Web Response