Intravenous Penicillin Research Articles

Optic perineuritis: A Canadian case series and literature review

BackgroundOptic perineuritis (OPN) is a rare orbital inflammatory disorder that primarily involves the optic nerve sheath (ONS). This study aimed to describe the clinical features of idiopathic OPN as well as OPN secondary to other infectious and inflammatory conditions in a Canadian case series as current literature on secondary OPN in Western countries is mostly limited to case reports. MethodsRetrospective case series of all patients seen in a tertiary neuro-ophthalmology practice with a diagnosis of OPN from 2014 to 2020. ResultsA total of 21 patients (14 women, mean age 55.8) corresponding to 29 eyes with OPN were identified. Fifteen cases were associated with inflammatory or infectious conditions and only 6 were idiopathic. All idiopathic cases were unilateral. The most common secondary causes of OPN were anti-myelin oligodendrocyte glycoprotein (MOG) antibody disease (n = 4), syphilis (n = 3), sarcoidosis (n = 3), and giant cell arteritis (n = 3). At initial presentation, best-corrected visual acuity (BCVA) was 20/20 or better in 24% (n = 7) and visual field mean deviation (VF MD) was better than −5 dB in 34% of eyes (10/29). Treatment consisted of intravenous penicillin for syphilitic OPN and high-dose corticosteroids followed by oral taper with or without immunosuppressive therapy for non-syphilitic OPN. BCVA improved in 34% (10/29) and VF MD improved in 45% (13/29) eyes. ConclusionOPN primarily occurred in association with systemic inflammatory conditions, especially in bilateral cases. Syphilis must be ruled out in all patients. Anti-MOG antibody disease is an important, newly recognized secondary cause of OPN, and serologic testing should be included in the investigation of all patients with OPN.

A case of ocular neurosyphilis in a patient with HIV

A case of ocular neurosyphilis in a patient with HIV

Neurosyphilis Presenting with Optic Neuritis

The incidence of syphilis has greatly reduced in the severity of affected individuals due to the early treatment with antibiotics. However, due to the increase in the prevalence of human immunodeficiency virus (HIV) infection, it has also caused a concurrent rise in the number of neurosyphilis patients. Most common ocular manifestations include uveitis, interstitial keratitis, and vasculitis. A healthy 28-years old man presented with a progressive blurring of vision in the right eye for one month. It was his second episode. The first episode occurred 4 months back which resolved spontaneously without treatment. Vision in the right eye was 6/18. The pupil was dilated and the relative afferent pupillary defect was positive. Fundus examination showed a hyperemic swollen right optic disc with blurred margins and no macular fan or star. Vision, anterior segment, and fundus were normal in the left eye. After the investigations, he was diagnosed as a case of neurosyphilis with optic neuritis. He was treated with intravenous penicillin for two weeks followed by oral penicillin for three weeks. Vision in the right eye improved to 6/6; the optic disc swelling resolved with clear margins. He maintained good vision during the follow-up of six months. Early referral to an ophthalmologist upon suspicion of syphilis, detailed evaluation, and immediate treatment is mandatory to prevent permanent vision loss in these patients.

Resident Perspectives 56-5

Resident Perspectives 56-5

28635 New onset exanthem in a 32-year-old with Hodgkin’s lymphoma

A 32-year-old male with classic Hodgkin’s lymphoma presented to our service with a new onset exanthem, fever, weakness, and sweats. Two months prior the patient was started on brentuximab/AVD (doxorubicin, vinblastine, dacarbazine). The onset of the rash was five days after his third cycle. On the trunk and face he showed multiple erythematous papules. Histology revealed lichenoid interface and perivascular lymphocytic and histiocytic dermatitis with vasculopathic alterations. Microbiologic stains were negative (PASD, GMS, gram, Fite, Toxo, CMV) and ruled out hematoproliferative infiltration. On review of clinical history, the patient was noted to be taking oral Truvada for pre-exposure prohylaxis (PrEP) of HIV, and had recent unprotected sexual partners. Infectious serologies for HIV, Hep B/C, and syphilis, which had been negative four months prior, were repeated. RPR was positive (1:64) and FTA-Abs reactive in serum. Since the patient described headaches, vision changes, and lancinating pain radiating through the arm, there was concern for CNS involvement of Treponema pallidum. CSF examination revealed elevated WBC and protein consistent with tertiary neurosyphilis. The patient was started on intravenous crystalline penicillin treatment over 14 days. Syphilis cases have been on the rise, disproportionately affecting men who have sex with men (MSM). In the immunocompromised, syphilis can progress to the manifestation of neurosyphilis if untreated. This case emphasizes the importance of serologic testing, especially in immunocompromised patients and raises awareness of the progression to complicated Treponema infections in patients receiving immunosuppressive medication.

A rare case of periprosthetic Trueperella bernardiae following a total hip arthroplasty and antimicrobial stewardship

Trueperella bernardiae is a rare, anaerobic Gram-positive bacillus. Very few published clinical reports1 of Trueperella infections, eludes its true incidence and pathogenicity. We share a case of a 70-year-old woman with recurrent peri-prosthetic joint infection (PJI) following a total hip arthroplasty. A month after hip replacement, she presented with PJI, which was treated with extensive debridement and oral Ciprofloxacin in community for ESBL Enterobacteriaceae from peri-prosthetic samples. Five months later, she represented with peri-prosthetic collection which grew Trueperella bernardiae, during stage 1 hip revision. This was treated in hospital with six-weeks intravenous (IV) benzyl penicillin. A month after the second stage revision, she presents with hip re-collection that grew ciprofloxacin resistant Escherichia coli. She was managed in community with a 6-week IV carbapenem. However, 12 months later she developed a psoas abscess and subsequently elected for cessation of active management, leading to her demise. This report emphasises on the emergence of antimicrobial resistance2 Enterobacteriaceae due to constant antibiotic pressure, possibly causing a prosthetic joint infection by a rare Trueperella bernardiae, which was treated effectively by a narrow spectrum penicillin. This case report calls the need for antimicrobial stewardship3 while elucidating the existence of rare pathogens. 1.Loïez C, Tavani F, Wallet F, et al. An unusual case of prosthetic joint infection due to Arcanobacterium bernardiae. J Med Microbiol 2009; 58: 842–3.2.Serwecińska L. Antimicrobials and antibiotic-resistant bacteria: a risk to the environment and to public health. Water 2020; 12: 3313.3.McKenzie D, Rawlins M, Del Mar C. Antimicrobial stewardship: what’s it all about? Aust Prescr 2013; 36: 116–20.

Syphilitic Outer Retinopathy: A Case Report and Review of the Literature.

This work presents a case of syphilitic outer retinopathy with findings similar to those of acute zonal occult outer retinopathy (AZOOR). We also discuss the clinical characteristics, treatment, and prognosis of this entity. A case report and systematic literature review are presented. A 56-year-old woman presented with acute vision loss, localized photopsia, a central scotoma, and retinal findings that were all consistent with AZOOR. A further workup led to a diagnosis of syphilis. Oral prednisone and intravenous penicillin resulted in the resolution of the posterior uveitis and the restoration of visual acuity. However, the central scotoma remained at the 3-year follow-up visit. Syphilitic outer retinopathy is a distinct entity characterized by the disruption of the ellipsoid zone visible on optical coherence tomography and a corresponding increase in fundus hyperautofluorescence in the affected areas. Although some patients may present with a demarcation line, as is seen with AZOOR, the fundus is oftentimes unremarkable or may show only subtle retinal pigment epithelium changes. Uveitis resolution and visual acuity restoration may be expected following treatment; however, visual field disturbances may persist.

Predictors of longer hospitalization of maxillofacial infections-a 17-year retrospective study.

To evaluate treatment outcomes in patients with severe maxillofacial infections requiring hospital care during a 17-year period. A retrospective cohort study reviewed 5,465 medical records, and the following data were collected: the reason for infection, locations of inflamed regions, treatment provided, bacteriological findings, and treatment outcomes. Other information included sociodemographic characteristics (age, gender), presence of systemic diseases, and smoking history. The annual incidence rate of patients with acute maxillofacial infections was 206±19 cases with a male to female ratio 1.4:1.0, a mean hospital stay of 7.9±4.9days. Older age (>65years), smoking and systemic diseases (diabetes), the causative tooth (molar), and need for extraoral incision predicted longer hospitalization. Intravenous penicillin was the most common drug prescribed in 50.5% of cases. A total of 132 different microorganisms were identified. The highest microorganism resistance occurred for metronidazole and the highest sensitivity was to clindamycin. Increased age, smoking, diabetes, causative tooth, and the occurrence of several infected spaces were associated with a longer hospital stay. Streptococcus α haemolyticus was the most common microorganism found in more than 70.0% of cases that were sensitive to intravenous penicillin.

Anterior uveal fungal abscess in an HIV positive patient

Endogenous endophthalmitis (EE) accounts for approximately 2% to 8% of all cases of endophthalmitis. Candida albicans abscesses in the iris and ciliary body are a rare form of presentation, with only 3 cases reported up until now. The case is presented of a 27-year-old patient with an elevated lesion in the iris at the temporal zone of the left eye, with hypopyon, pupil membrane, and 4+ cells in the anterior chamber. Tests for syphilis and HIV were positive, and were associated with extraocular manifestations of secondary syphilis. Treatment with intravenous penicillin and HAART therapy were started, but the clinical course worsened after 7 days. Pars plana vitrectomy and an abscess aspiration were performed, and the intraocular fluids and the purulent content were sent for microbiological examination. Cultures were positive for Candida albicans. The case is presented of an anterior uveal abscess by Candida albicans in an HIV-positive patient not previously reported in the literature.

Intrapartum Group B Streptococcal Prophylaxis and Childhood Allergic Disorders.

To determine if maternal intrapartum group B Streptococcus (GBS) antibiotic prophylaxis is associated with increased risk of childhood asthma, eczema, food allergy, or allergic rhinitis. Retrospective cohort study of 14 046 children. GBS prophylaxis was defined as administration of intravenous penicillin, ampicillin, cefazolin, clindamycin, or vancomycin to the mother, ≥4 hours before delivery. Composite primary outcome was asthma, eczema, or food allergy diagnosis within 5 years of age, identified by diagnosis codes and appropriate medication prescription. Allergic rhinitis was defined by using diagnostic codes only and analyzed as a separate outcome. Analysis was a priori stratified by delivery mode and conducted by using Cox proportional hazards model adjusted for multiple confounders and covariates. Secondary analyses, restricted to children retained in cohort at 5 years' age, were conducted by using multivariate logistic regression. GBS prophylaxis was not associated with increased incidence of composite outcome among infants delivered vaginally (hazard ratio: 1.13, 95% confidence interval [CI]: 0.95-1.33) or by cesarean delivery (hazard ratio: 1.08, 95% CI: 0.88-1.32). At 5 years of age, among 10 404 children retained in the study, GBS prophylaxis was not associated with the composite outcome in vaginal (odds ratio: 1.21, 95% CI: 0.96-1.52) or cesarean delivery (odds ratio: 1.17, 95% CI: 0.88-1.56) cohorts. Outcomes of asthma, eczema, food allergy, separately, and allergic rhinitis were also not associated with GBS prophylaxis. Intrapartum GBS prophylaxis was not associated with subsequent diagnosis of asthma, eczema, food allergy, or allergic rhinitis in the first 5 years of age.

An Early Presentation of Neurosyphilis Manifesting as Cranial Polyneuropathies: A Case Report

Neurosyphilis (NS) is a rarely reported disease, with neurological manifestations occurring in the late stages of the infection. The incidence of NS has steadily increased, particularly with increased cases of human immunodeficiency virus (HIV) infection among homosexual partners, and can occur at any stage of the disease. In this case report, we present a 53-year-old homosexual man with HIV who presented with a gradual onset of vertigo over a course of 2 weeks, followed by gradual onset of multiple cranial neuropathies. Magnetic resonance imaging of the brain revealed pathological enhancement of multiple cranial nerves. Laboratory workup revealed reactive Venereal Disease Research Laboratory dilutional titer in the cerebrospinal fluid, supporting the diagnoses of NS. He was treated with intravenous penicillin with gradual resolution of symptoms. Our case illustrates that NS can occur with no known prior evidence or manifestation of the infection. The diagnosis of NS should be entertained in individuals with a known history of HIV and unexplained multiple cranial neuropathies. J Neurol Res. 2021;11(1-2):27-31 doi: https://doi.org/10.14740/jnr650

An Early Presentation of Neurosyphilis Manifesting as Cranial Polyneuropathies: A Case Report

Neurosyphilis (NS) is a rarely reported disease, with neurological manifestations occurring in the late stages of the infection. The incidence of NS has steadily increased, particularly with increased cases of human immunodeficiency virus (HIV) infection among homosexual partners, and can occur at any stage of the disease. In this case report, we present a 53-year-old homosexual man with HIV who presented with a gradual onset of vertigo over a course of 2 weeks, followed by gradual onset of multiple cranial neuropathies. Magnetic resonance imaging of the brain revealed pathological enhancement of multiple cranial nerves. Laboratory workup revealed reactive Venereal Disease Research Laboratory dilutional titer in the cerebrospinal fluid, supporting the diagnoses of NS. He was treated with intravenous penicillin with gradual resolution of symptoms. Our case illustrates that NS can occur with no known prior evidence or manifestation of the infection. The diagnosis of NS should be entertained in individuals with a known history of HIV and unexplained multiple cranial neuropathies. J Neurol Res. 2021;11(1-2):27-31 doi: https://doi.org/10.14740/jnr650

Actinomycosis Hard Palate: A Rare Presentation

ABSTRACT Actinomycosis is a gradually evolving infection caused by bacteria of genus Actinomyces. Cervicofacial involvement is the most common presentation and palatal involvement is very rare. Presented below is the case report of a 79-year-old diabetic and hypertensive female who presented with nonhealing ulcer over the hard palate for 10 months, which enlarged and formed a large oroantral fistula within 4 months. Following the diagnosis of actinomycosis by histology, complete debridement and removal of necrotic tissue was done. She was treated with intravenous crystalline penicillin 6th hourly for 4 weeks and was discharged on oral amoxicillin for 12 months with regular follow-up. Only four cases of actinomycosis hard palate have been reported in English literature so far. How to cite this article: Dahiya V, George BR, Ramachandran K, et al. Actinomycosis Hard Palate: A Rare Presentation. Int J Otorhinolaryngol Clin 2019;11(3):73–75.

Congenital syphilis in Argentina: Experience in a pediatric hospital.

In spite of being preventable, Congenital syphilis (CS) is still an important, and growing health problem worldwide. Fetal infection can be particularly aggressive, but newborns can be asymptomatic at birth and, if left untreated, develop systemic compromise afterwards with poor prognosis. We analyzed 61 CS diagnosis cases between 1987-2019 presenting at the Buenos Aires Children' Hospital. The distribution of cases showed a bimodal curve, with a peak in 1992-1993 and in 2014-2017. Median age at diagnosis was 2 months (IQ 1-6 months). The main clinical findings were: bone alterations (59%); hepatosplenomegaly (54.1%); anemia (62.8%); skin lesions (42.6%) and renal compromise (33.3%). Cerebrospinal fluid (CSF) was abnormal in 5 patients, normal in 45 and was not available for 11 patients. Remarkably, spinal lumbar puncture did not modify therapeutic decisions in any case. Between mothers, only 46% have been tested for syphilis during pregnancy and 60.5% patients had non-treponemal titers equal to or less than fourfold the maternal titer. Intravenous penicillin G was prescribed for all except one patient, who received ceftriaxone with good therapeutic response. During follow-up, 1.6% infants died, 6.5% had persistent kidney disorders and 1.6% showed bone sequelae damage. RPR titers decreased after treatment, reaching negative seroconversion in 43% subjects at a median of 26.4 months. Low adherence to follow up was observed due to inherent vulnerable and low-income population characteristics in our cohort. Our results highlight a rising tendency in cases referred for CS in our population with high morbidity related to delayed diagnosis. A good therapeutic response was observed. CS requires a greater effort from the health system to adequately screen for this disease during pregnancy, and to detect cases earlier, to provide an adequate diagnosis and treatment.

A young girl with a sore throat.

BACKGROUND Tonsillitis is a common disease, and most cases proceed without complications. Common causes are viral and streptococcal infections. Sometimes the course of the disease is complicated, and interdisciplinary assessment is required. CASE PRESENTATION A previously healthy teenage girl was admitted after two weeks with throat pain. In the days before admission the pain worsened, a swelling developed on her neck and she developed lockjaw. CT-scans showed peritonsillar abscess, jugular vein thrombosis and septic embolism in the lungs. Streptococcus anginosus was found in blood cultures. The patient was treated with intravenous clindamycin and penicillin, in addition to anticoagulation therapy. Tonsillectomy was performed on day four after admission. INTERPRETATION Lemierre syndrome is an uncommon syndrome which often affects young, healthy people. The first symptoms are pharyngitis, tonsillitis and fever. The bacteria, most frequently Fusobacterium necrophorum, spread to the jugular vein and lead to thrombophlebitis and blood clot formation. Furthermore, septic embolies can occur and spread to the lungs, liver, kidneys, heart, joints and brain. Treatment of the syndrome requires interdisciplinary assessment. In our case paediatricians, ENT surgeons and specialists in infectious diseases were involved. Intravenous antibiotics with beta-lactamase resistance are recommended, in combination with beta-lactam antibiotics. Anticoagulation therapy should be considered.

A Case Series on Neuroborreliosis- An Emerging Infection in India

Lyme disease is a zoonotic disease spread by the bite of Ixodes ticks. These ticks are known to be found in wooded or grassy areas. The disease manifestations can be divided into early Lyme disease and late Lyme disease. The manifestations of late Lyme disease may include arthritis, cranial nerve palsies, short-term memory deficits and Lyme carditis. The disease is diagnosed by a two-step process of Enzyme immunoassay followed by Western blot Test. Disseminated disease is treated with Intravenous (IV) ceftriaxone, cefotaxime or penicillin G, or a combination of oral and IV regimens or in some cases, only oral drugs for up to 28 days. Lyme disease is endemic in temperate regions, especially in America. However, over the years the disease has been reported from various countries of Asia including in India, where there have been sporadic cases. Hereby, the author presents three paediatric cases with varied presentations. The neurological symptoms ranged from Lower Motor Neuron (LMN) facial nerve palsy to acute encephalitis. One patient also had non-erosive arthritis.

Erysipelothrix rhusiopathiae-induced endocarditis: a case report

Background: Erysipelothrix rhusiopathiae is a rare zoonosis. We present a case of E. rhusiopathiae bacteremia of unknown origin complicated by endocarditis of the aortic and mitral valves. Case Presentation: A 39-year-old man presented with fatigue, diaphoresis, fevers, and substantial weight loss. Upon physical examination, a gallop rhythm of the heart was heard. Blood cultures eventually revealed an E. rhusiopathiae infection. Vegetation on the non-coronary cusp of the aortic valve and the mitral valve were seen on echocardiography. The patient was treated with intravenous penicillin for 6 weeks. Following the treatment, the non-coronary cusp was found to be prolapsed and perforated. Aortic valve regurgitation had also led to dilatation and hypertrophy of the left ventricle. Conclusion: Erysipelothrix rhusiopathiae is a rare cause of infective endocarditis. As untreated E. rhusiopathiae can cause irreversible damage to the heart valves and death, prompt consideration of this infection is warranted in any patient at an increased risk.

Emergence of Different Autoimmune Diseases Including a Behçet's disease in a Sibling After tick bites. Remarkable cure of Behcet's disease by a Combination of Antibiotics and Hydroxychloroquine

We report therein the onset of three chronic diseases: Behcet's disease, fibromyalgia and rheumatoid arthritis in three sisters after tick bites. Only Behcet's disease was treated in our department. After failure of the initial treatment including colchicine and corticoids, the patient recovered within a prolonged antibiotic therapy time period of 18 months. A 23-year-old female patient was admitted to hospital in the Infectious Diseases Department as she presented with headache, diffuse inflammatory arthromyalgia, abdominal pain and cutaneous folliculitis, and for the umpteenth time for several past years, meningeal syndrome recurrence. The physical examination was unremarkable. The biological test assessment was normal, as were the ophthalmological and cerebral MRI examinations. The patient’s HLA B5 test was negative. The upper digestive fibroscopy shown digestive ulcerations. The diagnosis of Behcet's disease was made on the following: inflammatory arthralgias, digestive ulcerations, folliculitis lesions; recurrent bipolar aphthosis was found at patient’s interview. The patient was given prednisone 0.5 mg/kg/day and colchicine 1 mg/day. The evolution was characterized by an initial improvement of clinical symptoms followed by further iterative recurrence as soon as the corticosteroid doses were reduced. Upon resuming the interview with the patient’ s mother, clinical symptoms began at the age of 9 years old by the occurrence of a voluminous cutaneous erythema following multiple tick bites. One month later the patient presented with subacute lymphocytic meningitis, which was treated as tuberculosis meningitis without relevant bacteriological evidence. On the same day, the patient's two sisters were also bitten by ticks. A few weeks later on, one of them developed osteomyelitis of the tibia, which was operated on. The bacteriological examination result was negative, the histological examination showed non-specific osteomyelitis. Subsequently, she developed various multiple functional complaints that led to the diagnosis of fibromyalgia. Her other sister concomitantly developed seronegative rheumatoid arthritis. The diagnosis of chronic post-tick bite syndrome was suspected despite the negativity of the Lyme serology. The patient significantly improved thanks to high-dose of intravenous penicillin G, despite an initial exacerbation during the first month of treatment, which could be interpreted as confirmation of an infectious process (Jarisch-Herxheimer reaction). Corticosteroids and colchicine were discontinued ; the patient was given doxycycline for a total duration of 18 months. Antibiotic therapy was associated with hydroxychloroquine, the same way as reported for therapy of chronic Q fever and some types of Lyme disease [1]. In 2004, the patient was in complete remission of Behcet's disease. Ten years later, no recurrence has been observed.

Leptospira: An emerging zoonotic pathogen of climate change, global warming and unplanned urbanization: A review

Leptospirosis is a worldwide zoonotic infection with a much greater incidence in tropical regions and has now been identified as one of the emerging infectious diseases. The epidemiology of leptospirosis has been modified by changes in animal husbandry, climate and human behavior. Resurgent interest in leptospirosis has resulted from large outbreaks that have received significant publicity. The transmission cycle of leptospirosis involves maintenance hosts, carrier hosts, environment and human beings. The carrier animals in India include rats, pigs, cattle, bandicoots and dogs. Intervention strategies include vaccination, rodent control and improved environmental hygiene to eliminate possibility of water, soil and food contamination. Mass awareness or public education is of utmost importance. The development of simpler, rapid assays for diagnosis has been based largely on the recognition that early initiation of antibiotic therapy is important in acute disease but also on the need for assays which can be used more widely. The gold standard is microscopic agglutination test though serological studies are widely conducted for the diagnostic purpose. The antibiotics use for the treatment of leptospirosis includes oral doxycycline, azithromycin and penicillins. Among the parenteral therapy Intravenous penicillin G and third generation cephalosporins are used. We reviewed the clinical presentation, diagnosis, treatment and prevention of leptospirosis in this study.

Evaluation of First-Dose, Intravenous Push Penicillins and Carbapenems in the Emergency Department

Background: Early appropriate antibiotic administration is associated with improved outcomes in infectious illnesses. During drug shortages in 2017, the American Society of Health-System Pharmacists recommended intravenous push (IVP) administration of medications when possible to conserve small-volume parenteral solutions. Data supporting IVP penicillins and carbapenems was limited. Objective: The primary objective of this study compared time from patient emergency department (ED) arrival to antibiotic administration between IVP and intravenous piggy-back (IVPB) administration. Methods: This single-center pre-post protocol study assessed changes in administration timing and safety of ampicillin/sulbactam, piperacillin/tazobactam, and ertapenem from 2015-2018. Medication administration by IVPB (pre) or IVP (post), ED arrival, antibiotic order and administration times, potential effectors of administration time, and safety events were assessed. Acquisition costs were estimated. Results: A total of 696 administrations were included, with 351 and 345 subjects in the IVPB and IVP cohorts, respectively. The median time from ED arrival to initiation of antibiotic administration was 140 (IQR 87-221) minutes and 110 (IQR 68-181) minutes in the IVPB and IVP cohorts, respectively, (P < 0.01). IVP administration increased the proportion of indexed antibiotics administered within 60 minutes of ED arrival compared to IVPB (20% vs. 12%, respectively, P < 0.01). There was no difference in adverse events between both cohorts. Supply acquisition cost savings totaled an more than $5,000 with the IVP protocol. Conclusion: IVP administration of ampicillin/sulbactam, piperacillin/tazobactam, and ertapenem improved times to initiation of empiric, first-dose antibiotics in the ED without an increase in adverse events, saving over $5,000 annually.