Uncommon Presentation of Infective Endocarditis / Lao Medical Journal

@#Diagnosis of infective endocarditis is challenging as the clinical diversity of the disease sometimes misleads clinicians in the recognition, correct diagnosis and rapid treatment, which are important to reduce the morbidity and mortality associated with this disease. We report the case of a 14-year-old girl who presented with left axillary pain and fever. She was eventually diagnosed with infective endocarditis caused by Abiotropia defectiva, complicated by a large saccular aneurysm of the left axillary artery.@*@#

Staphylococcus Aureus Bacteraemia in the Lao People’s Democratic Republic: Antibiotic Susceptibility Patterns and Clinical Management / Lao Medical Journal

Staphylococcus aureus is a common and often serious human pathogen accounting for about a fifth of all cases of bacteraemia with an associated mortality of up to 50%. This review summarizes the aspects of S. aureus bacteraemia that are relevant in a Lao context, including the antibiotic susceptibility patterns seen at Mahosot Hospital, Vientiane over the past 11 years and provides guidance and rationale for clinical management. In the Lao PDR it is the third commonest cause of bacteraemia and the leading cause of skin and soft-tissue infection. Mahosot Hospital has seen almost 200 cases and antibiotic susceptibility testing shows that a significant proportion of isolates are tetracycline and erythromycin resistant. Methicillin-resistance remains very rare, though this is unlikely to continue. Key risk factors for S. aureus disease in financially-poor settings include surgical procedures and previous antibiotic exposure. The identification and removal or drainage of a focus of infection is a key part of the management strategy. Transthoracic echocardiography (TTE) is advised for all patients, where this technique is accessible, and consideration should be given to repeating this test or performing a transoesophageal echocardiogram for patients with a negative TTE, but with a high index of suspicion for infective endocarditis. Treatment with a !-lactam antibiotic (preferably cloxacillin), for 2 weeks in uncomplicated disease and 4 to 6 weeks in complicated disease, is essential to provide cure and prevent relapse. An oral switch may be required, though this should take place only if the patient has been afebrile for 48 hours and has no ongoing complications requiring intervention. Copyright: ∀ 2012 Elliot et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Treatment of Melioidosis / Lao Medical Journal

Melioidosis is recognized with increasing frequency in the Lao PDR, and is probably far more common than is currently appreciated. Recommendations for the antibiotic treatment of melioidosis are based on good evidence from a series of large clinical trials conducted mainly in northeast Thailand over the past 25 years. This review summarizes that evidence and considers it in a Lao context. Treatment is usually divided into 2 phases: in the first, or acute phase, parenteral drugs are given for at least 10 days with the aim of preventing death from overwhelming sepsis; in the second, or eradication phase, oral drugs are given, usually to complete a total of 20 weeks, with the aim of preventing relapse. Within these broad generalisations, specific treatment for individual patients needs to be tailored according to clinical manifestations and response, and there remain many unanswered questions. Some patients with very mild infections can probably be cured by oral agents alone. In the Lao PDR, ceftazidime is used for the acute phase, with co-amoxiclav as second line therapy. Co¬trimoxazole plus doxycycline is preferred for the eradication phase, with the alternative of co¬amoxiclav. It is likely that clinical trial evidence will soon support the use of co¬trimoxazole alone. In all cases, the best available supportive care is needed, along with drainage of abscesses whenever possible. Treatment for melioidosis is extremely expensive, but the relative costs have reduced over the past decade. Unfortunately there is no likelihood of any new or cheaper options becoming available in the immediate future.