2016 Lebanese society of infectious diseases and clinical microbiology guidelines of the management of febrile neutropenia in adult cancer patients in the era of growing antimicrobial resistance

Febrile neutropenia is common in cancer patients managed with chemotherapy. Many published international guidelines have included detailed recommendations on the management of various aspects of febrile neutropenia seen in this population. Various factors play a role in the management of febrile neutropenia in cancer patients including, local microbiology epidemiology, availability of diagnostic tests and available antimicrobial agents on the local market. On behalf of the Lebanese Society of Infectious Diseases and Clinical Microbiology, the panel members hope that the guidelines on the management of infections in patients with febrile neutropenia in an era of rising antimicrobial resistance will help health care providers standardize the care of these patients

Lebanese society of infectious diseases and clinical microbiology guidelines for the treatment of urinary tract infections

Urinary tract infection [UTI] is a common condition affecting men and women of all ages. It can have different presentations and can be acute, recurrent or chronic. It mandates prompt management to avoid complications and improve patient's outcome. In an era of increasing antimicrobial resistance and an urgent need for antimicrobial stewardship, national guidelines to standardize care of various infectious diseases have become a priority. Members of the Lebanese Society of Infectious Diseases and Clinical Microbiology [LSIDCM] drafted guidelines for the management of the various forms of UTI. These guidelines serve as a guide for health care workers, specifically primary care practitioners, family physicians, and emergency medicine physicians. They constitute an appropriate starting point before specialist consultation. They take into consideration the available local epidemiological data and the resistance profile of common urinary pathogens in Lebanon. This document includes the following sections: 1. Rationale and scope of the guidelines; 2. Definition of UTI; 3. Clinical presentation and diagnostic work-up of UTI; 4. Microbiological data of UTI; 5. Management and prevention strategies based on the latest Infectious Diseases Society of America [IDSA] and the European Society of Clinical Microbiology and Infectious Diseases [ESCMID] guidelines, tailored to the microbiological data in Lebanon. It addresses UTI in women [uncomplicated and complicated] and men [acute and chronic]. In addition, it covers management of asymptomatic bacteriuria and catheter related UTI. The recommendations in this document were graded based on the strength of the evidence as in the IDSA guidelines

case of PAN with positive Hbs Ag cured by immunosuppressive and antiviral therapies: a case report

Polyarteritis nodosa [PAN] first described by Kussmaul and Maier in 1866, is a multisystem necrotizing vasculitis of small and middle-sized muscular arteries. The presence of hepatitis B antigenemia [Hbs Ag] in approximately 30% of patients with PAN as well as immune complexes of Hbs Ag-Immunoglobulins and complement in the blood vessel walls strongly suggest the role of immunologic phenomena. The extremely poor prognosis of classic PAN has been modified by corticosteroid treatment with boluses of cyclophosphamide, and plasmapheresis. We report a case of PAN with renal, cardiac, central and peripheral nervous system involvement associated with active hepatitis B that got a total remission with corticosteroids, lamivudine and boluses of cyclophosphamide without plasmapheresis

Pseudomonas aeruginosa bacteremia at a tertiary care center: a cohort study

Pseudomonas aeruginosa bacteremia [PAB] is associated with high mortality and morbidity rates, but the outcome for patients with PAB has not been recently well evaluated. Between 1997 and 1999, all episodes of PAB at the Hotel-Dieu de France University Hospital, Lebanon, were analyzed to evaluate the outcome for patients with PAB. Fifty-five episodes of PAB in 53 patients [26 episodes in men and 29 in women] were analyzed. The mean age of the patients in the cohort was 60.7 years [range: 18-89 years]. The mean time between the onset of hospitalization and the first episode of PAB was 21 days [range: 0-77 days]. Most of the tested isolates showed favorable in vitro susceptibility to ceftazidime [85%], amikacin [77%] and imipenem [67%]. The overall in-hospital cumulative survival was 89% at one week and 49% at 2 months. Among the variables analyzed, four were statistically associated with a higher mortality rate: prior use of antimicrobials [85% vs 54%], use of systemic steroids [49% vs 36%], intubation [67% vs 32%], and admission to the intensive care unit [74% vs 39%] [P<.05]. Hospitalized patients with PAB have low survival rates. Newer strategies for prevention and treatment are crucial

Thrombotic thrombocytopenic purpura sine purpura occuring simultaneously with systemic lupus erythematosus. A case Report

The association between thrombotic thrombocytopenic purpura and systemic lupus erythematosus has been rarely described, especially when the occurrence of both situations is simultaneous. We report the case of a 21-year-old young woman who presented with this association. The simultaneous diagnosis of these two diseases is difficult because both share similar features. Treatment must be given early. It relies on therapeutic plasma exchange, systemic glucocorticoids or other immunosuppressive agents. The prognosis is very much related to the rapidity of the diagnosis and subsequent treatment