ABSTRACT
CASE PRESENTATION: A 51-year-old woman with a medical history of poorly controlled type 1 diabetes mellitus, hyperthyroidism, and tobacco abuse was admitted to the hospital with persistent nausea, vomiting, abdominal discomfort, dry cough, rhinorrhea, and sore throat. She denied fevers, chills, rigors, shortness of breath, hemoptysis, nasal congestion, postnasal drip, and facial pain. She denied any sick contacts, and there was no recent travel outside of Chicago.
Subject(s)
Antifungal Agents/administration & dosage , Bronchoscopy/methods , Lung Diseases , Lung , Mucormycosis , Nitriles/administration & dosage , Pneumonectomy/methods , Pyridines/administration & dosage , Triazoles/administration & dosage , Amphotericin B/administration & dosage , Diagnosis, Differential , Female , Humans , Lung/diagnostic imaging , Lung/microbiology , Lung/pathology , Lung Diseases/diagnosis , Lung Diseases/microbiology , Lung Diseases/physiopathology , Lung Diseases/surgery , Middle Aged , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/surgery , Respiration, Artificial/methods , Thoracic Surgery, Video-Assisted/methods , Treatment OutcomeABSTRACT
Emphysematous cystitis is a relatively rare and potentially life-threatening condition characterized by the collection of gas in the bladder wall and lumen due to infection caused by gas-forming organisms. Imaging studies are necessary to detect emphysematous cystitis. The management consists of broad-spectrum antibiotics, strict glycemic control, and bladder drainage. Complications may arise in some cases, requiring surgical treatment. We present a case of extended spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae emphysematous cystitis in a known diabetic.
ABSTRACT
We report a case of multiple brain abscesses due to Actinomyces species in a 35-year-old immunocompetent man who presented with a 2-month history of headache, diplopia, fever, and weight loss. Despite receipt of broad-spectrum antibiotics for over a month, he continued to have headaches and diplopia. He subsequently underwent right anterior temporal lobectomy and evacuation of abscesses. The diagnosis was aided by identification of sulfur granule on histopathological examination of cerebral cavitary lesion and Gram-positive filamentous rods seen on tissue-Gram stain.
Subject(s)
Actinomycosis/microbiology , Brain Abscess/microbiology , Actinomycosis/complications , Adult , Anterior Temporal Lobectomy , Brain Abscess/complications , Diplopia/etiology , Fever/etiology , Headache/etiology , Humans , Magnetic Resonance Imaging , Male , Neurosurgical Procedures , Tomography, X-Ray Computed , Weight LossABSTRACT
We report two cases of invasive infections caused by Panton-Valentine leukocidin-positive, community-associated, methicillin-resistant Staphylococcus aureus (CA-MRSA) after kidney transplantation. This report emphasizes the clinical importance of considering CA-MRSA as a causative agent in the differential diagnosis of infections of the skin and soft tissues in organ transplant recipients.
Subject(s)
Community-Acquired Infections/microbiology , Kidney Transplantation/adverse effects , Methicillin Resistance , Staphylococcal Infections/microbiology , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Adult , Bacterial Toxins/biosynthesis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/surgery , Exotoxins/biosynthesis , Humans , Leukocidins/biosynthesis , Male , Microbial Sensitivity Tests , Staphylococcal Infections/drug therapy , Staphylococcal Infections/surgeryABSTRACT
Although adenoviruses are a recognized cause of serious pulmonary and disseminated disease among stem cell transplant recipients, their importance in other immunocompromised patient populations is less clearly documented. We present a case of a person with AIDS who was receiving chemotherapy for Burkitt lymphoma in whom fatal adenovirus pneumonia and adenoviremia developed, and we review the published literature on adenovirus infection in the setting of HIV disease.
Subject(s)
Acquired Immunodeficiency Syndrome , Adenoviridae Infections , Burkitt Lymphoma/drug therapy , HIV-1 , Lymphoma, AIDS-Related/drug therapy , Pneumonia, Viral , Adenoviridae , Adenoviridae Infections/diagnosis , Adenoviridae Infections/drug therapy , Adenoviridae Infections/etiology , Adult , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antiviral Agents/therapeutic use , Burkitt Lymphoma/complications , Fatal Outcome , Humans , Immunocompromised Host , Lymphoma, AIDS-Related/complications , Male , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Pneumonia, Viral/etiology , Withholding TreatmentSubject(s)
Ascomycota/isolation & purification , Brain Abscess/microbiology , Mycoses/diagnosis , Mycoses/drug therapy , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Antiprotozoal Agents/therapeutic use , Brain/diagnostic imaging , Brain/pathology , Brain Abscess/drug therapy , Brain Abscess/pathology , Female , Humans , Middle Aged , Mycoses/pathology , Mycoses/physiopathology , Radiography , WomenABSTRACT
OBJECTIVE: To report pharmacokinetic alterations and optimal dosing of piperacillin/tazobactam in an obese patient. CASE SUMMARY: A 39-year-old morbidly obese (weight 167 kg, body mass index 50 kg/m2) man was treated with piperacillin/tazobactam 3.375 g every 4 hours for recurrent cellulitis. The wound culture grew Groups A and B Streptococcus and rare Pseudomonas aeruginosa. Blood samples were obtained at steady-state from a peripheral venous catheter at 0, 0.5, 1, 2, 3, and 4 hours after the start of the infusion. Population pharmacokinetics were generated from a previously published data set. The serum concentrations of piperacillin/tazobactam obtained in the patient were compared with the 95% confidence interval from the representative population. Pharmacokinetic parameters such as maximal serum concentration, minimal serum concentration, average steady-state concentration, half-life, elimination rate constant, volume of distribution (V(d)), clearance, area under the curve at steadystate, and percent of time greater than the minimum inhibitory concentration (%t>MIC) were calculated and qualitatively compared between the sample and the population. DISCUSSION: Substantial differences were noted in both the absolute values at the times of sample collection and the overall concentration-versus-time profile of both compounds. The morbidly obese individual compared with the population demonstrated a reduced average serum steady-state concentration: 39.8 mg/L versus 123.6 mg/L, an increased V(d): 54.3 L versus 12.7 L, and an increased half-life: 1.4 hours versus 0.6 hours, respectively. The %t >MIC of piperacillin for the patient, assuming MICs of 2, 4, 8, 16, 32, 64, and 128 mg/L, was 100%, 100%, 90.9%, 55.4%, 19.9%, 0%, and 0%, respectively. CONCLUSIONS: Pathogens with elevated MICs may require altered dosing schemes with piperacillin/tazobactam. Future studies are warranted to assess increased dosages, more frequent dosing intervals, or continuous infusion dosing schemes for obese individuals with serious infections.
