ABSTRACT
Leptospirosis is a zoonosis found worldwide, with an incidence that is approximately 10 times higher in the tropics than in temperate regions. The main reservoir of leptospirosis is the rat and human infection usually results from exposure to infected animal urine or tissues. Only 10% of cases are symptomatic. We present here two confirmed and two probable cases of leptospirosis in a family returning from whitewater rafting in Thailand, illustrating the wide variety of the clinical manifestations of this infection. Two of the patients were hospitalized and presented a probable Jarisch-Herxheimer reaction after initiation of beta-lactam therapy. The two others patients were treated empirically with doxycycline. We discuss here some relevant aspects of the epidemiology, clinical manifestations, therapy and the challenge of an early diagnosis of leptospirosis.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Doxycycline/therapeutic use , Leptospirosis/epidemiology , Zoonoses/epidemiology , Adolescent , Adult , Animals , Anti-Bacterial Agents/adverse effects , Female , Humans , Leptospirosis/diagnosis , Leptospirosis/drug therapy , Male , Recreation , Rivers , Thailand/epidemiology , Travel , Zoonoses/diagnosis , Zoonoses/drug therapy , beta-Lactams/adverse effects , beta-Lactams/therapeutic useABSTRACT
During the past recent years, Enterobacteriaceae have supplanted Gram-positives in terms of frequent resistant bacteria seen in the outpatent setting. This change involves common opportunistic pathogens such as E. coli and K. pneumoniae. It is mainly due to the appearance and dissemination of extended-spectrum beta-lactamases (ESBL), that hydrolyse penicillins and cephalosporins. Bacteria producing these enzymes are often also resistant to quinolones and trimethoprime-sulfamethoxazole. This article, illustrated by a clinical case, presents the current epidemiology of ESBL-producing Enterobacteriaceae and the possible prevention measures and treatment options to fight the growing number of infections that they are causing.
Subject(s)
Enterobacteriaceae/drug effects , Enterobacteriaceae/enzymology , Escherichia coli Infections/drug therapy , beta-Lactamases , Drug Resistance, Bacterial , Escherichia coli/drug effects , Escherichia coli/enzymology , Humans , Male , Middle AgedABSTRACT
We report the case of a 24-years old diabetic women hospitalised because of right-sided lower abdominal pain and diarrhea. She fulminantly developed shock before appendectomy could be performed and was transferred to intensive care unit. Hypotension remained and laparoscopy revealed primary peritonitis and toxic shock syndrome by Group A Streptococcus which was cultivated in blood and ascites. Therapy with penicilline and clindamycine resolved symptoms. During hospitalisation Clostridium difficile colitis occurred. This complication leaded to prolonged hospitalisation.
