Subject(s)
HIV Infections , Meningococcal Infections , Myocarditis , Pericarditis , HIV Infections/complications , HIV Infections/drug therapy , Humans , Meningococcal Infections/complications , Meningococcal Infections/diagnosis , Meningococcal Infections/drug therapy , Myocarditis/diagnosis , Myocarditis/etiology , Pericarditis/diagnosis , Pericarditis/etiologyABSTRACT
BACKGROUND: We describe a case of severe Guillain-Barre syndrome (GBS) associated with chronic active hepatitis C and mixed cryoglobulinemia (MC). To our knowledge, this association between GBS and hepatitis C virus (HCV) infection has been rarely reported. CASE PRESENTATION: A 56-year-old man developed symmetrical muscle weakness in all extremities, areflexia and sensorial disorder followed by acute respiratory failure associated with chronic active hepatitis C, which was confirmed by the presence of anti-HCV antibodies in the serum and persistence of HCV RNA viral load for more than 6 months. Chronic hepatitis C was further complicated by type 3 MC. Electromyography showed peripheral nerve injury (mainly in axon). A severe acute motor sensory axonal neuropathy (AMSAN) was diagnosed. After treatment with intravenous immunoglobulin and plasma exchange followed by antiviral therapy by direct-acting antiviral agent, patient showed progressive recovery and was transferred 3 months after his first admission to a rehabilitation center. CONCLUSIONS: Our case reported a severe GBS associated with HCV infection and MC. EMG classified for the first time the subtype of GBS (severe AMSAN) correlated with severe clinical form. HCV infection should be screened in high-risk patients to prevent silent progression of the chronic hepatitis C and its potentially severe extra-hepatic manifestations.
Subject(s)
Cryoglobulinemia/etiology , Guillain-Barre Syndrome/etiology , Hepatitis C, Chronic/etiology , Antiviral Agents/therapeutic use , Cryoglobulinemia/drug therapy , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/drug therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Middle Aged , Respiratory Distress Syndrome/drug therapy , Respiratory Distress Syndrome/etiologyABSTRACT
Objectives: To provide new insights into the spread of plasmidic cephalosporinase DHA-1, 16 strains of Klebsiella pneumoniae and a strain of Klebsiella variicola producing DHA-1 were isolated between January 2012 and December 2013 in six regions of France and two French overseas departments and territories. Methods: Disc diffusion assays, isoelectric focusing and PCRs were used to characterize the plasmidic DHA-1 ß-lactamase. Plasmid analysis was performed by the method of Kado and Liu and WGS. Virulence of the strains was studied by biofilm formation and the survival of Drosophila. Results: The strains were of low virulence and had one to three plasmids including one of various sizes (â¼40 to 319 kb) mediating DHA-1. Nine strains belonged to ST11 and possessed a pKPS30-type DHA-1 plasmid of the IncR (incompatibility) group. A strain of ST307 possessed pENVA, a DHA-1 plasmid of the IncH-type group. The seven remaining plasmids were unknown. Three belonged to the IncL/M group. They were closely related and their sequences were determined. One of the four remaining strains was chosen for further investigation. This strain of ST16 had two plasmids, a pUUH239.2-related plasmid and a new DHA-1 plasmid of â¼319 kb of IncHI2 type. Conclusions: These findings demonstrate the major role of the pKPS30-type plasmid in the spread of DHA-1 cephalosporinase in France and provide evidence of two new emerging plasmids carrying this enzyme.
