Meropenem resistant Lactobacillus endocarditis in an immunocompetent patient.

Lactobacilli are gram-positive bacteria usually found in the normal flora and are commonly used as probiotic treatments for vaginal candidiasis. Lactobacilli are normally considered non-pathogenic; however, certain risk factors can make a patient susceptible to severe infections. This case describes an immunocompetent 61-year-old female with an automated intracardiac defibrillator who presented with a 10-day history of nausea and vomiting. Furthermore, diagnostic tests, including a transesophageal echocardiography, revealed a large vegetation, and blood cultures were consistently positive for Lactobacillus. The patient was treated with intravenous penicillin and gentamicin, along with removal of the automated intracardiac defibrillator. In patients with significant underlying conditions, physicians should consider Lactobacillus as a causative organism to avoid delays in treatment.

Acute inflammatory demyelinating polyneuropathy or Guillain-Barré syndrome associated with COVID-19: a case report.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a global pandemic. The disease, typically characterized by bilateral pulmonary infiltrates and profound elevation of inflammatory markers, can range in severity from mild or asymptomatic illness to a lethal cytokine storm and respiratory failure. A number of recognized complications of COVID-19 infection are described in the literature. Common neurological complications include headache and anosmia. Guillain-Barré syndrome (GBS) is an uncommon complication described in isolated case reports. However, a causal relationship has yet to be established. This case report adds to the growing body of evidence that GBS is a potential COVID-19 complication. CASE PRESENTATION: A 70-year-old Caucasian woman with recently diagnosed COVID-19 infection presented to the emergency department with 4 days of gradually worsening ascending lower extremity weakness. Exam revealed bilateral lower extremity weakness, mute reflexes, and sensory loss. Soon after starting intravenous administration of immunoglobulin (IVIG), the patient developed respiratory distress, eventually requiring intubation. She remained intubated for the duration of her IVIG treatment. After five rounds of treatment, the patient was successfully extubated and transferred to acute rehab. Following 4 weeks of intense physical therapy, she was able to walk with assistance on room air. CONCLUSION: At the present time, this is one of the few reports of acute inflammatory demyelinating polyneuropathy (AIDP) or GBS associated with COVID-19 in the United States. It is unclear whether a causal relationship exists given the nature of the syndrome. However, in light of the growing number of reported cases, physicians should be aware of this possible complication when evaluating COVID-19 patients.

Daptomycin-induced eosinophilia without pulmonary involvement.

PURPOSE: The case of a patient who developed peripheral eosinophilia associated with the use of daptomycin is described. SUMMARY: A 63-year-old man with a history of rheumatic fever during childhood arrived at the emergency department with a chief complaint of left knee pain and swelling. One week before his arrival, the patient received a corticosteroid injection for worsening pain, with minimal relief. The patient's medical history also included type 2 diabetes mellitus, hypertension, coronary artery disease, and hypercholesterolemia. The patient had a documented allergy to cephalexin (skin rash). His initial white blood cell (WBC) count was 16,500 cells/mm(3) (normal, 4,000-10,600 cells/mm(3)), with 89% neutrophils (normal, 40-80%), 5.6% lymphocytes (normal,15-45%), and 0% eosinophils (normal, 0-6%). On hospital day 2, blood cultures and aspiration cultures from the patient's knee were positive for methicillin-sensitive Staphylococcus aureus. Nafcillin and gentamicin were initiated, but on hospital day 7 the patient developed a diffuse, pruritic, macular rash believed to be secondary to nafcillin. At this point, nafcillin treatment was discontinued and daptomycin was initiated. Six days into his treatment, a routine complete blood count revealed a WBC count of 7,620 cells/mm(3), with 11.8% eosinophils. The eosinophils continued to increase, peaking at 34.1% after 26 days of treatment with daptomycin. After cessation of daptomycin, the peripheral eosinophilia resolved. At no point during his hospitalization did the patient have evidence of pulmonary involvement. CONCLUSION: A 63-year-old man developed peripheral eosinophilia without evidence of pulmonary involvement while being treated with daptomycin.

Assessment of adherence to atovaquone-proguanil prophylaxis in travelers.

BACKGROUND: Malaria continues to be a serious, world-wide infection. Atovaquone-proguanil is one of the prophylactic agents recommended for travelers to endemic regions. However, little information is available regarding adherence with this medication. A large proportion of malaria cases reported from travelers is due to non-adherence to prescribed regimens. This study was undertaken to analyze adherence with atovaquone-proguanil prophylaxis and specific factors contributing to non-adherence. METHODS: Men and non-pregnant women > or = 18 years of age were eligible for inclusion. Enrolled travelers received a prescription for atovaquone-proguanil prophylaxis and were contacted by telephone within 3 weeks of return to the United States. A questionnaire was prepared by the authors to determine if subjects were adherent with the medication. Additional data included demographics, duration of malarious travel, previous use of prophylactic agents, underlying medical conditions, concurrent medications, and reasons for non-adherence. RESULTS: Complete data were available for 104/124 (84%) participants: 49 (47%) men, 55 (53%) women. Average duration of malarious travel was 12 days, and 19 (18%) travelers reported previous travel to a malarious region. Ninety-two (89%) subjects were completely adherent with their prophylactic atovaquone-proguanil course. Adverse effects were seen in 6 (5%) travelers. CONCLUSIONS: Adherence with atovaquone-proguanil malaria prophylaxis is high among travelers from a non-endemic region. Adverse effects are minimal. Non-adherence was primarily attributable to travelers' perception of need.