Case of Legionella pneumonia complicated with pulmonary thromboembolism.

We report a patient with community acquired Legionella pneumonia, complicated with pulmonary embolism. The patient was cured by levofloxacin and anticoagulant therapy. We performed laboratorial control and we excluded the thrombophilia and antiphospholipid syndrome. Our case report draws attention to the possible association between Legionella infection and pulmonary embolism.

In vitro activity of clarithromycin in combination with other antimicrobial agents against biofilm-forming Pseudomonas aeruginosa strains.

The aim of the study was to investigate the biofilm-production of 60 Pseudomonas aeruginosa strains isolated from clinical samples and to examine the effect of different antimicrobials and their combinations with clarithromycin on biofilm-formation. The minimal inhibitory concentrations (MICs), minimal biofilm inhibitory concentrations (MBICs), and antibiotic synergy by calculating the fractional inhibitory concentration (FIC) index were determined for the following antibiotics: ceftazidime, cefepime, piperacillin/tazobactam, imipenem, meropenem, levofloxacin, ciprofloxacin, gentamicin, amikacin, tobramycin, netilmicin and clarithromycin. A total of 14 (23.3%) isolates out of 60 isolates of P. aeruginosa were biofilm positive. Cefepime, imipenem and meropenem had the lowest MIC 90 values. Piperacillin/tazobactam and clarithromycin had the highest MIC 90 values. Imipenem, meropenem, piperacillin/tazobactam and clarithromycin had the lowest MBIC 90 values. For biofilm-forming P. aeruginosa strains 2-fold to 128-fold higher MBIC values than MIC values were obtained for ceftazidime, cefepime, imipenem, amikacin and netilmicin. The MBIC was 2-fold to 512-fold lower then the MIC values in the case of piperacillin/tazobactam, ciprofloxacin, levofloxacin and clarithromycin. Synergy was generally demonstrated for clarithromycin in combination with aminoglycosides, fluoroquinolones or ceftazidime. However, surprisingly it was found that combinations of clarithromycin with carbapenems or cefepime led to an antagonistic interaction: combination of clarithromycin with imipenem, meropenem or ertapenem showed antagonism in 37.5%, 50% and 62.5% of the strains tested whereas its combination with cefepime expressed antagonism in 75% of the strains, respectively. To the best of our knowledge no one has previously described this phenomenon so far.

Successful treatment of chronic disseminated candidiasis with fluconazole and a granulocyte-macrophage colony-stimulating factor combination.

We report a case of chronic disseminated candidiasis in a patient with acute non-lymphoid leukaemia. After 12 months of combined therapy with fluconazole and granulocyte-macrophage colony-stimulating factor, lesions in the liver and spleen resolved completely. The patient has given birth to a healthy baby and has been in complete hematological remission for 3 years.

Prevalence, genotype distribution and outcome of hepatitis C infections among the employees of the Hungarian Central Hospital for infectious diseases.

Blood samples from 477 hospital workers (HWs) at the Central Hospital for Infectious Diseases, Budapest, Hungary were tested for hepatitis C virus (HCV) antibodies by enzyme immunoassay (EIA), and 13 (2.7%) of these were found to be HCV antibody positive. Ten (2.7%) were from nursing/housekeeping staff and three (2.9%) from medical staff. HCV antibody positive HWs were detected in 10 of 17 work places, and the prevalence rates in these departments or units varied between 1.2% and 6.5%. The prevalence increased gradually with increasing age, being 0% in these under 21 years of age and 9.5% in those above 50 years of age. Eleven (85%) of 13 HCV antibody positive HWs had HCV RNA in their sera, four of them intermittently during the follow-up period. HCV genotype 1 was present in two HWs, 1b in six HWs, 3a in one HW and 4 in two HWs. Chronic hepatitis C has developed in six (46%) HCV antibody positive HWs. Although the source of infection through needlestick could only be traced directly in one case, circumstantial evidence indicated that the majority of infections were occupationally acquired, originating from percutaneous or mucocutaneous exposure.

In vitro and in vivo activities of amikacin, cefepime, amikacin plus cefepime, and imipenem against an SHV-5 extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strain.

The in vitro and in vivo effectiveness of amikacin, cefepime, and imipenem was studied using a high inoculum of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strain. An in vitro susceptibility test at the standard inoculum predicted the in vivo outcome of amikacin or imipenem while it did not do so for cefepime due to the inoculum effect.

[Experience with ciprofloxacin therapy of salmonellosis gastroenteritica]. / Salmonellosis gastroenteritica ciprofloxacin kezelésének tapasztalatai.

Five days' ciprofloxacin treatment resulted quick clinical improvement in all of the 45 patients with salmonella gastroenteritis and stool cultures of 35 patients became negative. The advantages of ciprofloxacin treatment are analysed in comparison with previous antibiotics. Indications for new quinolones in the treatment of salmonella gastroenteritis are summarized. It is emphasized that antibiotic therapy is unnecessary in mild cases of salmonella gastroenteritis. This is demonstrated on the basis of case reports of 12 patients with symptomatic treatment too.

[Diagnostic and therapeutic experiences with purulent meningitis in adults]. / Diagnosztikus és terápiás tapasztalatok felnöttkori gennyes agyhártyalobban.

The authors reviewed data of 137 patients with purulent meningitis treated in the period of 10 years. Attention was paid to the frequency of predisposing and associated diseases, to the factors helping and delaying the diagnosis and to those altering the prognosis. The importance of effective supportive care, particulary covering pressure of the CNS as well as specific therapy was stressed. The circumstances and the conditions of management depending on the condition of the patient was emphasized. Thirty eight of patients (27%) has died.

[Prevention of rabies (experience of the past, possibilities of the future)]. / A rabies prevenciója (a múlt tapasztalatai és a jövö lehetöségei).

The authors review the history of rabies prevention, the current national and international data. Neurologic adverse effects of the Hempt vaccine are discussed. Medical histories of two patients are demonstrated, one suffered of serious complication of the vaccine; the other died of rabies. Indications of vaccine Rabivac and issues about it's administration are outlined. The possibilities of the therapy are discussed in brief.