ABSTRACT
CASE PRESENTATION: We report a rare case of Moraxella bovis bacteremia and polyarticular septic arthritis in a 37-year-old pregnant woman with HIV who injects drugs. Two sets of blood cultures obtained 5 hours apart were positive for gram-negative bacilli, and purulent fluid was present intra-operatively from both her left knee and her right third MCP joints. DIAGNOSIS: Organism identification using ligation sequencing confirmed both her blood culture and synovial tissue isolates as M. bovis. Her infection was initially treated with third-generation cephalosporins and later changed to moxifloxacin because of a drug reaction; although she defervesced clinically with improvement in her C-reactive protein levels, she died most likely as a result of a non-traumatic fat embolism after an elective cesarean delivery. DISCUSSION: In contrast to Moraxella catarrhalis, other Moraxella species are rarely associated with disease in human hosts. M. bovis is classically associated with infectious bovine keratoconjunctivitis in cattle; interestingly, our patient denied significant animal exposure. To the authors' knowledge, this is the first case describing infection secondary to M. bovis in an adult host.
PRÉSENTATION DU CAS: Les auteurs rendent compte d'un rare cas de bactériémie à Moraxella bovis et d'arthrite septique polyarticulaire chez une femme enceinte de 37 ans atteinte du VIH qui s'injectait des médicaments. Deux séries d'hémocultures obtenues à cinq heures d'intervalle étaient positives aux bacilles Gram négatif, et du liquide purulent a été observé dans le genou gauche et la troisième articulation métacarpophalangienne pendant la période peropératoire. DIAGNOSTIC: La détection des organismes au moyen du séquençage par ligature a confirmé que les isolats des hémocultures et des tissus synoviaux contenaient du M. bovis. L'infection a d'abord été soignée au moyen de céphalosporines de troisième génération, qui ont ensuite été remplacées par de la moxifloxacine en raison d'une réaction au médicament. Même si elle a présenté une défervescence sur le plan clinique et que les taux de protéine C-réactive se sont améliorés, la patiente est décédée, probablement à cause d'une embolie graisseuse d'origine non traumatique après une césarienne non urgente. DISCUSSION: Contrairement au Moraxella catarrhalis, les autres espèces de Moraxella sont rarement associées à des maladies chez les hôtes humains. Le M. bovis est normalement relié à une kératoconjonctivite bovine infectieuse chez le bétail. Fait intéressant, la patiente a nié une exposition importante à des animaux. À la connaissance des auteurs, il s'agit de la première description d'une infection secondaire au M. bovis chez un hôte adulte.
ABSTRACT
OBJECTIVE: Heart failure (HF) is a chronic disease with growing numbers of patients and a significant compromise in quality of life and high mortality. The main purpose of this study was to evaluate the current practices in managing patients with HF among patients admitted to the hospital and discharged with a primary diagnosis of HF and patients managed in the heart function clinic. RESULTS: This study is a retrospective chart review of patients admitted to the hospital and discharged with a primary diagnosis of HF. A total of 448 patient charts were reviewed, of which 173 patients were in the hospital group and 275 patients in the Clinic group. 278 (62.1%) were men, and 170 (37.9%) were women. The Clinic group of patients were significantly received guideline-directed medical therapy (Beta-blockers, Angiotensin-converting enzyme inhibitors, Angiotensin receptor blockers, Diuretics, Mineralocorticoid receptor antagonists-p < 0.001). The Clinic group of patients (17.1%) were significantly less re-hospitalized (p < 0.001) compared to the Hospital group (28%) at 180 days. Physician led multidisciplinary Heart function clinics have better adherence to guideline directed medical therapy and significantly lower rates of re-hospitalization thereby providing cost effective heart failure management with usual care.
