Meningitis caused by Capnocytophaga canimorsus in a COVID-19 patient: a rare complication of dog bites.

Capnocytophaga canimorsus is a gram-negative rod that is part of the commensal microbiota of dogs' and cats' mouths. In this case, we report an 85-year-old man with COVID-19 who had his right arm bitten by a dog. His symptoms were impaired consciousness, agitation and aggressive behavior. Physical examination revealed neck stiffness and Brudzinski's sign. The cerebrospinal fluid culture was compatible with Capnocytophaga canimorsus. He required intensive care and received a 14-day prescription of meropenem. After 40 days of hospitalization, the patient was fully recovered and was discharged. This case highlights the importance of physician and microbiologist be awareness of this disease, mainly in patients with neurological symptoms after a dog or cat bite.

Meningitis caused by Capnocytophaga canimorsus in a COVID-19 patient: a rare complication of dog bites

ABSTRACT Capnocytophaga canimorsus is a gram-negative rod that is part of the commensal microbiota of dogs' and cats' mouths. In this case, we report an 85-year-old man with COVID-19 who had his right arm bitten by a dog. His symptoms were impaired consciousness, agitation and aggressive behavior. Physical examination revealed neck stiffness and Brudzinski's sign. The cerebrospinal fluid culture was compatible with Capnocytophaga canimorsus. He required intensive care and received a 14-day prescription of meropenem. After 40 days of hospitalization, the patient was fully recovered and was discharged. This case highlights the importance of physician and microbiologist be awareness of this disease, mainly in patients with neurological symptoms after a dog or cat bite.

Fosfomycin in severe infections due to genetically distinct pan-drug-resistant Gram-negative microorganisms: synergy with meropenem.

Background: In vitro and clinical studies using parenteral fosfomycin have suggested the possibility of using this drug against infections caused by MDR microorganisms. The aim of this study was to describe a case series of patients treated with fosfomycin who had severe infections caused by pan-drug-resistant Gram-negative bacteria. Methods: We describe a prospective series of cases of hospitalized patients with infections caused by Gram-negative bacteria resistant to ß-lactams and colistin, treated with 16 g of fosfomycin daily for 10-14 days. Isolates were tested for antimicrobial susceptibility and synergism of fosfomycin with meropenem. We tested for resistance genes and performed typing using PCR and WGS. Results: Thirteen patients received fosfomycin (seven immunosuppressed); they had bloodstream infections (n = 11; 85%), ventilator-associated pneumonia (n = 1; 8%) and surgical site infection (n = 1; 8%), caused by Klebsiella pneumoniae (n = 9), Serratia marcescens (n = 3) and Pseudomonas aeruginosa (n = 1). Overall, eight (62%) patients were cured. Using time-kill assays, synergism between fosfomycin and meropenem occurred in 9 (82%) of 11 isolates. Typing demonstrated that K. pneumoniae were polyclonal. Eight patients (62%) had possible adverse events, but therapy was not discontinued. Conclusions: Fosfomycin may be safe and effective against infections caused by pan-drug-resistant Gram-negative microorganisms with different antimicrobial resistance mechanisms and there seems to be synergism with meropenem.

Risk factors for death in acquired immunodeficiency syndrome-associated disseminated histoplasmosis.

We performed a retrospective study of 164 human immunodeficiency virus (HIV)-infected patients with disseminated histoplasmosis to identify the risk factors for death. Death occurred in 32% of the cases. Univariate analysis identified the following risk factors: diarrhea (odds ratio [OR] = 3.9, P = 0.001), neurologic manifestations (OR = 5.8, ; P = 0.001), hemoglobin level < 8.0g/dL (OR = 2.7, P = 0.004), urea level 2 times the normal upper limit (OR = 5.0, P < 0.001), creatinine level > 1.5 mg/dL (OR = 2.9, P = 0.005), aspartate aminotransferase (AST) level > 2.5 times the normal upper limit (OR = 3.1, P = 0.01), respiratory insufficiency (OR = 9.7, P < 0.001), sepsis (OR = 20.2, P < 0.001), and acute renal failure (OR = 2.5, P = 0.011). A hemoglobin level < 8.0 g/dL (OR = 3.8, P = 0.008), an AST level >or= 2.5 times the normal limit (OR = 1.0, P = 0.007), acute renal failure (OR = 2.96, P = 0.015), and respiratory insufficiency (OR = 12.2, P = 0.01) were independent risk factors for death.

Resposta terapeutica a esquema anti-retroviral inicial contendo efavirenz ou nelfinavir, na "Vida Real" / Therapeutic response in inicial antiretroviral therapy with efavirenz or nelfinavir

Comparameos resposta terapeutica, virologica e imunologica, em estudo na "vida real" entre esquemas de terapia inicial contendo ITRNN - Efavirenz (EFV) ou IP - Nelfinavir (NFV), por analise retrospectiva de 58 prontuarios (32 com EFV e 26 com NFV), de janeiro/1999 a outubro/2001. Os grupos nao diferiram quanto a sexo, idade media, tempo entre o diagnostico do HIV e inicio da terapia, tempo de avaliacao com a terapia em estudo e media de carga viral (CV) inicial. A media de CD4 inicial foi 258,6 cel/mm3 para EFVe 156,7 cel/mm3 para NFV (p=0,038). Dos pacientes com CD4 inicial <100 cel/mm3 (31 porcento do total), 27,7 porcento pertenciam ao grupo do EFV e 72 porcento ao do NFV(p=0,005). Apenas 25 porcento dos pacientes em EFV e 11,5 porcento com NFV apresentaram CV indetectavel durante a terapia. Resposta virologica foi percebida em 94,4 porcento no grupo EFV e 61,9 porcento no NFV(p=0,029), com diminuicao media da CV de 3,11 log para o grupo EFV e 1,85 log para NFV(p=0,02). Resposta imunologica foi alcancada em 96,8 porcento no grupo EFV e 79,1 porcento no NFV (p=0,033) com ganho medio de CD4 = 75 cel/mm3 para EFV e 96 cel/mm3 para NFV (p=0,0019). Nosso estudo evidenciou diferenca quanto a resposta virologicae imunologica entre os grupos EFV e NFV, em beneficio da primeira droga; assim como o grupo EFV apresentou maior numero de pacientes com Carga Viral indetectavel durante a terapia (25 porcento contra 11,5 porcento)