Listeria monocytogenes bacteremia in a centenarian and pathogen traceability: A case report.

BACKGROUND: Early diagnosis and appropriate antibiotic treatment are important to survival of Listeria monocytogenes (L. monocytogenes) bacteremia. Penicillin tends to be the most commonly used antibiotic. However, there are limited data on antibiotic use in elderly patients with serious complications. We describe the clinical presentation, antibiotic therapy, and traceability of L. monocytogenes in a centenarian with a history of eating frozen food. CASE SUMMARY: A 102-year-old man suffered from high fever with chill after hematochezia. Tentative diagnoses were lower gastrointestinal hemorrhage and localized peritonitis. Meropenem and ornidazole were the empirical therapy. The patient did not respond and developed multiple system dysfunction even after teicoplanin was added to the therapy. L. monocytogenes was identified from blood cultures on day 5 of admission. The patient had a history of consuming frozen dumplings. Meropenem/ornidazole/teicoplanin were replaced with meropenem/linezolid. The patient gradually became afebrile. He received meropenem/linezolid for 10 d, and piperacillin/tazobactam was applied as step-down treatment for 2 wk with good clinical results. There was no sign of relapse during follow-up after discharge. L. monocytogenes isolates from the patient and frozen dumplings belonged to different serotypes and sequence types (STs): 1/2b and ST5 from the patient and 1/2c and ST9 from the dumplings. CONCLUSION: More awareness of listeriosis should be raised. Linezolid might be an option for listeriosis in elderly people with serious complications.

Effect of coronary artery revascularization on in-hospital outcomes and long-term prognoses in acute myocardial infarction patients with prior ischemic stroke.

OBJECTIVE: To investigate whether coronary artery revascularization therapies (CART), including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), can improve the in-hospital and long-term outcomes for acute myocardial infarction (AMI) patients with prior ischemic stroke (IS). METHODS: A total of 387 AMI patients with prior IS were enrolled consecutively from January 15, 2005 to December 24, 2011 in this cohort study. All patients were categorized into the CART group (n = 204) or the conservative medications (CM) group (n = 183). In-hospital cardiocerebral events and long-term mortality of the two groups after an average follow-up of 36 months were recorded by Kaplan-Meier survival curves and compared by Logistic regression and the Cox regression model. RESULTS: The CART patients were younger (66.5 ± 9.7 years vs. 71.7 ± 9.7 years, P < 0.01), had less non-ST segment elevation myocardial infarction (11.8% vs. 20.8%, P = 0.016) and more multiple-vascular coronary lesions (50% vs. 69.4%, P = 0.031). The hospitalization incidence of cardiocerebral events in the CART group was 9.3% while 26.2% in the CM group (P < 0.01). CART significantly reduced the risk of in-hospital cardiocerebral events by 65% [adjusted odds ratio (OR) = 0.35, 95% CI: 0.13-0.92]. By the end of follow-up, 57 cases (41.6%) died in CM group (n = 137) and 24 cases (12.2%) died in CART group (n = 197). Cox regression indicated that CART decreased the long-term mortality by 72% [adjusted hazard ratio (HR) = 0.28, 95% CI: 0.06-0.46], while categorical analysis indicated no significant difference between PCI and CABG. CONCLUSIONS: CART has a significant effect on improving the in-hospital and long-term prognoses for AMI patients with prior IS.

[Effect of argon laser photocoagulation on diabetic retinopathy].

OBJECTIVE: To observe the clinical effect of argon laser photocoagulation on diabetic retinopathy (DR) in different stages. METHODS: A total of 263 eyes in 170 patients with DR in different stages were photocoagulated using argon laser machine 2000. Thirty eyes in non-proliferative stage received focal photocoagulation, 156 pre-proliferative eyes received subtotal panretina photocoagulation, and 77 proliferative eyes were treated with panretinal photocoagulation. Additional focal or grid treatment was given for the eyes with localized or diffused macular edema. The visual acuity, eye fundus examination and retinal fluorescein angiography were carried out 3 months after the treatment and the results compared with the preoperative findings. RESULTS: Improvement of visual acuity by at least one row on the visual chart was achieved in 92 eyes (35%), 144 eyes (55%) exhibited no changes, and 27 eyes (10%) deteriorated. Microaneurysm, retinal edema, exudates and fluorescence leakage were reduced in 89% of the eyes, with the rest eyes requiring additional treatment in the non-proliferative and pre-proliferative stages. For the retina in proliferative stage, neovascularization on the disc resolved completely in 67% eyes, whereas partially in 33% eyes which needed additional photocoagulation. The eyes with partial and complete resolution of macular edema accounted for 91% of the total eyes. Postoperative pre-retinal hemorrhage and vitreous hemorrhage occurred at the rates of 8% and 1%, respectively. CONCLUSION: Argon laser therapy is effective for the eyes with DR in different stages, but produces better efficacy in non- and pre-proliferative stages than in proliferative stage. Follow-up and additional photocoagulation are necessary for the eyes in proliferative stage to ensure better outcome.

[Clinical study of argon laser photocoagulation for central serous chorioretinopathy].

OBJECTIVE: To evaluate the clinical effect of argon laser photocoagulation for central serous chorioretinopthy. METHODS: This study included 102 consecutive cases of central serous chorioretinopathy (102 eyes) with fluorescein dye leakage located 500 microm away from the central fovea of the macula lutea as defined by fundus fluorescein angiography (FFA). Argon laser photocoagulation of the leakage spots was performed once (98 eyes) or twice (4 eyes) with the spot diameter for exposure ranging from 100 to 200 microm and exposure time of 0.2 s that delivered energy of 80 to 150 mW. RESULTS: The visual acuity was improved in 95 cases by one row on the standard vision chart within 2 or 3 d after the laser treatment, while in the other 7 cases, the visual acuity remained unchanged. The symptoms of micropsia, metamorphopsia and blurred vision disappeared in 87 cases. Serous detachment of the sensory retina and the fovea light reflex recovered in 80 cases within two weeks after the treatment and no fovea injuries due to photocoagulation were recorded. During the follow-up lasting for 6 to 12 months no recurrence or long-term complications in relation with photocoagulation treatment were observed in these cases. CONCLUSION: Argon laser photocoagulation is effective for central serous choiroretinopathy, and strict control of the photocoagulation conditions is crucial for preventing complications in relation to laser coagulation.