The Lebanese Society for Infectious Diseases and Clinical Microbiology (LSIDCM) guidelines for adult community-acquired pneumonia (Cap) in Lebanon.

Adult community-acquired pneumonia (CAP) is a common cause of morbidity and mortality which is managed by different disciplines in a heterogeneous fashion. Development of consensus guidelines to standardize these wide variations in care has become a prime objective. The Lebanese Society of Infectious Diseases and Clinical Microbiology (LSIDCM) convened to set Lebanese national guidelines for the management of CAP since it is a major and a prevalent disease affecting the Lebanese population. These guidelines, besides being helpful in direct clinical practice, play a major role in establishing stewardship programs in hospitals in an effort to contain antimicrobial resistance on the national level. These guidelines are intended for primary care practitioners and emergency medicine physicians. They constitute an appropriate starting point for specialists' consultation being based on the available local epidemiological and resistance data. This document includes the following: 1/ Rationale and scope of the guidelines; 2/ Microbiology of CAP based on Lebanese data; 3/ Clinical presentation and diagnostic workup of CAP; 4/ Management and prevention strategies based on the IDSA/ATS Consensus Guidelines, 2007, and the ESCMID Guidelines, 2011, and tailored to the microbiological data in Lebanon; 5/ Comparison to regional guidelines. The recommendations made in this document were graded based on the strength of the evidence as in the 2007 IDSA/ATS Consensus Guidelines. Hopefully, these guidelines will be an important step towards standardization of CAP care in Lebanon and set the agenda for further research in this area.

Bilateral multifocal posterior pole lesions in Reiter syndrome.

Reactive arthritis is associated with conjunctivitis or iritis. Rarely reactive arthritis is accompanied by permanent visual loss from macular infarction or foveal scarring. We present the case of a rheumatologist who had a sudden onset of skin lesions, arthritis of several joints and bilateral visual loss. Most of these manifestations resolved after a course of oral corticosteroids. However he was left with decreased vision in the left eye and multiple lesions in the fovea over a follow-up of 2 years.

Emergence of fluoroquinolone-resistant Streptococcus pneumoniae in Lebanon: a report of three cases.

The global emergence of Streptococcus pneumoniae resistance to fluoroquinolones is alarming and has grown to be a cause for significant concern worldwide. We report the first three cases of levofloxacin resistant S. pneumoniae isolates in a tertiary medical center in Beirut, Lebanon. Judicious use of antimicrobial agents is imperative to limit the spread of such resistant strains.

Successful treatment of pacemaker related endocarditis with acute embolic stroke without device removal.

Pacemaker related endocarditis is a rare potentially fatal condition, most commonly acquired during manipulation of the pacemaker system. Most patients have involvement of the right heart. Only rarely has involvement of the left-heart been documented. In the absence of controlled studies regarding management of such cases, many recommend complete removal of the pacing system along with intravenous antibiotics. We present a patient with documented pacemaker related left-sided endocarditis associated with an acute embolic stroke who was treated with antibiotics with complete recovery and its two-year follow up.