Hadeel Zainah

Fecal Bacteriotherapy: A Case Report in an Immunosuppressed Patient with Ulcerative Colitis and Recurrent Clostridium difficile Infection

We report a case of ulcerative colitis (UC) and recurrent Clostridium difficile infection (CDI) where the patient was on immunomodulatory therapy and had successful CDI eradication after fecal transplantation. This is the first case report in the literature documenting successful C. difficile eradication in an immunosuppressed patient. We feel that fecal transplantation should be studied as a treatment option in these patients.

Two Case Reports of Neuroinvasive West Nile Virus Infection in the Critical Care Unit

We describe the clinical course of two cases of neuroinvasive West Nile Virus (WNV) infection in the critical care unit. The first case is a 70-year-old man who presented during summer with mental status changes. Cerebrospinal fluid (CSF) analysis revealed pleocytosis with lymphocyte predominance. WNV serology was positive in the CSF. His condition worsened with development of left-sided weakness and deterioration of mental status requiring intensive care. The patient gradually improved and was discharged with residual left-sided weakness and near-complete improvement in his mental status. The second case is an 81-year-old man who presented with mental status changes, fever, lower extremity weakness, and difficulty in walking. CSF analysis showed pleocytosis with neutrophil predominance. WNV serology was also positive in CSF. During the hospital stay his mentation worsened, eventually requiring intubation for airway protection and critical care support. The patient gradually improved and was discharged with residual upper and lower extremity paresis. Neuroinvasive WNV infection can lead to significant morbidity, especially in the elderly. These cases should be suspected in patients with antecedent outdoor activities during summer. It is important for critical care providers to be aware of and maintain a high clinical suspicion of this disease process.

Daptomycin Failure for Treatment of Pulmonary Septic Emboli in Native Tricuspid and Mitral Valve Methicillin-Resistant Staphylococcus aureus Endocarditis

Daptomycin has been used with success for the treatment of right-sided methicillin-resistant Staphylococcus aureus (MRSA) endocarditis. However, its efficacy has not been completely assessed for the treatment of MRSA endocarditis when it is associated with pulmonary septic emboli. Hereby, we present a case of MRSA mitral and tricuspid native valve endocarditis with pulmonary septic emboli, which was treated with daptomycin as a sole agent, resulting in worsening pulmonary infiltrates and treatment failure.

A Rare Case of Diffuse Alveolar Hemorrhage Secondary to Acute Pulmonary Histoplasmosis.

Diffuse alveolar hemorrhage (DAH) is a rare presentation of acute pulmonary histoplasmosis. While histoplasmosis has been reported to cause hemoptysis and alveolar hemorrhage in children, the English language literature lacks any adult case reports documenting this association. We report a case of pulmonary histoplasmosis where the initial presentation was pneumonia with a subsequent diagnosis of DAH.

The Efficacy of Acticoat-Silver Dressing in Preventing Left-entricular-Assisted Device Infections

Background: The optimal local care of continuous-flow left ventricular-assisted device (CF-LVAD) exit site in unclear. We compared silver-coated wound dressing (Acticoat) with the conventional wound care method. Methods: A retrospective case-control study was conducted at Henry Ford Hospital, a tertiary teaching hospital in urban Detroit, between 11/1/2010 and 12/31/2011. Patients were divided into 2 groups based on Acticoatdressing use. Primary outcome was first CF-LVAD infection rate. Results: Forty-two patients were included in the study. Twenty patients used Acticoat-dressing, while 22 used the control dressing. Mean age was 60.3 ± 8.9 in the intervention group and 48.6 ± 4.8 in the control group (P: 0.004). Male patients were 15 (75%) in the intervention group and 15 (68.2%) in the control group (P: 0.74). Acticoat-dressing was used for a mean duration of 64.1 ± 122.9 days. The rate of first CF-LVAD infection was 15% (3) in the Acticoat group and 31.8% (7) in the control group (P: 0.25). Mortality at 200 days was 15% (3) in the intervention group; and 4.5% (1) in the control group (P: 0.25). Ten patients were infected in the whole study (23.8%); 9 of the infected patients (90%) required hospitalization after the first infection; while 3 patients (30%) required intensive-care unit admission. Mean time to the first infection was 276.3 ± 235.8 days in the intervention group and 276.3 ± 131.5 days in the control group (P: 0.99). Conclusion: There was no statistically significant difference in the infection rate or time to first infection between the Acticoat group and the control group.

Mycobacterium celatum Misdiagnosed as Mycobacterium tuberculosis: Case Report and Review of Literature

AbstractMycobacterium celatum has been shown to cause fatal disease in both immunocompetent and immunocompromised patients. The similarity in symptoms and radiological features between M celatum and M tuberculosis makes it difficult to differentiate between the 2 clinically or based on early laboratory testing. Clinical symptoms include cough, malaise, and weight loss associated with cavitary lesions and pulmonary infiltrates, whereas the initial laboratory testing includes positive acid-fast stain. Identification using nucleic acid amplification testing (NAAT) in the diagnostic process is sensitive; however, cross-reactivity between M celatum and M tuberculosis NAAT leading to diagnostic errors and inappropriate treatment has been reported. We report a case of pulmonary disease caused by M celatum misdiagnosed as M tuberculosis based on NAAT.

Methicillin-resistant staphylococcus aureus pneumonia what is the optimal duration of treatment?

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) pneumonia is associated with high morbidity and mortality. There is no consensus about the length of therapy. Current Infectious Diseases Society of America consensus guidelines recommend 7 to 21 days for duration. MethodsIn a retrospective study conducted in a 900-bed teaching hospital in urban Detroit over a 26-month period, we evaluated the charts of 706 patients with positive MRSA respiratory cultures. We studied 115 patients with MRSA pneumonia. ResultsThe mean ± SD age for the patients was 64.36 ± 14.44 years; 67 patients (58.77 %) were women, 44 patients (38.26%) had multilobar pneumonia. Patients were treated with either vancomycin or linezolid or treatment was switched between those 2 agents. The mean ± SD treatment duration was 13.1 ± 7.1 days. The overall 28-day mortality rate was 28.73% (n = 32). Among the 83 patients who survived to 28 days, 9 patients (10.8%) received treatment for less than 8 days, 33 patients (39.8%) received treatment for 8 to 13 days, 26 patients (31.3%) received treatment for 14 to 20 days, and 15 patients (18.1%) received treatment for more than 20 days. Among the 32 patients who did not survive to 28 days, 11 patients (34.4%) received treatment for less than 8 days, 14 patients (43.8%) received treatment for 8 to 13 days, 6 patients (18.8%) received treatment for 14 to 20 days, and 1 patient (3.1%) received treatment for more than 20 days; P < 0.001. ConclusionThe nonsurvivors were treated for shorter durations than survivors, indicating that MRSA pneumonia requires longer treatment durations (≥14 days).