Hari Polenakovik

Ceftaroline for meticillin-resistant Staphylococcus aureus bacteraemia: Case series and review of the literature

Data regarding ceftaroline use for meticillin-resistant Staphylococcus aureus bacteraemia (MRSAB) are lacking. Here we review the outcomes of 31 patients with MRSAB treated with ceftaroline, including 9 patients with endocarditis. Clinical success was observed in 23 patients (74.2%). Adverse events associated with prolonged therapy were rare and included eosinophilic pneumonia, rash and diarrhoea. We conclude that ceftaroline can be used for MRSAB.

Comparing Interferon-γ Release Assay with Tuberculin Skin Test Readings at 48–72 Hours and 144–168 Hours with Use of 2 Commercial Reagents

BACKGROUND Despite widespread use, the tuberculin skin test (TST) has many limitations, including a requirement for a second visit between 48 and 72 hours. The goal of this study was to determine the reliability of a TST reading between 144 and 168 hours. METHODS Tuberculin antigen was applied into both forearms (Aplisol in one arm and Tubersol in the other, from single lots of each product) by the Mantoux method. Blood samples were obtained for interferon- gamma release assay. Subjects were seen at 48-72 hours for the initial (day 2) TST reading and returned at 144-168 hours for a second (day 7) reading. RESULTS A total of 116 subjects at increased risk for tuberculosis were studied; 25 (22%) had positive results at day 2 with Tubersol and 27 (23%) had positive results at day 2 with Aplisol. Overall agreement between Tubersol and Aplisol at day 2 was 93% (kappa = 0.80) and at day 7 was 94% (kappa = 0.76). Overall agreement between day 2 and day 7 was 89% for Tubersol and 86% for Aplisol. Discordant results between day 2 and day 7 occurred mostly in persons with a history of bacille Calmette-Guerin vaccination. CONCLUSIONS Subjects who fail to present at 48-72 hours for TST reading may still have a reliable TST reading at up to 168 hours. Aplisol and Tubersol reagents produce comparable results when compared with the interferon- gamma release assay.

Lactobacillus paracasei Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis and Review of the Literature

ABSTRACT We describe the first case of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis due to Lactobacillus paracasei. It occurred in a 65-year-old patient with recurrent episodes of peritonitis while he was receiving a prolonged course of intraperitoneal vancomycin. L. paracasei should be considered in the differential diagnosis of pathogens in CAPD-related peritonitis, especially in patients receiving prolonged vancomycin or glycopeptide treatment.

Ceftaroline-induced eosinophilic pneumonia.

We present a case of eosinophilic pneumonia due to ceftaroline used for the treatment of methicillin‐resistant Staphylococcus aureus bacteremia associated with a postoperative spinal infection. Our patient developed shortness of breath and hypoxemia on the fifth week of ceftaroline therapy. Chest imaging disclosed diffuse bilateral infiltrates. Laboratory abnormalities included peripheral eosinophilia and eosinophilic predominant bronchoalveolar lavage fluid. The combination of ceftaroline discontinuation plus initiation of steroid treatment resulted in complete resolution of signs, symptoms, and radiologic abnormalities. We speculate about possible mechanisms underlying this adverse event and diagnostic criteria for drug‐induced eosinophilic pneumonia.

The use of ivacaftor in an adult with severe lung disease due to cystic fibrosis (ΔF508/G551D)

We report on an adult with cystic fibrosis (ΔF508/G551D) with severe lung disease (forced expiratory volume (FEV1) in one second 24% predicted) who was admitted for a pulmonary exacerbation. He was managed with maximal medical therapy, but did not have significant improvement until after he was started on ivacaftor on hospital day 15. He subsequently had significant improvement in lung function with normalization of hypercarbia, oxygen saturation on room air, and increase in FEV1 to 36% predicted. Prior to use of ivacaftor he was being assessed for a lung transplant. However, after ivacaftor therapy for 6 months, he is no longer considering this treatment modality due to his improvement of lung function and functional status.

Cyclo-oxygenase II inhibitors in the treatment of neoplastic fever

Neoplastic fever is relatively common in cancer patients. Naproxen is one of the most commonly used non-steroidal anti-inflammatory drugs for the treatment of neoplastic fever. Naproxen is associated with platelet dysfunction and gastrointestinal side effects. We substituted rofecoxib, a cyclooxygenase-II inhibitor, for naproxen in patients with a previous history of, or a newly diagnosed, neoplastic fever in whom naproxen was relatively contraindicated. In all patients the fever resolved completely without any side effects.

Challenges in the Management of Infections due to Carbapenem-Resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae (CRE) infections are increasing and are associated with considerable morbidity and mortality. Members of the Emerging Infections Network treating CRE encountered difficulties in obtaining laboratory results and struggled with limited treatment options. In addition, many treated patients experienced an alarming degree of drug toxicity from CRE therapies.

Moxifloxacin Is Efficacious for Treatment of Community-Acquired Lung Abscesses in Adults

grounds for exclusion of those studies” [8, section 6.10]. Our 11 criteria were determined under the assumption that failure to meet just 1 criterion could potentially invalidate an entire study. The Cochrane Handbook continues with the statement that “if reviewers raise the methodological cut-point for including studies, there will be less variation in validity among the included reports” [8, section 6.10]. Metaanalysis was not attempted in our review, because only 2 studies were deemed experimentally sound. With regard to vitamin C, the purpose of our study was not to review vitamin C studies and their validity. The studies of Diehl [9], Hayden et al. [10], and Chalmers [11] were cited in our review [3] to show the importance of proof of blinding and to demonstrate the placebo effect in action. The importance of proof of blinding has been established as a vital component of experimental design. The Cochrane Handbook states “there is empirical evidence suggesting that...lack of double blinding results in overestimates of the effects of treatment” [8, section 6.11]. We stand by the results reported in our review.

Acute limb ischemia due to Candida lusitaniae aortic valve endocarditis.

We present a case of a 35-year-old male with history of intravenous heroin use, who presented with acute limb ischemia and was found to have Candida lusitaniae endocarditis. After an urgent intervention to salvage the right lower extremity, successful outcome of his infection was achieved by a combined surgical and antifungal treatment.

An HIV-Infected Man with Odynophagia and Rash

Diagnosis: Scurvy. The patients serum ascorbic acid level was 0.1 mg/dL (normal range, 0.4-1.5 mg/dL). The punch biopsy of the skin of the right lower leg (figures 1 and 2) revealed minimal hyperkeratosis and thin epidermis (figure 3). There was extravasated blood in superficial dermis, admixed with karyorrhectic debris. Some of the dermal capillaries showed mild leukocytoclastic changes. There was no hair follicle in the specimen. Scurvy was diagnosed, and the patient was treated with high doses of ascorbic acid for 1 week. The leg edema and purpura quickly resolved during treatment (figure 4). Endoscopy of the upper gastrointestinal tract disclosed esophagitis with strictures, which were dilated. The pancytopenia was secondary to alcohol abuse, liver disease, and HIV infection. Scurvy is an uncommon disorder in developed countries. It is typically associated with malnutrition, alcoholism, severe gastroesophageal reflux, or/and advanced age [1-4]. Ascorbic acid deficiency leads to defective collagen formation. Histopathologic examination reveals RBC extravasation into the dermis, with a perivascular and perifollicular distribution; there may be sparse superficial perivascular infiltrate of inflammatory cells. Follicular hyperkeratosis with coiled, fragmented, cork-