Yu-Huai Ho

Levofloxacin versus tetracycline antibiotics for the treatment of scrub typhus

BACKGROUND Scrub typhus is an important febrile disease in Southeast Asia and is caused by Orientia tsutsugamushi. Fluoroquinolones have proved to be effective for scrub typhus in an animal model. However, it is unclear whether they are also effective clinically. METHODS We retrospectively reviewed the hospital-based medical records of patients diagnosed to have scrub typhus by an indirect immunofluorescence antibody assay or PCR at a large referral hospital in Taiwan for a 6-year period (2001-2007). To determine the efficacy of levofloxacin for the treatment of scrub typhus, we divided the patients into a levofloxacin-treated group and a tetracycline antibiotics-treated group. RESULTS Out of 132 patients with scrub typhus, 71 initially received levofloxacin and 61 initially received tetracycline antibiotics. There was no statistically significant difference in the effective rate between the two groups (91.5% and 95.1% cured, respectively; p=0.648). The time to defervescence in the levofloxacin-treated group was longer than in the other group (49+/-41.1 and 24+/-19.6hours, respectively; p=0.001). In the patients with higher APACHE II scores, higher mortality was found in the levofloxacin-treated group (44.4% and 0%; p=0.033). CONCLUSIONS Levofloxacin is effective in patients with scrub typhus, but has a longer time to defervescence compared with tetracycline antibiotics. When levofloxacin is used for severe scrub typhus, higher mortality may be attributed to the longer time to defervescence.

Different Clinical Characteristics Among Aeromonas hydrophila, Aeromonas veronii biovar sobria and Aeromonas caviae Monomicrobial Bacteremia

This study aimed to compare the clinical presentations of Aeromonas hydrophila, A. veronii biovar sobria and A. caviae monomicrobial bacteremia by a retrospective method at three hospitals in Taiwan during an 8-yr period. There were 87 patients with A. hydrophila bacteremia, 45 with A. veronii biovar sobria bacteremia and 22 with A. caviae bacteremia. Compared with A. hydrophila and A. veronii biovar sobria bacteremia, A. caviae bacteremia was more healthcare-associated (45 vs 30 and 16%; P = 0.031). The patients with A. caviae bacteremias were less likely to have liver cirrhosis (27 vs 62 and 64%; P = 0.007) and severe complications such as shock (9 vs 40 and 47%; P = 0.009) and thrombocytopenia (45 vs 67 and 87%; P = 0.002). The APACHE II score was the most important risk factor of Aeromonas bacteremia-associated mortalities. The APACHE II scores of A. caviae bacteremias were lower than A. hydrophila bacteremia and A. veronii biovar sobria bacteremia (7 vs 14 and 16 points; P = 0.002). In conclusion, the clinical presentation of A. caviae bacteremia was much different from A. hydrophila and A. veronii biovar sobria bacteremia. The severity and mortality of A. caviae bacteremia were lower than A. hydrophila or A. veronii biovar sobria bacteremia.

Intravenous minocycline versus oral doxycycline for the treatment of noncomplicated scrub typhus

BACKGROUND Scrub typhus is an acute febrile disease for which synthetic tetracycline antibiotics are efficacious. However, no clinical studies have compared oral doxycycline with intravenous minocycline for treatment of scrub typhus. METHODS We conducted a retrospective analysis in patients diagnosed with noncomplicated scrub typhus by serologic or molecular methods from August 2001 to July 2007. We compared the efficacy of intravenous minocycline with oral doxycycline for treatment of noncomplicated scrub typhus in these patients. RESULTS Forty seven cases receiving tetracycline antibiotics for the treatment of noncomplicated scrub typhus were included. There was no statistically significant difference for the response rate between the 25 cases receiving intravenous minocycline (96%) and the 22 cases receiving oral doxycycline (91%) (p=0.909). Kaplan-Meier curve with a long-rank test for the time to defervescence showed no statistically significant difference between minocycline therapy (mean 30 hours; range 4-124 hours) and doxycycline therapy (mean 32.4 hours; range 4-144 hours) (p=0.860). After multivariate Cox regression models, the time to defervescence was only affected by Acute Physiology and Chronic Health Evaluation II score (hazard ratio 0.868; p=0.016). Nearly all patients (93.6%) became afebrile within 72 hours after use of tetracycline antibiotics. Prolonged hospitalization (> 7 days) was correlated with the timing to start tetracycline antibiotics after admission. CONCLUSION Both antibiotics have similar efficacy for the treatment of noncomplicated scrub typhus. Nearly all cases responding to both antibiotics became afebrile within 3 days.

Use of a Sampling Area-Adjusted Adenosine Triphosphate Bioluminescence Assay Based on Digital Image Quantification to Assess the Cleanliness of Hospital Surfaces.

Contaminated surfaces play an important role in the transmission of pathogens. We sought to establish a criterion that could indicate “cleanliness” using a sampling area–adjusted adenosine triphosphate (ATP) assay. In the first phase of the study, target surfaces were selected for swab sampling before and after daily cleaning; then, an aerobic colony count (ACC) plate assay of bacteria and antibiotic-resistant bacteria was conducted. ATP swabs were also tested, and the ATP readings were reported as relative light units (RLUs). The results of the ACC and ATP assays were adjusted according to the sampling area. During the second phase of the study, a new cleaning process employing sodium dichloroisocyanurate (NaDCC) was implemented for comparison. Using the criterion of 2.5 colony-forming units (CFU)/cm2, 45% of the sampled sites were successfully cleaned during phase one of the study. During phase two, the pass rates of the surface samples (64%) were significantly improved, except under stringent (5 RLU/cm2) and lax (500 RLU) ATP criteria. Using receiver-operating characteristic curve analysis, the best cut-off point for an area-adjusted ATP level was 7.34 RLU/cm2, which corresponded to culture-assay levels of <2.5 CFU/cm2. An area adjustment of the ATP assay improved the degree of correlation with the ACC-assay results from weak to moderate.

Aeromonas Hydrophila Bacteremia Presenting as Epidural Abscess in a Cirrhotic Patient-A Case Report

Aeromonas hydrophila is a low-virulence gram-negative bacillus. Human infections secondary to Aeromonas hydrophila may present as a variety of diseases, such as wound infection, acute gastroenteritis, septicemia, pneumonia, septic arthritis or endocarditis. It has rarely been reported as a causative organism of epidural abscess. We present a case of epidural abscess due to Aeromonas hydrophila in a 50-year-old man with liver cirrhosis. It has been shown that the Aeromonas bacteremia usually affects immunocompromised subjects, such as those with liver cirrhosis. Epidural abscess should be highly suggested when a cirrhotic patient with Aeromonas bacteremia presents severe low back pain.

Successful Treatment of Two Cases of Invasive Aspergillus Sinusitis With Voriconazole

Abstract Aspergillosis is a spectrum of diseases caused by Aspergillus spp., which is a widespread fungus that produces microscopic spores. Immunocompetent people may breathe in numerous Aspergillus every day, yet experience no symptoms. Invasive Aspergillus is relatively rare. There is limited information about the use of voriconazole for the treatment of invasive Aspergillus sinusitis. Here, we present two cases of invasive Aspergillus in elderly female patients with diabetes mellitus. Both patients fully recovered after treatment using surgical debridement and an antifungal regimen that included voriconazole.

Angiostrongylus Cantonensis Myelomeningitis Presenting as Conus Medullaris Syndrome-A Case Report

Angiostrongylus cantonensis is the most common cause of eosinophilic meningitis worldwide. Infected patients usually present with severe headache, neck stiffness, nausea and vomiting. We report a case of Angiostrongylus cantonensis myelomeningitis presenting as conus medullaris syndrome in a 48-year-old man. The patient recovered spontaneously after one month. So far as we know, conus medullaris syndrome has rarely been reported as a presentation of Angiostrongylus cantonensis myelomeningitis. Angiostrongylus cantonensis myelomeningitis should be considered in the differential diagnosis of conus medullaris syndrome.