In Reply: Treatment of Bacillus Infections

PEDIATRICS ◽  
1989 ◽  
Vol 84 (2) ◽  
pp. 404-404
Author(s):  
HENRY M. FEDER
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Bacillus Cereus ◽  
Empiric Therapy ◽  
Susceptibility Test ◽  
Bacillus Species ◽  
Test Results

Dr Barson suggests that vancomycin should be used as empiric therapy for serious systemic and central nervous system Bacillus species infections pending susceptibility test results. This suggestion is based on the recent publication by Weber et al who reported that 54 strains of Bacillus cereus were susceptible to both vancomycin and chloramphenicol and that 35 strains on non-cereus Bacillus species were all susceptible to vancomycin; however, 14% of these 35 strains were resistant to chloramphenicol. Thus, chloramphenicol may be a poor choice for empiric therapy.

scholarly journals Diagnosing Ring-Enhancing Lesions in the Brain of a Patient With AIDS Without Brain Biopsy: A Case of Central Nervous System Histoplasmoma

2017 ◽  
Vol 8 (2) ◽  
pp. 86-91 ◽  
Author(s):  
Rachel Beekman ◽  
Jessica M. Hu ◽  
Steven I. Aronin ◽  
Maricar F. Malinis
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Histoplasma Capsulatum ◽  
Brain Mri ◽  
Central Nervous System Involvement ◽  
Brain Biopsy ◽  
Empiric Therapy ◽  
Fluid Analysis ◽  
The Brain

We report a case of a Puerto Rican male with advanced AIDS who presented with multiple falls and pancytopenia. Magnetic resonance imaging (MRI) of the brain, as initial workup, revealed 2 ring-enhancing brain lesions. Initial cerebrospinal fluid analysis revealed minimal cells, mildly elevated protein, and no organism seen on gram stain. Due to prohibitive thrombocytopenia, brain biopsy was deferred. He had neither clinical nor radiographic improvement despite empiric therapy for both toxoplasmosis and bacterial abscesses. Indicated by pancytopenia, bone marrow (BM) aspiration was performed. Culture of BM aspirate grew Histoplasma capsulatum. Urine histoplasma antigen was markedly elevated. He was treated with liposomal amphotericin B (LamB) for progressive disseminated histoplasmosis with probable central nervous system involvement. Cerebrospinal fluid histoplasma antigen obtained after 2 months of LamB was detected. After prolonged course of LamB, he took itraconazole. Brain MRI at 7-month follow-up revealed significant improvement from baseline study.

scholarly journals Prediction and Value of Ultrasound Image in Diagnosis of Fetal Central Nervous System Malformation under Deep Learning Algorithm

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yuehong Zhou
Keyword(s):  
Neural Network ◽  
Central Nervous System ◽  
Nervous System ◽  
Deep Learning ◽  
Ultrasound Examination ◽  
Ultrasound Image ◽  
Control Group ◽  
Test Results ◽  
Experimental Group ◽  
Central Nervous System Malformation

This study was to explore the application of deep learning neural network (DLNN) algorithms to identify and optimize the ultrasound image so as to analyze the effect and value in diagnosis of fetal central nervous system malformation (CNSM). 63 pregnant women who were gated in the hospital were suspected of being fetal CNSM and were selected as the research objects. The ultrasound images were reserved in duplicate, and one group was defined as the control group without any processing, and images in the experimental group were processed with the convolutional neural network (CNN) algorithm to identify and optimize. The ultrasound examination results and the pathological test results before, during, and after the pregnancy were observed and compared. The results showed that the test results in the experimental group were closer to the postpartum ultrasound and the results of the pathological result, but the results in both groups showed no statistical difference in contrast to the postpartum results in terms of similarity ( P > 0.05 ). In the same pregnancy stage, the ultrasound examination results of the experimental group were higher than those in the control group, and the contrast was statistically significant ( P < 0.05 ); in the different pregnancy stages, the ultrasound examination results in the second trimester were more close to the postpartum examination results, showing statistically obvious difference ( P < 0.05 ). In conclusion, ultrasonic image based on deep learning was higher in CNSM inspection; and ultrasonic technology had to be improved for the examination in different pregnancy stages, and the accuracy of the examination results is improved. However, the amount of data in this study was too small, so the representative was not high enough, which would be improved.

scholarly journals A Single-center, Quasi-experimental Study to Evaluate the Impact of a Multiplex Polymerase Chain Reaction System Combined with Antimicrobial Stewardship Intervention on Time to Targeted Therapy in Patients with Suspected Central Nervous System Infection

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S8-S8 ◽  
Author(s):  
Kelsey Powell ◽  
Sara Revolinski ◽  
Allison Gibble ◽  
Anne Daniels ◽  
J Njeri Wainaina ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Polymerase Chain Reaction ◽  
Nervous System ◽  
Targeted Therapy ◽  
Multiplex Polymerase Chain Reaction ◽  
Antimicrobial Agents ◽  
Empiric Therapy ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
Research Grant

Abstract Background Empiric treatment for central nervous system (CNS) infections consists of coverage with multiple antimicrobial agents that may be continued until a pathogen can be identified. Identification may take significant time to result, leading to extended durations of multiple antimicrobial agents, delays in targeted therapy and subsequent adverse effects, such as nephrotoxicity and Clostridium difficile infection. A multiplex polymerase chain reaction (PCR) system that can identify 14 pathogens responsible for community-acquired CNS infections in 1 hour was recently FDA-approved for cerebrospinal fluid (CSF) analysis. The objective of this study was to determine the effect of this PCR paired with antimicrobial stewardship (AMS) team intervention on the time to targeted therapy. Methods During the intervention (Int) phase (January 25, 2017–April 30, 2017), all PCR results were called to the AMS team, who reviewed clinical data and provided antimicrobial recommendations per pre-determined protocol. Recommendations consisted of de-escalation or addition of therapy. The pre-intervention (PI) group consisted of patients with CSF culture obtained between January 25, 20116 and April 30, 2016. Results A total of 138 patients were evaluated; 46 in the Int group and 92 in the PI. Of the 46 patients in the Int group, 25 had a negative PCR result and were never initiated on antimicrobials. One patient required antimicrobial escalation. Twenty patients were started on empiric therapy and were candidates for de-escalation. In the PI group, there were no patients with CSF cultures that required therapy escalation, while 33 patients were initiated on empiric antimicrobials. Results from the subgroup of patients in whom empiric therapy was started as shown in Table 1. Conclusion Implementation of a multiplex PCR with AMS intervention resulted in decreased time to targeted therapy. This project was funded through a competitive stewardship grant provided by Merck & Co. Disclosures S. Revolinski, Merck: Grant Investigator, Research grant; J. N. Wainaina, Merck: Grant Investigator, Research grant; A. Huang, Merck: Grant Investigator, Research grant

Nosocomial meningitis: A case of Bacillus cereus central nervous system infection

2019 ◽  
pp. 1-3
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Antibiotic Therapy ◽  
Bacillus Cereus ◽  
Central Nervous System Infection ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Nosocomial Meningitis ◽  
High Index Of Suspicion ◽  
Immunocompromised Hosts

We present a case of nosocomial Bacillus cereus meningitis, a rare cause of central nervous system infection with significant morbidity and mortality. While often contaminants, gram positive bacilli in the bloodstream of immunocompromised hosts requires a high index of suspicion to deliver timely antibiotic therapy.

scholarly journals Bacillus cereusBloodstream Infection in a Preterm Neonate Complicated by Late Meningitis

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Toshinobu Horii ◽  
Kiyoko Tamai ◽  
Shigeyuki Notake ◽  
Hideji Yanagisawa
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Bacillus Cereus ◽  
Gel Electrophoresis ◽  
Preterm Neonate ◽  
Pulsed Field Gel Electrophoresis ◽  
Central Nervous System Infections ◽  
Acute Meningitis

Central nervous system infections caused byBacillus cereushave rarely been reported in infants. In this paper, the case of a 2-month-old low-birth-weight female who developed meningitis 45 days after resolution of a bloodstream infection (BSI) is described. The pulsed-field gel electrophoresis results revealed that the patterns of bothB. cereusisolates responsible for the acute meningitis and for the prior bacteraemic episode were closely related. Although the source of the infection from within the patient was not clear, it is suggested that theB. cereusBSI developed in the neonate was complicated by acute meningitis.

scholarly journals Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole

2015 ◽  
Vol 59 (12) ◽  
pp. 7857-7861 ◽  
Author(s):  
Marjolaine Morgand ◽  
Blandine Rammaert ◽  
Sylvain Poirée ◽  
Marie-Elisabeth Bougnoux ◽  
Hugo Tran ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Central Nervous System ◽  
Renal Failure ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Immunocompromised Patients ◽  
Test Results ◽  
Galactomannan Antigen ◽  
Chronic Invasive

ABSTRACTInvasive aspergillosis (IA) is a severe disseminated fungal disease that occurs mostly in immunocompromised patients. However, central nervous system IA, combining meningitis and skull base involvement, does not occur only in groups with classic risk factors for IA; patients with chronic renal failure and diabetes mellitus are also at risk for more chronic forms. In both of our proven IA cases, voriconazole monotherapy was effective without surgery, and cerebrospinal fluid and serum 1,3-β-d-glucan test results were initially positive, in contrast to galactomannan antigen results.

scholarly journals Emergence of Parechovirus A4 Central Nervous System Infections among Infants in Kansas City, Missouri, USA

2019 ◽  
Vol 57 (5) ◽  
Author(s):  
A. Sasidharan ◽  
C. J. Harrison ◽  
D. Banerjee ◽  
R. Selvarangan
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Kansas City ◽  
Maximum Temperature ◽  
Cns Infection ◽  
Test Results ◽  
Central Nervous System Infections ◽  
Laboratory Findings ◽  
Cns Infections ◽  
Laboratory Test Results

ABSTRACT Among known parechovirus (PeV) types infecting humans, PeV-A3 (formerly HPeV3) and PeV-A1 (formerly HPeV1) are associated with pediatric central nervous system (CNS) infections. The prevalence of PeV-A3 among hospitalized infants with sepsis-like illness and viral CNS infection is well described; however, the contribution of PeV-A4 to infant CNS infection is relatively unexplored. We report the first 11 U.S. cases of PeV-A4 CNS infections occurring in Kansas City infants during 2010 to 2016 and compare the clinical presentation with that of PeV-A3. PeV-positive cerebrospinal fluid (CSF) specimens from 2010 to 2016 underwent sequencing for genotyping. Among all PeV-CSF positives, PeV-A4 was detected in 11 CSF samples from 2010 to 2016. PeV-A4 was first detected in 2010 (n = 1/4), followed by detections in 2014 (n = 1/39), 2015 (n = 6/9), and 2016 (n = 3/33). The median age of PeV-A4-infected infants in weeks (median, 4; range, 1 to 8) was similar to that of infants infected with PeV-A3 (median, 4; range, 0.25 to 8). Clinical characteristics of PeV-A4 (n = 11) were compared with those of select PeV-A3-infected children (n = 34) with CNS infections and found to be mostly similar, although maximum temperature was higher (P = 0.017) and fever duration was shorter (P = 0.03) for PeV-A4 than for PeV-A3. Laboratory test results were also similar between genotypes, although they showed significantly lower peripheral white blood cell (P = 0.014) and absolute lymphocyte (P = 0.04) counts for PeV-A4 infants. Like PeV-A3, PeV-A4 caused summer-fall seasonal clusters of CNS infections in infants, with mostly similar presentations. Further surveillance is necessary to confirm potential differences in laboratory findings and in fever intensity/duration.

scholarly journals Bacillus cereus bacteremia with central nervous system involvement: A neuropathological study

2018 ◽  
Vol 37 (01) ◽  
pp. 22-27 ◽  
Author(s):  
Jean Philippe Brouland ◽  
Nathalie Sala ◽  
Selin Tusgul ◽  
Caterina Rebecchini ◽  
Enikö Kovari
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Bacillus Cereus ◽  
Central Nervous System Involvement ◽  
System Involvement

scholarly journals Effects of Combined and General Anesthesia on Cognitive Functions for Patients Undergoing Cardiac Surgery Under CPB

2021 ◽  
Vol 24 (4) ◽  
pp. E593-E597
Author(s):  
Greta Kasputytė ◽  
Rasa Bukauskienė ◽  
Edmundas Širvinskas ◽  
Tadas Lenkutis ◽  
Renata Vimantaitė ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cardiac Surgery ◽  
Cognitive Function ◽  
General Anesthesia ◽  
Cognitive Functions ◽  
Test Results ◽  
The Central Nervous System ◽  
Combined Anesthesia ◽  
Function Assessment

Background: Patients may experience a variety of neurological complications after heart surgery. The most common complication observed in clinical practice is delayed neurocognitive recovery (dNCR). The role of the anesthesiologist is very important, as the risk of dNCR may be reduced, depending on the anesthesia tactic chosen. Although the possibility that neuropsychological complications are less common in patients undergoing combined anesthesia (general + epidural) than in patients undergoing general anesthesia is not yet confirmed, the results are being discussed. The aim of this study was to determine impact of combined anesthesia (general + epidural) on cognitive functions of patients after cardiac surgery. Methods: The prospective, case-controlled study included 80 patients undergoing cardiac surgery from 2015 to 2017 at the Department of Cardiothoracic and Vascular Surgery in the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. After approval from the local bioethics center, informed consent was obtained from all study participants. Inclusion criteria were age 51 to 80 years, elective cardiac surgery, left ventricular ejection fraction > 35%, anamnesis of not using agents affecting the central nervous system, absence of neuropathology, and sufficient renal function. Exclusion criteria were patients suffering from diseases causing cognitive function or using agents affecting the central nervous system, emergency or re-surgery, carotid artery atherosclerosis with artery diameter 50 or more percent reduction, and a patient’s disagreement. MMSE test and 6-CIT test were used for a cognitive function assessment, Trail making test and WAIS Digital Symbol Substitution test were used for psychomotor function assessment. All tests were used a day before surgery and seven days after surgery. According to the planned anesthesia, patients were assigned into two groups: 1 – combined general + epidural anesthesia and 2 – general anesthesia. Standardized protocol of anesthesia was followed for all patients. Preoperative patients and surgery factors, preoperative and postoperative neuropsychological test results were recorded. Results: Eighty patients were enrolled in the study. Both groups did not differ in demographic, perioperative values, and baseline (preoperative) test results. Postoperative (7th day) WAIS (P = .042) and 6-item cognitive impairment (P = .016) test results were statistically different when comparing the GA and CA groups. Comparing preoperative and postoperative test results, there was a significant decline in the WAIS test score in the GA group (P = .013).

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