scholarly journals A Case Series of Diarrheal Diseases Associated with Yersinia frederiksenii

2021 ◽  
Vol 13 (2) ◽  
pp. 552-557
Author(s):  
Eugene Y. H. Yeung
Keyword(s):  
Yersinia Pseudotuberculosis ◽  
Diarrheal Disease ◽  
Case Series ◽  
Antimicrobial Treatment ◽  
Medical Attention ◽  
Enterocolitica Strain ◽  
Yersinia Species ◽  
Antimicrobial Management ◽  
Amoxicillin Clavulanate ◽  
Biochemical Testing

To date, Yersinia pestis, Yersinia enterocolitica, and Yersinia pseudotuberculosis are the three Yersinia species generally agreed to be pathogenic in humans. However, there are a limited number of studies that suggest some of the “non-pathogenic” Yersinia species may also cause infections. For instance, Yersinia frederiksenii used to be known as an atypical Y. enterocolitica strain until rhamnose biochemical testing was found to distinguish between these two species in the 1980s. From our regional microbiology laboratory records of 18 hospitals in Eastern Ontario, Canada from 1 May 2018 to 1 May 2021, we identified two patients with Y. frederiksenii isolates in their stool cultures, along with their clinical presentation and antimicrobial management. Both patients presented with diarrhea, abdominal pain, and vomiting for 5 days before presentation to hospital. One patient received a 10-day course of sulfamethoxazole-trimethoprim; his Y. frederiksenii isolate was shown to be susceptible to amoxicillin-clavulanate, ceftriaxone, ciprofloxacin, and sulfamethoxazole-trimethoprim, but resistant to ampicillin. The other patient was sent home from the emergency department and did not require antimicrobials and additional medical attention. This case series illustrated that diarrheal disease could be associated with Y. frederiksenii; the need for antimicrobial treatment should be determined on a case-by-case basis.

scholarly journals Prevalence of the “High-Pathogenicity Island” of Yersinia Species among Escherichia coliStrains That Are Pathogenic to Humans

1998 ◽  
Vol 66 (2) ◽  
pp. 480-485 ◽  
Author(s):  
S. Schubert ◽  
A. Rakin ◽  
H. Karch ◽  
E. Carniel ◽  
J. Heesemann
Keyword(s):  
Gene Cluster ◽  
Yersinia Pseudotuberculosis ◽  
Pathogenicity Island ◽  
Uptake System ◽  
Highly Pathogenic ◽  
E Coli ◽  
Yersinia Species ◽  
The Family ◽  
High Pathogenicity ◽  
Dna Sequence Comparison

ABSTRACT The fyuA-irp gene cluster contributes to the virulence of highly pathogenic Yersinia (Yersinia pestis,Yersinia pseudotuberculosis, and Yersinia enterocolitica 1B). The cluster encodes an iron uptake system mediated by the siderophore yersiniabactin and reveals features of a pathogenicity island. Two evolutionary lineages of this “high pathogenicity island” (HPI) can be distinguished on the basis of DNA sequence comparison: a Y. pestis group and a Y. enterocolitica group. In this study we demonstrate that the HPI of the Y. pestis evolutionary group is disseminated among species of the family Enterobacteriaceae which are pathogenic to humans. It prevails in enteroaggregativeEscherichia coli and in E. coli blood culture isolates (93 and 80%, respectively), but is rarely found in enteropathogenic E. coli, enteroinvasive E. coli, and enterotoxigenic E. coli isolates. In contrast, the HPI was absent from enterohemorrhagic E. coli, Shigella, and Salmonella entericastrains investigated. Polypeptides encoded by the fyuA,irp1, and irp2 genes located on the HPI could be detected in E. coli strains pathogenic to humans. However, these E. coli strains showed a reduced sensitivity to the bacteriocin pesticin, whose uptake is mediated by the FyuA receptor. Escherichia strains do not possess thehms gene locus thought to be a part of the HPI of Y. pestis. Deletions of the fyuA-irp gene cluster affecting solely the fyuA part of the HPI were identified in 3% of the E. coli strains tested. These results suggest horizontal transfer of the HPI between Y. pestis and some pathogenic E. coli strains.

scholarly journals COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a case series from a tertiary care pediatric hospital in Qatar

2021 ◽  
Author(s):  
Mohammad Hasan ◽  
Khaled Al Zubaidi ◽  
Karim Diab ◽  
Yahia Hejazi ◽  
Sharon Bout-Tabaku ◽  
...  
Keyword(s):  
Clinical Features ◽  
Early Recognition ◽  
Tertiary Care ◽  
Case Series ◽  
Case Definition ◽  
Cardiac Biomarkers ◽  
Medical Attention ◽  
Laboratory Findings ◽  
First Case ◽  
Inflammatory Syndrome

Abstract Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe complication of coronavirus disease 2019 (COVID-19) in children, which is increasingly being reported worldwide. Here we report the first case series of 7 children diagnosed with MIS-C in Qatar. Methods: Clinical features and outcomes of COVID-19 positive patients admitted to Sidra Medicine, Qatar from June to October 2020, who met the WHO case definition for MIS-C were reviewed.Results: The mean age in our case series was 5.6 years, of which 71.4% were males. All patients were previously healthy but had a history of COVID-19 infection. Fever, rash, vomiting and abdominal pain were the most common symptoms (70%-100%). The average hospitalization was 12.9 days with no case fatalities. Laboratory findings included lymphopenia and thrombocytopenia in most patients, as well as evidence of coagulopathy and elevated inflammatory markers such as C-reactive protein, ferritin and procalcitonin. Many patients (71.4%) required inotropic support in intensive care, while only one required respiratory support. Although all patients had elevated cardiac biomarkers, cardiovascular involvement was observed in 42.9% of patients with one patient developing a giant coronary aneurysm. All patients received intravenous immunoglobulin (IVIG) and 86% of patients received corticosteroids, with two patients requiring treatment with IL-1 inhibitors.Conclusions: Our report is one of the first reports on MIS-C from Asia. Although clinical features and outcomes are not significantly different from those reported elsewhere, lack of case fatalities in our cohort may indicate that early recognition and prompt medical attention is necessary for a favorable outcome in MIS-C.

scholarly journals A Novel Computer-Assisted Drug-Induced Liver Injury Causality Assessment Tool (DILI-CAT)

2021 ◽  
Author(s):  
Hans L. Tillmann ◽  
Ayako Suzuki ◽  
Michael Merz ◽  
Richard Hermann ◽  
Don C. Rockey
Keyword(s):  
Assessment Tool ◽  
Causality Assessment ◽  
Case Series ◽  
Data Driven ◽  
Computer Assisted ◽  
Published Data ◽  
Polygonum Multiflorum ◽  
Drug Induced ◽  
Amoxicillin Clavulanate ◽  
R Value

AbstractObjectiveWe hypothesized that a drug-characteristic DILI-phenotype could be defined and be used to develop a computer-assisted DILI causality assessment-tool (DILI-CAT).DesignA drug-specific DILI-phenotype was developed for amoxicillin-clavulanate (AMX/CLA), cefazolin, cyproterone, and polygonum multiflorum using data from published case series, and subsequently a DILI-CAT Score (DILI-CAT-S) was created for each drug. The phenotype was made up of the following three parameters: (1) latency, R-value, and (3) AST/ALT ratio (also de Ritis ratio). A point allocation system was developed with points allocated depending on the degree of deviation from the core of published data for the three phenotypic parameters.ResultsThe four drugs had a significantly different phenotype based on the three parameters utilized. For example, the median cyproterone latency was 150 days versus less than 43 days for the other three drugs (median: 26 for AMX/CLA, 20 for cefazolin, and 20 days for polygonum multiflorum; p<0·001). The R-value for the four drugs was also significantly different (median: cyproterone [12.4] and polygonum multiflorum [10.9]) from AMX/CLA (1.44) and cefazolin (1.57; p<0.001). The resulting DILI-CAT-S effectively separated cyproterone and polygonum multiflorum from AMX/CLA and cefazolin, respectively (p<0·001). Notably, because of overlap in phenotype AMX/CLA and cefazolin could not be differentiated by DILI-CAT-S.ConclusionDILI-CAT is a data-driven, diagnostic tool built to define drug-specific phenotypes. Data presented here provide proof of principle that a drug-specific, data-driven causality assessment tool can be developed for different drugs and raise the possibility that such a process could improve and standardize causality assessment methods.FundingDCR was supported by the NIH, grant P30 DK 123704

scholarly journals Resolution of cryptosporidiosis in transplant recipients: review of the literature and presentation of a renal transplant patient treated with nitazoxanide, azithromycin, and rifaximin

2021 ◽  
Author(s):  
Ewa Tomczak ◽  
April N McDougal ◽  
A Clinton White
Keyword(s):  
Renal Transplant ◽  
Renal Transplant Patient ◽  
Transplant Patient ◽  
Diarrheal Disease ◽  
Case Series ◽  
Combination Therapies ◽  
Middle Income ◽  
Transplant Patients ◽  
Current Therapies ◽  
Cellular Immune

Abstract Cryptosporidium is a major cause of diarrheal disease worldwide, including chronic disease in malnourished children and patients with AIDS. There are increasing reports of cryptosporidiosis in transplant patients, especially from middle-income countries. The literature on treatment of cryptosporidiosis in transplant patients was reviewed and included no controlled trials, but only small case series. Nitazoxanide, azithromycin, spiramycin, and combination therapies have been used, but none are consistently efficacious. We present a case of chronic diarrhea from cryptosporidiosis in a renal transplant patient. His illness resolved with decreasing immunosuppression and treatment with the 3-drug combination of nitazoxanide, azithromycin, and rifaximin. While current therapies are not reliably effective in the absence of an effective cellular immune response, combination therapies hold promise for improved responses.

Is Crohn’s Disease the Price to Pay Today for Having Survived the Black Death?

2019 ◽  
Vol 13 (10) ◽  
pp. 1318-1322 ◽  
Author(s):  
Anne Dumay ◽  
Olivier Gergaud ◽  
Maryline Roy ◽  
Jean-Pierre Hugot
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Yersinia Pseudotuberculosis ◽  
Balancing Selection ◽  
Statistical Significance ◽  
European Ancestry ◽  
Loss Of Function ◽  
Yersinia Species ◽  
Mediterranean Countries ◽  
Pubmed Search

Abstract Background and Aims Nucleotide Oligomerisation Domain 2 [NOD2] is a key gene of innate immunity which participates in the host defence against pathogens. Several loss-of-function NOD2 mutations are associated with Crohn’s disease [CD]. Their high frequencies in populations of European ancestry suggest a model of balancing selection. Because NOD2 deficiency has been associated with a resistance to Yersinia pseudotuberculosis in mice, we hypothesised that NOD2 mutations have been selected during past plague outbreaks due to the closely related bacterium Yersinia pestis. Methods Contemporary frequencies of the main CD-associated NOD2 mutations [R702W, G908R, and 1007fs], measured in healthy people from European and Mediterranean countries, were collected from 60 studies via a PubMed search. Plague exposure was calculated from a dataset providing outbreaks from 1346 to 1860 in Europe and the Mediterranean Bassin. A plague index was built to capture the intensity of plague exposure in the studied geographical areas. Results NOD2 mutation frequencies were associated with the past exposure to plague. Statistical significance was obtained for the most frequent mutation [R702W, p = 0.03] and for the pooled three mutations [p = 0.023]. The association remained significant when putative demographic biases were considered. Conclusions This result argues for a selection of CD-associated NOD2 mutations by plague outbreaks and further questioned the role of exposure to enteropathogenic Yersinia species in CD.

scholarly journals Pyogenic Arthritis of the Fingers and the Wrist: Can We Shorten Antimicrobial Treatment Duration?

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Rahel Meier ◽  
Thomas Wirth ◽  
Frederik Hahn ◽  
Esther Vögelin ◽  
Parham Sendi
Keyword(s):  
Treatment Duration ◽  
Antimicrobial Treatment ◽  
University Hospital ◽  
Surgical Interventions ◽  
Tertiary Center ◽  
Small Joint ◽  
Amoxicillin Clavulanate ◽  
Joint Arthritis ◽  
Pyogenic Arthritis

Abstract Background Pyogenic arthritis of the small joints of the hand and wrist is a known but poorly described entity. The objective of this work was to characterize the clinical presentation, antimicrobial treatment, and surgical interventions of native small joint arthritis (SJA) treated in our tertiary center. Methods According to predefined variables, medical records of adult patients with SJA treated in a Swiss university hospital between 2005 and 2013 were retrospectively analyzed. Results The median age of 97 patients (101 joints) was 52 years (interquartile range [IQR], 38–68 years); 52% had no comorbidity. Small joint arthritis of the second and third fingers accounted for 53% of infections, with metacarpal-phalangeal and proximal interphalangeal joints most commonly involved. Of 86 (89%) episodes with an exogenous source, 63 (65%) followed a trauma. The most commonly isolated microorganism was Staphylococcus aureus (38%), followed by β-hemolytic streptococci (13%) and Pasteurella spp (11%). Eighty-seven episodes (89 joints) in patients with follow-up examinations were included in treatment and outcome analyses. Up to 2 surgical interventions were required to cure infection in 74 (83%) joints. Median antimicrobial treatment duration was 14 days (IQR, 12–28 days), with amoxicillin/clavulanate administered in 74 (85%) episodes. At follow up, cure of infection was noted in all episodes and good functional outcome in 79% of episodes. Conclusions Small joint arthritis shows considerable differences from clinical patterns reported for larger joints. In our series, the outcome was good with no more than 2 surgical interventions and median treatment duration of 14 days in 79% of episodes.

scholarly journals 1484. Prevalence of Pyuria With and Without Bacteriuria in Healthy Pre-Menopausal Women

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S541-S541
Author(s):  
Ann E Stapleton ◽  
Pacita Roberts ◽  
Thomas M Hooton
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Asymptomatic Bacteriuria ◽  
Premenopausal Women ◽  
Antimicrobial Treatment ◽  
Medical Attention ◽  
Healthy Women ◽  
Day Range ◽  
History Of

Abstract Background Pyuria has long been considered key to diagnosis of urinary tract infection in women, but there is a paucity of data on its prevalence and association with asymptomatic bacteriuria (ASB) in healthy women, even though pyuria and ASB often trigger inappropriate antimicrobial treatment. Methods We enrolled 104 healthy premenopausal women with a history of recurrent urinary tract infection (UTI) in an observational study and performed daily assessments of bacteriuria, pyuria (leukocyte esterase strips) and UTI symptoms over a 3-month period. These data enabled an evaluation of the prevalence of pyuria and ASB and associations between them. Results The mean age of participants was 22 and 74% were white. Pyuria occurred frequently in this cohort of women, with 72 (77%) of 94 evaluable subjects having pyuria on at least one day with no symptomatic UTI diagnosed. The median percent of days with pyuria reported was 7% (range, 0–100%). Asymptomatic bacteriuria (ASB, urine culture with colony count ≥105 CFU/mL of uropathogen on days with no symptomatic UTI diagnosed) occurred in 45 (45%) women on 159 (2.5%) of 6,283 days. ASB was most commonly caused by E. coli, which was present in 1.4% of days with median duration one day (range, 1–10). The positive predictive value of pyuria in detecting ASB was 4%. Five women had 11 transient episodes of pyuria, significant bacteriuria, and UTI symptoms (“preclinical UTI”) but did not seek medical attention. Conclusion In this population of healthy women at high risk for UTI and ASB, asymptomatic pyuria was a frequent occurrence and ASB rarely lasted more than 2 days. Pyuria, whether associated with bacteriuria or not, was generally not accompanied by urinary symptoms and did not appear to be clinically meaningful. Young women with recurrent UTI are often advised by their providers to test their urine with dipsticks for pyuria or bacteriuria, and be treated if either are positive, regardless of absence of UTI symptoms. Such practices, which contribute to antimicrobial resistance, are not supported by our data. Disclosures All authors: No reported disclosures.

Plasma concentrations resulting from continuous infusion of meropenem in a community-based outpatient program: A case series

2020 ◽  
Vol 77 (24) ◽  
pp. 2074-2080
Author(s):  
Amy Legg ◽  
Melanie Halford ◽  
Kate McCarthy
Keyword(s):  
Continuous Infusion ◽  
Drug Exposure ◽  
Plasma Concentrations ◽  
Case Series ◽  
Infectious Complications ◽  
Antimicrobial Treatment ◽  
Therapeutic Drug ◽  
Community Based ◽  
Drug Concentrations ◽  
Tertiary Center

Abstract Purpose Traditionally meropenem has been considered too unstable in solution for continuous infusion. However, in the era of increasing antimicrobial resistance, use of meropenem is becoming more frequently required, and the ability to facilitate its administration via community-based programs would be beneficial. There are some reassuring data about meropenem stability in solution, but data about actual drug exposure in patients and subsequent clinical outcomes are lacking. Summary Here we present a case series of 4 patients at a single tertiary center who received meropenem via continuous infusion coordinated through an outpatient parenteral antimicrobial treatment (OPAT) program. We provide plasma drug concentrations achieved and report on the patients’ clinical progress. All patients achieved drug concentrations of at least 2 times the minimum inhibitory concentration (MIC) while receiving meropenem via continuous infusion and had resolution of their infectious complications. No adverse effects of meropenem continuous infusion were noted. Conclusion Meropenem continuous infusion along with therapeutic drug monitoring was used successfully in a community-based program. Due to interpatient pharmacokinetic variability, we consider meropenem concentration monitoring compulsory during continuous-infusion meropenem therapy.

scholarly journals In Vitro Activity of Pexiganan and 10 Comparator Antimicrobials against 234 Isolates, Including 93 Pasteurella Species and 50 Anaerobic Bacterial Isolates Recovered from Animal Bite Wounds

2017 ◽  
Vol 61 (6) ◽  
Author(s):  
Ellie J. C. Goldstein ◽  
Diane M. Citron ◽  
Kerin L. Tyrrell ◽  
Eliza S. Leoncio
Keyword(s):  
Pasteurella Multocida ◽  
Antimicrobial Agents ◽  
Topical Therapy ◽  
Emergency Department Visits ◽  
Medical Attention ◽  
Office Visits ◽  
Content Type ◽  
Amoxicillin Clavulanate ◽  
Bite Wounds

ABSTRACTAnimal bite wounds affect more than 5 million Americans annually, resulting in 300,000 emergency department visits, 10,000 hospitalizations, and an untold number of physician office visits. Various forms of topical therapy are empirically self-employed by many patients prior to seeking medical attention. Pexiganan, a 22-amino-acid synthetic cationic analogue of the peptide magainin II, acts by selectively damaging bacterial cell membranes. We determined the MICs for pexiganan and other antimicrobial agents often used for treatment of bite wounds. Most isolates were from U.S. patients, and ∼10% were from European and Canadian patients. The comparator antimicrobials studied were penicillin, amoxicillin-clavulanate, piperacillin-tazobactam, meropenem, clindamycin, doxycycline, moxifloxacin, ceftriaxone, linezolid, and metronidazole. The MIC90s of pexiganan were 32 μg/ml (againstPasteurella multocidasubsp.multocida), 16 μg/ml (P. multocidasubsp.septica,Pasteurella canis, andPasteurella dagmatis), 8 μg/ml (Pasteurella stomatis), 8 μg/ml (Eikenella corrodens), 2 μg/ml (Neisseria weaveri,Neisseria zoodegmatis, andMoraxella canis-Moraxella lacunatagroup), 16 μg/ml (Bergeyella zoohelcum), 64 μg/ml (Bacteroides pyogenes), 4 μg/ml (Fusobacterium russii), 32 μg/ml (Fusobacterium canifelinum), and 64 μg/ml (Prevotella heparinolytica). The concentration of pexiganan in the cream used was 8,000 μg/ml, more than 60 to 100 times the highest MIC obtained. Pexiganan exhibited a broad range of antimicrobial activity, showing potential for treating animal bite infections. A clinical trial seems warranted.

scholarly journals Intensive Care Unit-Acquired Weakness and Positioning-Related Peripheral Nerve Injuries in COVID-19: A Case Series of Three Patients and the Latest Literature Review

2021 ◽  
Vol 11 (9) ◽  
pp. 1177
Author(s):  
Keiichi Hokkoku ◽  
Carmen Erra ◽  
Cristina Cuccagna ◽  
Daniele Coraci ◽  
Dario Mattia Gatto ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Literature Review ◽  
Peripheral Nerve ◽  
Case Series ◽  
Medical Attention ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Muscle Mri ◽  
Prolonged Immobilization

A subgroup of COVID-19 patients requires intensive respiratory care. The prolonged immobilization and aggressive treatments predispose these patients to develop intensive care unit-acquired weakness (ICUAW). Furthermore, this condition could increase the chance of positioning-related peripheral nerve injuries. On the basis of the latest literature review, we describe a case series of three patients with COVID-19 who developed ICUAW complicated by positioning-related peripheral nerve injuries Every patient presented sensorimotor axonal polyneuropathy and concomitant myopathy in electrophysiological studies. Furthermore, muscle MRI helped the diagnosis of ICUAW, showing massive damage predominantly in the proximal muscles. Notably, nerve ultrasound detected positioning-related peripheral nerve injuries, even though the concomitant ICUAW substantially masked their clinical features. During the acute phase of severe COVID-19 infection, most medical attention tends to be assigned to critical care management, and neuromuscular complications such as ICUAW and positioning-related peripheral nerve injuries could be underestimated. Hence, when starting post-ICU care for COVID-19 cases, the combination of electrophysiological and imaging studies will aid appropriate evaluation on the patients with COVID-19-related ICUAW.

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