1/7. levofloxacin treatment failure in a patient with fluoroquinolone-resistant streptococcus pneumoniae pneumonia.The frequency of fluoroquinolone-resistant streptococcus pneumoniae has increased as fluoroquinolone administration for treatment of respiratory tract infections has increased. levofloxacin treatment failed in a patient who had pneumococcal pneumonia and had received three previous courses of levofloxacin therapy. Susceptibility testing revealed high-level resistance to levofloxacin (minimum inhibitory concentration [MIC] > 32 microg/ml), and cross-resistance to moxifloxacin (MIC 4 microg/ml), trovafloxacin (6 microg/ml), and gatifloxacin (12 microg/ml). Sequencing of the quinolone-resistance determining region revealed a mutation of serine-81 to phenylalanine (Ser81-->Phe) in the gyrA region of dna gyrase and a Ser79-->Phe mutation in the parC region of topoisomerase IV The patient was treated successfully with intravenous ceftriaxone followed by oral cefprozil. Clinicians must be aware of local resistance patterns and the potential for fluoroquinolone treatment failures in patients with infections caused by S. pneumoniae.- - - - - - - - - - ranking = 1keywords = respiratory tract infection, respiratory tract, tract infection, tract (Clic here for more details about this article) |
2/7. Acute reversible myocardial depression associated with sepsis.A 30-year-old man was admitted to our hospital for left lobar pneumonia with septic shock. Acute left-sided heart failure became evident as sepsis developed. echocardiography revealed diffuse severe hypokinesis of the left ventricle (LV) and a pulmonary artery catheter showed Forrester subset II hemodynamics. Along with amelioration of sepsis and decrease of the serum concentrations of tumor necrosis factor-alpha and interleukin-6, LV hypokinesis improved. It is suggested that the patient's heart failure may have been due to functional depression of myocardial contractility resulting from a direct effect of the cytokines towards the cardiomyocytes, the so-called "septic myocardial depression".- - - - - - - - - - ranking = 7.2315201123658E-5keywords = tract (Clic here for more details about this article) |
3/7. ciprofloxacin treatment failure in a patient with resistant streptococcus pneumoniae infection following prior ciprofloxacin therapy.Reported here is the case of a patient with underlying chronic obstructive pulmonary disease (COPD) in whom ciprofloxacin treatment of a lower respiratory tract infection failed subsequent to ciprofloxacin treatment of an exacerbation of COPD several weeks earlier. During the second course of ciprofloxacin therapy, the patient's condition continued to deteriorate, and she was admitted to the intensive care unit. Bilateral pneumonia was diagnosed. streptococcus pneumoniae, serotype 11A, resistant to ciprofloxacin was isolated from the sputum. Sequencing revealed a S79F mutation in parC and there was evidence of an efflux pump. The patient improved rapidly after administration of azithromycin and ampicillin/sulbactam. This report of treatment failure due to ciprofloxacin-resistant streptococcus pneumoniae shows that fluoroquinolones should be avoided when treating patients who have recently received this class of antibiotics.- - - - - - - - - - ranking = 1keywords = respiratory tract infection, respiratory tract, tract infection, tract (Clic here for more details about this article) |
4/7. Failure of levofloxacin treatment in community-acquired pneumococcal pneumonia.BACKGROUND: streptococcus pneumoniae is the leading cause of community-acquired pneumonia (CAP). High global incidence of macrolide and penicillin resistance has been reported, whereas fluoroquinolone resistance is uncommon. Current guidelines for suspected CAP in patients with co-morbidity factors and recent antibiotic therapy recommend initial empiric therapy using one fluoroquinolone or one macrolide associated to other drugs (amoxicillin, amoxicillin/clavulanate, broad-spectrum cephalosporins). Resistance to fluoroquinolones is determined by efflux mechanisms and/or mutations in the parC and parE genes coding for topoisomerase IV and/or gyrA and gyrB genes coding for dna gyrase. No clinical cases due to fluoroquinolone-resistant S. pneumoniae strains have been yet reported from italy. CASE PRESENTATION: A 72-year-old patient with long history of chronic obstructive pulmonary disease and multiple fluoroquinolone treatments for recurrent lower respiratory tract infections developed fever, increased sputum production, and dyspnea. He was treated with oral levofloxacin (500 mg bid). Three days later, because of acute respiratory insufficiency, the patient was hospitalized. levofloxacin treatment was supplemented with piperacillin/tazobactam. Microbiological tests detected a S. pneumoniae strain intermediate to penicillin (MIC, 1 mg/L) and resistant to macrolides (MIC >256 mg/L) and fluoroquinolones (MIC >32 mg/L). Point mutations were detected in gyrA (Ser81-Phe), parE (Ile460-Val), and parC gene (Ser79-Phe; Lys137-Asn). Complete clinical response followed treatment with piperacillin/tazobactam. CONCLUSION: This is the first Italian case of community-acquired pneumonia due to a fluoroquinolone-resistant S. pneumoniae isolate where treatment failure of levofloxacin was documented. Molecular analysis showed a group of mutations that have not yet been reported from italy and has been detected only twice in europe. Treatment with piperacillin/tazobactam appears an effective means to inhibit fluoroquinolone-resistant strains of S. pneumoniae causing community-acquired pneumonia in seriously ill patients.- - - - - - - - - - ranking = 1keywords = respiratory tract infection, respiratory tract, tract infection, tract (Clic here for more details about this article) |
5/7. Prevention of pneumococcal infection in a patient with normal immunoglobulin levels but impaired polysaccharide antibody production.BACKGROUND: patients with normal immunoglobulin levels may have an impaired response to immunization with pneumococcal vaccine and increased susceptibility to infection with encapsulated organisms. In children, but not adults, immunoglobulin replacement has been shown to be effective in reducing the infection rate. OBJECTIVE: To reduce the incidence of infection in an adult with impaired response to pneumococcal vaccine but normal serum IgG levels. methods: Intravenous IgG, 350 mg/kg, was given every 4 weeks. RESULTS: The patient, who was hospitalized 3 times in 3 years with respiratory tract infections and who had documented infection with streptococcus pneumoniae and haemophilus influenzae, did not require antibiotic therapy for more than 15 months while undergoing intravenous immunoglobulin replacement therapy. CONCLUSION: Adults with impaired response to vaccination with polyvalent pneumococcal vaccine and normal IgG levels may benefit from replacement therapy.- - - - - - - - - - ranking = 1keywords = respiratory tract infection, respiratory tract, tract infection, tract (Clic here for more details about this article) |
6/7. Round pneumonia in adults.We recently evaluated three adult patients with rounded densities on their chest roentgenograms in whom the final diagnosis was presumed to be lower respiratory tract infection. In all cases, the circular infiltrates proved to be localized "round pneumonias." Round pneumonia has been well described in children but is less well known in adults. While uncommon, round pneumonia in adults may not be rare and deserves early diagnostic consideration to prevent unnecessary investigation.- - - - - - - - - - ranking = 1keywords = respiratory tract infection, respiratory tract, tract infection, tract (Clic here for more details about this article) |
7/7. Emergency percutaneous balloon mitral valvotomy in a patient with septic shock.We report an 18-year-old patient with severe mitral stenosis complicated by right lower lobe pneumonia, sepsis, and shock. Intractable low cardiac output led to an emergency percutaneous balloon mitral valvotomy in a patient, resulting in immediately improved hemodynamic parameters. We are unaware of another report of percutaneous balloon mitral valvotomy performed in a patient with sepsis and shock. This case supports previous isolated reports of the benefit from emergency percutaneous balloon mitral valvotomy in critical situations where thoracotomy is not possible due to coexisting medical problems.- - - - - - - - - - ranking = 7.2315201123658E-5keywords = tract (Clic here for more details about this article) |