1/257. Gonococcal scalp abscess in a neonate delivered by caesarean section. Gonococcal infection in caesarean delivered babies is very rare and is usually limited to ophthalmia neonatorum. The mother had rupture of membranes 14 hours before the caesarean section. The infection was most likely introduced by the fetal scalp electrode probes applied 2 hours before delivery. This is the first reported of a neonatal gonococcal abscess in a caesarean delivered infant. ( info) |
2/257. Contact dermatitis from a gonococcal discharge: a case report. A 53-year-old man with gonococcal urethritis had an erythrematous and vesicular eruption on the left inner thigh at the level of the tip of his penis. It is suggested that this lesion represented dermatitis caused by gonococcal endotoxin in the urethral discharge. ( info) |
3/257. Genotypic evolution in a quinolone-resistant neisseria gonorrhoeae isolate from a patient with clinical failure of levofloxacin treatment. Recently, a reduction in the antimicrobial susceptibility of clinical isolates of neisseria gonorrhoeae to newer fluoroquinolones including levofloxacin in vitro has been recognized in japan. We examined the quinolone resistance mechanisms in N. gonorrhoeae isolates from a patient with clinical failure of levofloxacin treatment. Man with gonococcal urethritis was treated with oral 100 mg levofloxacin 3 times daily for 7 days. However, clinical failure of the treatment was observed. The minimum inhibitory concentration of levofloxacin for the posttreatment isolate (4.0 microg/ml) was 4-fold higher than that for the pretreatment isolate (1.0 microg/ml). To analyze quinolone resistance mechanisms in the set of isolates, we performed dna sequencing of the quinolone resistance-determining regions within the gyrA and parC genes. Moreover, we assayed the intracellular levofloxacin and norfloxacin accumulation level in these isolates. The pretreatment isolate contained three substitutions compared to susceptible wild-type isolate, including serine to phenylalanine at position 91 and aspartic acid to asparagine at position 95 in the GyrA protein, and serine to proline at position 88 in the ParC protein. The posttreatment isolate had four substitutions, including the same three substitutions and an additional glutamic acid to glutamine substitution at position 91 in ParC. There was no significant difference in the level of accumulation of levofloxacin and norfloxacin between the pretreatment and posttreatment isolates. Our results indicate that levofloxacin selects a mutant having an additional alteration within the gene cording for the ParC protein during treatment, which may have enhanced quinolone resistance in the organism. ( info) |
4/257. Sonographically guided intralesional antibiotic injection for treatment of a recalcitrant pelvic abscess: a case report. A pelvic abscess occurred in an infertile woman with an endocervical gonococcal infection after hysterosalpingographical examination. The pelvic abscess was not cured despite rigorous antimicrobial chemotherapy until two intra-abscess ceftriaxone injections were administered. This shows that antibiotics administered systemically may not reach therapeutic concentration in an abscess and an intra-abscess antibiotic injection may help to cure it. ( info) |
5/257. Urgent aortic valve replacement in disseminated gonococcaemia associated with sinus of valsalva aneurysm and fistula formation. A patient with aortic valve disruption due to gonococcal endocarditis and associated with a sinus of valsalva aneurysm and fistula into the right ventricle is described. The rarity of this combination of conditions and the place of surgery in their management are discussed. ( info) |
| We report a case of gonococcal meningitis with an intraabdominal abscess in a 19-y-old woman, who had a ventriculoperitoneal shunt after craniotomy for astrocytoma. Percutaneous drainage was performed for the intraabdominal abscess. ceftriaxone was administered with the ventriculoperitoneal shunt removal. The clinical course improved, but visual impairment last for 3 months following treatment. ( info) |
7/257. Gonococcemia associated with fatal septic shock. Gonococcal infection can be associated with septic shock leading to multiple organ failure and death. ( info) |
| BACKGROUND AND OBJECTIVES: The Cuban Ministry of public health plans to implement the syndromic approach to sexually transmitted diseases in persons with urethral or vaginal syndrome in cuba using 500 mg ciprofloxacin as therapy. Although the emergence of clinical isolates of neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin have been sporadically detected in cuba, there has been no report of isolates that exhibited significant resistance to this drug. This is the first report of the isolation of a N gonorrhoeae strain resistant to ciprofloxacin in cuba. STUDY DESIGN: Case report. CONCLUSIONS: This case emphasizes the need for awareness regarding the potential emergence of a clinically significant resistance of N gonorrhoeae in cuba. There is a need for continued antimicrobial susceptibility surveillance of Cuban isolates to ciprofloxacin and other fluoroquinolones. ( info) |
9/257. Emergence of cephem- and aztreonam-high-resistant neisseria gonorrhoeae that does not produce beta-lactamase. Regarding neisseria gonorrhoeae, the National Committee for Clinical Laboratory Standards (NCCLS) has not defined the breakpoint minimum inhibitory concentration (MIC) for expanded spectrum cephems such as cefpodoxime and ceftizoxime, because of the absence of resistant strains to these antibiotics. To date, in gonococcal urethritis, after treatment with third generation cephems and aztreonam, clinical failures caused by resistant N. gonorrhoeae strains have not been reported. However, we experienced two clinical failures in patients with gonococcal urethritis treated with cefdinir and aztreonam. N. gonorrhoeae isolates from these two patients showed high-level MICs to these agents. The MIC of cefdinir was 1 microg/ml for both strains and that of aztreonam was 8 microg/ml for both strains, while the MICs of other beta-lactams were also higher than the NCCLS value, except for ceftriaxone, for which the MIC was 0.125 microg/ml for both strains. Moreover, the MICs of fluoroquinolones, tetracyclines, and erythromycin against these two isolates were higher than the NCCLS susceptibility value. These isolates were susceptible to spectinomycin. In N. gonorrhoeae, the emergence of these beta-lactam-resistant isolates is of serious concern. However, a more serious problem is that these isolates were already resistant to non-beta-lactam antimicrobials. In japan, ceftriaxone has not been permitted for clinical use against gonococcal infections. Therefore, in japan, patients with gonococcal urethritis caused by these resistant N. gonorrhoeae strains should be treated with cefodizime or spectinomycin. ( info) |
10/257. Dermatological symptoms and sexual abuse: a review and case reports. Dermatological symptoms in cases of sexual abuse can be very diverse. To establish a causal relationship between skin diseases and sexual abuse is particularly difficult. In dermatology, three main areas of presentation can be identified. ACUTE CONSEQUENCES: Direct injuries found on the genitalia and body. Behaviour and psychological changes seen. sexually transmitted diseases (STD) may be identified, after an appropriate incubation period. LONG-TERM CONSEQUENCES: In the long term, even decades later, patients may manifest with a wide spectrum of psychosomatic manifestations of skin diseases, particularly factitious disorders. IMITATIONS: A group whose skin manifestations may mimic and be mistaken for sexual abuse. The initial suspicion of sexual abuse and the need for specific questioning and investigations can lead to a disturbance in the doctor-patient relationship. ( info) |