We present a rare case of pulmonary actinomycosis complicated with massive hemoptysis. The patient was a 41-year-old male farmer, who had experienced prolonged fever and off-and-on blood streaked sputum for 2 years. He was admitted to our hospital because of 3 days of massive hemoptysis. He had no underlying medical illnesses, but was a heavy smoker and an alcoholic. The chest radiograph revealed patchy alveolar infiltration of the right upper lobe, mimicing tuberculosis. Massive hemoptysis was not controlled using conservative treatment and anti-tuberculous drugs. Emergency right upper lobe lobectomy was needed to stop the bleeding. Histopathologic examination demonstrated aggregates of filamentous gram-positive organisms in characteristic "sulfur granules", indicating actinomycosis. The fever subsided after intravenous augmentin was given, followed by 6 months of oral amoxicillin. The patient is doing well and has had no recurrent hemoptysis.
S. enterica serovar Heidelberg (n=105) strains were tested using 4 different AST methods: agar disk diffusion, broth microdilution using Sensititre with the NARMS (CMV1AGNF) panel, manual broth microdilution and Vitek with GNS-207 cards.
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In vitro experiments.
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Patients were randomly treated with 30-day courses of either placebo (PLAC) or AMOX/CLAV (40 mg/kg in 3 divided doses daily).
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Predominant Bifidobacterium strains belonging to the intestinal flora of four human volunteers were isolated on selective medium before and after eight days of treatment with oral amoxicillin-clavulanic acid (Augmentin). These antimicrobial agents are known to be strongly active against the genus Bifidobacterium. A fifth volunteer did not receive the antibiotics and was considered as a control. Bifidobacteria were characterized by hybridizing a ribosomal 23S DNA probe onto their EcoRV restriction patterns, and were identified by comparing the ribosomal patterns obtained to collection strains. A total of 17 distinct ribosomal patterns and 23 distinct pattern types were revealed for the 95 isolates tested. Each type characterized was correlated with a specific ribosomal pattern associated with a specific total restriction pattern. Similar-sized molecular bands permitted isolates to be unambiguously discriminated into the species B. longum, B. bifidum, and B. adolescentis. This study enabled us to show considerable strain variability among individuals. Three months after penicillin ingestion, no significant changes were observed in Bifidobacterium flora. Each flora remained relatively stable for strain composition over time, with some slight variations also detected in our control subject.
We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In head and neck cancer surgery antibiotic prophylaxis is effective in reducing the incidence of surgical site infections (SSI). However, controversies between antibiotic prophylaxis and curative antibiotic therapy exist, particularly when complex and decaying surgeries are performed in risky underlying conditions, with a risk of persisting salivary effusion in the postoperative period, or in the case of reconstruction with myo-cutaneous flaps. We have performed a systematic review of the literature according to PRISMA recommendations to answer the following questions: indications for antibiotic prophylaxis and curative antibiotic therapy, optimal duration, and choice of antibiotics for prophylaxis in head and neck cancer surgery. Literature analysis allows to conclude that patients undergoing Altemeier classes 2 and 3 surgical procedures should receive perioperative antibiotic prophylaxis restricted to the first 24 postoperative hours. No benefit has been shown with its extension beyond these 24 hours. The most adapted combinations of antibiotics in this setting are "amoxicillin+clavulanic acid" and "clindamycin+gentamicin". However, the level of evidence regarding the most decaying surgeries with high risk of SSI is low, making it necessary to perform new high-powered randomized trials in these patients. Eventually, it should be noted that antibiotic prophylaxis should be an integral part of SSI preventive measures, including application of hygiene measures, and postoperative monitoring of SSI clinical signs.
A 77-year-old farmer developed cough with sputum production, fever, bloody nasal discharge and a mass in his right maxillary sinus leading to necrotic ulceration of the sinus. Corynebacterium ulcerans, carrying the beta-phage for the diphtheria toxin and secreting the toxin, was detected microscopically and by culture from the sinusoidal and ulcer discharge. Despite immediate antimicrobial chemotherapy the patient died of pulmonary failure associated with the production of large amounts of very viscous sputum. Identification of the causative agent, pathophysiological aspects and risk factors of this unusal infection are discussed.
Changes in bacterial findings during the course of AOM are common in patients not receiving treatment, and even possible despite adequate treatment. In bilateral otorrhea, disparate bacterial findings are common.
To alert clinicians to the hepatotoxic potential of Augmentin (amoxycillin and clavulanic acid), a widely prescribed antibiotic, in susceptible patients, and to point out that the hepatic illness may be delayed but serious and protracted.
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The paper describes features of myiasis in a cohort of 163 dogs in an animal shelter, monitored over 3.5 years (4 fly activity seasons). Seven dogs (4 males, 3 females) were presented with myiasis; two dogs were presented twice with infestation in different areas of their body. The overall incidence rate (IR) of myiasis was 5.8 cases per 10(3) animal-months at risk, or else 0.0058 case per animal-month at risk. Six cases occurred from May to July and three from August to October, giving IRs of 7.7 per 10(3) animal-months and 3.9 per 10(3) animal-months, respectively, and an IR ratio of 1.97 (P=0.35). Five cases occurred in males and four in females, giving IRs of 7.8 per 10(3) animal months and 4.3 per 10(3) animal-months, respectively, and an incidence rate ratio of 1.78 (P=0.41). Three cases were diagnosed as cutaneous myiasis of the thigh, 2 cases as myiasis of the ear canal, 2 as myiasis of the prepuce, 1 as myiasis of the toes and 1 case as myiasis of the vagina. Median time from entrance into the shelter to infestation was 5 months; it was 1m in three dogs which were injured at entrance of animal into the shelter, but longer (5-15m) in the other four dogs. Larvae were identified as 2nd or 3rd stage instars of Wohlfahrtia magnifica. Signs characteristic of local inflammation, in the affected area of the body, were recorded. Treatment included mechanical removal of larvae, cleansing of the area, administration of injectable moxidectin and a broad-spectrum antimicrobial agent. Complete recovery was achieved within 1.5 months, bar that of preputial infestations which required 2.5 months.
The results showed that swelling could be accurately quantified following surgery. Furthermore, there was a significant reduction in the amount of swelling 1 month postoperatively. Furthermore, the facial morphology returned to approximately 90% of the baseline facial scan at 3 months.