Meningitis caused by Streptococcus suis: a case report

Introduction. Streptococcus suis, a diplococcus Gram +, alfa haemolytic, commensal in pigs. Infection in humans is due to a different location and is one of the most common cause of meningitis in adults. Risks: consumption of undercooked pork, rearing and slaughter of pigs. Clinical case.Woman, 46aa., caregiver, Romanian, presents to the emergency of our hospital with fever (39.5C), drowsiness, no neurological deficits. Neutrophilia 93%, ESR 140 mm/h, CRP 26.40 mg/dl; LCR turbid, cell count 950/mm3, glicorrachia undetectable and, proteinorrachia 5.3g/l, PMN prevailing, presence diplococci Gram +, pneumococcal antigen negative. Tac cerebral negative for focal parenchymal lesions, alterations densitometric signs of bleeding. Improving after empiric therapy (ceftriaxone, ampicillin and levofloxacin iv) but emergence of the sense of “muffled ear dx”. Tac fortresses petros and paranasal sinuses: ”breasts not procidenti side of dura mater. Presence of tissue density of the soft parts at the right external ear canal.” Methods. Blood cultures (Bactec 9240 BD) negative. LCR culture (12 h in CO2): development of alfa haemolytic colonies, Gram + diplococci, catalase -, bile esculin -, PYR -, lysis of bile salts -, optochin R. Identified with API 20 strep (bioMérieux) as Streptococcus suis and confirmed by molecular studies. Susceptible to penicillin, ceftriaxone, vancomycin, resistant to tetracycline and clindamycin. Improvement after this therapy, administered for 14 days with disappearance of “the sense of muffled“ and normalization of blood chemical parameters. Conclusions. According to literature, S. suis meningitis is often not recognized.Awareness of the clinicians of this possible etiology and an accurate history of the patient intended to reveal dietary habits (consumption of undercooked pork) and profession (butchers, etc...) are important factors for a prompt diagnosis, since there are negligible sequelae as hearing loss (50% of cases) and complications (TSS, arthritis, pneumonia)

Extended Infusion of beta-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis: An Observational Multicenter Study

Background. We analyzed the impact of continuous/extended infusion (C/EI) vs intermittent infusion of piperacillin-tazobactam (TZP) and carbapenems on 30-day mortality of patients with liver cirrhosis and bloodstream infection (BSI). Methods. The BICRHOME study was a prospective, multicenter study that enrolled 312 cirrhotic patients with BSI. In this secondary analysis, we selected patients receiving TZP or carbapenems as adequate empirical treatment. The 30-day mortality of patients receiving C/EI or intermittent infusion of TZP or carbapenems was assessed with Kaplan-Meier curves, Cox-regression model, and estimation of the average treatment effect (ATE) using propensity score matching. Results. Overall, 119 patients received TZP or carbapenems as empirical treatment. Patients who received C/EI had a significantly lower mortality rate (16% vs 36%, P = .047). In a Cox-regression model, the administration of C/EI was associated with a significantly lower mortality (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.11-0.936; P = .04) when adjusted for severity of illness and an ATE of 25.6% reduction in 30-day mortality risk (95% CI, 18.9-32.3; P = 25 (HR, 0.26; 95% CI, 0.08-0.92). At competing risk analysis, C/EI of beta-lactams was associated with significantly higher rates of hospital discharge (subdistribution hazard [95% CI], 1.62 [1.06-2.47]). Conclusions. C/EI of beta-lactams in cirrhotic patients with BSI may improve outcomes and facilitate earlier discharge

A holistic evaluation of patients with chronic Hepatitis D virus (HDV) infection enrolled in the Italian PITER-B and delta cohort

Background and Aims: We aimed to characterize the epidemiologic and comorbidities profiles of patients with chronic Hepatitis D (CHD) followed in clinical practice in Italy and explored their interferon (IFN) eligibility. Methods: This was a cross-sectional study of the PITER cohort consisting of consecutive HBsAg-positive patients from 59 centers over the period 2019-2023. Multivariable analysis was performed by logistic regression model. Results: Of 5492 HBsAg-positive enrolled patients, 4152 (75.6%) were screened for HDV, 422 (10.2%) were anti-HDV positive. Compared with HBsAg mono-infected, anti-HDV positive patients were more often younger, non-Italians, with a history of drug use, had elevated alanine transaminase (ALT), cirrhosis, or hepatocellular carcinoma (HCC). Compared with Italians, anti-HDV positive non-Italians were younger (42.2% age ≤ 40 years vs. 2.1%; P < 0.001), more often females (males 43.0% vs. 68.6%; P < 0.001) with less frequent cirrhosis and HCC. HDV-RNA was detected in 63.2% of anti-HDV-positive patients, who were more likely to have elevated ALT, cirrhosis, and HCC. Extrahepatic comorbidities were present in 47.4% of anti-HDV positive patients and could affect the eligibility of IFN-containing therapies in at least 53.0% of patients in care. Conclusions: CHD affects young, foreign-born patients and older Italians, of whom two-thirds had cirrhosis or HCC. Comorbidities were frequent in both Italians and non-Italians and impacted eligibility for IFN