Corynebacterium CDC group G native and prosthetic valve endocarditis

We report the first case of native and recurrent prosthetic valve endocarditis with <em>Corynebacterium</em> CDC group G, a rarely reported cause of infective endocarditis (IE). Previously, there have been only two cases reported for prosthetic valve IE caused by these organisms. A 69-year-old female with a known history of mitral valve regurgitation presented with a 3-day history of high-grade fever, pleuritic chest pain and cough. Echocardiography confirmed findings of mitral valve thickening consistent with endocarditis, which subsequently progressed to become large and mobile vegetations. Both sets of blood cultures taken on admission were positive for <em>Corynebacterium</em> CDC group G. Despite removal of a long-term venous access port, the patient’s presumed source of line associated bacteremia, mitral valve replacement, and aggressive antibiotic therapy, the patient had recurrence of vegetations on the prosthetic valve. She underwent replacement of her prosthetic mitral valve in the subsequent 2 weeks, before she progressed to disseminated intravascular coagulation and expired. Although they are typically considered contaminants, corynebacteria, in the appropriate clinical setting, should be recognized, identified, and treated as potentially life-threatening infections, particularly in the case of line-associated bacteremias, and native and prosthetic valve endocarditis

Distribution of antibody titer against <it>Salmonella enterica </it>among healthy individuals in nepal

Abstract Background Enteric fever is an endemic problem in Nepal and Widal agglutination test is widely used for its diagnosis but a normal baseline titer in healthy population and cutoff values have not been established. Methods We measured average baseline antibody titers against "O" and "H" antigens of Salmonella enterica serotype Typhi and "H" antigens of serotypes Paratyphi A and Paratyphi B among apparently healthy blood donors in Nepal. The antibody titers were measured using Standard Widal Confirmatory Quantitative Tube test. Results Among the 100 blood samples collected from healthy volunteers, 62 individuals had significant antibody titers (≥ 1:20) against one of the four antigens against S. enterica. Among 54 samples with an anti-O titer against serotype Typhi, 15 and 36 samples had titers of ≥ 1:60 and ≥ 1:40, respectively. A significant proportion (12% of all) had anti-O titer of ≥ 1:80. Similarly, among the 59 samples demonstrating anti-H titers of ≥ 1:20 to S. enterica serotype Typhi, 29 had a titer of ≥ 1:80 and 12 had 1:160. For S. enterica serotypes Paratyphi A and B, anti-H titers of ≥ 1:20 were found only in 12% and 3%, respectively, of all samples tested. Conclusion When a single Widal agglutination titer is used for the diagnosis of enteric fever, it will be more appropriate to change the currently used cutoff levels against S. enterica serotype Typhi to > 1:80 for anti-O and > 1:160 for anti-H titers for Nepal.</p

Gabapentin Induced Anasarca in a Young Patient: An Under-Recognized Side Effect of a Common Medication

Case Presentation: 47-year-old male presented with complaint of generalized body swelling after three days of starting Gabapentin therapy (600 mg twice daily). Lower extremity edema gradually progressed to abdomen and upper extremity within this short duration. He denied trauma, insect bites, prior blood clots, chest pain, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, anorexia, skin changes, dysuria, frothy urine, blood in urine or use of any herbal supplements. Vitals stable. On exam, 3+ pitting edema present extending up-to upper extremity. Chest, cardiovascular and neurological exam were benign. No stigmata of chronic liver disease were seen. Complete blood count, metabolic panel, liver function, albumin, brain natriuretic peptide, thyroid stimulating hormone and random cortisol were within normal range. Echocardiogram revealed ejection fraction of 75 %, normal diastolic function and normal pulmonary artery pressure. Urinalysis was negative for bacteria, leukocytes, casts or protein. CT abdomen and ultrasound doppler lower extremities unremarkable. Gabapentin was discontinued, and his peripheraledema dramatically improved over the next few days with leg elevation, compression stockings and intravenous Furosemide. Discussion: Data published on gabapentin associated edema is very scarce and exact mechanism is unclear. Our casehighlights the three important points in association with gabapentin use. 1. occurrence of this rare side effect in a young adult 2. side effects noted at lower dose than reported in the literature 3. more severe form of generalized edema rather than localized lower extremity edema Conclusions: Gabapentin is a relatively safe drug frequently prescribed as an analgesic, antiepileptic and even used for multiple psychiatric conditions. Gabapentin associated bilateral pedal edema is rather an uncommon adverse effect reported at doses higher than 1200 mg/day mostly in geriatric population (7-7.5%). Recognition of this entity is crucial, especially in the presence of confounding factors such as heart failure, nephrotic syndrome and others as discontinuation of Gabapentin leads to full recovery

Cumulative proportion of participants with progressive kidney disease.

<p>Cumulative proportion of participants with progressive kidney disease.</p

Association of Hepatitis C viremia with progressive kidney disease.

<p>Hepatitis C (HCV)-RNA was further stratified by quartiles to determine whether there is clinically useful threshold HCV-RNA level associated with increased risk of progressive kidney disease. The number of patients (events) included for HCV antibody negative and for increasing quartiles of HCV-RNA were 2963 (102), 108 (4), 154 (7), 102 (7), and 107 (7), respectively. Final models were adjusted for trial, age, race, infection through same sex exposure, prior AIDS diagnosis, CD4, CD4 nadir, previous exposure to antiretrovirals, previous exposure to indinavir, treatment with antihypertensives, treatment with lipid lowering therapy, estimated glomerular filtration rate, year of randomization, and Hepatitis B surface antigen status, all measured at randomization into the parent trial.</p

Baseline characteristics associated with progressive CKD in univariate and multivariate analysis.

<p>Baseline characteristics associated with progressive CKD in univariate and multivariate analysis.</p

Markers of hepatic fibrosis as proposed mediators of progressive chronic kidney disease (CKD).

<p>Data available for¹n = 827,</p>2<p>n = 1421,</p>3<p>n = 1268.</p><p>The number of participants who developed progressive kidney disease was ¹n = 42,</p>2<p>n = 73,</p>3<p>n = 63.</p><p>APRI, aspartate aminotransferase platelet ratio index.</p

Association of Hepatitis B and C viremia and Hepatitis C genotype with progressive kidney disease.

<p>Final models were adjusted for trial, age, race, infection through same sex exposure, prior AIDS diagnosis, CD4, CD4 nadir, previous exposure to antiretrovirals, previous exposure to indinavir, treatment with antihypertensives, treatment with lipid lowering therapy, estimated glomerular filtration rate, and year of randomization, all measured at randomization into the parent trial. As appropriate, analyses were also adjusted for ¹Hepatitis C (HCV) antibody status or ² Hepatitis B surface antigen (HBsAg) status. Participants with positive HBsAg were further stratified by the presence or absence of detectable HBV DNA, with a cutoff of <357 IU/ml. The number of patients (events) for HBsAg negative, positive with HBV DNA <357 IU/mL, and positive with HBV DNA ≥357 IU/ml were 3321 (113), 44 (6), and 70 (8), respectively. Participants with positive HCV antibody were further stratified into those with undetectable HCV RNA, low HCV RNA (≤800,000 IU/ml), and high HCV RNA (>800,000 IU/ml). The number of patients (events) for HCV antibody negative, positive with undetectable HCV RNA, low HCV RNA, and high HCV RNA were 2963 (102), 108 (4), 212 (9), and 151 (12), respectively. The analysis of HCV genotype was limited to participants with positive HCV antibody and known HCV genotype, stratified as genotype 1 (258 patients, 18 events) or other (95 patients, 3 events).</p

Baseline characteristics of study participants, stratified by the development of progressive chronic kidney disease (CKD).

<p>Baseline was defined at randomization into the parent trial (SMART or ESPRIT).</p><p>Categorical variables are presented as N (%) and continuous variables presented as median (interquartile range).</p>1<p>Data on HIV RNA and Hepatitis B surface antigen were available for 3435 participants (99.8%).</p>2<p>Data on Hepatitis C antibody status were available for 3436 participants (99.8%).</p>3<p>Among 473 participants with positive Hepatitis C antibody, RNA viral load was available for 471 (99.6%) and genotype was available for 353 (74.6%).</p><p>eGFR, estimated GFR calculated using the CKD-EPI formula; BMI, body mass index.</p