Endemic Gastrointestinal Anthrax in 1960s Lebanon: Clinical Manifestations and Surgical Findings

Anthrax is an ancient disease caused by the gram-positive Bacillus anthracis; recently, it has gained much attention because of its potential use in biologic warfare. Anthrax infection occurs in three forms: cutaneous, inhalational, and gastrointestinal. The last type results from ingestion of poorly cooked contaminated meat. Intestinal anthrax was widely known in Lebanon in the 1960s, when a series of >100 cases were observed in the Bekaa Valley. We describe some of these cases, introduce the concept of the surgical management of advanced intestinal anthrax, and describe some of the approaches for treatment

Reported cases of communicable diseases per year between 2011 and 2014 in Syria, Lebanon, and Jordan.

a<p>Data obtained from the Syrian Ministry of Health website in the Quarterly Report of Communicable Diseases <a href="http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1004438#ppat.1004438-XX4" target="_blank">[30]</a>.</p>b<p>Data obtained from the Global Polio Eradication Initiative website <a href="http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1004438#ppat.1004438-Global1" target="_blank">[16]</a>.</p>c<p>Data obtained from the Epidemiologic Surveillance Department of the Lebanese Ministry of Public Health <a href="http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1004438#ppat.1004438-Lebanese1" target="_blank">[26]</a>.</p>d<p>Data obtained from the Communicable Diseases System on the Jordan Ministry of Health Website <a href="http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1004438#ppat.1004438-Jordan1" target="_blank">[25]</a>.</p>∧<p>2014 Data last reported on 08/13/14 from the Global Polio Eradication Initiative website <a href="http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1004438#ppat.1004438-Global1" target="_blank">[16]</a>.</p><p>* 2014 Data last reported on 08/01/14 from the Epidemiologic Surveillance Department of the Lebanese Ministry of Public Health <a href="http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1004438#ppat.1004438-Lebanese1" target="_blank">[26]</a>.</p><p>Reported cases of communicable diseases per year between 2011 and 2014 in Syria, Lebanon, and Jordan.</p

Syrian child from a Lebanon refugee camp, presenting multiple lesions from cutaneous leishmaniasis, courtesy of Dr. Ibrahim Khalifeh

<p>Syrian child from a Lebanon refugee camp, presenting multiple lesions from cutaneous leishmaniasis, courtesy of Dr. Ibrahim Khalifeh</p

Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis

Pseudomonas aeruginosa is a pathogen often encountered in a healthcare setting. It has consistently ranked among the most frequent pathogens seen in nosocomial infections, particularly bloodstream and respiratory tract infections. Aside from having intrinsic resistance to many antibiotics, it rapidly acquires resistance to novel agents. Given the high mortality of pseudomonal infections generally, and pseudomonal sepsis particularly, and with the rise of resistant strains, treatment can be very challenging for the clinician. In this paper, we will review the latest evidence for the optimal treatment of P. aeruginosa sepsis caused by susceptible as well as multidrug-resistant strains including the difficult to treat pathogens. We will also discuss the mode of drug infusion, indications for combination therapy, along with the proper dosing and duration of treatment for various conditions with a brief discussion of the use of non-antimicrobial agents

A randomized trial of tigecycline versus ampicillin-sulbactam or amoxicillin-clavulanate for the treatment of complicated skin and skin structure infections

Background: Complicated skin and skin structure infections (cSSSIs) frequently result in hospitalization with significant morbidity and mortality.Methods: In this phase 3b/4 parallel, randomized, open-label, comparative study, 531 subjects with cSSSI received tigecycline (100 mg initial dose, then 50 mg intravenously every 12 hrs) or ampicillin-sulbactam 1.5-3 g IV every 6 hrs or amoxicillin-clavulanate 1.2 g IV every 6-8 hrs. Vancomycin could be added at the discretion of the investigator to the comparator arm if methicillin-resistant Staphylococcus aureus (MRSA) was confirmed or suspected within 72 hrs of enrollment. The primary endpoint was clinical response in the clinically evaluable (CE) population at the test-of-cure (TOC) visit. Microbiologic response and safety were also assessed. The modified intent-to-treat (mITT) population comprised 531 subjects (tigecycline, n = 268; comparator, n = 263) and 405 were clinically evaluable (tigecycline, n = 209; comparator, n = 196).Results: In the CE population, 162/209 (77.5%) tigecycline-treated subjects and 152/196 (77.6%) comparator-treated subjects were clinically cured (difference 0.0; 95% confidence interval [CI]: -8.7, 8.6). The eradication rates at the subject level for the microbiologically evaluable (ME) population were 79.2% in the tigecycline treatment group and 76.8% in the comparator treatment group (difference 2.4; 95% CI: -9.6, 14.4) at the TOC assessment. Nausea, vomiting, and diarrhea rates were higher in the tigecycline group.Conclusions: Tigecycline was generally safe and effective in the treatment of cSSSIs.Trial registration: ClinicalTrials.gov NCT00368537. © 2012 Matthews et al.; licensee BioMed Central Ltd