A case of Listeria monocytogenes meningitis complicated by Hydrocephalus and Intraventricular hemorrhage: A review of treatment options and outcomes

Listeria monocytogenes is a gram-positive bacillus known to cause various human infections including central nervous system infections. The most common central nervous system manifestations are meningitis and rhomboencephalitis, however rare complications including hydrocephalus and intracerebral hemorrhage can occur and are associated with increased mortality and incidence of lasting neurologic sequelae. The mortality ranges from 17 % to greater than 30 % in patients with neurological involvement [1–3]. Various case reports have studied the differing treatment approaches and outcomes of patients who experienced these complications, and there is still no consensus on optimal treatment approaches. In this paper, we report a case of Listeria meningitis complicated by both acute hydrocephalus and intracerebral hemorrhage and analyze the factors that led to a favorable outcome by reviewing the existing literature. Keywords: Listeria, Intracerebral, Intrathecal, Hydrocephalus, Hemorrhage, Meningiti

Adult onset immunoglobulin A vasculitis (Henoch-Schonlein purpura) with alveolar hemorrhage

S. pyogenes is the cause of many important human diseases, ranging from mild superficial skin infections to life-threatening systemic diseases. The post streptococcal syndromes are immune mediated phenomena including Immunoglobulin A Vasculitis (Henoch-Schönlein purpura).HSP is more common in children and usually self limited but it can cause skin, joint, renal, gastrointestinal and rarely respiratory involvement. We present a case with Streptococcus pyogenes pneumonia that presented with respiratory failure, pulmonary hemorrhage, extensive rash and renal failure

Acremonium pneumonia in an AIDS patient

Acremonium is a saprophytic fungus mostly causing superficial skin, nail, or ocular infections after traumatic inoculation. However, it is being recently recognized as one of the opportunistic infections in immunocompromised patients including neutropenia, malignancies, chronic granulomatous disease (CGD) and transplant recipients. To our knowledge there have been no reported cases of Acremonium infection, related to HIV or AIDS. We present a case of Acremonium pneumonia in a patient with no past medical history who was found to have AIDS

172 Can Procalcitonin (PCT) Be Used as an Early Marker of Sepsis in Patients with Intracranial Hemorrhage (ICH)?

Background. To assess whether PCT can be used as a reliable early marker of sepsis in patients with ICH. Methods. In this prospective observational study we enrolled 73 patients with ICH (defined as subarachnoid hemorrhage, subdural hematoma, epidural hematoma, intraventricular hemorrhage, intraparenchymal hemorrhage) who were febrile above 38.3 C at anytime during hospitalization. Serum PCT was measured on day one (PCT 1) and 48-72 h later (PCT2. Patients were determined to have an infection (pneumonia (PNA), urinary tract infection (UTI) or blood stream infection) based on cultures, imaging and clinical impression of the treating team and were assigned a score of 1 based on the presence of an infection that was microbiologically proven. The clinical impression regarding the cause of the fever was also noted (infection vs central fever). Results. There was no statistically significant difference between the mean PCT1 of patients with no infection (M = 0.22 ng/ml, SD = .40) as compared to those with microbiologically proven infection (M = .45, SD = .55), p = .063. There was no statistically significant difference between the mean PCT2 among those with no infection (M = 0.21, SD = .37) as compared to those with microbiologically proven infection (M = .56, SD = .73), p = .084. However, at PCT1, those with infection based on clinical impression (M = 0.18, SD = .17) had significantly lower PCT scores as compared to those with central fever(M = 0.44, SD = .69), F(1, 72) = 6.33, p = .014. This difference did not remain significant at PCT2 (M = .22, SD = .41; M = .41, SD = .61, p = .302). PCT1 levels were not significantly different in patients with PNA (M = 0.22, SD = .39) vs central fever (M = 0.50, SD = .67), p = .06. Similarly, PCT2 levels were not significantly different in patients with PNA (M = 0.21, SD = .38) vs central fever (M = 0.56, SD = .73), p = .09. PCT1 levels were also not different in patients with a UTI diagnosis (M = .27, SD = .46) vs central fever (M = .31, SD = .38), p = .85. There was only 1 patient with a central fever at PCT2, so we could not examine that association. Conclusion. The results of our study indicate that serum PCT is not a reliable marker in differentiating between early sepsis and central fever in patients with ICH