Arthritis in adults with community-acquired bacterial meningitis: a prospective cohort study

BACKGROUND: Although the coexistence of bacterial meningitis and arthritis has been noted in several studies, it remains unclear how often both conditions occur simultaneously. METHODS: We evaluated the presence of arthritis in a prospective nationwide cohort of 696 episodes of community-acquired bacterial meningitis, confirmed by culture of cerebrospinal fluid, which occurred in patients aged >16 years. The diagnosis of arthritis was based upon the judgment of the treating physician. To identify differences between groups Fisher exact statistics and the Mann-Whitney U test were used. RESULTS: Arthritis was recorded in 48 of 696 (7%) episodes of community-acquired bacterial meningitis in adults. Joint-fluid aspirations were performed in 23 of 48 patients (48%) and joint-fluid cultures yielded bacteria in 6 of 23 patients (26%). Arthritis occurred most frequently in patients with meningococcal meningitis (12%). Of the 48 patients with bacterial meningitis and coexisting arthritis, four died (8%) and 10 (23%) had residual joint symptoms. CONCLUSION: Arthritis is a common manifestation in patients with community-acquired bacterial meningitis. Functional outcome of arthritis in bacterial meningitis is generally good because meningococcal arthritis is usually immune-mediated, and pneumococcal arthritis is generally less deforming than staphylococcal arthritis. Nevertheless, additional therapeutic measures should be considered if clinical course is complicated by arthritis. In patients with infectious arthritis prolonged antibiotic therapy is mandatory

CEFETAMET PIVOXIL IN THE TREATMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN

The efficacy and safety of cefetamet pivoxil in the treatment of community-acquired pneumonia in children were assessed in an open, randomised, comparative multicentre study in which 260 children (in- and outpatients) with either bacterial pneumonia (n = 170) or bronchopneumonia (n = 90) were enrolled. Cefetamet pivoxil, an oral third generation cephalosporin, was administered to 85 children at a dosage of 10 mg/kg twice daily, the recommended therapeutic dosage, and to 94 children at a dosage of 20 mg/kg twice daily. Cefaclor was administered to 81 children at a dosage of 10 mg/kg three times daily. The duration of treatment was 7 days. Assessments were performed on days 0, 3, 7 and 14 after initiation of treatment. Clinical signs and symptoms began to improve soon after the start of treatment, and continued to improve in all 3 treatment groups. The therapeutic outcome was considered successful in 80 of the 81 assessable patients receiving cefetamet pivoxil 10 mg/kg twice daily (98.8%), in 79 of the 81 assessable patients receiving cefetamet pivoxil 20 mg/kg twice daily (97.6%), and in 71 of the 75 assessable patients receiving cefaclor 10 mg/kg three times daily (94.7%). The differences in outcome between the 3 groups were not statistically significant. Adverse events were of gastrointestinal origin (mainly diarrhoea, nausea, and/or vomiting), and occurred with similar frequencies in the groups treated with cefetamet pivoxil 10 mg/kg twice daily and cefaclor 10 mg/kg three times daily.Cefetamet pivoxil administered at the standard dosage of 10 mg/kg twice daily was effective and well tolerated in children with bacterial pneumonia or bronchopneumonia. The twice-daily cefetamet pivoxil dose schedule compares favourably with the well-established cefaclor 3-times-daily regimen and may result in improved compliance.F HOFFMANN LA ROCHE & CO LTD,CLIN RES DEPT,CH-4002 BASEL,SWITZERLANDUNIV HOSP PATRAS,DEPT PEDIAT,PATRAI,GREECEHOSP GAFFREE & GUINLE,RIO JANEIRO,BRAZILHOSP AHEPA,UNIV CLIN,DEPT PEDIAT,THESSALONIKI,GREECEFAC CIENCIAS MED SANTA CASA SAO PAULO,DEPT PEDIAT,SAO PAULO,BRAZILPHILIPPINES GEN HOSP,DEPT PEDIAT,MANILA,PHILIPPINESHOSP SAO PAULO,SAO PAULO,BRAZILPOLICLIN SAN MATTEO,PAVIA,ITALYCHULALONGKORN HOSP,DEPT PEDIAT,BANGKOK,THAILANDHOP LE DANTEC,DAKAR,SENEGALHOSP SAO PAULO,SAO PAULO,BRAZILWeb of Scienc

Case Report: Simple Nodular Cutaneous Leishmaniasis Caused by Autochthonous Leishmania (Mundinia) orientalis in an 18-Month-Old Girl: The First Pediatric Case in Thailand and Literature Review

We report an autochthonous case of simple, localized cutaneous leishmaniasis in a healthy 18-month-old girl from southern Thailand. The patient presented with a solitary chronic cutaneous nodular lesion on her left cheek for approximately 1 year. Histopathological dissection of the cheek skin biopsy demonstrated remarkably nodular and interstitial infiltrates of lymphocytes and histiocytes full of intracellular oval-shaped amastigotes, consistent with cutaneous leishmaniasis. The Leishmania promastigotes were also cultured successfully from the lesion biopsy and were designated with the WHO code MHOM/TH/2021/CULE5. Using internal transcribed spacer 1-specific polymerase chain reaction, the parasite DNA was demonstrated in both saliva and lesion biopsy. Based on the BLASTn and phylogenetic analysis, the parasite was identified as Leishmania orientalis, clustered in the Mundinia subgenus. The patient responded well to a 6-week course of oral itraconazole, without recurrence. To our knowledge, this is the fourth case of autochthonous leishmaniasis resulting from L. orientalis and the youngest patient of leishmaniasis ever reported in Thailand. More importantly, we also demonstrate the clinical course of the lesion according to the timeline before and after treatment, which can help physicians better understand and provide an accurate diagnosis with appropriate treatment of this emerging parasitic disease