Cefepime is a fourth-generation cephalosporin, developed in 1994, and is well known for its adverse effects. In 2002, the Food and Drug Administration adjusted the labeling to account for increased risk of seizures, encephalopathy and myoclonus, especially in the setting of renal impairment. Here we present a case of an 86-year-old female, undergoing Cefepime treatment, with encephalopathy mimicking acute stroke.
Aged, 80 and over ; Brain Diseases ; Female ; Humans ; Myoclonus ; Seizures ; Stroke ; United States Food and Drug Administration

Scrub typhus develops after the individual is bitten by a trombiculid mite infected with Orientia tsutsugamushi. Since it has been reported that pneumonia is frequently observed in patients with scrub typhus, we investigated whether intranasal (i.n.) vaccination with the outer membrane protein of O. tsutsugamushi (OMPOT) would induce a protective immunity against O. tsutsugamushi infection. It was particular interest that when mice were infected with O. tsutsugamushi, the bacteria disseminated into the lungs, causing pneumonia. The i.n. vaccination with OMPOT induced IgG responses in serum and bronchoalveolar lavage (BAL) fluid. The anti-O. tsutsugamushi IgA Abs in BAL fluid after the vaccination showed a high correlation of the protection against O. tsutsugamushi. The vaccination induced strong Ag-specific Th1 and Th17 responses in the both spleen and lungs. In conclusion, the current study demonstrated that i.n. vaccination with OMPOT elicited protective immunity against scrub typhus in mouse with O. tsutsugamushi infection causing subsequent pneumonia.