Pancytopaenia is a rare clinical presentation of severe leptospirosis. We would like to report a case of severe leptospirosis that progressed to pancytopaenia despite initial penicillin therapy. The patient needed a second course of antibiotic with doxycycline to improve his persistent symptoms and cytopaenia. Persistent pancytopaenia in severe leptospirosis and its management were reviewed.
Doxycycline/administration & dosage ; Drug Therapy, Combination ; Leptospirosis/*complications ; Leptospirosis/drug therapy ; Pancytopenia/drug therapy ; Pancytopenia/*etiology ; Penicillins/administration & dosage

PURPOSE: To report a case of a neurosyphilis patient with cilioretinal artery occlusion as the first manifestation. CASE SUMMARY: A 58-year old man presented with a visual impairment which developed 5 days earlier in his right eye. During initial evaluation, the visual acuity in the right eye was 0.02. On fundus examination, a whitening adjacent to the macula was observed and fluorescein angiography showed filling delay and late leakage of the cilioretinal arteries. The patient was diagnosed with cilioretinal artery occlusion. Two weeks after his initial visit, visual acuity in the patient's right eye improved to 0.7 and retinal whitening was decreased on fundus examination. Three months later, a visual decrease in the right eye reoccurred and the visual acuity was 0.01. Anterior chamber cell reaction with hypopyon was observed on slit lamp examination and vitreal opacity was noted during fundus examination. Among the numerous tests performed in order to determine the cause of uveitis, RPR antibody and treponemal antibody were found positive. The patient was diagnosed with neurosyphylis and 2 weeks after intravenous administration of penicillin, visual acuity improved to 0.7 and anterior chamber cell reaction as well as vitreal opacity decreased. CONCLUSIONS: The authors reported a case of cilioretinal artery occlusion suspected secondary to neurosyphilis.
Administration, Intravenous ; Anterior Chamber ; Arteries ; Eye ; Fluorescein Angiography ; Humans ; Neurosyphilis ; Patient Rights ; Penicillins ; Retinaldehyde ; Syphilis ; Uveitis ; Vision Disorders ; Visual Acuity

OBJECTIVETo investigate the susceptibility of Streptococcus mutans (S. mutans) biofilms to antimicrobial agent by confocal laser scanning microscopy (CLSM).

METHODSS. mutans biofilms formed in vitro on glass slice were acted on with penicillin of different concentrations for 3 h. Then these biofilms were stained by fluorescence and were observed by CLSM. The bacterial density and viability of biofilms were recorded.

RESULTSWhen S. mutans biofilms were exposed to penicillin of 2 500 mg/L for 3 h, it was not completely killed. The higher the concentration of penicillin was, the weaker the biofilms against penicillin.

CONCLUSIONSCompared with planktonic S. mutans, S. mutans biofilms produced stronger resistance to penicillin. It suggests that we should find new strategies to control the infection caused by biofilm in clinic.

Anti-Infective Agents ; administration & dosage ; pharmacology ; Biofilms ; drug effects ; Dose-Response Relationship, Drug ; Microbial Sensitivity Tests ; Microscopy, Confocal ; Penicillins ; administration & dosage ; pharmacology ; Streptococcus mutans ; drug effects

Actinomycosis is a chronic suppurative and granulomatous disease, characterized by the formation of abscess, draining sinuses, abundant granulation, and dense fibrous tissue. Actinomycosis of the gallbladder is extremely rare. We report a case of an 56-years old man who abruptly presented with right upper quadrant abdominal pain. Abdominal CT showed that the gallbladder had 2 cm sized stone and an edematous thick wall. Our preoperative diagnosis was acute calculous cholecystitis. After the management of acute cholecystitis, laparoscopic cholecystectomy was performed but converted to open surgery due to severe adhesion to liver and greater omentum. Partial cholecystectomy was performed. Histologic section of the gallbladder showed sulfur granule with gram-positive branching bacilli compatible with actinomyces. After cholecystectomy, the patient received intravenous penicillin G for 2 weeks, followed by oral penicillin for 3 months.
Actinomycosis/*diagnosis/drug therapy/pathology ; Cholecystectomy ; Cholecystitis, Acute/*diagnosis/surgery ; Gallbladder Diseases/*diagnosis/drug therapy/pathology ; Humans ; Male ; Middle Aged ; Penicillins/administration & dosage ; Tomography, X-Ray Computed

Although it is debatable whether Helicobacter pylori may play a role in the pathogenesis of rosacea, some authors suggested that the treatment of H. pylori might have a beneficial effect. The aim of this investigation was to compare the prevalence of H. pylori between rosacea patients and controls, and to evaluate an effect of H. pylori eradication on rosecea by a 2-week triple therapy that was composed of amoxicillin, clarithromycin and omeprazole. H. pylori was detected by using gastroscopic biopsy with Warthin-Starry stain. Forty-two (84%) of 50 patients with rosacea and 39 (78%) of 50 controls had H. pylori, showing no significant difference in prevalence. The cure rates of H. pylori in rosacea patients and controls were 80% (16/20) and 85% (17/20), respectively. There was no significant decrease in the intensity of erythema in active treatment and placebo groups both during and after the treatment. Temporary improvement in papulopustules exclusively during the treatment (within 2 weeks) could be independent of H. pylori eradication. Overall, no significant reduction in the number of papulopustules was observed in active treatment and placebo groups after the treatment (in 2 months). Taken together, our study found no significant lessening of rosacea lesions by treating H. pylori infection, which conclusively does not concur with a view that H. pylori may be related to rosacea.
Acne Rosacea/microbiology* ; Acne Rosacea/epidemiology* ; Adult ; Amoxicillin/administration & dosage ; Anti-Ulcer Agents/administration & dosage ; Antibiotics, Macrolide/administration & dosage ; Biopsy ; Clarithromycin/administration & dosage ; Cohort Studies ; Erythema/microbiology ; Erythema/epidemiology ; Female ; Follow-Up Studies ; Helicobacter Infections/pathology ; Helicobacter Infections/epidemiology* ; Helicobacter Infections/drug therapy* ; Helicobacter pylori* ; Human ; Male ; Middle Age ; Omeprazole/administration & dosage ; Penicillins/administration & dosage ; Prevalence

Administration, Cutaneous ; Amoxicillin ; therapeutic use ; Child ; Child, Preschool ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Male ; Penicillins ; therapeutic use ; Phytotherapy ; Respiratory Tract Infections ; drug therapy ; prevention & control ; Secondary Prevention

With increase of multi-drug resistant Escherichia coli in community-acquired urinary tract infections (CA-UTI), other treatment option with a therapeutic efficacy and a low antibiotic selective pressure is necessary. In this study, we evaluated in vitro susceptibility of E. coli isolates from CA-UTI to fosfomycin (FM), nitrofurantoin (NI), temocillin (TMO) as well as trimethoprim-sulfamethoxazole (SMX), ciprofloxacin (CIP) and cefepime (FEP). The minimal inhibitory concentrations were determined by E-test or agar dilution method according to the Clinical and Laboratory Standards Institute guidelines, using 346 E. coli collected in 12 Korean hospitals from March 2010 to February 2011. FM, NI and TMO showed an excellent susceptibility profile; FM 100% (346/346), TMO 96.8% (335/346), and NI 99.4% (344/346). Conversely, resistance rates of CIP and SMX were 22% (76/346) and 29.2% (101/349), respectively. FEP still retained an activity of 98.5%. In Korea, NI and TMO in addition to FM are a good therapeutic option for uncomplicated CA-UTI, especially for lower UTI.
Anti-Bacterial Agents/*administration & dosage ; Cell Survival/*drug effects ; Cephalosporins/administration & dosage ; Ciprofloxacin/administration & dosage ; Community-Acquired Infections/drug therapy/*microbiology ; Dose-Response Relationship, Drug ; Drug Combinations ; Drug Resistance, Bacterial/drug effects ; Escherichia coli/*drug effects ; Escherichia coli Infections/drug therapy/*microbiology ; Fosfomycin/administration & dosage ; Humans ; Nitrofurantoin/administration & dosage ; Penicillins/administration & dosage ; Republic of Korea ; Sulfadoxine/administration & dosage ; Treatment Outcome ; Trimethoprim/administration & dosage ; Urinary Tract Infections/diagnosis/*microbiology

With increase of multi-drug resistant Escherichia coli in community-acquired urinary tract infections (CA-UTI), other treatment option with a therapeutic efficacy and a low antibiotic selective pressure is necessary. In this study, we evaluated in vitro susceptibility of E. coli isolates from CA-UTI to fosfomycin (FM), nitrofurantoin (NI), temocillin (TMO) as well as trimethoprim-sulfamethoxazole (SMX), ciprofloxacin (CIP) and cefepime (FEP). The minimal inhibitory concentrations were determined by E-test or agar dilution method according to the Clinical and Laboratory Standards Institute guidelines, using 346 E. coli collected in 12 Korean hospitals from March 2010 to February 2011. FM, NI and TMO showed an excellent susceptibility profile; FM 100% (346/346), TMO 96.8% (335/346), and NI 99.4% (344/346). Conversely, resistance rates of CIP and SMX were 22% (76/346) and 29.2% (101/349), respectively. FEP still retained an activity of 98.5%. In Korea, NI and TMO in addition to FM are a good therapeutic option for uncomplicated CA-UTI, especially for lower UTI.
Anti-Bacterial Agents/*administration & dosage ; Cell Survival/*drug effects ; Cephalosporins/administration & dosage ; Ciprofloxacin/administration & dosage ; Community-Acquired Infections/drug therapy/*microbiology ; Dose-Response Relationship, Drug ; Drug Combinations ; Drug Resistance, Bacterial/drug effects ; Escherichia coli/*drug effects ; Escherichia coli Infections/drug therapy/*microbiology ; Fosfomycin/administration & dosage ; Humans ; Nitrofurantoin/administration & dosage ; Penicillins/administration & dosage ; Republic of Korea ; Sulfadoxine/administration & dosage ; Treatment Outcome ; Trimethoprim/administration & dosage ; Urinary Tract Infections/diagnosis/*microbiology

Factors affecting bacteriological cure rates (BCR) and new intramammary infections (IMI) during the dry period as well as clinical mastitis (CM) during early lactation were investigated in 414 German Holstein dairy cows receiving dry cow therapy. Cows were treated with either benethamine benzylpenicillin (300,000 IU), penethamate hydriodide (100,000 IU), and framycetin sulphate (100 mg, n = 136), or cefquinome (150 mg, n = 135), or benzathine cloxacillin (1,280 mg, n = 143). Overall BCR, IMI, and CM at parturition were 86.4%, 20.7%, and 4.3%, respectively. The three antibiotic treatments differed only in BCR, with cloxacillin yielding better results than the others. Udder quarters from cows with > 4 lactations had a higher risk of IMI and CM at calving. Chronic changes in udder tissues were linked to a lower BCR and were associated with a higher risk of CM during early lactation. The risk of CM at calving was higher in udder quarters with unspecific or subclinical mastitis before drying off. In conclusion, with antibiotic dry cow therapy, age and health status of the udder appear to be major determinants of IMI and CM during the dry period and early lactation, while BCR was associated with the antibiotic type and udder tissue status.
Animals ; Anti-Bacterial Agents/administration & dosage/*therapeutic use ; Bacterial Infections/drug therapy/epidemiology/prevention & control/*veterinary ; Cattle ; Cephalosporins/administration & dosage/therapeutic use ; Female ; Framycetin/administration & dosage/therapeutic use ; Germany/epidemiology ; Incidence ; Lactation ; Mammary Glands, Animal/*microbiology/physiology ; Mastitis, Bovine/drug therapy/*epidemiology/prevention & control ; Penicillins/administration & dosage/therapeutic use ; Risk Factors

The year 1943 saw the introduction, by Mahoney and his associates, of penicillin treatment for syphilis. That period was an epic turning point in many respects, not least of which was the commencement of the antibiotic era in venereology. Frorn that point on, there were no antibiotics as effective, as cheap,or as low in toxicity as penir.illin, despite the discovery of a number of ather. a.ntibiotics. Also, na signs of resistance by Treponema pallidum t,o the antibiotic have yet been noted, although this possibility ha.a not bcen evaluated adequately. Sirice then Benzathine penicillin G, a long acting l3epo-penicillin, (discovered by Seifter, et al, in 1951), has been uti.lized for treating ayphilis. Aft.er the discovery of penicillin, syphilis began to decline. However, during the r.niddle 1950s the incidence of syphilis began to increa se throughout the world. In the 1960's, this rate of increase became quite pronounced. Thus, the present trend. is to treat most syphi]is with Benzathine penicillin Ci. However, occasional adverse reacf.ions, (e.g. hypersensitivity, anaphyIactic shack, phobia of injections and other untoward effects), sometimes render treatment with Renzathine Fenicillin G irnpossible. In such cases, treatment consists of the oral administration of Vibramycin' (Doxycycline to compensate for the defects of the penicillin. Although the previous alternatives have tra,ditionally been Tetracycline and Erythromyr,in, by utiIizing Vibramycin, we are a.41e to repozt the results comparing the effectiveness of Vibramycin with the effectiveness of Renza.cillin. The results focus on clini.cal irnprcivement and serological tests. Thirty five patients were treateif, with Vibramycin, but despite our requests, only ten patients participated in the foliowup study. among these ten patients, three patients were hypersensitive to penicillin. Forty nine patients were treated with Benzacillin, among which only thirteen patients responded to our follow-up studies. All members of the Benzacillin group were skin tested for penicillin hypersensitivity before treatment was initiated. The Vibramycin treatment regirnen was the oral administration of 200mg twice on the first day, and from the second day to the fourteenth day, 100mg twice daily. Three million units of Benzacillin were given .intra;nuscularly in weekly intervals for three weeks. The therapeutic results obtained were as follows: 1) The Vibramycin group showed remarkable clinical irnprovernent en the third day of treatment, with clinical manifestations completely disappearing en the following days- Lymphangitis dorsalis penis, sixth day of treatment; headache ninth day' maculopapulo-squamous syphilids, eleventh day; condyloma lata, fourteenth day' primary chancre, tenth day after finishing treatrnent. However, regional lymphadenopathies persisted for over four and a half months. 2) In most patients, serological follow-up studies, (VDRL slide test, and Wasserrnann complement fixation test), revealed declining titers one month after concluding treatment. These titers continued to decline in the following months. One case of sero-relapse, howe ver, was shown in both the Vibramycin group and the Benzacillin group. R) No cases of side effects were observed in either treatrnent group. 4) It is concluded from this study that nine of ten patients (90%) in the Uibramycin group, and twelve of thirteen patients (92. 3 %) in the Benzacillin group showed serological improvement. Thus, in those instances where penicillin is contraindicated, (e.g. hypersensitivity, anaphylactic shock, etc.), Vibramycin (Doxycycline) appears to be one of the most valuable treatment alternatives available.
Administration, Oral ; Anaphylaxis ; Anti-Bacterial Agents ; Chancre ; Complement System Proteins ; Doxycycline* ; Follow-Up Studies ; Headache ; Humans ; Hypersensitivity ; Incidence ; Lymphangitis ; Male ; Penicillin G Benzathine ; Penicillins ; Penis ; Phobic Disorders ; Serologic Tests ; Skin Tests ; Syphilis* ; Syphilis, Cutaneous ; Tetracycline ; Treponema pallidum ; Venereology