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Latest Results for BMC Infectious Diseases, 21.10.2019
Tilføjet 21.10.2019 20:01
Atypical presentation of Lemierre’s syndrome: case report and literature review
The classic Lemierre’s syndrome refers to a septic thrombosis of the internal jugular vein, usually caused by a Fusobacterium necrophorum infection starting in the oral cavity, and typically complicated by pulmonary emboli. However, unusual forms of the disorder have been rarely reported.
We describe an unusual case of a previously healthy 58-year-old male with Lemierre’s syndrome, manifesting with lumbar pain and fever. A thrombosis of the iliac veins and abscesses in the right iliac and the left psoas muscles was diagnosed by a computed tomography scan, together with a right lung pneumonia complicated by pleural effusion and an L4-L5 spondylodiscitis. Blood culture and pus drainage were positive for Fusobacterium nucleatum and an atypical Lemierre’s syndrome was suspected. The patient was treated with anticoagulant therapy for 12 weeks and intravenous antibiotic therapy for 6 weeks with a good evolution and resolution of the thrombosis.
This case illustrates the thrombogenic and thromboembolic tendency of Fusobacterium nucleatum and its potential invasiveness, regardless of the site of primary infection. The concept of an atypical Lemierre’s syndrome is redefined here to take into consideration non-cervical sites.
Tilføjet 06.12.2019 01:34
Efficacy and safety of upadacitinib in patients with active ankylosing spondylitis (SELECT-AXIS 1): a multicentre, randomised, double-blind, placebo-controlled, phase 2/3 trial
Upadacitinib 15 mg was efficacious and well tolerated in patients with active ankylosing spondylitis who had an inadequate response or contraindication to non-steroidal anti-inflammatory drugs. These data support the further investigation of upadacitinib for the treatment of axial spondyloarthritis.
Tilføjet 06.12.2019 01:34
JAK inhibitors: promising for a wider spectrum of autoimmune diseases?
JAK and signal transducers and activators of the transcription signal transduction (known as STAT) pathway and upstream cytokine receptor signalling have a principal role in the pathogenesis of many inflammatory and autoimmune conditions, including inflammatory bowel disease, psoriasis, rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus.1 There are four JAKs in humans, JAK1, JAK2, and JAK3, and TYK2. Several JAK inhibitors have been developed over the past decade targeting a broad range of JAKs (ie, pan-JAK) or only specific JAKs (ie, selective JAK inhibitors), providing promising alternatives to parenteral biological disease-modifying antirheumatic drugs (DMARDs) in some autoimmune disorders.
Latest Results for Infection, 13.09.2019
Tilføjet 16.09.2019 09:02
Real-world experience with dalbavancin therapy in gram-positive skin and soft tissue infection, bone and joint infection
Dalbavancin is a novel lipoglycopeptide with potent activity against several gram-positive pathogens, an excellent safety profile and a long elimination half-life.
In this case series observed at the University Hospital of Vienna between 2015 and 2017, all adult patients with gram-positive infections who received at least one dosage of dalbavancin were screened (n = 118). A total of 72 patients were included in the final analysis. The number of included patients stratified by the source of infection was: skin and soft tissue infection (SSTI) (n = 26), osteomyelitis (n = 20), spondylodiscitis (n = 14), acute septic arthritis (n = 4) and prosthetic joint infection (n = 8).
In 46 patients (64%), clinical cure was detected at the end of dalbavancin therapy without additional antibiotic therapy. Of the 26 patients who received additional antibiotic therapy other than dalbavancin, 15 patients (21%) showed no clinical improvement under dalbavancin therapy, four patients (5%) had side effects (nausea n = 1, exanthema n = 2, hyperglycemia n = 1), and in seven patients (10%) clinical improvement under dalbavancin therapy was detected but antibiotic therapy was de-escalated to an oral drug.
We demonstrated high clinical effectiveness of dalbavancin for acute gram-positive infections primarily acute SSTI, acute septic arthritis, acute osteomyelitis and spondylodiscitis. In patients with biofilm-associated infection (chronic infection or joint prosthesis), source control was absolutely necessary for treatment success.
AAC Accepts: Articles Published Ahead of Print, 11.03.2019
Tilføjet 12.03.2019 02:26
Safety and efficacy of prolonged use of dalbavancin in bone and joint infections [Clinical Therapeutics]
Background: Dalbavancin is a lipoglycopeptide with potent activity against gram-positive microorganisms, with a long half-life, favorable safety profile and a high bone concentration which makes it an interesting alternative for osteoarticular infections.Patients and Methods: Multicentric retrospective study of all patients with an osteoarticular infection (septic arthritis, spondylodiscitis, osteomyelitis or orthopedic implant related infections) treated with at least one dose of dalbavancin between 2016 and 2017 in 30 institutions in Spain. In order to evaluate the response, patients with or without an orthopedic implant were separated.Results: A total of 64 patients were included. S. epidermidis and S. aureus were the most frequent microorganism. The reasons for switching to dalbavancin were simplification (53.1%), adverse events (25%), or failure (21.9%). There were 7 adverse events and none patient had to discontinue dalbavancin. In 45 cases infection was related to an orthopedic implant. The material was retained in 23 cases, 15 (65.2%) were classified as cured and 8 (34.8%) presented improvement. In 21 cases the implant was removed and 16 (76.2%) were considered as success, 4 (19%) as improvement and 1 (4.8%) as failure. Among the 19 cases without implants 14 (73.7%) were considered cured, 3 (15.8%) as improvement and 2 (10.5%) as failures.Conclusion: The results show that dalbavancin is a well-tolerated antibiotic, even when administering > 2 doses, and is associated with a high cure rate. This is preliminary data with a short follow-up, therefore, it is necessary to have more experience and in the future to establish the most appropriate dose and frequency.