Unusual oral presentation of HSV-1 lesions in an adult liver transplant recipient

Herpes Simplex Virus (HSV) hepatitis in liver transplant patients is a rarely reported infective complication of HSV with severe consequences, often leading to fulminant hepatitis if left untreated. The clinical signs are often atypical, leading to under-reporting in the literature and potential delays in treatment. Our case report describes such atypical mucocutaneous lesions in a liver transplant recipient. We highlight the need for further reports, especially those with images, in order to aid the diagnosis of HSV infection, and to allow prompt treatment to prevent complications such as HSV hepatitis.

Consensus document on management of cardiac implantable electronic de­vice leads and lead extraction

New expert consensus document is a result of cooperation of 10 worldwide scientific societes, including HRS and EHRA, updates knowledge and recommendations on management of cardiac implantable electronic device leads and lead extraction. The definition of extraction clinical success was changed limiting the residual part of the lead left in cardiovascular system to 4 cm. Significant part of the document is dedicated to diagnosis of lead failure and its differential diagnosis with other reasons which cause a lead malfunction. New precise definition of different examples of infective complication of CIED from pocket erosion to CIED endocarditis were established. Antibiotic therapy is necessary after all extractions due to infective complication but its longevity should be form 10 days to 6 weeks or more depending on the final diagnosis. All infective indications for lead extraction except for superficial incisional infection belongs to class I indications. Numerous indications for lead extraction due to non-infective indications were simplified and class of recommendation has been lowered. Periprocedural management of patients has been described in details. Risk factors of complications and long term mortality were listed.

Prospective study of the risk of not using prophylactic antibiotics in nasal packing for epistaxis

Background:There is wide variation in UK prescribing practice regarding prophylactic antibiotics for nasal packing in spontaneous epistaxis. There are few published cases of infective complications in such patients.Method:This prospective study examined 149 consecutive patients admitted to a tertiary otorhinolaryngology centre with spontaneous epistaxis, who underwent nasal packing, over a six-month period. In the first three-month period, 78 patients were routinely prescribed prophylactic antibiotics; in the second three months, 71 patients were not routinely prescribed antibiotics. Exclusion criteria included antibiotics prescribed for unrelated pathology and post-operative epistaxis. Signs and symptoms of acute otitis media, sinusitis and toxic shock syndrome were assessed using clinical examination and a questionnaire.Results:Fourteen of the 149 patients experienced otalgia, most commonly following posterior nasal packing. No patient in either group had evidence of any infective complication.Conclusion:We do not recommend the routine prescription of prophylactic antibiotics for patients undergoing nasal packing for spontaneous epistaxis.

Characterization of Campylobacter jejuni and Campylobacter coli strains isolated in the region of Nis, Serbia

Introduction. Campylobacter jejuni and Campylobacter coli represent one of the main causes of bacterial diarrhoea in humans. Although the disease is usually mild and self-limiting, severe chronic sequelae may occur, such as reactive arthritis, Guillain-Barr? and Miller Fisher syndromes. Serotyping is used as an epidemiological marker, while post-infective polyneuropathies are associated with several O serotypes. Objective. Strains of C. jejuni and C. coli were serotyped based on heat stable (HS) and heat labile (HL) antigens, as well as biotypes to determine strain diversity. Methods. Campylobacter spp. was isolated using selective blood media with antibiotics. Differentiation to the species level was done by a combination of biotyping tests and by a PCR-based RFLP test. The isolates were characterised by Penner and Lior serotyping methods. Results. The serotypes showed diversity without predominant serotypes. 24 HS serotypes were detected among 29 C. jejuni strains, and seven serotypes among nine C. coli strains. HL serotyping method successfully typed 62.5% of strains. Among 16 C. jejuni strains 14 serotypes were detected, and three among four C. coli strains. A C. jejuni strain associated with a patient with Guillain-Barr? syndrome was typed as biotype II, O:19. Conclusion. The biotyping and serotyping results have indicated that C. jejuni and C. coli strains in the region of Nis, Serbia are diverse and could be probably of unrelated sources of origin or reservoirs. The strain associated with the Guillain-Barr? syndrome patient was serotype O:19, one of the most common in this post-infective complication.

Levofloxacin Disposition over Time in Aqueous Humor of Patients Undergoing Cataract Surgery

ABSTRACT The ocular disposition of levofloxacin in patients receiving two 500-mg oral doses 10 h apart before cataract surgery was assessed with the intent of defining drug ocular exposure over time. The mean aqueous humor concentrations persisted above 1.5 mg/liter between 1.5 and 6.0 h after the second dose, with average aqueous-to-plasma ratios ranging between 0.33 and 0.57. This favorable ocular disposition provides support for trials of systemic levofloxacin for prophylaxis of postoperative endophthalmitis in selected patients or as adjunctive therapy for the treatment of this potentially devastating infective complication.