Bihemispheric Cortical Infarcts in an Adult Secondary to Escherichia coli K1 Meningitis

Cerebral ischemia is a known complication of meningitis. Most <i>Escherichia coli</i> meningitis-induced infarcts have been reported in the neonatal and pediatric population. To the best of our knowledge, there have been no previous reports describing bilateral cortical infarcts in an adult secondary to a K1 strain of <i>E. coli</i> meningitis, and herein we report a case in a 25-year-old female. The challenge in treating this patient was determining the duration of systemic antibiotic treatment and whether or not to use steroids. This study demonstrates the necessity of early diagnosis and treatment of <i>E. coli</i> meningitis to prevent neurological complications, including stroke.

Traumatic Blepharitis Including Cutanous Changes with a Clinical Appearance of Immune-Mediated Disease

A four-year-old intact male Labrador retriever was presented with acute onset of ulcerative lesions around both eyes, on the mucocutaneous junctions around the muzzle and nares, and on the lateral aspects of paw pads. All lesions were symmetrical and well demarcated. The rest of ocular and systemic examination was unremarkable. The onset of lesions was acute and coincided with an episode of intense hunting in switchgrass. Similar lesions were present in another dog used in the same hunting trip. The clinical presentation was suggestive of a possible immune-mediated skin disease. However, the patient responded to systemic antibiotic treatment with full recovery without recurrence upon cessation of therapy. Traumatic origin should be included into differential diagnosis of mucocutaneous ulcerative lesions presenting as a possible immune-mediated skin disease.

Nocardia Subretinal Abscess: A Rare and Challenging Case Report

Purpose. To describe a positive clinical response of a patient with submacular Nocardia abscess due to a rapid and efficient treatment. Case report. We describe a case of a 50-year-old man with a painless visual decline of the left eye. Four years later, he had been diagnosed with systemic nocardiosis. Examination of the left eye revealed a submacular white mass with fluffy borders and another smaller white lesion, with well-defined borders, in the inferior temporal vascular arch. A systemic antibiotic treatment with SMX-TMP and intravenous imipenem and a single intravitreal injection of bevacizumab was performed. Conclusion. Prompt diagnosis and treatment ensured an expeditious resolution of the abscess and significant improvement of visual acuity. The diagnostic approach of a high index of suspicion coupled with directed treatment is required when dealing with subretinal inflammatory lesions.

Lung and gut microbiota are altered by hyperoxia and contribute to oxygen-induced lung injury in mice

Inhaled oxygen, although commonly administered to patients with respiratory disease, causes severe lung injury in animals and is associated with poor clinical outcomes in humans. The relationship between hyperoxia, lung and gut microbiota, and lung injury is unknown. Here, we show that hyperoxia conferred a selective relative growth advantage on oxygen-tolerant respiratory microbial species (e.g., Staphylococcus aureus) as demonstrated by an observational study of critically ill patients receiving mechanical ventilation and experiments using neonatal and adult mouse models. During exposure of mice to hyperoxia, both lung and gut bacterial communities were altered, and these communities contributed to oxygen-induced lung injury. Disruption of lung and gut microbiota preceded lung injury, and variation in microbial communities correlated with variation in lung inflammation. Germ-free mice were protected from oxygen-induced lung injury, and systemic antibiotic treatment selectively modulated the severity of oxygen-induced lung injury in conventionally housed animals. These results suggest that inhaled oxygen may alter lung and gut microbial communities and that these communities could contribute to lung injury.

Immediate Vitrectomy and Intravenous Antibiotics for the Treatment of Postoperative Bacterial Endophthalmitis

The Endophthalmitis Vitrectomy Study (EVS) was a randomized, controlled clinical trial to determine the roles of immediate pars plana vitrectomy and systemic antibiotic treatment in the management of postoperative endophthalmitis in patients with clinical signs and symptoms of bacterial endophthalmitis within 6 weeks of cataract surgery or secondary intraocular lens (IOL) implantation and visual acuity between 20/50 and light perception. The study found that routine immediate pars plana vitrectomy is not necessary in patients with better than light perception vision at presentation but is of substantial benefit for those who have light perception-only vision (or worse). Most patients do not require treatment with intravenous antibiotics. Omission of systemic antibiotic treatment can reduce toxic effects, costs, and length of hospital stay.

Wolf’s Panniculitis

A 28-year-old male patient, presented with a one-week history of pain and itching on the skin of the left upper leg. Erythematous indurated, warm and painful on palpation, subcutaneous plaques and nodules were clinically observed, affecting the skin of the left upper leg, within a recent black-wolf tattoo. The diagnosis of traumatic panniculitis with superposed bacterial infection, provoked by a wolf tattoo was made. The patient underwent 7-days systemic antibiotic treatment regimen and topical application of iodine povidone unguent under occlusion for 7 days. Significant alleviation of the subjective complaints was achieved within the first week, with a total clinical resolution of the symptoms. The role of the procedure as a source of trauma for subcutaneous inflammation (traumatic panniculitis) and the contamination of the equipment or the staff (infective panniculitis) in simultaneously triggering of the pathogenetic chain of the reported Wolf’s panniculitis could be present.