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Kenyon C, Laumen J, Van Den Bossche D, Van Dijck C. Where have all the susceptible gonococci gone? A historical review of changes in MIC distribution over the past 75 years. BMC Infect Dis 2019; 19:1085. [PMID: 31881862 PMCID: PMC6935233 DOI: 10.1186/s12879-019-4712-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Does the emergence of antimicrobial resistance in Neisseria gonorrhoeae include the erasure of highly susceptible strains or does it merely involve a stretching of the MIC distribution? If it was the former this would be important to know as it would increase the probability that the loss of susceptibility is irreversible. METHODS We conducted a historical analysis based on a literature review of changes of N. gonorrhoeae MIC distribution over the past 75 years for 3 antimicrobials (benzylpenicillin, ceftriaxone and azithromycin) in five countries (Denmark, Japan, South Africa, the United Kingdom and the United States). RESULTS Changes in MIC distribution were most marked for benzylpenicillin and showed evidence of a right shifting of MIC distribution that was associated with a reduction/elimination of susceptible strains in all countries. In the case of ceftriaxone and azithromycin, where only more recent data was available, right shifting was also found in all countries but the extent of right shifting varied and the evidence for the elimination of susceptible strains was more mixed. CONCLUSIONS The finding of right shifting of MIC distribution combined with reduction/elimination of susceptible strains is of concern since it suggests that this shifting may not be reversible. Since excess antimicrobial consumption is likely to be responsible for this right shifting, this insight provides additional impetus to promote antimicrobial stewardship.
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Affiliation(s)
- Chris Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium.
- Division of Infectious Diseases and HIV Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7700, South Africa.
| | - Jolein Laumen
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
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Schulfer AF, Schluter J, Zhang Y, Brown Q, Pathmasiri W, McRitchie S, Sumner S, Li H, Xavier JB, Blaser MJ. The impact of early-life sub-therapeutic antibiotic treatment (STAT) on excessive weight is robust despite transfer of intestinal microbes. ISME J 2019; 13:1280-1292. [PMID: 30651608 PMCID: PMC6474226 DOI: 10.1038/s41396-019-0349-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 12/07/2018] [Accepted: 12/31/2018] [Indexed: 01/12/2023]
Abstract
The high-fat, high-calorie diets of westernized cultures contribute to the global obesity epidemic, and early life exposure to antibiotics may potentiate those dietary effects. Previous experiments with mice had shown that sub-therapeutic antibiotic treatment (STAT)-even restricted to early life-affected the gut microbiota, altered host metabolism, and increased adiposity throughout the lifetime of the animals. Here we carried out a large-scale cohousing experiment to investigate whether cohousing STAT and untreated (Control) mice would transfer the STAT-perturbed microbiota and transmit its impact on weight. We exposed pregnant dams and their young offspring to either low-dose penicillin (STAT) or water (Control) until weaning, and then followed the offspring as they grew and endured a switch from normal to high-fat diet at week 17 of life. Cohousing, which started at week 4, rapidly approximated the microbiota within cages, lowering the weight of STAT mice relative to non-cohoused mice. The effect, however, varied between cages, and was restricted to the first 16 weeks when diet consisted of normal chow. Once mice switched to high-fat diet, the microbiota α- and β-diversity expanded and the effect of cohousing faded: STAT mice, again, were heavier than control mice independently of cohousing. Metabolomics revealed serum metabolites associated with STAT exposure, but no significant differences were detected in glucose or insulin tolerance. Our results show that cohousing can partly ameliorate the impact of STAT on the gut microbiota but not prevent increased weight with high-fat diet. These observations have implications for microbiota therapies aimed to resolve the collateral damage of antibiotics and their load on human obesity.
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Affiliation(s)
- Anjelique F Schulfer
- Department of Medicine, New York University Langone Medical Center, New York, NY, 10016, USA
| | - Jonas Schluter
- Computational Biology Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Yilong Zhang
- Department of Population Health, New York University Langone Medical Center, New York, NY, 10016, USA
| | - Quincy Brown
- Department of Medicine, New York University Langone Medical Center, New York, NY, 10016, USA
| | - Wimal Pathmasiri
- Eastern Regional Comprehensive Metabolomics Resource Core, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Susan McRitchie
- Eastern Regional Comprehensive Metabolomics Resource Core, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Susan Sumner
- Eastern Regional Comprehensive Metabolomics Resource Core, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Huilin Li
- Department of Population Health, New York University Langone Medical Center, New York, NY, 10016, USA
| | - Joao B Xavier
- Computational Biology Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA.
| | - Martin J Blaser
- Department of Medicine, New York University Langone Medical Center, New York, NY, 10016, USA.
- New York Harbor Veterans Affairs Medical Center, New York, NY, 10010, USA.
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Peng RR, Wu J, Zhao W, Qi T, Shi M, Guan Z, Lu H, Long F, Gao Z, Zhang S, Zhou P. Neutropenia induced by high-dose intravenous benzylpenicillin in treating neurosyphilis: Does it really matter? PLoS Negl Trop Dis 2017; 11:e0005456. [PMID: 28288165 PMCID: PMC5363990 DOI: 10.1371/journal.pntd.0005456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 03/23/2017] [Accepted: 03/03/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Prompt therapy with high-dose intravenous benzylpenicillin for a prolonged period is critical for neurosyphilis patients to avoid irreversible sequelae. However, life-threatening neutropenia has been reported as a complication of prolonged therapy with high doses of benzylpenicillin when treating other diseases. This study aimed to investigate the incidence, presentation, management and prognosis of benzylpenicillin-induced neutropenia in treating neurosyphilis based on a large sample of syphilis patients in Shanghai. METHODOLOGY/PRINCIPAL FINDINGS Between 1st January 2013 and 31st December 2015, 1367 patients with neurosyphilis were treated with benzylpenicillin, 578 of whom were eligible for recruitment to this study. Among patients without medical co-morbidities, the total incidence of benzylpenicillin-induced neutropenia and severe neutropenia was 2.42% (95% CI: 1.38-4.13%) and 0.35% (95% CI: 0.06-1.39%), respectively. The treatment duration before onset of neutropenia ranged from 10 to 14 days, with a total cumulative dose of between 240 and 324 megaunits of benzylpenicillin. Neutropenia was accompanied by symptoms of chills and fever (5 patients), fatigue (2 patients), cough (1 patient), sore throat (1 patient), diarrhea (1 patient) and erythematous rash (1 patient). The severity of neutropenia was not associated with age, gender or type of neurosyphilis (p>0.05). Neutropenia, even when severe, was often tolerated and normalized within one week. A more serious neutropenia did not occur when reinstituting benzylpenicillin in patients with mild or moderate neutropenia nor when ceftriaxone was used three months after patients had previously experienced severe neutropenia. CONCLUSIONS/SIGNIFICANCE Benzylpenicillin-induced neutropenia was uncommon in our cohort of patients. Continuation of therapy was possible with intensive surveillance for those with mild or moderate neutropenia. For severe neutropenia, it is not essential to aggressively use hematopoietic growth factors or broad-spectrum antibiotics for patients in good physical condition after withdrawing anti-neurosyphilis regimen. We did not see an exacerbation of neutropenia in patients with the readministration of benzylpenicillin.
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Affiliation(s)
- Rui-Rui Peng
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Juan Wu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Wei Zhao
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Tengfei Qi
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Mei Shi
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Zhifang Guan
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Haikong Lu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Fuquan Long
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Zixiao Gao
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Sufang Zhang
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Pingyu Zhou
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
- * E-mail:
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Hendriks KD, van Etten RW, van Wijngaarden P. [Fever and hypotension after treatment of syphilis; the Jarisch-Herxheimer reaction]. Ned Tijdschr Geneeskd 2017; 161:D649. [PMID: 28181892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 73-year-old man presented with fever and hypotension, which had developed a few hours after receiving treatment with benzyl-penicillin for secondary syphilis. These symptoms were due to the so-called Jarisch-Herxheimer reaction. The patient was admitted to hospital and treated with prednisone and intravenous fluids. Within 24 hours the patient had fully recovered. The symptoms, pathogenesis and treatment of Jarisch-Herxheimer reaction are discussed.
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Affiliation(s)
- K D Hendriks
- Amphia Ziekenhuis, afd. Inwendige Geneeskunde, Breda
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Covelli V, Khanapara DB, Naut ER. Penicillin Encephalopathy: An Unlikely Adversary in the Treatment of Neurosyphilis--Case Report and Review of the Literature. Conn Med 2016; 80:143-145. [PMID: 27169296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Penicillin encephalopathy is a rare, potentially reversible phenomenon of drug-induced neurotoxicity. CASE A 65-year-old female with a history of HIV was admitted with a three-day history of worsening headache, confusion, and lethargy. On examination she was awake but confused. Cerebrospinal fluid (CSF) and serum venereal disease research laboratory (VDRL) test returned positive and the patient was started on intravenous penicillin G with probenecid. On the second day of therapy, she developed myoclonic jerking, consistent with penicillin neurotoxicity. Repeat labs also showed new onset renal failure. Penicillin and probenecid therapy were stopped with a resolution of symptoms. Subsequently, therapy without probenecid was reinstituted uneventfully. DISCUSSION Herein, we describe a female who developed penicillin neurotoxicity after initiation of intravenous penicillin therapy with probenecid for neurosyphilis. It is important that penicillin-induced toxicity be considered if characteristic myoclonic movements accompany encephalopathy. The presence of coexistent renal compromise should heighten the vigilance of clinicians.
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Kaya E, Yilmaz S. Penicillin G-induced hemorrhagic cystitis. Korean J Intern Med 2015; 30:742. [PMID: 26354072 PMCID: PMC4578024 DOI: 10.3904/kjim.2015.30.5.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/22/2014] [Accepted: 07/10/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Engin Kaya
- Department of Urology, Gulhane Military Medical Academy, Ankara, Turkey
- Correspondence to Engin Kaya, M.D. Department of Urology, Gulhane Military Medical Academy, General Tevfik Saglam St, Kecioren, Ankara 06010, Turkey Tel: +90-505-706-0175 Fax: +90-312-304-2700 E-mail:
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Bircher AJ. Lymphocyte transformation test in the diagnosis of immediate type hypersensitivity reactions to penicillins. Curr Probl Dermatol 2015; 22:31-7. [PMID: 7587330 DOI: 10.1159/000424228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A J Bircher
- Department of Dermatology, University Hospital, Basel, Switzerland
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Tokiwa T, Zimin L, Ishizuka S, Inoue T, Fujii M, Ishiguro H, Kajigaya H, Owada Y, Suzuki M, Yamakawa T. The Palm-Sized Cryoprobe System Based on Refrigerant Expansion and Boiling and Its Application to an Animal Model of Epilepsy. IEEE Trans Biomed Eng 2015; 62:1949-58. [PMID: 25730822 DOI: 10.1109/tbme.2015.2407692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
GOAL The purpose of this study is to propose the palm-sized cryoprobe system based on a new concept and to suggest that the freezing technique could be used for treatment of epilepsy. METHODS We propose herein a cryoprobe system based on the boiling effect that uses a specific refrigerants with a boiling point higher than that of liquid nitrogen yet low enough to result in cell necrosis. To evaluate and verify the effectiveness of the proposed system, cooling characteristics are investigated in agar. In addition, the system is applied to a Wistar rat brain-model, in which the epileptic activities are induced in advance by a potent epileptogenic substance. RESULTS The design concept yielded the following benefits: 1) the selected refrigerant promotes sealing in the tank; 2) the tank can be made as compact as possible, limited only by the volume required for the refrigerant; 3) because the tank and probe units can be separated by a nonconducting, flexible, and high-pressure tube, the tank unit can be manipulated without disturbing the probe tip with mechanical vibrations and electrical noise. Although the agar experiments, we verified that the proposed system can uniquely and reproducibly create an ice ball. Moreover, in the rat experiments in vivo, it was confirmed that penicillin G-induced epileptic activities disappeared on freezing with the proposed system. CONCLUSIONS The palm-sized system has desired characteristics and can apply for an animal model of epilepsy. SIGNIFICANCE Results of in vivo experiments suggest that cryosurgery may be an effective treatment for epilepsy.
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Abstract
We herein report a heterosexual Japanese man in his forties who had been suffering from advanced dementia and personality change for 4 years. Positive results of a serological test for syphilis, Treponema pallidum hemagglutination assay, and fluorescent treponemal antibody-absorption test of both serum and cerebral spinal fluid led to the diagnosis of neurosyphilis. Jarisch-Herxheimer reaction was seen shortly after the first dose of penicillin was administered to the patient. His cognitive function did not recover after treatment. The incidence of syphilis has been reported to be increasing. Neurosyphilis should not be overlooked as an etiology for progressive dementia even in this post-antibiotic era.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Kim MK, Kang CK, Kim MJ, Jun KI, Lee YK, Jeong SJ, Song KH. Penicillin G-induced hemorrhagic cystitis: a case and review of the literature. Korean J Intern Med 2013; 28:743-5. [PMID: 24307855 PMCID: PMC3847005 DOI: 10.3904/kjim.2013.28.6.743] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/25/2013] [Accepted: 07/18/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Min-Kyung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Jae Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kang Il Jun
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Markham R, Slack A, Gerrard J. The Jarisch-Herxheimer reaction in a patient with leptospirosis: a foreseeable problem in managing spirochaete infections. Med J Aust 2012; 197:276-7. [PMID: 22938123 DOI: 10.5694/mja11.11175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lipp HP. [Revival of selected well-tried antibiotics. Special features of the antiinfective agents penicillin G, fosfomycin, aztreonam and colistin]. Med Monatsschr Pharm 2012; 35:367-377. [PMID: 23094579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although a worldwide increasing incidence of bacterial infections with panresistant pathogens may need innovative antiinfective agents, no breakthrough developments can be expected in the near future. As a consequence, well-tried antibiotics like aztreonam, fosfomycin and colistin, are experiencing a clinical revival, particularly if they are used in an improved manner. Even penicillin G with its narrow spectrum of antimicrobial activity remains an important considerable agent of first choice in special indications compared to broad spectrum antiinfectives.
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Kortunay S, Erken HA, Erken G, Genç O, Sahiner M, Turgut S, Turgut G. Orexins increase penicillin-induced epileptic activity. Peptides 2012; 34:419-22. [PMID: 22394654 DOI: 10.1016/j.peptides.2012.02.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 02/18/2012] [Accepted: 02/18/2012] [Indexed: 11/17/2022]
Abstract
Orexins have been implicated with physiological function including sleep-wake cycle, energy homeostasis, drinking behavior, analgesia, attention, learning and memory but their effects on excitability are controversial. We investigated the effects of intracortical injections of orexin A (100 pmol) and B (100 pmol) on the electrophysiological manifestation of epileptic seizures induced by cortical penicillin application in adult male rats. In comparison to saline, orexin A and B enhanced significantly the spike number, spike amplitude and spectral power values induced by cortical penicillin. Our findings indicates that orexins enhances the hyperexcitable and hypersyncronic cortical epileptic activity induced by focal application of penicillin-G.
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Affiliation(s)
- Selim Kortunay
- Pamukkale University, Faculty of Medicine, Department of Pharmacology, Denizli, Turkey
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Wangrattanasopon P, Ruxrungtham K, Chantaphakul H, Buranapraditkun S, Klaewsongkram J. Alkali-treated penicillin G solution is a better option than penicillin G as an alternative source of minor determinants for penicillin skin test. Allergy Asthma Proc 2012; 33:152-9. [PMID: 22525392 DOI: 10.2500/aap.2012.33.3496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Both benzylpenicilloyl-polylysine (PPL) and minor determinant mixture (MDM) are the recommended standard reagents for penicillin skin testing. However, penicillin G is commonly suggested as an alternative source of minor determinants. This study evaluated the accuracy of penicillin G and alkali-treated penicillin G compared with the standardized MDM for skin testing. Sixty-eight patients with histories of allergies to penicillin or semisynthetic penicillins were skin tested with commercial Kit penicillin allergenic determinants (DAP) (PPL and DAP-MDM; Diater Laboratorios, Madrid, Spain). The in-house MDM (IH-MDM), prepared by alkali-treated aged penicillin, and fresh penicillin G sodium (PGs) were tested alongside DAP-MDM. Positive penicillin skin test results were identified in 22 patients (32.4%) using commercial reagents (PPL+ DAP-MDM) and 19 of them reacted to DAP-MDM alone or together with PPL. The accuracy of IH-MDM and PGs compared with DAP-MDM was 89.7 and 76.5%, respectively. Our study shows that alkali-treated penicillin G is a better option than penicillin G as an alternative source of MDM for skin testing in case the commercialized MDM is not available. Minor determinants play a significant role for penicillin allergy in Thailand and should be included in the penicillin skin test panel to verify suspected cases of penicillin allergy. (ClinicalTrials.gov number: NCT00789217).
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Affiliation(s)
- Pongsak Wangrattanasopon
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Figueira-Coelho J, Pereira O, Picado B, Mendonça P, Neves-Costa J. The use of granulocyte colony-stimulating factor does not appear to reduce recovery time in penicillin-related agranulocytosis during the treatment of endocarditis. J Heart Valve Dis 2010; 19:810-811. [PMID: 21214116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Goerlich A. Error in route of administration of penicillin G potassium. J Am Vet Med Assoc 2010; 236:730; author reply 730. [PMID: 20397309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Abstract
A case of non-oliguric acute interstitial nephritis during treatment with ampicillin, benzylpenicillin and cephalothin is reported. There were symptoms of drug hypersensitivity, including fever, exanthema, eosinophilia and elevated serum IgE. Renal biopsy showed marked interstitial edema and infiltration with numerous eosinophils, some mononuclear cells and giant cells, and scattered tubular damage, but normal glomeruli and vessels. There was no pathological deposition of immunoglobulins or complement in the renal tissue. Renal function recovered after withdrawal of antibiotics and treatment with steroids. The findings suggest a drug-induced, hypersensitivity-mediated pathogenesis of the renal lesions, with participation of both humoral and cell-mediated immunological reactions.
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Abstract
Two cases of penicillin-induced and one case of cephalosporin-induced leucopenia are described. This unusual complication of widely used beta-lactam antibiotics can occur when these antibiotics are administered parenterally in high doses for prolonged periods (14 days or more). The close monitoring of the white cell count is important when treating patients with high doses of beta-lactam antibiotics for prolonged periods. We would like to emphasize that when penicillin- or cephalosporin-induced leucopenia is suspected, continuation with another beta-lactam antibiotic may be dangerous.
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Toma Y, Ishiki T, Nagahama K, Okumura K, Kamiyama T, Kohagura K, Kakihana A, Tana T, Ohya Y, Takishita S. Penicillin G-induced hemorrhagic cystitis with hydronephrosis. Intern Med 2009; 48:1667-9. [PMID: 19755771 DOI: 10.2169/internalmedicine.48.1842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Irritable urological symptoms with gross hematuria and bilateral lumbar pain developed when the patient received penicillin G for endocarditis. These symptoms were followed by renal insufficiency. A contrast-enhanced abdominal computed tomography (CT) scan revealed a thickened bladder wall, bilateral hydroureter and hydronephrosis, suggesting hemorrhagic cystitis complicated with urinary tract obstruction. Urine culture was negative. After discontinuation of penicillin G, all symptoms subsided and renal function recovered; hence, penicillin G seems to have been associated with hemorrhagic cystitis and acute kidney injury. Positive findings in the drug lymphocyte stimulation test (DLST) for penicillin G were consistent with this diagnosis.
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Affiliation(s)
- Yuichiro Toma
- The Third Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan.
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Kløvstad H, Høiby EA, Aavitsland P. [Antibiotic treatment of women with group B Steptococci during delivery?]. Tidsskr Nor Laegeforen 2008; 128:2467-2469. [PMID: 19096471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Transmission of group B Steptococci from mother to child during delivery may cause serious disease in some children, but this can be prevented by use of antibiotic treatment during delivery. We have estimated how antibiotic treatment of all pregnant carriers of group B streptococcus during delivery would affect the total antibiotic use in Norway. MATERIAL AND METHODS We estimated the use of penicillin G for treatment of 10 %, 20 % and 30 % of streptococcus carriers among those delivering. The Medical Birth Registry was used to obtain number of births and the Norwegian Drug Wholesalers Database to obtain total use of the various substances. RESULTS If 30 % of delivering women were carriers of group B streptococcus and treated with penicillin G, the treatment would equal 2.8 % of today's total use of penicillin G and 0.09 % of the total use of the whole group of beta-lactam antibacterial agents, penicillins. INTERPRETATION Prophylactic antibiotic treatment of pregnant carriers of group B streptococcus during delivery would not lead to a substantial change in the current antibiotic use. The possibility of increasing antibiotic resistance should not be a main argument against using antibiotics in prevention of group B streptococcus infection in newborns.
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Affiliation(s)
- Hilde Kløvstad
- Avdeling for infeksjonsovervåking Nasjonalt folkehelseinstitutt Postboks 4404 Nydalen 0403 Oslo.
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Berger EM, Galadari HI, Gottlieb AB. Unilateral facial paralysis after treatment of secondary syphilis. J Drugs Dermatol 2008; 7:583-585. [PMID: 18561591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Bell's palsy is an acute facial paralysis of unknown etiology. Infections including syphilis have been implicated as causes for peripheral facial paresis. The Jarisch-Herxheimer reaction is an acute worsening of skin manifestations and systemic symptoms occurring after administration of antimicrobial therapy for spirochetal infections. Although rare, neurological signs can present as part of the Jarisch-Herxheimer reaction. The authors report a case of Bell's palsy experienced by a patient shortly after treatment with penicillin for secondary syphilis and propose that this acute unilateral peripheral facial paralysis was a Jarisch-Herxheimer reaction in response to therapy.
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Frigas E, Park MA, Narr BJ, Volcheck GW, Danielson DR, Markus PJ, Olson KEK, Schroeder DR, Kita H. Preoperative evaluation of patients with history of allergy to penicillin: comparison of 2 models of practice. Mayo Clin Proc 2008; 83:651-62. [PMID: 18533082 DOI: 10.4065/83.6.651] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study whether allergy consultation and penicillin allergy skin testing affects the selection of antibacterial prophylaxis perioperatively in surgical patients with history of allergy to penicillin (HOAP). PATIENTS AND METHODS From January 1 through June 30, 2004, we compared 2 different models of practice at our institution. At the Preoperative Evaluation Clinic (POEC), all patients with HOAP are evaluated by an allergist and undergo skin testing for allergy to penicillin. At other (non-POEC) preoperative evaluation settings (OPES), patients with HOAP do not undergo allergy consultation and penicillin skin testing before surgery. Of the 4889 patients screened at the POEC during the study period, 412 consecutive patients with HOAP were included in the study. Of the 416 patients screened at OPES, 69 consecutive patients with HOAP were studied. Logistic regression was used to assess whether allergy consultation was associated with the choice of antibiotic for antibacterial prophylaxis perioperatively, after adjusting for age, sex, and type of surgery. RESULTS Perioperative cephalosporin use was greater among patients screened at POEC vs those screened at OPES (70% vs 39%, P<.001 unadjusted; P=.04 adjusted for age, sex, and type of surgery). Vancomycin use was lower for patients screened at POEC vs those screened at OPES (10% vs 28%, P<.001 unadjusted; P=.03 adjusted). CONCLUSION For patients with HOAP, evaluation at the POEC was associated with increased use of cephalosporin and decreased use of vancomycin.
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Affiliation(s)
- Evangelo Frigas
- Division of Allergic Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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Abstract
BACKGROUND Little is known about the development of drug allergy during pregnancy or in patients with altered immune status. OBJECTIVE To report a case of new-onset penicillin allergy during pregnancy in a woman with rheumatoid arthritis. METHODS A 39-year-old woman with rheumatoid arthritis developed intrapartum anaphylaxis that led to fetal demise. She had previously received penicillin-based antibiotics without any allergic reactions. Because of group B streptococcus colonization, an intravenous infusion of penicillin G was started during labor. Within minutes, she developed severe anaphylaxis. RESULTS A fluorescent enzyme immunoassay revealed a moderate level of specific IgE to penicilloyl G and penicilloyl V (3.15 kU/L and 2.77 kU/L, respectively). Given the patient's history, these positive results were considered confirmatory of penicillin allergy. This case raises a number of salient points. First, patients can develop severe allergy to penicillin despite having safely received penicillins in the past. Possible factors that influenced the development of severe penicillin sensitivity in this patient are discussed. Second, unexpected intrapartum anaphylaxis can occur, which can be life threatening to the mother or fetus. Third, safe and reliable methods for diagnosis of drug allergy must be available. CONCLUSIONS This case illustrates that during the current unavailability of skin testing reagents in the United States, a positive result on in vitro testing can be helpful in confirming penicillin allergy in cases in which drug challenge is deemed unsafe.
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Affiliation(s)
- Javed Sheikh
- Department of Medicine, Division of Allergy & Inflammation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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25
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Abstract
BACKGROUND Identification of risk factors is an integral part of a physician's evaluation of a patient. OBJECTIVE To determine whether female sex is an independent risk factor for penicillin allergy. METHODS Rates of positive penicillin skin test (PST) results, according to sex, were determined in patients with a history of penicillin allergy undergoing penicillin allergy evaluation with major and minor determinants of penicillin between June 1, 2002, and June 30, 2004. Univariate and multivariate logistic regression analyses were used to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for sex differences in the rates of positive PST results. RESULTS Of the 1,921 patients, 1,759 underwent PST and 157 did not; 5 medical records were not available for review. The mean patient age was 60 years. Sixty-four patients (4%) had a positive PST reaction; of these, 53 (83%) were females and 11 (17%) were males (OR, 3.6; 95% CI, 1.9-7.2; P < .001). In a multivariate logistic regression analysis adjusted for age, history of multiple drug allergies, and elapsed time from the initial penicillin adverse drug reaction to PST, female sex again had a significant risk of a positive PST reaction (OR, 3.2; 95% CI, 1.6-6.7; P = .001). CONCLUSION A greater risk of penicillin allergy exists in association with female sex in patients with a history of penicillin allergy.
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Affiliation(s)
- Miguel A Park
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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26
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Olsén L, Ingvast-Larsson C, Broström H, Larsson P, Tjälve H. Clinical signs and etiology of adverse reactions to procaine benzylpenicillin and sodium/potassium benzylpenicillin in horses. J Vet Pharmacol Ther 2007; 30:201-7. [PMID: 17472651 DOI: 10.1111/j.1365-2885.2007.00851.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Case reports of 59 horses reacting adversely to procaine benzylpenicillin or to sodium or potassium benzylpenicillin in Sweden in 2003-2005 were obtained through contacts with horse-owners. For the assessment of the reports, various parameters were evaluated, such as the times to the reactions, information on previous penicillin treatment, the clinical signs and the actions taken in the reacting horses. Among the reports, two horses had received sodium or potassium benzylpenicillin intravenously, whereas the remaining 57 horses had been treated with procaine benzylpenicillin intramuscularly. Allergy may underlie the adverse reactions in the horses given sodium and potassium benzylpenicillin, and in a few of the horses given procaine benzylpenicillin. However, in most horses in the latter group, the clinical signs may be due to the toxic effects of procaine. In these horses, the dominating clinical signs were locomotor and behavioral changes. Some risk factors may enhance the probability that horses react to procaine. One is repeated injections, which increase the likelihood of intravascular administration and also may increase the sensitivity to procaine due to neuronal sensitization (kindling). Procaine is rapidly hydrolyzed by plasma esterases to nontoxic metabolites. When high amounts of procaine enter the circulation, the hydrolyzing capacity may be exceeded and toxicity occurs. Analyses of plasma esterases from reacting horses showed lower activity than in nonreacting control horses. Low esterase activity may increase the possibility of procaine toxicity and constitute another risk factor.
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Affiliation(s)
- L Olsén
- Division of Pathology, Pharmacology and Toxicology, Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, Uppsala, Sweden.
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27
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Walton AL, Howden BP, Grayson LM, Korman TM. Continuous-infusion penicillin home-based therapy for serious infections due to penicillin-susceptible pathogens. Int J Antimicrob Agents 2007; 29:544-8. [PMID: 17398076 DOI: 10.1016/j.ijantimicag.2006.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Revised: 10/27/2006] [Accepted: 10/30/2006] [Indexed: 11/28/2022]
Abstract
To evaluate the feasibility of continuous-infusion (CI) penicillin in the treatment of serious bacterial infections, consecutive adult patients with deep-seated infections due to penicillin-susceptible pathogens were treated with CI aqueous penicillin G in a home-based programme, and their treatment outcomes were reviewed. Thirty-one patients with microbiologically proven infections completed the planned course of treatment. Twenty of 31 (65%) were followed for at least 2 months thereafter, and all remained free of relapse. One patient had fever attributable to penicillin hypersensitivity, two patients developed catheter-site infections and one patient developed catheter-related bacteraemia. Thus, CI penicillin is feasible for the home-based treatment of a variety of deep-seated infections with minimal toxicity.
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Affiliation(s)
- Aaron L Walton
- Infectious Diseases Department, Monash Medical Centre, Clayton, Australia.
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Abstract
Nicolau Syndrome, also known as livedo-like dermatitis (LLD) or embolia cutis medicamentosa (ECM) is an infrequent complication following intramuscular and intra-articular injection of various drugs. This rare entity is characterized by severe pain and erythematous-ecchymotic reticular lesions at the injection site, which in many cases lead to necrotic ulcers and scarring. We report three cases of Nicolau Syndrome following injection of diclofenac, penicillin G, and cyanocobalamin.
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Affiliation(s)
- Kelli Luton
- PGY-2 Dermatology Resident at the University of Oklahoma in Oklahoma City, Department of Dermatology, Oklahoma University Health Sciences Center of Dermatology, OK 73104, USA
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Spanou Z, Keller M, Britschgi M, Yawalkar N, Fehr T, Neuweiler J, Gugger M, Mohaupt M, Pichler WJ. Involvement of drug-specific T cells in acute drug-induced interstitial nephritis. J Am Soc Nephrol 2006; 17:2919-27. [PMID: 16943303 DOI: 10.1681/asn.2006050418] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Drug-induced interstitial nephritis can be caused by a plethora of drugs and is characterized by a sudden impairment of renal function, mild proteinuria, and sterile pyuria. For investigation of the possible pathomechanism of this disease, drug-specific T cells were analyzed, their function was characterized, and these in vitro findings were correlated to histopathologic changes that were observed in kidney biopsy specimens. Peripheral blood mononuclear cells from three patients showed a proliferative response to only one of the administered drugs, namely flucloxacillin, penicillin G, and disulfiram, respectively. The in vitro analysis of the flucloxacillin-reactive cells showed an oligoclonal immune response with an outgrowth of T cells bearing the T cell receptor Vbeta9 and Vbeta21.3. Moreover, flucloxacillin-specific T cell clones could be generated from peripheral blood, they expressed CD4 and the alphabeta-T cell receptor, and showed a heterogeneous cytokine secretion pattern with no clear commitment to either a Th1- or Th2-type response. The immunohistochemistry of kidney biopsies of these patients revealed cell infiltrations that consisted mostly of T cells (CD4+ and/or CD8+). An augmented presence of IL-5, eosinophils, neutrophils, CD68+ cells, and IL-12 was observed. In agreement with negative cytotoxicity assays, no cytotoxicity-related molecules such as Fas and perforin were detected by immunohistochemistry. The data indicate that drug-specific T cells are activated locally and orchestrate a local inflammation via secretion of various cytokines, the type of which depends on the cytokine pattern secreted and which probably is responsible for the renal damage.
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Affiliation(s)
- Zoi Spanou
- Division of Allergology, Clinic of Rheumatology and Clinical Immunology/Allergology, PKT2, D572, Inselspital, CH-3010 Bern, Switzerland
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Torres MJ, Blanca M. Importance of skin testing with major and minor determinants of benzylpenicillin in the diagnosis of allergy to betalactams. Statement from the European Network for Drug Allergy concerning AllergoPen withdrawal. Allergy 2006; 61:910-1. [PMID: 16867041 DOI: 10.1111/j.1398-9995.2006.01047.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M J Torres
- Allergy Service, Carlos Haya Hospital, Málaga, Spain
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31
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Pujal Herranz M, Roca Massa M, Domínguez Tordera P, Codina Jané C, Ribas Sala J. Desensibilización de cotrimoxazol, rifampicina y penicilina G en nueve pacientes con hipersensibilidad previa. Farmacia Hospitalaria 2006; 30:254-9. [PMID: 17022720 DOI: 10.1016/s1130-6343(06)73984-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To present a protocol for the administration and development technique of the desensitization regimens for cotrimoxazole, rifampicin and penicillin G hypersensibility. METHOD A review of the available desensitization protocols for these antibiotics and a retrospective study of desensitization processes undertaken in the center from 1998. A development technique of the antibiotic dosages was designed. RESULTS Desensitization regimens for cotrimoxazole, rifampicin and penicillin G undertaken in the center in 9 patients came from a protocol by Glucksteins et al., Holland et al. and Wendal et al., respectively. After the literature review and the satisfactory results that allowed subsequent antibiotic administration in the 9 cases, these regimens were established as protocols of the center. CONCLUSIONS Dosage development and patient administration have a practical application and can help to decrease the potential mistakes related to the complexity of the process.
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Abstract
OBJECTIVE To report a case of Jarisch–Herxheimer reaction (JHR) in a patient with presumed neurosyphilis and HIV. CASE SUMMARY A 45-year-old HIV-positive man (CD4+ count 450 cells/mm3 and history of AIDS-defining illness) presented with JHR after an initial intravenous dose of penicillin G for presumed neurosyphilis. The patient described feeling cold with worsening headache and chills approximately one hour after infusion of the first dose of penicillin. On examination, rigors, shallow inspirations, and chills were noted. He was afebrile, tachycardic, and tachypneic and had an oxygen saturation of 94% while breathing room air. His symptoms resolved within 10 minutes. Initially, this reaction was thought to be a result of a drug allergy, but upon further review, we determined that it was JHR. DISCUSSION It is not uncommon to confuse drug allergy with JHR. An objective causality assessment suggests that the JHR in our patient was probably related to penicillin. JHR is a self-limiting condition that warrants the continuation of antibiotic treatment in syphilis patients. CONCLUSIONS JHR should be an anticipated reaction to early doses of antibiotic treatment for treponemal diseases, such as syphilis. Treatment of JHR is largely supportive, such as administering antipyretic and antiinflammatory agents. Antibiotic treatment should be continued.
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Affiliation(s)
- Sharon See
- College of Pharmacy and Allied Health Professions, St. John's University, Queens, NY 11439, USA.
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Abstract
Syphilis has challenged scientists and clinicians since its first appearance in the late 1400s and debate continues to surround the best practice in management. Difficulties in defining the goals of successful treatment have contributed to problems in determining recommendations for the ideal management. Treatment regimens currently in use were developed before randomised controlled trials became standard. This, combined with national differences in disease definition, staging and varying interpretations of the studies, as well as the emergence of complicating comorbid conditions, such as HIV, has resulted in a lack of consensus for treatment. This paper will discuss the history and current treatment of syphilis focusing on dilemmas faced by clinicians today, including the emergence of a resistant strain. Despite the difference between current national guidelines, penicillin G largely remains the treatment of choice. Close follow up, monitoring and ensuring adequate compliance remain the most important aspects in the treatment of syphilis.
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Affiliation(s)
- Linda Dayan
- Sexual Health Department, Royal North Shore Hospital, Clinic 16, Block 3, Pacific Highway, St Leonards, Sydney, 2065, Australia.
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García-Avilés C, Sanz ML, Gamboa PM, Urrutia I, Antépara I, Jauregui I, De Weck AL. Antigen specific quantification of sulfidoleukotrienes in patients allergic to Betalactam antibiotics. J Investig Allergol Clin Immunol 2005; 15:37-45. [PMID: 15864881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND After in vitro allergen-specific stimulation, basophils become activated and release sulfidoleukotrienes LTC4, LTD4 and LTE4. This can be detected by means of the CAST assay. We assessed the positivity criteria and the reliability of antigen-specific sulfidoleukotriene production (CAST) in the in vitro diagnosis of betalactam (BL) allergic patients. MATERIAL AND METHODS We studied a sample of 67 patients (age 48.94 +/- 15.76 years) who had presented with anaphylaxis or urticaria-angioedema within the first 60 minutes after administration of Amoxicillin (54/67), Penicillin G (7/67), Cefuroxime (5/67) or Cefazoline (1/67). All of them had a positive skin test to at least one of the antigenic determinants of Penicillin. As control group 30 adults with negative skin tests who tolerated BL were included. All of them underwent skin tests, oral provocation tests, specific IgE (CAP-FEIA, Pharmacia) and CAST. RESULTS Positivity criteria were established by means of ROC curves: a sLT release induced by Betalactams of at least 100 pg/ml and greater than or equal to 3 times the basal value. The overall sensitivity of CAST is 47.7% and specificity 83.3%. Sensitivity of specific IgE is 37.8% and specificity 83.3%. CONCLUSIONS We have established validated positivity criteria for the CAST technique in patients allergic to Betalactams. This technique is a useful in vitro diagnostic method in patients with IgE-mediated allergy to Betalactam antibiotics.
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Affiliation(s)
- C García-Avilés
- Departamento de Alergología e Inmunología Clínica, Clínica Universitaria de Navarra, Pamplona, Spain.
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Brügger-Andersen T, Reiersen R. [A 34-year-old man with hemorrhagic cystitis]. Tidsskr Nor Laegeforen 2004; 124:3075-7. [PMID: 15593448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND A 34-year-old male presented with macroscopic haematuria, abdominal pain and dysuria while being treated with penicillin for bacterial endocarditis. All blood cultures yielded Streptococcus mutans. After four weeks of treatment he developed haemorrhagic cystitis, thrombophlebitis and eosinophilia. The symptoms disappeared when he was taken off penicillin. After change of medication to ceftriaxone, the patient developed reversible neutropenia and recovered completely. INTERPRETATION Haemorrhagic cystitis caused by penicillin can be potentially fatal; two cases have earlier been described. Because of cross reaction this patient also developed reversible neutropenia. It is well known that beta-lactam antibiotics can induce severe neutropenia.
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Sachs B, Al Masaoudi T, Merk HF, Erdmann S. Combined in vivo and in vitro approach for the characterization of penicillin-specific polyclonal lymphocyte reactivity: tolerance tests with safe penicillins instead of challenge with culprit drugs. Br J Dermatol 2004; 151:809-16. [PMID: 15491421 DOI: 10.1111/j.1365-2133.2004.06238.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Amino-penicillins are a major cause of delayed-type reactions to penicillins. OBJECTIVES The aim of this study was to establish a diagnostic approach for the characterization of the individual penicillin-specific polyclonal lymphocyte reactivity in order to detect side chain-specific sensitization to amino-penicillins. Patients can then be advised to undergo a tolerance test with safe penicillins instead of provocation with culprit penicillins for confirmation of penicillin allergy. METHODS We investigated penicillin-specific polyclonal lymphocyte reactivity in nine patients with delayed-type reactions to amino-penicillins by a combined in vivo (patch, prick and intracutaneous tests with delayed readings) and in vitro (lymphocyte transformation test, LTT) approach. RESULTS A combination of LTT and skin tests improved the sensitivity for the characterization of penicillin-specific polyclonal lymphocyte reactivity and allowed the detection of three different patterns of lymphocyte reactivity. Four patients showed a side chain-specific sensitization to amino-penicillins in vivo and in vitro and were advised to undergo tolerance tests with safe penicillins. Two patients agreed and were exposed to parenteral benzyl-penicillin and oral phenoxymethyl-penicillin which they tolerated without complications. CONCLUSIONS These data suggest that a combined in vivo and in vitro approach is helpful for the detection of side chain-specific sensitization to amino-penicillins. Patients with such sensitization are very likely to tolerate safe penicillins, thereby expanding their therapeutic options when antibiotic treatment is required.
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Affiliation(s)
- B Sachs
- Department of Dermatology and Allergology, Rheinisch-Westfälische Technische Hochschule Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
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Abstract
BACKGROUND Short-course treatment of meningococcal disease (including meningitis) with 4-5 days of an i.v. beta-lactam is of proven efficacy. Since April 1998, all adult patients with meningococcal disease admitted to Auckland Hospital were prospectively treated with 3 days of i.v. benzylpenicillin. AIMS To assess the clinical features, laboratory findings, disease complications and outcome of patients with meningococcal disease prospectively treated with 3 days of i.v. benzylpenicillin. METHODS A retrospective chart review of all adult patients with meningococcal disease admitted to Auckland Hospital from April 1998 to December 2002 was conducted. RESULTS Ninety patients with definite (n = 72) or -probable (n = 16) meningococcal disease were admitted during the study period. Two were excluded on the basis of treatment duration. The remaining 88 patients received a mean +/- standard deviation duration of treatment of 3.1 +/- 0.5 days (excluding those who died while receiving treatment). Six patients (7%) died, four of whom while on treatment. There were no relapses. CONCLUSION Three days of i.v. benzylpenicillin for the treatment of adults with meningococcal disease is effective.
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Affiliation(s)
- S Briggs
- Infectious Diseases Unit, Auckland Hospital, Auckland, New Zealand
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Zeglaoui F, Dziri C, Mokhtar I, Ezzine N, Kharfi M, Zghal M, Fazaa B, Kamoun MR. Intramuscular bipenicillin vs. intravenous penicillin in the treatment of erysipelas in adults: randomized controlled study. J Eur Acad Dermatol Venereol 2004; 18:426-8. [PMID: 15196155 DOI: 10.1111/j.1468-3083.2004.00938.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of the study was to evaluate the efficacy of intramuscular penicillin: mixture of benzyl penicillin and procain penicillin (2 MU x 2 times daily) and intravenous benzyl penicillin (4 MU x 6 times daily) in the treatment of hospitalized adult patients with erysipelas. A prospective randomized unicentric trial was conducted. In total, 112 patients entered the study; 57 in the intramuscular group and 55 patients in the intravenous group completed the trial. The failure rate was 14% for intramuscular group and 20% for the intravenous group (P = 0.40). Local complications such as of the leg abscesses were observed in the two groups (intravenous 9.1%, intramuscular 7%; P = 0477). Of the patients treated with intravenous benzyl penicillin, 25.5% presented complications related to the route (venitis). Intramuscular penicillin should be considered an effective and well-tolerated treatment of erysipelas in adult patients.
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Affiliation(s)
- F Zeglaoui
- Department of Dermatology, Hopital Charles Nicolle Boulevard du 9 Avril 1006, Tunis, Tunisia
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40
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Abstract
Summary Penicillin causes immune haemolytic anaemia by the 'drug-adsorption' mechanism and typically occurs after prolonged exposure to large doses of the drug. Withdrawal of the drug is associated with improved red cell survival and gradual cessation of haemolysis. Although this complication is uncommon, it can be potentially serious. An unusual case is described herein. The patient was exposed to a short course (9 days) of standard dose penicillin but suffered acute severe haemolysis about 1 week after cessation of therapy. A high titre anti-penicillin antibody (1 : 512) not cross-reacting with cephalosporins, was demonstrated. The delay in the development of immune haemolysis vis-à-vis penicillin therapy may be due to the patient being immunologically naive to the drug. Penicillin may persist for weeks in circulation, coating red cells and providing continued antigenic stimulation for the development of anti-penicillin antibody.
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Affiliation(s)
- W K Ho
- Department of Haematology, Austin and Repatriation Medical Centre, Melbourne, Australia.
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41
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Zdziarski P. Role of pencillin binding proteins in pencillin allergy. Pol J Microbiol 2004; 53:243-7. [PMID: 15790073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
All beta-lactam sensitive bacteria contain enzymatic penicillin binding proteins (PBPs), which are membrane-bound enzymes and targets of beta-lactam antibiotics. In this work evaluation of the significance of PBPs in immune response to benzylpenicillin was presented. 35 patients with allergic reactions to penicillin and 17 subjects without penicillin allergy, but exposed, were studied. Proliferative T-cell responses to benzylpenicillin, penicillin and PBPs conjugates (Pc-PBPs) from E. coli, K. oxytoca, S. aureus, S. epidermidis or serum protein (Pc-S) were measured. Although each allergic individual responds to Pc-PBPs in several different ways, specific proliferation of T lymphocytes with Pc-PBPs from bacterial membranes was significant higher than with Pc or Pc-S. This observation gives us a real insight into the causes of the drug allergy: individual allergic reaction and susceptibility to the drug is in strict correlation with bacterial infection. It seems likely that acylation of PBPs could be the trigger for primary immune response to the hapten benzylpenicillin.
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Borch JE, Bindslev-Jensen C. [Investigation of penicillin allergy. Procedures and retrospective statement of results for the period 1997 to 2001]. Ugeskr Laeger 2003; 165:3157-61. [PMID: 12968411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION We describe procedures in and findings of investigation for allergy to penicillin as it was performed at the Dermatological Department and the Allergy Centre of Odense University Hospital in the 5-year period 1997-2001 and compare history with findings on skin tests and systemic challenge. MATERIAL AND METHODS Retrospective evaluation of findings in the investigation of penicillin allergy. A total of 109 patients with a history of reaction to treatment with penicillins and a negative specific IgE for penicillins G and V were successively skin prick tested, intracutaneously skin tested, challenged orally and by intramuscular injection. Further testing was cancelled when a positive result occurred. RESULTS Fifteen of 109 (13.7%) had positive reactions on investigation. There was no correlation between the type and severity of cutaneous or systemic reactions to penicillin or presence of other allergies and test positivity or negativity. 20% of the test-positive developed severe systemic reactions (respiratory, cardiovascular) upon systemic challenge. DISCUSSION 13.7% in a selected patient material with a history of penicillin allergy and negative specific IgE were found to have reaction to penicillin upon investigation. A high percentage of patients (20%) experienced systemic reactions to provocation. This finding has resulted in new procedures for the investigation of allergy to penicillin in our clinic.
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Affiliation(s)
- Jakob E Borch
- Odense Universitetshospital, Allergicentret, Dermatologisk Afdeling I, Sdr. Boulevard 29, DK-5000 Odense C.
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Scala E, Giani M, Pastore S, Pallotta S, Guerra EC, Pirrotta L, Locanto ML, Frezzolini A, De Pità O, Puddu P. Distinct delayed T-cell response to beta-methasone and penicillin-G in the same patient. Allergy 2003; 58:439-44. [PMID: 12752333 DOI: 10.1034/j.1398-9995.2003.00117.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multiple drug allergy syndrome is a clinical condition characterized by reactions against more than one different class of, both pharmacologically and structurally, unrelated drugs. Scanty data are available to date about a multiple drug delayed hypersensitivity syndrome. Our aim was to report the case of a delayed reaction to both beta-methasone (beta-MT) and penicillin-G (pen-G) occurring in the same patient, and analyse beta-MT- and pen-G-specific T-cell Lines (TCLs) with regard to their specificity, phenotype and cytokine profile. METHODS We generated two drug-specific TCLs from biopsies at the site of positive intradermal reactions, and analysed their immunophenotype, T-cell receptor Vbeta (TCR-Vbeta) domains expression and cytokine profile. RESULTS We demonstrated the specificity of the T cells isolated from positive intradermal test reactions to pen-G and beta-MT through the strict dose-dependent proliferation in response to drug-pulsed autologous antigen presenting cells. Fluorescence activated cell sorter (FACS) analysis revealed a predominance of CD4+ cells in the inflammatory cell infiltrate of intradermal test with beta-MT, while a predominance of CD8+ T cells in the site of delayed reaction to pen-G was found. The drug specific CD4+ and CD8+ T cells were heterogeneous, with regard to TCR-Vbeta usage. CD8+ pen-G-TCL displayed a preferential T helper 2 (Th2) profile, while a substantially heterogeneous pattern of cytokine production characterized specific beta-MT TCL. CONCLUSION The study describes the coexistence in the same patient of a delayed hypersensitivity to both penicillin G and beta-MT, driven, respectively, by pen-G-specificTh2-skewed CD8+ and beta-MT specificTh0 CD4+ T cells. This case further support the existence of a multiple drug allergy syndrome also for delayed hypersensitivity.
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Affiliation(s)
- E Scala
- Istituto Dermopatico dell'Immacolata - IDI, IRCCS, Department of Onco-Immuno-Dermatology, Rome, Italy
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Affiliation(s)
- C J Waller
- Trauma and Orthopaedics Dorset County Hospital Williams Avenue Dorchester Dorset DT1 2JY UK.
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Scala E, Giani M, Pirrotta L, Guerra CE, Locanto M, De Pità O, Pietro P. Double allergy to the same drug in the same patient. Allergy 2003; 58:160-1. [PMID: 12622752 DOI: 10.1034/j.1398-9995.2003.00056_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zdziarski P. [Role of bacterial infection in the pathophysiology of benzylpenicillin allergy]. Pol Merkur Lekarski 2003; 14:50-4. [PMID: 12712830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
In this paper current data on the pathogenesis of benzylpenicillin allergy is presented. Individual allergic reaction and susceptibility for the drug perhaps is not related to chemical properties of benzylpenicillin. An association between bacterial infection and allergy to benzylpenicillin is reviewed.
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Abstract
The clinical manifestation of human infections with Pasteurella multocida is most often cellulitis and this pathogen rarely causes septicaemia. We describe 2 Swedish patients with P. multocida septicaemia who were admitted to the same ward within the space of 7 months.
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Affiliation(s)
- Andreas Berge
- Divisions of Infectious Diseases, Karolinska Institutet, Karolinska Hospital, Stockholm
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Abstract
OBJECTIVES To determine the pattern of penicillin use in the treatment of pneumococcal pneumonia, and factors contributing to the use of alternative antibiotics. METHODS This study included all adult inpatients of St. Vincent's Hospital and Medical Center who had documented pneumococcal pneumonia between December 1998 and October 1999. St. Vincent's is a 600 bed tertiary teaching hospital in New York City. Patients who had Streptococcus pneumoniae isolated from a respiratory tract specimen were identified through microbiology laboratory records. A retrospective chart review of these patients was conducted, and those identified with clinical pneumonia were included in this study. Antibiotic use, patient demographics, resistance data, and clinician awareness of the antibiotic susceptibility results were noted. RESULTS Sixty adult patients hospitalized with documented pneumococcal pneumonia were identified. Thirteen (21.6%) of the 60 patients received penicillin or ampicillin. Susceptibility results were not noted in the medical record in 21 (35.0%) of the 60 patients, and none received penicillin. High rates of reported penicillin allergy in 8 (13.3%) of the 60 patients, and reluctance to use penicillin when isolates demonstrated intermediate susceptibility in 8 (13.3%) of the 60 patients were observed. CONCLUSIONS Several remediable obstacles to penicillin use were identified in this study. An increased awareness of susceptibility results by physicians and education of practitioners could have increased the use of penicillin as therapy to two-thirds of these patients.
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Affiliation(s)
- J A Nord
- Section of Infectious Diseases, Department of Medicine, St. Vincent's Hospital and Medical Center, New York, New York 10011, USA.
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Zdziarski P. [Difficulties with using T lymphocyte culture as a method for diagnosing allergies to benzylpenicillin]. Wiad Lek 2002; 55:81-7. [PMID: 12043320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The activation of T lymphocytes upon antigen stimulation plays a crucial role in adverse immune responses including drug-specific hypersensitivity reactions. The helpfulness of conventional tritiated thymidine incorporation assay for penicillin allergy diagnostics is limited. Benzylpenicillin, as a reactive compound, constitutes typical example of hapten. Most of research on penicillin hypersensitivity use benzylpenicillin-albumin (BPO-HSA) conjugates. Thus in this study we describe an in vitro proliferation assay with benzylpenicillin or penicillin and autologous serum protein conjugates. Interestingly these conjugates enhanced incorporation of tritiated thymidyne, when benzylpenicillin did not exert an influence on PBMCs proliferation (correlation coefficient r = -0.0119). This so-called carrier-effect indicates that benzylpenicillin and serum globulin complexes can take part in penicillin allergy (primary immune response). Optimal secondary response is obtained when the benzylpenicillin bind the same carrier for both primary and secondary immunization. Father-proliferation assay with modification of responses to phytohaemagglutinin by benzylpenicilloilated serum protein results in significant decrease of incorporation of [3H] thymidyne. Otherwise benzylpenicillin did not modify postmitogenic proliferation of PBMCs. Our findings indicate that the use of penicillin and autologous serum protein conjugates is helpful. This study show the manner in which benzylpenicillin forms T-cell epitopes.
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Zhibang Y, BiXia Z, Qishan L, Lihao C, Xiangquan L, Huaping L. Large-scale outbreak of infection with Mycobacterium chelonae subsp. abscessus after penicillin injection. J Clin Microbiol 2002; 40:2626-8. [PMID: 12089291 PMCID: PMC120593 DOI: 10.1128/jcm.40.7.2626-2628.2002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An outbreak of infection with Mycobacterium chelonae subsp. abscessus after the injection of penicillin in 86 patients attending a factory hospital is reported. The bacterium was isolated both from lids and from the soil where the drug was stored. Molecular analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of whole-cell proteins and plasmids revealed a pattern identical to that of the strains isolated from the wounds. The source of the infections was soil contamination of the vial lids and was caused by improper use and sterilization of penicillin vials.
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Affiliation(s)
- Yang Zhibang
- Department of Microbiology, Chongqing University of Medical Science, Chongqing, People's Republic of China 400016.
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