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Routine maternal immunizations for all pregnant women
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Streptococcus pneumoniae infection is a significant health problem in the United States (27). It is estimated that 3000 cases of meningitis, 500,000 cases of pneumonia, and 7 million cases of otitis media are due to the pneumococcus. This translates into 175,000 hospitalizations and an adult fatality rate of 40,000 persons per year. With aging populations, an increasing antibiotic oesistance to S. pneumonia, and more adults immunosuppressed, the annual number of fatalities will rise.
Transplantation immunology
Published in Gabriel Virella, Medical Immunology, 2019
Satish N. Nadig, Jane C. Kilkenny
The initial proliferation of donor T cells takes place in lymphoid tissues, particularly in the liver and spleen (leading to hepatomegaly and splenomegaly). Later, at the peak of the proliferative reaction, the skin, liver, and intestinal walls are heavily infiltrated leading to severe skin rashes or exfoliative dermatitis, hepatic insufficiency, and severe diarrhea or even intestinal perforation. The splenic involvement results in a loss of function, not unlike that seen in splenectomized patients. The patients often develop Streptococcus pneumoniae bacteremia, and antibiotic prophylaxis may be necessary.
Respiratory Medicine
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Colin Wallis, Helen Spencer, Sam Sonnappa
Pneumonia usually begins as nasopharyngeal colonisation followed by spread into the lower respiratory tract. The source of the infection can be community acquired or nosocomial. Bacteria, viruses, atypical organisms and fungi are all known to cause pneumonia. Respiratory viruses appear to be responsible for approximately 40% of cases of community-acquired pneumonia in children who are hospitalised, particularly in those under 2 years of age, whereas Streptococcus pneumoniae is responsible for 27–44% of community-acquired pneumonia. Table 4.3 lists causative organisms according to age.
Enhancing efficacy of existing antibacterials against selected multiple drug resistant bacteria using cinnamic acid-coated magnetic iron oxide and mesoporous silica nanoparticles
Published in Pathogens and Global Health, 2022
Noor Akbar, Muhammad Kawish, Tooba Jabri, Naveed Ahmed Khan, Muhammad Raza Shah, Ruqaiyyah Siddiqui
Among multiple drug resistance (MDR) bacteria, Escherichia coli and Methicillin-resistant Staphylococcus aureus (MRSA) cause several infections including gastroenteritis, meningitis, urinary tract infections (UTIs), skin, respiratory, and other nosocomial infections [11–13]. Pseudomonas aeruginosa being a nosocomial pathogen causes 20% of hospital-acquired infections, bloodstream infections and is prevalent in patients with acute leukemia, burn wounds, cystic fibrosis, and organ transplants [14,15]. Serratia marcescens colonizes the intensive care unit and causes opportunistic infections [16]. A wide spectrum of invasive infections are caused by Klebsiella pneumonia including pneumonia, meningitis, pyogenic liver abscess, UTIs, bloodstream infection, and intra-abdominal infection etc [17]. Streptococcus pneumoniae causes pneumonia in children and has been isolated from patients with purulent pleuritis [18].
Evaluating ravulizumab for the treatment of children and adolescents with paroxysmal nocturnal hemoglobinuria
Published in Expert Review of Hematology, 2022
Justin J. Yoo, Satheesh Chonat
A primary concern for complement inhibition is its risk of infection, particularly Neisserial infection. We now routinely vaccinate patients against meningococcal serotypes ACWY and B, including booster recommendations as per Center of Disease Control recommendations [44]. Additionally, we ensure the patient is routinely vaccinated against 23-valent Streptococcus pneumoniae and Haemophilus influenzae. As part of the FDA’s black box warning, patients are strongly encouraged to be immunized with both meningococcal and pneumococcal vaccines at least 2 weeks before the first dose of ravulizumab, and if awaiting vaccination, to start antibiotic prophylaxis. With meningococcal immunization, there were no incidences of meningococcal disease in those small studies in pediatric aHUS and pediatric PNH. But surveillance studies have reported meningococcal infections with a risk of 0.5% per year or 1,000- fold to 2,000-fold higher when on eculizumab [45,46]. For these reasons, we routinely recommend penicillin prophylaxis in addition to vaccination for all children and adolescents with PNH while on complement inhibition. Additionally, these patients on complement inhibition remain vulnerable to infections from Neisseria gonorrhoeae, requiring education to patients on safe sexual practices [47]. Another theoretical concern specifically to ravulizumab is its higher affinity to the neonatal Fc receptor, which would competitively inhibit the recycling of normal immunoglobulins. However, a study by Roth et al. showed no evidence of hypogammaglobulinemia while on chronic ravulizumab therapy [48].
Delayed cerebral thrombosis complicating bacterial meningitis
Published in Acta Clinica Belgica, 2022
Sofie Depoortere, Jonas Toeback, Sophie Lunskens, Erwig Van Buggenhout, Regilio Oedit, Dimitri Hemelsoet
Patient characteristics are summarized in Table 1. Median age was 65 years. Approximately half (54%) of the patients were male. About one-third (35%) were known to have an otitis or sinusitis and one-quarter (26%) had an immunocompromised state. Patients were judged to be immunocompromised when they were using immunosuppressive drugs or had diabetes mellitus, chronic alcohol use, asplenia or HIV infection [1,11]. Presentation with the classic triad of fever, neck stiffness and impaired consciousness (defined as a score on the GCS ≤ 14) occurred in 70%. Most common symptom on initial presentation was impaired consciousness (86%). Brain CT was performed in 24 out of 28 patients. Brain abnormalities were found in four patients and included hydrocephalus, ventriculitis, cerebral edema and combined mastoiditis and pneumocephalus [11–13]. LP was performed to confirm the diagnosis of bacterial meningitis in all but one patient [9]. In the latter case, diagnosis was based upon clinical findings and positive blood cultures for Streptococcus pneumoniae [9]. Later in the disease course of this patient, particularly at the time of deterioration, LP was performed, revealing neutrophilic pleocytosis [9]. Streptococcus pneumoniae was the pathogen in 89% of cases. DCT occurred in two patients with Listeria monocytogenes meningitis and in one patient with Staphylococcus aureus meningitis [11,14].