Cyclophosphamide
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Cyclophosphamide Cerebral meningitis caused by penicillin-non-susceptible group B streptococcus:case report
A 41-year-old man developed cerebral meningitis secondary to penicillin-non-susceptible group-B Streptococcus (GBS) during treatment with cyclophosphamide for Langerhans cell histiocytosis. The man hospitalised with chills and fever for 4h. He had Langerhans cell histiocytosis, and he had been receiving cyclophosphamide [route and dosage not stated]. His significant medical history includes methicillin-susceptible Staphylococcus aureus cervical spine infection that occurred 3.years ago after surgery of his compression fracture. At the current admission, investigations showed Glasgow Coma Scale of 15 BP of 125/74mm.Hg, HR of 125.beats/min, temperature of 38.6°C and oxygenation rate of 98% on room air. Laboratory data findings showed leucocyte count of 15 700 cells/mm3 and elevated CRP were indicative of presence of bacterial infection. CSF-analysis and gram-staining carried out following lumbar puncture showed elevated pressure with a glucose level of 1 mg/dL, neutrophil count of 5954 cells/mm3, and protein level of 1245 mg/dL, suggestive of Streptococcus pneumoniae (S. pneumoniae) infection. Gram-staining of the spinal fluid showed gram-positive cocci in pairs and chains indicative that the infective organism was probably S. pneumoniae. After obtaining a CSF culture and two sets of blood culture, the man was commenced on ceftriaxone, vancomycin and dexamethasone following a diagnosis of bacterial meningitis due to S. pneumoniae. However, the growth of a β-haemolytic organism in the CSF culture on blood agar was observed. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis promptly identified presence of GBS. The serotype was confirmed to be Ib on the basis of agglutination test. On the basis of susceptibility studies, the isolate was confirmed to be penicillinnon-susceptible [duration of treatment to reaction onset not stated]. He showed satisfactory progress on the third day of admission. Ceftriaxone, vancomycin, and dexamethasone were continued for 4.days. The therapy was transitioned to definitive therapy comprising ampicillin. His inflammatory markers like WBC and CRP returned to near normal on day 10 and CSF culture was sterile with decreased neutrophil count. He recovered without neurologic sequelae and completed a 3-week treatment. Hirai J, et al. A case report of cerebral meningitis caused by penicillin-non-susceptible group B streptococcus in an immunocompromised adult patient. Infection and Drug 803497698 Resistance 13: 2155-2160, 2020. Available from: URL: http://doi.org/10.2147/IDR.S251250
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Reactions 22 Aug 2020 No. 1818
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