1. Aerococcus Viridans sepsis in a hemodialysis patient Mediterraneo Hospital- March 23, 2011 Tsoutsos Elias (1), Fili Konstantina (1), Merentiti Vassiliki (1), Akrivos Theodoros (1), Giannopoulou Sappho (2), Augustianos Charalambos(2) (1) Mediterraneo Hospital Renal (Kidney) Clinic,(2) Mediterraneo Hospital Microbiology Lab
Aerococcus Viridans organisms are gram-positive saprophytic cocci which rarely impact on humans (on a number of occasions they have only been accused of causing bacteraemia to immunosuppressed patients). They are normally detected in hospitalised patients as well as marine organisms and are known to be fatal for lobsters. In humans such air-borne cocci may be found in the upper respiratory tract and the skin; they have only seldom been incriminated as a cause of meningitis, endocarditis, bacteraemia and urinary tract infections. This case of Aerococcus Viridans sepsis in a dialysis patient is a first in currently available bibliography. CASE STUDY: Male, age 68, end-stage polycystic kidney disease patient undergoing hemodialysis as of November 1989, suffering from both triple vessel disease (was operated on in 2000) and cardiac failure (EF= 30%), was admitted to our Kidney Clinic as a serious case, in a state of confusion, with symptoms of dyspnoea, orthopnoea, tachypnoea (40-45 breaths/min), low arterial pressure (AP=70/40mmHg), tachycardia (100 beats/min), fever with chills up and body temperature up to 39οC, the afore-stated arousing suspicions over possible sepsis or endocarditis (cause unknown). Lab and imaging tests which were performed right away gave: Ht=41.7%, PLT=166, WBC=1770 (d=81%) Κ+=4.3, ESR=10, CRP=34.3. Chest radiograph showed infiltrations in the right lower lung field and a triplex unveiled heart chamber dilation as well as serious left ventricular systolic dysfunction with anterior, low/mid-abdominal wall akinesia, moderate mitral valve failure, left ventricular dilation and right cavities within normal value range. Patient was placed blindly on vancomycin-ceftazidime & amikacin after blood cultures were sent to the lab. Upon day two, his condition had not changed: patient was still feverish while test results showed hepatic enzymes had risen considerably (SGOT=1591, SGPT=1216, LDH=1005, total cholesterol=2.18, dir. chol.=1.01) and white cell count stood at 4260. Blood cultures detected Aerococcus Viridans sensitive to penicillin, ampicillin, vancomycin and tetracycline. Given blood culture outcome, patient was next treated with vancomycin. On day three, fever was gone and nine days after having been admitted he was discharged in an overall excellent condition. CONCLUSION: Let it be noted that Aerococcus Viridans infections, though quite rare and found solely in immunosuppressed patients, should be considered in cases of hemodialysis patients (who are moreover immunosuppressed). The fact that Aerococcus Viridans resembles streptococcus viridans stands in the way of drawing a safe conclusion; it is imperative there be further processing and incubation thereof in the lab. It is self-evident that close collaboration between physicians and the lab is fundamental so as to properly investigate, assess and treat patients effectively.
• Child, Adolescent and Adult Psychiatry • Medical Director – The Child & Family • Voluntary Faculty – Virginia Commonwealth University (Psychiatry in Family Practice) • Voluntary Faculty – George Washington University School of Medicine (4th Year Medical Students) • Voluntary Faculty – Georgetown Medical School • To become familiar with the different classes of medi
RN0460256 ARC Molecular and Materials Structure Network Annual Report to the ARC 2005-6 Prof. Cameron J. Kepert; [email protected]; 02-9351-5741 Dr Peter Turner; [email protected]; 02-9351-4270 MMSN Goals and 2005 Strategy and Activity The principal focus of the multi-disciplinary ARC Molecular and Materials Structure Network (MMSN) in 2005, has been to develop and e