Case #1: Case #1 Alexa Simon MSIV September 19, 2007 UNC Infectious Disease


CC: Nausea vomiting, fever: CC: Nausea vomiting, fever HPI: 56 y/0 AAF with history significant for ovarian cancer stage IIIC with a complicated surgical history including debulking surgery in 2005, ileocecal resection, and recent repair of enterocutaneous fistula presented to Johnston Memorial with acute onset of nausea, vomiting, fever and abdominal pain.


HPI cont….: HPI cont….


HPI cont….: HPI cont….


Tumor History: Tumor History


Infection History: Infection History


Additional History: Additional History


Additional History: Additional History Meds Ceftazidine 2g IV q12 Flagyl 500mg q12 Linezolid 600mg q12 Micafungin 100 mg IV QD Dopamine GGT Morphine PRN Benadryl PRN Phenergan PRN Zofran PRN Allergies Zosyn: Rash Ace Inhibitors: Rash Vancomycin: Rash PCN: Rash Zofran: Rash


Physical Exam: Physical Exam


Slide10: Labs: Ca:7.4 Mg:1.9 Phos:4.6 GGT:122 Differential: ANC: 18.0↑ ALC:0.8 AMC: 0.8 AEC:0.2 ABC: 0 20.7 27.5 9.2 51 139 3.1 112 14 31 20.4 1.5 84 74 21.6 2.2 6.2


Radiology: Radiology


CT Adomen/ Pelvis: CT Adomen/ Pelvis


Radiology: Radiology


DISCUSSION………..: DISCUSSION………..


Slide30: TTE: Left Ventricle: hyperdynamic EF: 65-70% Mitral Valve: thickened with mild prolapse, moderate regurgitation Aortic Valve: trileaflet with mild thickening Right Ventricle: normal Tricupsid Valve: mild thickening with mobile echo from the atrial surface consistent with degenerative, disease and vegetation, with mild regurgitation Pulmonary Valve: not well imagine Microbiology: Urine Culture: gram positive cocci in chains Blood Culture (peripheral and central line): GPCs in chains and GPRs Abdominal abscess: GPCs in chains


Infectious Disease Diagnosis: Infectious Disease Diagnosis


B. cereus now…: B. cereus now…


Bacillus cereus: Bacillus cereus


Bacillus cereus cont’d…: Bacillus cereus cont’d…


Bacillus cereus Toxins: Bacillus cereus Toxins


Bacillus cereus Infections: Bacillus cereus Infections


Food-Poisoning: Food-Poisoning


Endophthalmitis: Endophthalmitis


5 year Review of Cleveland Hospitals  : 5 year Review of Cleveland Hospitals Medicine (Baltimore) 1987;66(3):218-23.


5 year Review continued…: 5 year Review continued… Medicine (Baltimore) 1987;66(3):218-23.


Bacillus spp. Among hospitalized patients with Haematological malignancies: Bacillus spp. Among hospitalized patients with Haematological malignancies Journal of Hospital Infections 2006.;64(2):169-76.


Pseudo Epidemics: Pseudo Epidemics


Contaminated Transfusions: Contaminated Transfusions


Treatment: Treatment Journal of Clinical Microbiology 2006;44(10):3814-18


References: References


References (cont’d.): References (cont’d.) Callegan M, et al. Bacillus endophthalmitis: Role of bacterial toxins and motility during infections. Investigative Ophthalmology and Visual Science 2005;46(9):3233-8. Citron DM, Appleman MD. In vitro activities of daptomycin, ciprofloxacin, and other antimicrobial agents against the cells and spores of clinical isolates of bacillus species. Journal of Clinical Microbiology 2006;44(10):3814-8. Mahler H, et al. Fulminant liver failure in association with the emetic toxin of bacillus cereus. NEJM 1997;336(16):1142-8. Ozkocaman V, et al. Bacillus spp. among hospitalized patients with haematological malignancies: clinical features, epidemics and outcomes. Journal of Hospital Infections 2006;64(2):169-76.


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