Case Report

MRSA bacteraemia complicating amphotericin B treatment of cryptococcal meningitis

J Scriven, J Cirota, C Viljoen, M Black, G Meintjes
Southern African Journal of HIV Medicine | Vol 14, No 3 | a70 | DOI: https://doi.org/10.4102/sajhivmed.v14i3.70 | © 2013 J Scriven, J Cirota, C Viljoen, M Black, G Meintjes | This work is licensed under CC Attribution 4.0
Submitted: 12 December 2013 | Published: 17 September 2013

About the author(s)

J Scriven, Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Liverpool School of Tropical Medicine, Liverpool, United Kingdom
J Cirota, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
C Viljoen, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
M Black, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
G Meintjes, Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Medicine, Imperial College London, United Kingdom


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Abstract

Intravenous amphotericin B is a key component of the antifungal therapy for cryptococcal meningitis recommended in South African and international guidelines. Unfortunately, its use is associated with significant toxicity including deterioration in renal function, electrolyte disturbance, anaemia and infusion reactions. Chemical phlebitis is common following administration via peripheral cannulae. This can be complicated by bacterial infection, resulting in localised cellulitis or bacterial sepsis. Here we describe two patients with cryptococcal meningitis who developed methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia during, or shortly after treatment with amphotericin B. These cases illustrate the dangers of line-related sepsis in hospitalised individuals and some of the difficulties encountered during treatment of this condition.


Keywords

MRSA; Staphylococcus; amphotericin B; cryptococcal meningitis

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