September/October - West Virginia State Medical Association

| Scientifi c Articleuse of vancomycin in clinical practice.Although infections secondary toLeuconostoc spp are uncommon,there have been sporadic casereports of Leuconostoc spp humaninfection in both pediatric andadult patients (4,5). Most of thesepatients had underlying diseases.In the English literature reviewedby Dhodapkar et al in 1996 (5),there were 29 cases of Leuconostocspp infection. Sixty percent of thecase reports were children. Fiveout of 18 pediatric cases werepremature infants. Since the reviewin 1996, there have been at least ninepediatric case reports. Eight are inEnglish literature. One of these wasa healthy infant. To our knowledge,this presenting case is the youngestand smallest infant that sufferedwith Leuconostoc spp infection.We reviewed 28 cases of pediatricpatient infected with Leuconostocspp from the English literature.Only three cases did not have anunderlying disease. One was a16 year old who presented witha classical manifestation of acutemeningitis (15). The second case wasa 9 month old infant who presentedwith right-side pneumonia (16).The third case was a 2.5 month oldinfant who presented with acutebronchiolitis and concomitantRSV infection (7). There was onecase where the infection occurredin a normal term newborn infantconcomitant with CONS. The infantdid not show any clinical symptomsor signs and was sent home withoutany treatment (16). Eleven out of28 cases (39%) had gastrointestinalabnormalities as an underlyingdisease. Short gut syndrome wasthe majority of these cases. Five casereports, including our case, wereborn prematurely. In the report byHardy (17) the infant was 26 weekGA when she was born. The infectionoccurred at 34 week corrected age.Two cases reported by Gollege (18)occurred in a 28 week-old and 32week-old infant. The corrected ageand the time that the infectionsoccur were not specified. The casereport by Carapetis (4) discussedan infant born at 28 week GA butLeuconostoc spp infection occurredat 20 months of age. In our case, thebaby was born at 24 6/7 week GA.The infection occurred when he was28 week corrected. Besides prematureinfants, the other major categoriesof pediatric patients infected withLeuconostoc spp were those who hadobvious immunosuppressive statessuch as leukemia and the humanimmunodeficiency virus (HIV)infection. Central venous catheter isalso a major risk factor to Leuconostocspp infection. Half of these patientshad central venous catheter inplace when the infection occurred.Exposure to vancomycin was foundin 64% of all pediatric case reports.The source of Leuconostoc sppinfections is still controversial. SomeHELPING WEST VIRGINIA PHYSICIANS TAKE THE RIGHT PATH……in litigation, privacy and security compliance, certificate of need, medical staff and professionaldisciplinary matters, credentialing concerns, complex regulatory matters and business transactions.HEALTH CARE PRACTICE GROUPRyan A. BrownRobert L. CoffieldAlaina N. CrislipJ. Dustin DillardSam FoxMichele GrinbergJohn D. HoffmanAmy R. HumphreysCharlestonJustin D. JackRichard D. JonesEdward C. MartinMark A. RobinsonAmy L. RothmanDon R. Sensabaugh, Jr.Salem C. SmithMorgantownStephen R. BrooksStacie D. HonakerWheelingDavid S. GivensPhillip T. GlyptisRobert C. JamesEdward C. Martin, Responsible Attorney | tedm@fsblaw.com | www.fsblaw.com | (304) 345-0200 | (800) 416-3225September/October 2009 | Vol. 105 25