i contracted this nasty cronic infection in 6-02 from discogram, my infectious disease docs say gemella is very rare and they don't really know what antibiotic will kill it. I was on IV Rocephin for 6 weeks and then blood levels elavated again so they switched to Cleocin IV 9 weeks and now oral clindimycin 300mg 4v times a day. I still have severe cronic pain and other symptoms and ;[sed rate of 30. which is what it was when detected in 9-02. Does anyone out there know what antibiotic I should be taking to kill the gemella haemolysans bacteria?

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Rick

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Rick

Have they tried Metronidazole, vancomycin, imipenem etc?

THEY USED VANCOMYCIN IN HOSP[ITAL AND I STAETED TO FEEL DETTER AND THEN THEY SEND NE HOME WITH ROCEPHIN AMD CLEOCIN IV FOR BOTH, THANKS FOR THE SUGGESTION, i SEE DOC IN 2 WEEKSAND GET NEW MRI NEXT WEEG, i HAVE SOMEWHAR BEEN ABLE TO READ THEM , REALLY LOOOKING FORWARD TO THAT THANKS AND GOD BLESS

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Rick

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Rick

I have OM of the maxilla. I am much better, but here's what the standard treatment is - you have to do all of this - a bone infection is very hard to cure. I have been battling it for a year, which in OM time is pretty short - same as you. I think you need to find a REALLY good Infectious Disease doctor and Back Surgeon (and this means travel, by all means go! this is serious) and get back on IV antibiotics as soon as you can. They need to grow your bugs and then the ID doctor will tell you which is the best med to treat it with. I hope you are not in much pain, if any. I have a lot. PLEASE also consider the HBO Hyperbaric Oxygen Therapy as an adjunct. It helps in healing. By the way, have you considered a law suit? What happened with how you contracted it?

PROTOCOL FOR TREATING OSTEOMYELITIS:

Treatment Guideline for Acute or Chronic Osteomyelitis
Disrupt the infectious foci.
Debride any foreign bodies necrotic tissue, or sequestra.
Culture and identify specific pathogens for eventual definitive
antibiotic treatment.
Drain and irrigate the region.
Begin empiric antibiotics based on Gram stain.
Stabilize calcified tissue regionally.
Consider adjunctive treatments to enhance microvascular reperfusion
(usually reserved for refractory forms only).
Trephination
Decortication
Vascular flaps
Hyperbaric oxygen therapy
Reconstruction as necessary following resolution of the infection.

Osteomyelitis

The cause of osteomyelitis is associated with Staphylococcus aureus, a
skin surface bacterium. The organism is iatrogenically introduced
into the deeper tissue planes by surgery or trauma, resulting in an
infectious process that is either localized or hematogenously
metastatic or both. However, the idea of S aureus as the primary
pathogen of tooth-bearing bone does not hold true. Acute
osteomyelitis of the jaw is usually a polymicrobial disease, with
streptococci, Bacteroides, peptostreptococci, and other organisms
involved.

Hudson (1993) wrote that Acute osteomyelitis of the jaws may
manifest itself with fever, malaise, facial cellulitis, trismus, and
significant leukocytosis. Osteomyelitis of the jaws of a chronic
nature has findings consistent with swelling, pain, purulence,
intraoral or extraoral draining fistulae, and nonhealing bony and
overlying soft tissue wounds. Computerized tomography gives a more
definitive picture of the calcified tissue involvement, especially
with regard to disruption of the cortical plates. Diagnosis is based
on the presence of painful sequestra and suppurative areas of
tooth-bearing jaw bone unresponsive to debridement and conservative
therapy.

The goal of definitive therapy is to attenuate and eradicate the
proliferating pathogenic microorganisms and to support healing.
Pathogenic supportive debris should be removed and vascular
permeability to the infected area must be reestablished. This will
aid the host immune response in coming into contact with the offending
organisms.

thank you, thank you and thank you , this is the best info I've received, Ill definately follow up thanks again trying to feelgood

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Rick

you are so very welcome. i wish you no pain! pain sucks! a lot of doctors do not deal with this - please get to a good infectious disease doctor, but by all means you may want to discuss this with the surgeon who performed your surgery.. which is most likely where you received the infection. if you act quickly you can really save yourself so much pain. Geez - you are in PA? I suggest calling Hospital of the UNiversity of Penn - I am being treated by a doctor there who specializes in jaws - There should be an orthopedic or (whomever/speciality) that is able to perform a back surgery/debridement.

PLEASE feel free to ask questions. It is hard for me to come back here, but since I struck a bone (HAHA!) with you I am on the lookout for frequent updates from you. I am heading for HBOT next week.

hi tryingtofeelgood, you are right about pain it sure does suck!!!! I have had it for about 2 1/2 years, first from back injury then from osteomyelitis, I have an infectious disease doc, but I'm readdy to fire him and look for another, I have been seen by all three in his practice and they stioll don't give me the right antibiotic, as for orthopedic surgeon, hi is with university of Pittsburgh Medical enter, a big teaching Hospital so they should be good, they did debredment in `12- 02 and removed my disc at L-3-4 that was infected. It did not fuse and they want to debride again and put in hardware for L-3-4v disc, Thanks again for all of your help, wishing you a pain reduced day,

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Rick

perhaps you could get them to give you Hyperbaric treatment as an adjunct therapy. Just make sure when they do surgery and add hardware that you are on some serious antibiotics and that they test again for any signs of infection by taking cultures and doing sensitivity testing as to which antibiotic will work. Don't take NO for an answer - just do it to make sure you are OK in the future. Get a LOT of rest. Your immune system must be tired.

wishing you health and light,

Hi tryingtofeelgood, My orthpedic surgeon already told me that I will be coming home with another picc line after surgery, I hope it is on vancomycin, every time I'm in hospital, they have me on vanco 3 times a day and they send me home without it on some other useless antibiotic!!!! If I don't hear the right answers when I see my Infectious Disease Doc in 1 1/2 weeks I am going to different hospital and get a new ID doc. By the way, how I contracted my infection was from a pain mgmnt. doc performing a discogram back in 6-02 and was formally diagnosed in 9-02.I had just got home from trip to las Vegas with my wife, I was soo sick out there it was terrible. I couldn't get out of bed for the last 2 days there. Pain was horrible and the pain meds I had were so inefficiant!!!!! I now take methadone and neurontin for the pain, I was on dilaudid for BT pain but doc took me off it while lowering my methadone from 160 to 90mgs per day. He gave me some percocet 10's but all the tylenol was upseting my stomach, not to say what it is doing to my liver, I am going to beg him for the dilaudid again, at least until surgery again. I am not going to let them schedule that until I am totally satisfied that they are adressing all my bad discs and infection.I did mention about HBOT to my ID doc but he didn't say if that was an option yet,I do want another blood culture grown to see if gemella is still present or not,my sed rate still has not dropped below 32 which was what it was when I was diagnosed with all this a year ago. I hope your HBOT goes well this week , please keep me informed, and thank you ever so much for all the info and friendship. Good luck and God bless,

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Rick

Hi Lostsoul,

I had Chronic Osteomylitis in L1-L2 Disc space.It was pure hell!!!Actually was diagnosed as having Vertebral Osteomylitis Septic Discitis.Ten cc's pure corruption was drawn out of my Spine.

The Neurosurgeon told my Mother he had NEVER seen in his 35 years of practice pure Infection drawn from someones Spine.

To this day I have no idea how I got such a nasty Infection.The whole time I had it I ran nothing more than a low grade temp.I didnt have an Infection in the Blood.My SED rate was greater than 100.

At first I was put on Rocephin IV.After finding the strain of Staph they put me on Nafcillin IV.I also took Rifadin which is an Anti-Tubercular for 3 months.

Was on IV Antibiotics for 3 months.After a month post hospital of Nafcillin,I took Keflex for a month.I had so many shots for pain the 3 weeks I was in Hospital that my hips were numb for a good 6 mths!

Of all things the Groshong became infected on the inside and I ran a VERY high temperature.It grew a moderate growth of Klebsiella Pnemonia(sp).I took a course of Cipro.

All I know is:I NEVER NEVER NEVER want it to return.The pain I experienced was to much to endure.

You may ask your Doctor about Nafcillin.I know it was a lifesaver in my ordeal.

All the best guy..I know what you went thru and are going thru.

I count my blessings daily that I can walk,that I dont have a disfunctional Heart,that it hasnt come back but most of all that Im still alive.

These Infection can get nasty...VERY nasty..

I had a rare bacterial infection (serratia) of my spinal canal from surgery and the only thing that touched it was IV Rocephin and strong doses of cipro orally for 6 weeks.

You need to find out if this is a gram negative or gram posotive bacteria and then you can find out what treatment will kill of this bacteria.

Good Luck

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i contracted this nasty cronic infection in 6-02 from discogram, my infectious disease docs say gemella is very rare and they don't really know what antibiotic will kill it. I was on IV Rocephin for 6 weeks and then blood levels elavated again so they switched to Cleocin IV 9 weeks and now oral clindimycin 300mg 4v times a day. I still have severe cronic pain and other symptoms and ;[sed rate of 30. which is what it was when detected in 9-02. Does anyone out there know what antibiotic I should be taking to kill the gemella haemolysans bacteria?

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Rick


Gemella is not a rare organism, but is frequently misidentified because the gram stain is frequently over decolorized making it a gram negatrive cocci or gram negative bacilli

In reality, the organism is a gram positive cocci and is also misidentified as one of the Viridans strep group.

Vancomycin should work well, but ampicillin would work just as well and you would have fewer side effects and save a lot of money.

Here is part of an article from the Journal of Clinical Microbiology.



However, for the present, phenotypic characterization remains the standard approach to bacterial identification, with Gram staining being one of the most important first steps of most routine identification schemes (5). A mistake at this stage can lead to the application of inappropriate tests and therefore unnecessary delays in processing; thus, it is important that all efforts be made to ensure correct interpretation of the Gram staining result. The reference method for assessing cell wall type is electron microscopy, and although it is accurate, the method is expensive, is time-consuming, and requires specialized equipment. As an alternative we have added vancomycin and colistin to our standard antibiotic susceptibility tests. Most gram-positive bacteria are susceptible to vancomycin, whereas most gram-negative bacteria are susceptible to colistin. Such a method has previously been shown to be beneficial for the determination of cell wall type among nonenterobacterial rods (24). The test is easy to perform (Fig. 2) and is inexpensive. It must be noted, however, that this test is not definitive, since a vancomycin-resistant strain of G. haemolysans has been encountered (18).

Bruce

Here are three cases of Gemella infection. The combination of penicillin or ampicillin plus gentamicin, or tobrymycin, amikacin gives a synergistic effect and is used to treat systemic infections such as septicemia or osteo.


Top
Abstract
Introduction
Case Report
Materials & Methods
Results
Discussion
References
Patient 1. A 63-year-old man who was a heavy smoker with chronic obstructive bronchitis and a very poor dental state was admitted to hospital complaining of intermittent fever, loss of weight, and anorexia over a 1-month period. He had no history of rheumatic disease, although a moderate heart murmur had been discovered 1 year previously, and at that time an echocardiogram had yielded moderate mitral valve regurgitation. On initial examination, the patient had an increased heart murmur, a temperature of 38.5°C, and a pulse of 100 beats/min. An ejection systolic murmur was heard at the apex of the heart. Laboratory investigations showed a hemoglobin concentration of 100 g/liter, an erythrocyte sedimentation rate of 97 mm/h, and a leukocyte count of 8.53 × 109/liter (77% neutrophils). A transesophageal echocardiogram demonstrated the presence of vegetation on the mitral valve with moderate mitral valve regurgitation. Six sets of blood samples for cultures were taken on admission and the following day, and the blood samples were inoculated into BACTEC aerobic (NR 6-A*) and anaerobic (NR-7A*) bottles in a BACTEC NR-860 automated instrument (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md.). All yielded slowly growing, gram-positive cocci, subsequently identified as G. haemolysans. A kidney echography, carried out for microscopic hematuria, yielded a lesion inside of the left kidney which was compatible with an abscess. The patient's treatment began the day after his admission, in which treatment with amoxicillin (4 g intravenously at 6-h intervals) and amikacin (5 mg/kg of body weight intravenously at 8-h intervals) was begun. His condition improved rapidly, and after 2 weeks of this regimen, he underwent cardiac surgery in order to remove the motile vegetation. One week after surgery antibiotic therapy was discontinued. After 2 years of follow-up he remains well.

Patient 2. A 74-year-old man with a history of Pott's disease in infancy, chronic alcoholism, and a poor dental state was admitted to hospital complaining of intermittent fever, sweating, loss of weight, and basithoracic pain over a 3-month period. He had neither a history of rheumatic disease nor a previous heart murmur. On initial examination, the patient had a diastolic heart murmur, a temperature of 38°C, and a pulse of 100 beats/min. Laboratory investigations showed a hemoglobin concentration of 95 g/liter, an erythrocyte sedimentation rate of 63 mm/h, and a leukocyte count of 12.8 × 109/liter (87% neutrophils). A transesophageal echocardiogram demonstrated aortic valve incompetence but failed to show any vegetation. Six sets of blood samples for culture were taken on admission and the following day, and the blood samples were inoculated into BACTEC aerobic (NR 6-A*) and anaerobic (NR-7A*) bottles in a BACTEC NR-860 automated instrument. All yielded slowly growing, gram-variable cocci and coccobacilli subsequently identified as G. morbillorum. The patient's treatment began the day after his admission and comprised amoxicillin (4 g intravenously at 6-h intervals) and gentamicin (1 mg/kg intravenously at 8-h intervals). Although his condition improved rapidly, it was necessary to transfer him to a cardi-thoracic unit because he was also suffering from significant aortic valve regurgitation and a dilated left ventricle. The aortic valve was successfully replaced with a prosthetic device, and the patient made an uneventful postoperative recovery. Gentamicin was discontinued 1 week later, and amoxicillin was discontinued 3 weeks later. After 1 year of follow-up he remains well.

Patient 3. A small, fastidious, gram-negative rod which had been isolated from the blood of a male patient with infectious endocarditis by using BACTEC aerobic (NR 6-A*) and anaerobic (NR-7A*) bottles was sent to our laboratory for identification, because it was thought that it could be a Bartonella sp. The patient was a farmer and suffered from a bicuspid aortic valve. Clinical symptoms included intermittent fever and a weight loss of 12 kg over a period of several months. Attempts to amplify citrate synthase and 16S rRNA genes with specific primers for Bartonella (27) were unsuccessful. Standard phenotypic characterization methods for gram-negative rods also failed to provide an identity. The bacterium was identified as G. morbillorum by 16 rRNA gene sequencing.