scholarly journals Cystoisospora belli Gallbladder Infection in a Liver Transplant Donor

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Clifford Akateh ◽  
Christina A. Arnold ◽  
Dathe Benissan-Messan ◽  
Anthony Michaels ◽  
Sylvester M. Black
Keyword(s):  
High Risk ◽  
Disease Transmission ◽  
Incidental Finding ◽  
Immunocompromised Patients ◽  
Severe Diarrhea ◽  
Patient Will ◽  
Harmful Organisms ◽  
High Index Of Suspicion ◽  
Immunocompromised Hosts ◽  
Liver Transplant Donor

Introduction. Cystoisospora belli (previously Isospora belli) is a parasitic protozoan of the human gastrointestinal system. It rarely causes symptoms in immunocompetent hosts but can cause severe diarrhea in immunocompromised patients, with a rate of recurrence and risk of dissemination. Gallbladder infections are however rare. The treatment of choice for symptomatic patients is a 7–10-day course of trimethoprim-sulfamethoxazole. Case. In this case, we report on an incidental finding of Cystoisospora belli organisms in the donor gallbladder following a transplant cholecystectomy. There was no report of symptoms in the donor. The recipient was treated with a course of trimethoprim-sulfamethoxazole, without evidence of cystoisosporiasis. Given the risk of recurrence in immunocompromised hosts, the patient will continue to be monitored for reactivation in the future. Conclusion. Despite advances in transplant protocols and screening, disease transmission from the donor to recipient still occurs in about 0.2% of all organ transplants. With the increased use of organs from drug overdose victims and other high-risk donors, practitioners (including pathologists, hepatologists, and surgeons) must maintain a high index of suspicion for such potentially harmful organisms.

scholarly journals Mask-Ematics: Modeling the Effects of Masks in COVID-19 Transmission in High-Risk Environments

Epidemiologia ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 207-226
Author(s):  
Anthony Morciglio ◽  
Bin Zhang ◽  
Gerardo Chowell ◽  
James M. Hyman ◽  
Yi Jiang
Keyword(s):  
Public Health ◽  
High Risk ◽  
Disease Transmission ◽  
Large Fraction ◽  
Critical Mass ◽  
Transmission Model ◽  
Reproductive Number ◽  
High Quality ◽  
Moderate Quality ◽  
Epidemic Size

The COVID-19 pandemic has placed an unprecedented burden on public health and strained the worldwide economy. The rapid spread of COVID-19 has been predominantly driven by aerosol transmission, and scientific research supports the use of face masks to reduce transmission. However, a systematic and quantitative understanding of how face masks reduce disease transmission is still lacking. We used epidemic data from the Diamond Princess cruise ship to calibrate a transmission model in a high-risk setting and derive the reproductive number for the model. We explain how the terms in the reproductive number reflect the contributions of the different infectious states to the spread of the infection. We used that model to compare the infection spread within a homogeneously mixed population for different types of masks, the timing of mask policy, and compliance of wearing masks. Our results suggest substantial reductions in epidemic size and mortality rate provided by at least 75% of people wearing masks (robust for different mask types). We also evaluated the timing of the mask implementation. We illustrate how ample compliance with moderate-quality masks at the start of an epidemic attained similar mortality reductions to less compliance and the use of high-quality masks after the epidemic took off. We observed that a critical mass of 84% of the population wearing masks can completely stop the spread of the disease. These results highlight the significance of a large fraction of the population needing to wear face masks to effectively reduce the spread of the epidemic. The simulations show that early implementation of mask policy using moderate-quality masks is more effective than a later implementation with high-quality masks. These findings may inform public health mask-use policies for an infectious respiratory disease outbreak (such as one of COVID-19) in high-risk settings.

Bouveret syndrome: a rare form of gallstone ileus

2021 ◽  
Vol 14 (2) ◽  
pp. e238126
Author(s):  
Don Haering ◽  
Mattie Murphy ◽  
John Craig ◽  
Gavin A Falk
Keyword(s):  
Clinical Evidence ◽  
Incidental Finding ◽  
Gallstone Ileus ◽  
Definitive Treatment ◽  
Abdominal Radiograph ◽  
Quadrant Pain ◽  
Abdominal Ct Scan ◽  
History Of ◽  
Bouveret Syndrome ◽  
High Index Of Suspicion

A 57-year-old woman presented with a 5-day history of worsening right upper quadrant pain, bilious emesis and approximately 20 pounds of weight loss. The patient was afebrile, without jaundice and had mild tenderness in her right upper quadrant. She noted an incidental finding of asymptomatic cholelithiasis on imaging 4 years earlier. An abdominal radiograph revealed pneumobilia and a large ectopic calculus. An abdominal CT scan confirmed pneumobilia, a large concretion completely obstructing the third portion of the duodenum and a soft tissue communication between the gallbladder and proximal duodenum. She was brought to the operating room for definitive treatment and had the obstructing gallstone removed via a transverse duodenotomy. Bouveret syndrome is a rare cause of small bowel obstruction that requires a high index of suspicion for diagnosis. It should be considered in older patients with clinical evidence of gastric or duodenal obstruction, particularly with a history of cholelithiasis.

scholarly journals Point-Counterpoint: Should Serum β-d-Glucan Testing Be Used for the Diagnosis of Pneumocystis jirovecii Pneumonia?

2019 ◽  
Vol 58 (1) ◽  
Author(s):  
Gabriela Corsi-Vasquez ◽  
Luis Ostrosky-Zeichner ◽  
Edward F. Pilkington ◽  
Paul E. Sax
Keyword(s):  
High Risk ◽  
Prophylactic Antibiotics ◽  
Induced Sputum ◽  
Pneumocystis Jirovecii ◽  
Outpatient Clinics ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Content Type ◽  
Aids Epidemic

Despite the widespread use of prophylactic antibiotics in high-risk individuals, Pneumocystis jirovecii remains an important cause of pneumonia in immunocompromised patients. During the peak of the AIDS epidemic, many hospitals and outpatient clinics were very proficient at collecting induced sputum specimens for the diagnosis of Pneumocystis jirovecii pneumonia (PJP).

scholarly journals Foreign body stone in oesophagus: a unique case

2015 ◽  
Vol 12 (2) ◽  
pp. 140-142 ◽  
Author(s):  
B P Sah ◽  
S T Chettri ◽  
J N. Prasad ◽  
P P Gupta ◽  
S P Shah ◽  
...  
Keyword(s):  
Foreign Body ◽  
High Risk ◽  
Rare Case ◽  
Mentally Retarded ◽  
Risk Groups ◽  
High Index ◽  
Common Occurrence ◽  
Unique Case ◽  
History Of ◽  
High Index Of Suspicion

Foreign body ingestion is a common occurrence in children and in specific high-risk  groups. It is usually diagnosed based on a history of ingestion given by the patient  or an observer. However, children and mentally retarded adults may be unable to  give an accurate history, and a high index of suspicion must be maintained in these  groups. We report a rare case of foreign body stone in an mentally retarded adult  which presented with drooling and impaired feeds, thence enabling for high index  for suspicion.  Health Renaissance 2014;12(2): pp: 140-142

scholarly journals Prolonged hospitalisation for immigrants and high risk patients with positive smear pulmonary tuberculosis

2015 ◽  
Vol 75 (2) ◽  
Author(s):  
R. Luzzati ◽  
M. Confalonieri ◽  
A. Cazzadori ◽  
P. Della Loggia ◽  
R. Cifaldi ◽  
...  
Keyword(s):  
High Risk ◽  
Disease Transmission ◽  
Illegal Immigrants ◽  
Sputum Smear ◽  
Prolonged Hospitalisation ◽  
Early Outcome ◽  
High Risk Patients ◽  
Tb Treatment ◽  
Conversion Rates ◽  
Risk Patients

Background and objective. Tuberculosis (TB) occurring in immigrants and resistance to drugs are major problems for TB control in Western countries. Directly observed therapy (DOT) reduces disease transmission, but this approach may have poor results among illegal immigrants. Our aim was to evaluate a prolonged hospitalisation programme to improve early outcome of TB treatment in high risk patients. Methods. All the consecutive adult patients with sputum smear-positive pulmonary TB admitted to 2 Italian referral TB Centres were evaluated. Hospital-based DOT was provided to high risk patients up-to smear conversion. Demographic, microbiological and clinical conditions, as potential factors associated with confirmed smear conversion at 60 and 90 days of anti-tuberculous therapy were evaluated. Results. 122 patients were studied, 45.9% of them were immigrants (20% illegal) from high-prevalence TB countries. HIV testing was negative in all cases. Twelve patients had M. tuberculosis resistant to ≥ 1 first-line anti-tuberculous agents. The rate of defaulting from TB treatment was 7.3%. Sputum smear became negative in 84.4% cases after 60 days and 93.3% cases after 90 days. At such time, smear conversion rates were similar among different high risk subgroups such as illegal immigrants (95.9%), legal foreign-born (92.5%) and Italian persons (94.8%). Persistent sputum smear positivity was independently correlated with the extent of pulmonary lesions at 60 (p<0.0001) and 90 days (p=0.038) of hospital-based DOT. Conclusions. These findings suggest that prolonged hospitalisation for illegal immigrants and high risk TB patients, may positively influence the early outcome of TB treatment despite of drug resistance and legal status.

scholarly journals Two cases of imported respiratory diphtheria in Edinburgh, Scotland, October 2019

2020 ◽  
Vol 148 ◽  
Author(s):  
Lucy Li ◽  
Daniella Ross ◽  
Katherine Hill ◽  
Sarah Clifford ◽  
Louise Wellington ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Corynebacterium Diphtheriae ◽  
High Index ◽  
Contact Tracing ◽  
Emerging Infections ◽  
Diphtheria Antitoxin ◽  
History Of ◽  
Risk Areas ◽  
High Index Of Suspicion

Abstract We report two cases of respiratory toxigenic Corynebacterium diphtheriae infection in fully vaccinated UK born adults following travel to Tunisia in October 2019. Both patients were successfully treated with antibiotics and neither received diphtheria antitoxin. Contact tracing was performed following a risk assessment but no additional cases were identified. This report highlights the importance of maintaining a high index of suspicion for re-emerging infections in patients with a history of travel to high-risk areas outside Europe.

Customized electronic alerts to boost pneumococcal vaccinations in high risk cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18227-e18227
Author(s):  
Ananta Bhatt ◽  
Shoshana Hort ◽  
Daniel J Gelb ◽  
Todd MacKenzie ◽  
Frederick Lansigan
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Case Fatality ◽  
Primary Care Providers ◽  
The United States ◽  
Immunocompromised Patients ◽  
Care Providers ◽  
Electronic Alerts ◽  
Cdc Guidelines ◽  
Order Set

e18227 Background: Streptococcus pneumoniae remains a leading cause of serious illness, including bacteremia, meningitis, and pneumonia among adults in the United States. Approximately 10% of all patients with invasive pneumococcal disease die of their illness, but case-fatality rates are higher for immunocompromised adults including cancer patients. Current Center for Disease Control (CDC) guidelines recommend routine use of 13-valent (Prevnar 13) and 23-valent (Pneumovax 23) pneumococcal vaccines (PV) for immunocompromised patients. We conducted a quality improvement (QI) project utilizing our electronic medical record (EMR) system to improve PV compliance (PVC) rates in our patients. Methods: We created automatic reminders called best practice alerts (BPA) and linked them to a smart order set within our EMR that appeared upon opening patient charts. The smart set ordered the correct vaccine in sequence based on CDC guidelines. From August 2015- January 2017, we implemented this BPA for one of six hematology providers and the remaining providers were provided with verbal guidelines and reminders to administer PV to their patients. Results: At baseline only 22% of 3000 hematology patients within the practice had received PV. The pilot provider with the BPA linked to a smart order set within the EMR improved PVC within his patients from 23% to 66%. Providers who were just given verbal guidelines improved PVC from an average of 22% to 45%. The difference in the improvement between the pilot provider and the reference group is 21% (p < 0.001). Conclusions: In an EMR era, we took advantage of the tools within our system to improve PVC rates. BPA linked to a smart order set within the EMR provided better means of improving PVC than verbal prompts in high-risk immunocompromised patients. Additionally, the increase in PVC throughout the hematology practice is due to primary care providers using similar reminders within the same EMR. The PV BPA will be conducted as a standard of care in our clinic and will be expanded to oncology patients as well.

scholarly journals Usefulness of ultrasound in the diagnosis of peritoneal tuberculosis

2012 ◽  
Vol 6 (12) ◽  
pp. 886-890 ◽  
Author(s):  
Sebastiana Atzori ◽  
Gianpaolo Vidili ◽  
Giuseppe Delitala
Keyword(s):  
High Risk ◽  
Diagnostic Tests ◽  
Diagnostic Process ◽  
Tuberculous Infection ◽  
Peritoneal Tuberculosis ◽  
Ultrasound Guided ◽  
High Risk Patients ◽  
High Prevalence ◽  
Risk Patients ◽  
High Index Of Suspicion

The peritoneum is one of the most common extrapulmonary sites of tuberculous infection. We report a case of peritoneal tuberculosis (TB) in a 25-year-old man. In this case, ultrasound of the abdomen played an important role in the diagnostic process. The diagnosis of this disease, however, remains a challenge because of its insidious nature, the variability of its presentation, and the limitations of available diagnostic tests. A high index of suspicion should be considered, particularly in high-risk patients with unexplained ascites. In our case ultrasound guided the diagnosis by rapidly identifying abnormal signs, which in high-prevalence settings are extremely suggestive of peritoneal tuberculosis.

scholarly journals Pilot evaluation of risk assessment and enhanced protocols regarding contacts at an international professional golf event

2021 ◽  
Vol 7 (3) ◽  
pp. e001127
Author(s):  
Patrick G Robinson ◽  
Andrew Murray ◽  
Volker Sheer ◽  
Graeme Close ◽  
Denis F Kinane
Keyword(s):  
Risk Assessment ◽  
Pilot Study ◽  
High Risk ◽  
Disease Transmission ◽  
Low Risk ◽  
Contact Tracing ◽  
Sporting Events ◽  
Medical Surveillance ◽  
Rt Pcr ◽  
Antigen Testing

ObjectivesThe aim of this study was to assess whether a risk assessment and managed risk approach to contact tracing was practical and feasible at the Gran Canaria Lopesan Open 2021 and could inform further pilot work regarding disease transmission during elite sporting events.MethodsThis prospective cohort study included all international attendees. All participants required a minimum of one negative reverse transcriptase PCR (RT-PCR) test prior to travelling to each tournament. High-risk contacts were isolated for 10 days. Moderate-risk contacts received education regarding enhanced medical surveillance, had daily rapid antigen testing for 5 days, with RT-PCR day 5, mandated mask use and access to outside space for work purposes only. Low-risk contacts received rapid antigen testing every 48 hours and PCR testing on day 5.ResultsA total of 550 persons were accredited and were required to undergo RT-PCR testing before the event. Two of these tests were positive (0.36%). Of these, case 1 had 1 high, 23 moderate and 48 low-risk contacts. Case 2 did not have any significant travel history within 2 days of positive test and had one high-risk contact. There were no further positive tests on site in the wider cohort of attendees, from a total of 872 RT-PCR and 198 rapid antigen tests.ConclusionsThis pilot study showed it is practical, feasible and well accepted to provide enhanced (daily) virus testing and risk-mitigating measures at a professional golf event. Further study is required to assess the efficacy of these interventions; however, no transmission was found in this pilot study.

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