scholarly journals A Fatal Case of Concurrent Disseminated Tuberculosis, Pneumocystis Pneumonia, and Bacterial Septic Shock in a Patient with Rheumatoid Arthritis Receiving Methotrexate, Glucocorticoid, and Tocilizumab: An Autopsy Report

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Shin-Ichiro Ohmura ◽  
Ryuhei Ishihara ◽  
Ayaka Mitsui ◽  
Yoshiro Otsuki ◽  
Toshiaki Miyamoto
Keyword(s):  
Rheumatoid Arthritis ◽  
Escherichia Coli ◽  
Septic Shock ◽  
Respiratory Failure ◽  
Causes Of Death ◽  
Opportunistic Infections ◽  
Fatal Case ◽  
Pneumocystis Pneumonia ◽  
Disseminated Tuberculosis ◽  
Autopsy Report

Recently, treatment for rheumatoid arthritis has dramatically improved but increases the risk of bacterial and opportunistic infections. Herein, we report a fatal case of concurrent disseminated tuberculosis, pneumocystis pneumonia, and septic shock due to pyelonephritis caused by extended-spectrum β-lactamase-producing Escherichia coli in a patient with rheumatoid arthritis who received methotrexate, glucocorticoid, and tocilizumab. Despite undergoing intensive treatment, the patient developed respiratory failure and died after 7 days of admission. An autopsy indicated that pulmonary tuberculosis were the ultimate causes of death, while pyelonephritis was controlled.

scholarly journals Parallels in Sepsis and COVID-19 Conditions: Implications for Managing Severe COVID-19

2021 ◽  
Vol 12 ◽  
Author(s):  
Charles Ochieng’ Olwal ◽  
Nora Nghuchuzie Nganyewo ◽  
Kesego Tapela ◽  
Alexandra Lindsey Djomkam Zune ◽  
Oloche Owoicho ◽  
...  
Keyword(s):  
Septic Shock ◽  
Respiratory Failure ◽  
Host Response ◽  
Cytokine Production ◽  
Opportunistic Infections ◽  
Global Burden ◽  
Life Threatening ◽  
Patients Experience ◽  
Sepsis Care ◽  
Multi Organ Dysfunction Syndrome

Sepsis is a life-threatening systemic illness attributed to a dysregulated host response to infection. Sepsis is a global burden killing ~11 million persons annually. In December 2019, a novel pneumonia condition termed coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged and has resulted in more than 1,535,982 deaths globally as of 8th December 2020. These two conditions share many pathophysiological and clinical features. Notably, both sepsis and COVID-19 patients experience consumptive thrombocytopenia, haemolytic anaemia, vascular microthrombosis, multi-organ dysfunction syndrome, coagulopathy, septic shock, respiratory failure, fever, leukopenia, hypotension, leukocytosis, high cytokine production and high predisposition to opportunistic infections. Considering the parallels in the immunopathogenesis and pathophysiological manifestations of sepsis and COVID-19, it is highly likely that sepsis care, which has a well-established history in most health systems, could inform on COVID-19 management. In view of this, the present perspective compares the immunopathogenesis and pathophysiology of COVID-19 and non-SARS-CoV-2 induced sepsis, and lessons from sepsis that can be applicable to COVID-19 management.

scholarly journals Lung fibrosis in deceased HIV-infected patients with Pneumocystis pneumonia

2012 ◽  
Vol 13 (2) ◽  
Author(s):  
Erica J Shaddock ◽  
Guy A Richards ◽  
Jill Murray
Keyword(s):  
Respiratory Failure ◽  
Lung Fibrosis ◽  
Opportunistic Infections ◽  
Fungal Infections ◽  
Interstitial Fibrosis ◽  
Pneumocystis Pneumonia ◽  
Post Mortem ◽  
Ventilator Induced Lung Injury ◽  
The Mean ◽  
Lung Biopsies

Background. Pneumocystis pneumonia (PcP) is one of the most common opportunistic infections found in patients with HIV. The prognosis if ventilation is required is poor, with mortality of 36 - 80%. Although more recent studies have shown improved survival, our experience has been that close to 100% of such patients die, and we therefore decided to investigate further. Methods. All patients with confirmed or suspected PcP who died owing to respiratory failure were eligible for the study. Where consent was obtained, trucut lung biopsies were performed post mortem, stored in formalin and sent for histopathological assessment. Results. Twelve adequate lung biopsies were obtained from 1 July 2008 to 28 February 2011 – 3 from men and 9 from women. The mean age was 34.7 years (range 24 - 46), and the mean admission CD4 count was 20.8 (range 1 - 68) cells/μl and median 18.5 cells/μl. All specimens demonstrated typical PcP histopathology; in addition, 9 showed significant interstitial fibrosis. Three had co-infection with cytomegalovirus (CMV), two of which had fibrosis present. There was no evidence of TB or other fungal infections. Conclusion. The high mortality seen in this cohort of PcP patients was due to intractable respiratory failure from interstitial lung fibrosis. whereas the differential includes ventilator induced lung injury, drug resistance or co-infections, we suggest that this is part of the disease progression in certain individuals. Further studies are required to identify interventions that could modify this process and improve outcomes in patients with PcP who require mechanical ventilation. S Afr J HIV Med 2012;13(2):64-67.

scholarly journals Causes of death in patients with tuberculosis and human immunodeficiency virus co-infection

2021 ◽  
Vol 2 (1) ◽  
pp. 59-62
Author(s):  
O. P. Frolova ◽  
O. V. Butylchenko ◽  
V. A. Stakhanov ◽  
I. I. Enilenis ◽  
M. A. Romenko ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Causes Of Death ◽  
Opportunistic Infections ◽  
Pneumocystis Pneumonia ◽  
Social Characteristics ◽  
Hepatitis C Infection ◽  
Tuberculosis Patients ◽  
Immunodeficiency Virus ◽  
Cause Of Deaths

Objectives. The aim of the study was to investigate the cause of death of tuberculosis patients infected with the human immunodeficiency virus (HIV). Many researchers and experts note the urgency of the problem of tuberculosis combined with HIV infection in the world and in Russia. One of the main criteria for assessing the effectiveness of medical care for tuberculosis patients infected with the human immunodeficiency virus is the mortality rate.Materials and methods. For a detailed study of the causes of death of patients with tuberculosis in combination with HIV infection, we analyzed the causes of death of this contingent of patients in 5 regions of the Russian Federation.Results. The social characteristics of patients, the forms and course of the disease, the main and immediate causes of death of 223 patients with co-infection with HIV and tuberculosis were studied.Conclusion. Half of the deaths of tuberculosis patients infected with human im­munodeficiency virus were not associated with tuberculosis. Among these cases, there was either the presence of several infections at the same time, equally leading to death, or separate opportunistic infections (candidiasis, Pneumocystis pneumonia, toxoplasmosis), or cancer. In addition, the lifestyle of patients often became the cause of deaths, namely: drug poisoning and accidents, or cirrhosis of the liver, which develops as a result of alcoholism or hepatitis C infection which occurred during intravenous administration of drugs.

Suicidal Death Autopsy Analysis at Dhaka Medical College

1970 ◽  
Vol 40 (1) ◽  
pp. 18-21 ◽  
Author(s):  
MN Hossain ◽  
Z Rahman ◽  
S Akhter
Keyword(s):  
Forensic Medicine ◽  
Causes Of Death ◽  
Cross Sectional Study ◽  
Age Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medical College ◽  
Autopsy Report ◽  
Common Causes ◽  
Suicidal Death

A cross sectional study was carried out at the department of Forensic Medicine in Dhaka Medical College during the period of January 2008 to December 2009. Data were collected from 3rd copy of the post mortem reports which were preserved in the department of Forensic Medicine with the verbal consent of the doctors who performed autopsy report. During this period total 5114 autopsies were conducted. Out of this 970 cases (19%) were suicidal in nature. It was noticed that all suicidal deaths occurred from 10 years to all age group respectively, but top amongst age group of suicidal deaths occurred in between 21 to 30 years of people. Suicidal deaths are more common in female than male. Suicidal deaths due to hanging is highest, next common causes of death due to organophosphorus compund poisoning. Suicidal deaths by hanging is more in female than male but in poisoning cases male are more lvictimised than female. Objectives of our study are to see the occurrence and methods of suicidal death. DOI: http://dx.doi.org/10.3329/bmj.v40i1.9957 BMJ 2011; 40(1): 18-21

scholarly journals Undetected Causes of Death in Hospitalized Elderly with COVID-19: Lessons from Autopsy

2021 ◽  
Vol 10 (7) ◽  
pp. 1337
Author(s):  
Astrid Malézieux-Picard ◽  
Cecilia Ferrer Soler ◽  
David De Macedo Ferreira ◽  
Emilie Gaud-Luethi ◽  
Christine Serratrice ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Causes Of Death ◽  
Clinical Findings ◽  
Pathological Examination ◽  
Post Mortem ◽  
Hypoxemic Respiratory Failure ◽  
Hospitalized Elderly ◽  
Acute Decompensation ◽  
Clinical Chart ◽  
Full Body

Background: Mechanisms and causes of death in older patients with SARS-CoV-2 infection are still poorly understood. Methods: We conducted in a retrospective monocentric study, a clinical chart review and post-mortem examination of patients aged 75 years and older hospitalized in acute care and positive for SARS-CoV-2. Full body autopsy and correlation with clinical findings and suspected causes of death were done. Results: Autopsies were performed in 12 patients (median age 85 years; median of 4 comorbidities, mainly hypertension and cardiovascular disease). All cases showed exudative or proliferative phases of alveolar damage and/or a pattern of organizing pneumonia. Causes of death were concordant in 6 cases (50%), and undetected diagnoses were found in 6. Five patients died from hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19), five had another associated diagnosis and two died from alternative causes. Deaths that occurred in the second week were related to SARS-CoV-2 pneumonia whereas those occurring earlier were related mainly to heart failure and those occurring later to complications. Conclusions: Although COVID-19 hypoxemic respiratory failure was the most common cause of death, post-mortem pathological examination revealed that acute decompensation from chronic comorbidities during the first week of COVID-19 and complications in the third week contributed to mortality.

scholarly journals Survival, prognosis, and causes of death in rheumatoid arthritis

1986 ◽  
Vol 29 (6) ◽  
pp. 706-714 ◽  
Author(s):  
Donald M. Mitchell ◽  
Patricia W. Spitz ◽  
Donald Y. Young ◽  
Daniel A. Bloch ◽  
Dennis J. McShane ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Causes Of Death ◽  
Survival Prognosis
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