scholarly journals Purpura Fulminans: a Rare but Fierce Presentation of Pneumococcal Sepsis

2019 ◽  
Author(s):  
Adeel Nasrullah ◽  
Anam Javed ◽  
Usman Tariq ◽  
Meilin Young ◽  
Zunera Moeen ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Purpura Fulminans ◽  
Skin Lesions ◽  
Immunocompetent Patient ◽  
Community Acquired Pneumonia ◽  
Rare Presentation ◽  
Disseminated Intravascular Coagulopathy ◽  
Intravascular Thrombosis ◽  
Pneumococcal Sepsis ◽  
Intravascular Coagulopathy

Infectious purpura fulminans (PF) is a rare presentation of disseminated intravascular coagulopathy (DIC) due to diffuse intravascular thrombosis and haemorrhagic infarction of the skin. PF can present in infancy/childhood or adulthood and usually presents as ecchymotic skin lesions, fever and hypotension. It is most commonly a consequence of sepsis related to Neisseria meningitidis, Streptococcus pneumoniae or Haemophilus influenzae. Despite aggressive management of sepsis with intravenous fluids, antibiotics, and conventional and nonconventional therapies, the condition still carries a mortality rate of 43%[1]. Streptococcus pneumoniae mostly presents with community-acquired pneumonia. We present a case of PF secondary to DIC related to Pneumococcal sepsis in an otherwise healthy and immunocompetent patient.

scholarly journals Endobronchial Enigma: A Clinically Rare Presentation ofNocardia beijingensisin an Immunocompetent Patient

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Nader Abdel-Rahman ◽  
Shimon Izhakain ◽  
Walter G. Wasser ◽  
Oren Fruchter ◽  
Mordechai R. Kramer
Keyword(s):  
Present Report ◽  
Signs And Symptoms ◽  
Immunocompetent Patient ◽  
Clinical Findings ◽  
Community Acquired Pneumonia ◽  
Rare Presentation ◽  
Pulmonary Nocardiosis ◽  
Neoplastic Processes ◽  
Paratracheal Lymph Node ◽  
Aerobic Actinomycetes

Nocardiosis is an opportunistic infection caused by the Gram-positive weakly acid-fast, filamentous aerobic Actinomycetes. The lungs are the primary site of infection mainly affecting immunocompromised patients. In rare circumstances even immunocompetent hosts may also develop infection. Diagnosis of pulmonary nocardiosis is usually delayed due to nonspecific clinical and radiological presentations which mimic fungal, tuberculous, or neoplastic processes. The present report describes a rare bronchoscopic presentation of an endobronchial nocardial mass in a 55-year-old immunocompetent woman without underlying lung disease. The patient exhibited signs and symptoms of unresolving community-acquired pneumonia with a computed tomography (CT) scan that showed a space-occupying lesion and enlarged paratracheal lymph node. This patient represents the unusual presentation of pulmonaryNocardia beijingensisas an endobronchial mass. Pathology obtained during bronchoscopy demonstrated polymerase chain reaction (PCR) confirmation of nocardiosis. Symptoms and clinical findings improved with antibiotic treatment. This patient emphasizes the challenge in making the diagnosis of pulmonary nocardiosis, especially in a low risk host. A literature review presents the difficulties and pitfalls in the clinical assessment of such an individual.

scholarly journals Sepsis-induced digital ischaemia in a professional pianist, in the absence of vasopressors

2019 ◽  
Vol 12 (10) ◽  
pp. e229659
Author(s):  
Vishnu Kurup ◽  
R Scott Simpson
Keyword(s):  
Rapid Development ◽  
Treatment Options ◽  
Coagulation Factors ◽  
Sepsis Syndrome ◽  
Limb Ischaemia ◽  
Optimal Care ◽  
Disseminated Intravascular Coagulopathy ◽  
Pneumococcal Sepsis ◽  
Intravascular Coagulopathy ◽  
Digital Ischaemia

Peripheral limb ischaemia and gangrene are devastating complications of pneumococcal sepsis. We report a 43-year-old professional pianist who presented with early sepsis and rapid development of this syndrome. No vasopressor medication was ever administered. We urgently reviewed the medical literature on a range of therapies recommended by consulting teams, to ensure he received optimal care. Based on our review and on feedback from the patient himself, we gained valuable insights into this illness and the merits of selected treatment options. His fingers ultimately recovered their function, intact, although several toes were later amputated. More recently published reviews postulate that imbalances in coagulation factors and natural anticoagulants occur as a result of disseminated intravascular coagulopathy and ‘shock liver’ in the sepsis syndrome, leading to microcirculatory thromboses. We submit this report as we believe it supports this hypothesis and adds further valuable information. We hope our observations will assist other critical care clinicians confronting this serious condition.

Disseminated Intravascular Coagulopathy during Experimental Pneumococcal Sepsis: Studies in Normal and Asplenic Rhesus Monkeys

1977 ◽  
Vol 6 (4) ◽  
pp. 203-218 ◽  
Author(s):  
H. Bradford Hawley ◽  
Tadataka Yamada ◽  
Deane F. Mosher ◽  
Douglas P. Fine ◽  
Richard F. Berendt
Keyword(s):  
Rhesus Monkeys ◽  
Disseminated Intravascular Coagulopathy ◽  
Pneumococcal Sepsis ◽  
Intravascular Coagulopathy

Purpura fulminans skin lesions in a newborn with complete protein C deficiency

1998 ◽  
Vol 132 (3) ◽  
pp. 558 ◽  
Author(s):  
Gideon Paret ◽  
Asher Barzilai ◽  
Zohar Barzilay
Keyword(s):  
Protein C ◽  
Purpura Fulminans ◽  
Skin Lesions ◽  
Protein C Deficiency ◽  
Complete Protein

Disseminated Intravascular Coagulopathy in Critically Ill Patients in Amman, Jordan

2021 ◽  
pp. 109980042110172
Author(s):  
Eman Mahmoud Qasim Emleek ◽  
Amani Anwar Khalil
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Scoring System ◽  
Elevated Serum ◽  
Underlying Disease ◽  
Disseminated Intravascular Coagulopathy ◽  
Period Prevalence ◽  
Lower Baseline ◽  
Intravascular Coagulopathy

Background: The disseminated intravascular coagulation (DIC) is under-recognized in critically ill patients. The International Society of Thrombosis and Haemostasis (ISTH; DIC) provides a useful scoring system for accurate DIC identification. The study investigated the period prevalence of ISTH DIC from 2015 to 2017 in critically ill patients. Methods: In this multi-center, retrospective observational study, we included all patients identified with a DIC code or medically diagnosed with DIC during all admissions. Based on ISTH DIC scores ≥ 5, patients were classified with overt DIC. Results: A total of 220 patients were included in this study. The period prevalence of DIC was 4.45%. The point prevalence of DIC has increased from 3.49% to 5.58% from 2015 to 2017 (27.7% female; median age 61.6 years). Based on the ISTH-Overt DIC criteria, 45.2% of the sample had sepsis. Overt DIC patients had significantly lower baseline hemoglobin (HB; t = 2.137, df = 193, p = 0.034), platelet count ( t = 3.591, df = 193, p < 0.001) and elevated serum creatinine level ( M = 2.1, SD = 1.5, t = 2.203, df = 193, p = 0.029) compared to non–Overt DIC. There was a statistically significant elevation in FDPs among Overt DIC compared to non–Overt DIC (χ2 = 30.381, df = 1, p < 0.001). Overt DIC patients had significantly prolonged PT ( U = 2,298, z = 5.7, p < 0.001), PTT ( U = 2,334, z = 2.0, p = 0.045) and INR ( U = 2,541, z = 5.1, p < 0.001) compared to those with non–Overt DIC. Conclusion: The ISTH overt-DIC score can be used in critically ill patients regardless of the underlying disease. Efforts are required to predict and identify overt DIC using a valid scoring system on admission and follow-up of adult patients admitted to ICU.

Group B Streptococcal and Pneumococcal Sepsis in Newborn Infants: The Role of Pneumococcal Antibody

PEDIATRICS ◽  
1978 ◽  
Vol 62 (4) ◽  
pp. 620-621
Author(s):  
Gerald W. Fischer ◽  
James W. Bass ◽  
George H. Lowell ◽  
Martin H. Crumrine
Keyword(s):  
Streptococcus Pneumoniae ◽  
Hydrochloric Acid ◽  
Group B Streptococcus ◽  
Newborn Infants ◽  
Polysaccharide Antigen ◽  
Type Iii ◽  
Pneumococcal Sepsis ◽  
Group B

The article by Bortolussi et al. on pneumococcal septicemia and meningitis in the neonat (Pediatrics 60:352, September 1977) was of great interest to us, since we have been analyzing the effect of antibody directed against Streptococcus pneumoniae on group B Streptococcus type III. We have recently shown (unpublished data) that antibody directed against S. pneumoniae type 14 precipitates the hot hydrochloric acid-extracted polysaccharide antigen of group B Streptococcus type III. Further studies have shown that this antibody is opsonic for group B Streptococcus type III in an in vitro bactericidal assay and protective in a suckling rat model of group B Streptococcus type III sepsis.1

Primary cutaneous nocardiosis of the head and neck in an immunocompetent patient

2021 ◽  
Vol 14 (5) ◽  
pp. e241217
Author(s):  
Claudio Tirso Acevedo ◽  
Frank Imkamp ◽  
Ewerton Marques Maggio ◽  
Silvio Daniel Brugger
Keyword(s):  
Head And Neck ◽  
Skin Lesions ◽  
Immunocompetent Patient ◽  
Rrna Gene ◽  
Gene Sequence Analysis ◽  
Rare Manifestation ◽  
Life Threatening ◽  
Amoxicillin Clavulanic Acid ◽  
Disseminated Nocardiosis ◽  
The Right

Nocardiosis is known to be an opportunistic infection most commonly affecting immunocompromised patients that can lead to life-threatening conditions. Primary cutaneous disease remains a rare manifestation and unlike pulmonary or disseminated nocardiosis, it usually affects immunocompetent individuals. We present a case of a primary cutaneous nocardiosis of the head and neck after an insect bite in a healthy 50-year-old woman who had recently travelled from Greece. She presented with a painful right-sided swelling of her face and neck and an ulcerated plaque over the right temple. Biopsy of the plaque revealed inflammation with abscess formation indicating underlying infection. Culture from the biopsy showed growth of Nocardia spp and 16S rRNA gene sequence analysis identified Nocardia brasiliensis. The patient was treated with trimethoprim/sulfamethoxazole and subsequently switched to amoxicillin/clavulanic acid due to a drug eruption. Antibiotic therapy was continued for a total of 3 months with complete resolution of the skin lesions.

Clinical and epidemiological features of community-acquired pneumonia during an epidemic of respiratory viral infection

2021 ◽  
Vol 31 (4) ◽  
pp. 490-498
Author(s):  
N. I. Izmozherova ◽  
A. A. Popov ◽  
E. R. Prokopeva ◽  
A. A. Kuryndina ◽  
E. I. Gavrilova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Streptococcus Pneumoniae ◽  
Causative Agent ◽  
Community Acquired Pneumonia ◽  
Influenza Viruses ◽  
X Rays ◽  
Imaging Data ◽  
Cross Sectional ◽  
Epidemiological Features ◽  
Working Age

Community-acquired pneumonia (CAP) is one of the most common lower respiratory tract diseases. An increase in the CAP incidence has been reported to be associated with epidemics of acute respiratory viral infections (ARVI).Aim. Аssess clinical and epidemiological features of CAP in patients admitted to hospital during an ARVI epidemic.Methods. A cross-sectional study included 208 patient records. Medical history, physical examination, laboratory and imaging data were analyzed. CAP severity was assessed by CRB-65 scale and the systemic inflammatory response syndrome (SIRS) criteria.Results. Most CAP patients (75%) were of active working age; all presented signs of ARVI upon admission. Nasal mucosa diagnostic smears have revealed type A influenza viruses: H1N1 – 5 (83.3%) and H3N2 – 1 (16.7%) cases. 195 (93.8%) patients were not vaccinated against influenza. X-rays showed that unilateral (81.7%) and lobular pneumonia (55.8%) were the most common CAP types. 93.2% patients had nonsevere CAP, according to CRB-65. But 88 (42.3%) subjects qualified for SIRS upon admission. Concomitant conditions as risk factors of an adverse course of CAP were present in 89 patients (42.8%). Sputum analysis, if available, most frequently identified Streptococcus pneumoniae (23 cases or 38.9%) as a causative agent. Antibacterial drugs (ABD) used to treat CAP were ceftriaxone 206 (99%), macrolides 188 (90.4%), and fluoroquinolones 94 (45.2%). The initial antibacterial treatment regimens were: 186 (89.4%) prescriptions of ceftriaxone + macrolides, 16 (7.7%) prescriptions of ceftriaxone alone, and 6 (2.9%) prescriptions of levofloxacin. A switch between ABDs was reported in 78 (37.5%) cases, including 61 switches to fluoroquinolones. The median ABD administration duration was 10 (8 – 13) days.Conclusion. Most of the hospitalized CAP patients were of working age and not vaccinated against influenza. Streptococcus pneumoniae was the most common causative agent. PCR (polymerase chain reaction) smear analysis was performed only in 6 patients with ARVI, which does not allow us to assess the role of viruses and viral-bacterial associations in the etiology of CAP. In spite of non-severe CAP, all hospitalizations were justified, due to multiple risk factors of unfavorable prognosis of CAP and epidemiological factors. Most patients received a combination of generation 3 cephalosporins and macrolides as the initial therapy for CAP.

scholarly journals Clinical Presentation and Bacterial Etiology of Adult Community Acquired Pneumonia

2017 ◽  
Vol 34 (3) ◽  
pp. 128-134
Author(s):  
Md Abdus Salam ◽  
Md Robed Amin ◽  
Quazi Tarikul Islam
Keyword(s):  
Streptococcus Pneumoniae ◽  
Blood Culture ◽  
Mycoplasma Pneumoniae ◽  
Chlamydia Pneumoniae ◽  
Community Acquired Pneumonia ◽  
Sputum Culture ◽  
Gram Positive ◽  
Gram Negative ◽  
The Mean ◽  
Gram Positive Cocci

Introduction: Pneumonia is a worldwide, serious threat to health and an enormous socio-economic burden for health care system. According to recent WHO data, each year 3-4 million patients die from pneumonia. The clinical presentations and bacterial agents responsible for community acquired pneumonia (CAP) varies according to geography and culture.Methods: A cross sectional observational study conducted among the 53 consecutive patients with a clinical diagnosis of CAP in admitted patient in the department of Medicine, DMCH, during January 2010 to December 2010. Hematological measurements (TC of WBC, Hb%, ESR, platelet count), blood culture, chest X-ray P/A view, sputum for Gram staining and culture sensitivity, sputum for AFB, blood urea and random blood sugar were done in all cases. ELISA for IgM antibody of Mycoplasma pneumoniae and Chlamydia pneumoniae were done in sputum culture negative cases.Results: The mean (±SD) age was 38.9±17.3 years and Male female ratio was 3:1. Fever, chest pain and productive cough were the most common clinical features. The mean (±SD) respiratory rate was 23.0±2.8 /minute . COPD and DM were found in 17.0% and 5.7% of patients respectively . Blood culture was found positive in only 1.9% of the study patients. Gram positive Cocci 62.26%, Gram negative Bacilli 9.43%, mixed Gram positive cocci and Gram negative bacilli 11.32% and Gram negative Cocco Bacilli 1.9% were observed and in 15.03 % cases, no bacteria could be seen. Sputum culture revealed 53.8% streptococcus pneumoniae, 26.9% Klebsiella pneumonia as predominant organism. Mycoplasma pneumoniae and Chlamydia pneumoniae were found in 7.4% and 3.7% respectively by serological test. For Streptococcus pneumoniae, sensitive antibiotics were Amoxyclav and Levofloxacin. For Gram negative bacilli and coccobacilli, more sensitive antibiotics were Meropenem, Ceftriaxone, and Clarithromycin. The best sensitive drug were found meropenem. The mean (±SD) duration of hospital stay was 5.0±1.7 days with ranging from 3 to 10 days.Conclusion: Region based bacteroiological diagnosis of Cap is important for selecting the best and sensitive drugs for complete cure.J Bangladesh Coll Phys Surg 2016; 34(3): 128-134

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