scholarly journals Proven Fatal Invasive Aspergillosis in a Patient With COVID-19 and Staphylococcus aureus Pneumonia

2021 ◽  
Vol 7 (3) ◽  
pp. 230
Author(s):  
Frank van Someren van Someren Gréve ◽  
Romy du du Long ◽  
Raju Talwar ◽  
Charlotte J. P. Beurskens ◽  
Huibertus J. Voerman ◽  
...  
Keyword(s):  
Lung Biopsy ◽  
Positive Culture ◽  
Diagnostic Procedures ◽  
Invasive Fungal Disease ◽  
Post Mortem ◽  
Opportunistic Pathogens ◽  
Pulmonary Aspergillosis ◽  
Proven Case ◽  
Staphylococcus Aureus Pneumonia ◽  
And Staphylococcus Aureus

There is increasing attention for opportunistic pathogens such as Aspergillus fumigatus complicating SARS-CoV-2 infections in the critically ill. For invasive fungal disease, establishing a clear diagnosis can be challenging due to the invasiveness of diagnostic procedures required for a proven case. Here we present one of the first proven cases of COVID-19-associated pulmonary aspergillosis by positive culture of post-mortem lung biopsy.

Epidural Lipomatosis Simulating an Epidural Abscess: Case Report and Literature Review

Neurosurgery ◽  
1987 ◽  
Vol 21 (5) ◽  
pp. 744-747 ◽  
Author(s):  
Regis W. Haid ◽  
Howard H. Kaufman ◽  
Sydney S. Schochet ◽  
Gary D. Marano
Keyword(s):  
Spinal Cord ◽  
Epidural Abscess ◽  
Cord Compression ◽  
Fatty Tissue ◽  
Epidural Lipomatosis ◽  
Neurological Improvement ◽  
Computed Tomographic ◽  
Dose Corticosteroid ◽  
Staphylococcus Aureus Pneumonia ◽  
And Staphylococcus Aureus

Abstract A case of epidural lipomatosis in a 49-year-old man presenting with paraparesis, midthoracic pain, and Staphylococcus aureus pneumonia is reported. The patient had been on low dose corticosteroid therapy for 7 years for rheumatoid arthritis. The clinical and myelographic findings suggested a diagnosis of epidural abscess, but the only abnormality discovered at operation was abundant fatty tissue in the dorsal epidural space significantly compressing the spinal cord, and this was partially removed. Postoperative neurological improvement suggested that the lipomatosis was responsible for the spinal cord compression and dysfunction. If this diagnosis had been suspected, it might have been confirmed by magnetic resonance imaging or postmyelography computed tomographic scanning. With such a diagnosis, an alternative treatment could have been to decrease the steroid dose, observe for clinical improvement, and perhaps avoid operation. (Neurosurgery 21:744-747, 1987)

scholarly journals Allergen Immunotherapy in an HIV+ Patient with Allergic Fungal Rhinosinusitis

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ian A. Myles ◽  
Satyen Gada
Keyword(s):  
Allergen Immunotherapy ◽  
Severe Infection ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Fungal Sinusitis ◽  
Opportunistic Pathogens ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
Invasive Fungal Rhinosinusitis ◽  
Chronic Invasive

Patients with HIV/AIDS can present with multiple types of fungal rhinosinusitis, fungal balls, granulomatous invasive fungal rhinosinusitis, acute or chronic invasive fungal rhinosinusitis, or allergic fungal rhinosinusitis (AFRS). Given the variable spectrum of immune status and susceptibility to severe infection from opportunistic pathogens it is extremely important that clinicians distinguish aggressive fungal invasive fungal disease from the much milder forms such as AFRS. Here we describe a patient with HIV and AFRS to both remind providers of the importance of ruling out invasive fungal disease and outline the other unique features of fungal sinusitis treatment in the HIV-positive population. Additionally we discuss the evidence for and against use of allergen immunotherapy (AIT) for fungal disease in general, as well as the evidence for AIT in the HIV population.

Risk Factors and Prevention of Peritoneal Dialysis-Related Peritonitis

2019 ◽  
Vol 39 (2) ◽  
pp. 119-125 ◽  
Author(s):  
Liliana Gadola ◽  
Carla Poggi ◽  
Patricia Dominguez ◽  
María V. Poggio ◽  
Eliana Lungo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Educational Program ◽  
Positive Culture ◽  
Major Complication ◽  
Free Survival ◽  
Gram Positive Bacteria ◽  
Cox Analysis ◽  
And Staphylococcus Aureus

Background Peritonitis is a major complication and the main cause of peritoneal dialysis (PD) failure. The aim of the present study was to evaluate peritonitis risk factors and its prevention with a new peritoneal educational program (NPEP). Methods We performed a retrospective analysis of a cohort of chronic PD patients, older than 16 years, who began PD in the period 1 January 1999 to 31 December 2015 at a Uruguayan PD center, with follow-up until 31 December 2016. Results The population included 222 cases (219 patients, 128 men), median age 59 (interquartile range [IQR] 47.0 – 72.0) years, median time on PD 17.5 (IQR 6.0 – 36.2) months. Ninety-five patients suffered 1 or more episodes of peritonitis, and they had been on PD for a longer period and had nasal-positive culture more frequently. A NPEP started in September 2008; patients who trained with it, as well as younger patients, had longer peritonitis-free survival. After the NPEP, global peritonitis rates decreased significantly (from 0.48 to 0.29 episodes/patient-year, respectively), particularly gram-positive bacteria and Staphylococcus aureus / coagulase-negative (CoNS) (from 0.26 to 0.12 and 0.21 to 0.07 episodes/patient-year, respectively). In the multivariate Cox analysis of peritonitis risk factors, survival to first peritonitis was significantly associated only with age (hazard ratio [HR] 1.024, 95% confidence interval [CI] 1.007 – 1.397, p = 0.007) and the NPEP (HR 0.600, 95% CI 0.394 – 0.913, p = 0.017). Conclusion A multidisciplinary peritoneal educational program may improve peritonitis rates, independently of other risk factors.

scholarly journals Diagnostic-driven management of invasive fungal disease in hematology in the era of prophylaxis and resistance emergence: Dutch courage?

2019 ◽  
Vol 57 (Supplement_3) ◽  
pp. S267-S273
Author(s):  
E A de Kort ◽  
J Maertens ◽  
P E Verweij ◽  
B J A Rijnders ◽  
N M A Blijlevens
Keyword(s):  
Antifungal Therapy ◽  
Standard Of Care ◽  
Diagnostic Procedures ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Antifungal Treatment ◽  
Clinical Implementation ◽  
Hematopoietic Stem ◽  
Haematological Patient ◽  
Emergence Of Resistance

Abstract Patients receiving intensive anti-leukemic treatment or recipients of allogeneic hematopoietic stem cell transplantation (HSCT) are prone to develop invasive fungal disease caused by both Aspergillus and non-Aspergillus moulds. Overall mortality following invasive mould disease (IMD) is high; adequate and timely antifungal treatment seems to ameliorate the outcome, yet early diagnosis in the haematological patient remains a challenge for most clinicians. Prophylaxis and the empiric addition of antifungal therapy to neutropaenic patients with fever persisting or recurring during broad-spectrum antibiotic treatment is therefore standard of care in many institutions. However, aside from the potential for overtreatment and important side effects, the emergence of resistance to medical triazoles in Aspergillus fumigatus poses a risk for inadequate initial treatment. Initial voriconazole therapy in patients with azole-resistant invasive aspergillosis was recently shown to be associated with a 23% increased mortality rate compared to the patients with azole-susceptible infection, despite changing to appropriate antifungal therapy once resistance was detected. Moreover, fever is not always present with IMD; therefore, cases may be missed when relying solely on this symptom for starting diagnostic procedures and antifungal treatment. At our institution, a diagnostic-driven treatment approach for IMD was implemented relying on clinical but also laboratory markers to start antifungal treatment. We describe the basis and clinical implementation of our diagnostic-driven approach in this review.

scholarly journals Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

2013 ◽  
Vol 8 ◽  
Author(s):  
Nuri Tutar ◽  
Gokhan Metan ◽  
Ayşe Nedret Koç ◽  
Insu Yilmaz ◽  
Ilkay Bozkurt ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Amphotericin B ◽  
Clinical Status ◽  
Invasive Pulmonary Aspergillosis ◽  
Positive Culture ◽  
Common Finding ◽  
Chronic Obstructive ◽  
Pulmonary Aspergillosis ◽  
Obstructive Pulmonary Disease

Background: Invasive pulmonary aspergillosis (IPA) is an infection often occurring in neutropenic patients and has high mortality rates. In recent years, it has been reported that the incidence of IPA has also increased in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study is to investigate the clinical and demographic characteristics and treatment responses of IPA in patients with COPD. Methods: Seventy-one patients with a positive culture of Aspergillus from lower respiratory tract samples were examined retrospectively. Eleven (15.4%) of these patients, affected with grade 3 or 4 COPD, had IPA. Results: Aspergillus hyphae were detected in lung biopsy in three (27.3%) out of 11 patients and defined as proven IPA; a pathological sample was not taken in the other eight (72.7%) patients, and these were defined as probable IPA. Aspergillus isolates were identified as six cases of Aspergillusfumigatus and three of Aspergillusniger in nine patients, while two isolates were not identified at species level. While five patients required intensive care unit admission, four of them received mechanical ventilation. The most common finding on chest X-ray and computed tomography (CT) (respectively 63.6%, 72.7%) was infiltration. Amphotericin B was the initial drug of choice in all patients and five patients were discharged with oral voriconazole after amphotericin B therapy. Six patients (54.5%) died before treatment was completed. Conclusions: IPA should be taken into account in the differential diagnosis particularly in patients with severe and very severe COPD presenting with dyspnea exacerbation, poor clinical status, and a new pulmonary infiltrate under treatment with broad-spectrum antibiotics and steroids.

scholarly journals A Triad Algorithm for Analysing Individual Ante- and Post-Mortem Findings to Improve the Quality of Intensive Care

2011 ◽  
Vol 39 (6) ◽  
pp. 1086-1092 ◽  
Author(s):  
M. Podbregar ◽  
E. Kralj ◽  
R. Čičak ◽  
A. Pavlinjek
Keyword(s):  
Intensive Care ◽  
Diagnostic Procedures ◽  
Class Ii ◽  
Massive Pulmonary Embolism ◽  
Class I ◽  
Algorithm Analysis ◽  
Post Mortem ◽  
Abdominal Ultrasonography ◽  
Autopsy Examination ◽  
Post Mortem Findings

Autopsy is an important source of data for education and quality control. The aim of this study was comparison of ante- to post-mortem findings to detect weak points of intensive care unit (ICU) care. Patients who died in our 14-bed university medical ICU care and underwent an autopsy examination over 20 months (September 2007 to May 2009) were included. Modified Goldman's criteria were used to categorise discrepancies between diagnoses and post-mortem findings. A triad algorithm was constructed to analyse individual ante- to post-mortem findings. One hundred and seventy post-mortem examinations were conducted (45.6% autopsy rate). Major diagnostic discrepancies were detected in 20 patients (11.8%); four class I (2.4%) and 16 class II (9.4%). Massive pulmonary embolism with cardiac arrest was the most common class I discrepancy (75%). Triad analysis of major class I discrepancies showed that all patients had a history of chronic disease; the majority (75%) had a short ICU length of stay. In 75% adequate tests were used to detect disorders. There were interpretation problems of bedside data in complex emergency clinical conditions, especially with less experienced ICU physicians. Inappropriate or incorrectly interpreted diagnostic procedures were performed in more than half of cases with class II discrepancies (9/16, 56%). Abdominal ultrasonography was misleading in 31% (5/16) cases with class II discrepancies. In conclusion, triad algorithm analysis revealed problematic interpretation of bedside diagnostics in emergency cases by inexperienced physicians in class I major discrepancies detected at autopsy. No correct test and wrong interpretation of abdominal ultrasonography were major causes of class II discrepancies.

scholarly journals Acute aortic rupture in a dog with spirocercosis following the administration of medetomidine : clinical communication

2005 ◽  
Vol 76 (3) ◽  
Author(s):  
K.E. Joubert ◽  
M.J. McReynolds ◽  
F. Strydom
Keyword(s):  
Aortic Wall ◽  
Aortic Rupture ◽  
Clinical Signs ◽  
Diagnostic Procedures ◽  
Definitive Diagnosis ◽  
Aortic Aneurysms ◽  
Post Mortem ◽  
Clinical Communication ◽  
Acute Rupture ◽  
Strong Suspicion

Spirocercosis is an emerging disease in veterinary medicine. A strong suspicion of spirocercosis is usually evident after a thorough clinical examination and radiography of the chest has been performed. Lesions seen on radiography include an oesophageal mass, spondylitis and oesophageal air. Unfortunately, radiography is not diagnostic and additional diagnostic procedures are required to confirm the diagnosis. Endoscopy is commonly performed to diagnose the condition. The dog presented in this study had radiographic and clinical signs consistent with spirocercosis and definitive diagnosis was required. Shortly after sedation with medetomidine, the dog went into cardiac arrest and failed to respond to resuscitative measures. On post mortem, the diagnosis of spirocercosis was confirmed and the cause of death was identified as acute aortic rupture. Aortic aneurysms are not an uncommon finding and cause of acute death in dogs with spirocercosis. The acute rupture of the aorta in this case is most probably the result of cardiovascular changes associated with the administration of medetomidine. Medetomidine causes an acute rise in systemic vascular resistance with hypertension. The increase in shear stress across the weakened aortic wall resulted in rupture. Caution with the use of medetomidine in patients with spirocercosis is advised.

scholarly journals Polymyxin B and Doxycycline for Treatment of Multidrug Resistant Klebsiella Pneumoniae and Staphylococcus Aureus Pneumonia in Intensive Care Unit

2019 ◽  
Vol 4 (2) ◽  
pp. 762-764
Author(s):  
Niraj Kumar Keyal ◽  
Manish Nakarmi ◽  
Pooja Adhikari
Keyword(s):  
Intensive Care Unit ◽  
Large Scale ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Broad Spectrum Antibiotic ◽  
Alternative Agent ◽  
Hospital Acquired Pneumonia ◽  
Staphylococcus Aureus Pneumonia ◽  
Hospital Acquired ◽  
And Staphylococcus Aureus

Doxycycline is a broad spectrum antibiotic. We hereby report a case report of patients that developed multidrug resistant hospital acquired pneumonia. Patients were treated with Polymyxin B and Doxycycline. From this we want to emphasize that Doxycycline can be used as alternative agent in combination with Polymyxin B for treatment of multidrug resistant pneumonia although there are no large scale studies on combination of Polymyxin B and Doxycycline.

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