Сlostridium difficile Infection in a COVID-19 Patient

Aim. The clinical observation highlights plausible compound origins of diarrhoea, fever and neutrophilic leucocytosis in COVID-19 and the rationale to exclude Clostridium difficile infection in such patients.Key points. A 57-yo female patient was admitted in May 2020 with the complaints of 39 °C fever, general weakness, polymyalgia, diarrhoea to 3–4 times a day (mushy stool, no morbid inclusions). Initial diarrhoea was non-severe and likely triggered by the coronavirus infection. A background antibiotic and putative-immunosuppressive therapy proceeded with watery diarrhoea to 7–8 times a day and C. difficile toxins A and B detected in stool. The C. difficile infection relapsed on day 10 of vancomycin withdrawal and associated with elevated body temperature, diarrhoea and neutrophil leucocytosis; signs of colitis determined in ultrasound and CT. Exacerbation was successfully treated in a repeated metronidazole-combined vancomycin course.Conclusion. Patients with COVID-19 are at risk of clostridial colitis due to massive antibiotic, systemic glucocorticoid and biologics-based therapy they receive. The opportunistic bacterial infection of C. difficile often proceeds undetected due to its potential mirroring of COVID-19 presentation. A screening algorithm in COVID-19 patients with diarrhoea should imply steps for C. difficile detection.

Multisystem Inflammatory Syndrome in Children (MIS-C): New challenges of a new era

In the background of a sudden surge of coronavirus disease 2019 (COVID-19) cases, reports of themultisystem inflammatory syndrome in children from different parts of the globe are a matter ofconcern for physicians. We report a similar case presenting with persisting fever, rashes, bulbarconjunctivitis, abdominal pain, respiratory difficulty, and shock. Initial reports suggestive of highinflammatory markers, neutrophilic leucocytosis, high d-dimer, transaminitis, and found to haveCOVID 19 IgG antibodies positive in high titer. The echo at the bedside is suggestive of poor LVfunction with normal coronaries. Managed successfully in PICU with non-invasive ventilation support,ionotropy, aspirin, IVIG, and steroids and discharged. Early referral, a high index of suspicion,prompt recognition of shock, and early management by steroids and intravenous immunoglobulin(IVIG) may bring success.

Haematobiochemical and electrolytes studies on clinical cases of rumen impaction in murrah buffaloes

The study was conducted to investigate hemato-biochemical and electrolytes changes caused by rumen impaction in 106 buffaloes diagnosed with rumen impaction during the period from July 2016 to June 2017 with the history of mild inappetance to complete anorexia, less water intake, scanty hard mucoid faeces and reduction in milk yield. Clinical examination revealed congested mucous membrane, mild to moderate degree of dehydration, decreased or absence of ruminal motility, slight rise in temperature and hard consistency of rumen on palpation and also on per rectal examination. The affected buffaloes revealed significantly higher values of WBC and neutrophils count indicating neutrophilic leucocytosis. However other haematological parameters were within the normal range. Blood film revealed no haemoprotozoan infection. Coproscopy did not exhibit any parasitic egg/ova/cyst/oocyst. Significant increase in glucose level, indirect bilirubin level, blood urea nitrogen, serum creatinine, ALT and AST enzyme activities was observed in the serum samples of affected buffaloes. A significant decrease was observed in electrolytes viz., sodium, potassium, iCa and chlorides. Present study concludes that marked changes in haematological and serum biochemical profile observed in rumen impaction cases may be useful in understanding the pathogenesis, treatment and prognosis of the disease.

Mediastinum Teratoma Rupture: A Rare Manifestation

We present the case of a 22-year-old man who presented with cough, haemoptysis and fever of 3 days’ duration. A teratoma had been diagnosed 2 years previously. Physical examination was unremarkable but laboratory tests showed anaemia, neutrophilic leucocytosis and an increase in C-reactive protein. Chest CT revealed a teratoma of the anterior mediastinum with post-obstructive pneumonitis suggestive of tumour rupture. Antibiotic treatment resulted in a good clinical outcome. The patient was submitted to a left upper lobectomy and pathological examination revealed a mature teratoma. Teratomas are germ cell tumours that are usually asymptomatic and their rupture is a rare event.

Hematologic changes in experimentally induced feline steatitis: A comparative study between the Domestic shorthair and Siamese breed

In order to study the hematological abnormalities in feline steatitis 10 Domestic shorthair (DSH) and 10 Siamese 2 to 3 month-old kittens were used to whom cooked sardines supplemented with minerals and vitamins, except vitamin E, were given for 4 consecutive months (experimental groups). An equal number of age and sex matched kittens for each breed that were being fed a commercial canned cat food based on oily fish and for the same period of time served as controls. Blood samples were taken at 0 time and at 15-day intervals thereafter for a CBC. Red and white blood cell morphology was also studied. Steatitis was reproduced in all the 20 kittens of the experimental groups. Five DSH kittens developed the clinical and 5 the subclinical form of the disease. The relevant figures for the affected Siamese kittens were 6 and 4, respectively. The clinical disease was significantly more severe in the DSH breed only at the very beginning of the experimental period (time 1). None of the controls belonging to both breeds developed clinical signs or lesions associated with steatitis. Low PCV(<25%) and decreased Hb concentration (<8 g/100ml) indicating anemia, and appearing as early as time 1, in the experimental groups were significantly more severe in the Siamese than in the DSH breed. Evidently the anemia was non-regenerative attributable to chronic inflammatory nature of steatitis. In most of the observation times significant neutrophilic leucocytosis was detected only in the experimental groups; a regenerative left shift was seen in approximatery 50% of all the cases with neutrophilia. Eosinophilia and monocytosis were of minor significance for both breeds. No erythrocyte and leucocyte morphological abnormalities were seen in the DSH or the Siamese experimental groups all over the experimental period.

Disseminated Tuberculosis with Involvement of Appendix, Peritoneum and Right Knee Joint - A Case Report

A 27 year old male presented with painful swelling of right knee joint for the last 6 months. Initially it was diagnosed as a case of reactive arthritis and was treated with NSAID with intraarticular steroids without significant improvement. Two months after the initial episode he again developed painful swelling of the right knee joint with severe abdominal pain and high grade fever. There was an ill defined ovoid mass in the right iliac fossa with generalized tenderness. ESR was raised and the ultrasonography revealed loculated ascites with appendicular lump. CT scan of the whole abdomen showed appendicular lump. FNAC from the lump showed tuberculosis. Joint fluid aspiration showed neutrophilic leucocytosis with the Total count 50,000/cmm. AFB was not found. So septic arthritis was diagnosed, but as the patient was not improving we send the patient to orthopedic department for synovial biopsy but they refused as it was septic. So a diagnosis of disseminated Tuberculosis was made with the involvement of right knee joint, appendix and peritoneum. He was put on anti TB and well responded.DOI: http://dx.doi.org/10.3329/jom.v15i2.20702 J MEDICINE 2014; 15 : 153-155

Oxaliplatin-Induced Haemolytic Anaemia: A Case Report

Oxaliplatin plus 5Fluorouracil (5FU) and leucovorin (LV) is the standard treatment of metastatic colorectal cancer (CRC). We describe a rare clinical case of acute renal failure probably oxaliplatin-related at one day from the end of the palliative treatment. A 36 year-old woman developed a stage I CRC. Five months later a liver lesion was detected and treated with FOLFOX4 schedule. Because of progression the patient underwent surgery and she repeated the Oxaliplatin-based therapy for more than one cycle. After many months of therapy, on the second day, the patient noticed urine discoloration. Immediate urinanalysis demonstrated haemoglobinuria. The patient's complete blood count exhibited signs consistent with acute hemolysis, neutrophilic leucocytosis, thrombocytopenia and acute renal failure. She was treated with blood transfusion and hemodialysis and she was managed conservatively with monitored intravenous hydration and loop diuretics. The patient gradually recovered and the results of successive hematological and biochemical tests confirmed the improvement of her condition but a cardiologic evaluation showed a iatrogenic depressed systolic function (ejection fraction of 40%).