HIV-child with disseminated Talaromyces Marneffei (Penicillium marneffei) infection: a rare severe case report

Background Talaromyces Marneffei (Penicillium marneffei, T.marneffei) has been frequently reported in patients with adult acquired immunodeficiency syndrome. Still, cases of children with HIV combined with T.marneffei infection are very rare. This report describes the case of a HIV-child who is a girl from China. Her special clinical manifestations and laboratory diagnosis results can provide clinicians with the basis for diagnosis and treatment of T.marneffei related rare diseases. Case presntation We reported a single case of 7-year-old Chinese female patient who presented with fever, abdominal pain, multiple lymphadenopathy, hepatosplenomegaly, left lower extremity ecchymosis, and bloody stool. The patient received anti-inflammatory therapy; however, her symptoms did not improve. Consequently, she was diagnosed with T.marneffei and HIV infection; it was also confirmed that her mother did not undergo HIV blocking therapy during pregnancy. Yet, the child’s family refused all treatment, after which the child was discharged from the hospital. The patient died a few days later. Conclusion This case suggested that children with AIDS suffering from fever, lymphadenopathy and coagulation dysfunction, penicilliosis should be suspected. Clinicians should diagnose the disease early through laboratory and imaging results, which can help reduce the mortality, prolong the survival time and improve the quality of life of children.

Efficacy of Praziquantel for the Treatment of Human Schistosomiasis in Ethiopia: A Systematic Review and Meta-Analysis

Background. Schistosomiasis is one of the neglected tropical diseases causing a serious human health problem in Ethiopia. Praziquantel is the only drug that has been used for the treatment of human schistosomiasis in the country. In line with this, the efficacy of praziquantel has been evaluated in a few interventional studies in the country, but there is a lack in systematically gathered and analyzed information for policymakers. The aim of this systematic review and meta-analysis was to provide a summary of the efficacy of praziquantel for the treatment of human schistosomiasis in Ethiopia. Methods. We conducted a literature search from ScienceDirect, PubMed/Medlin, and Google Scholar databases. A total of 140 articles published in English from 1980 to June 2021 were accessed and 15 of them were eligible for this meta-analysis. The meta-analysis was conducted using Stata 14 software, “metan command.” The heterogeneities among studies were evaluated using I2 test. Results. A total of 140 articles were reviewed, but only 15 of them fulfilled the inclusion criteria. The polled cure rate of 40 mg/kg praziquantel was 89.2% (95% CI: 85.4–93.1) and 93.6% (95% CI: 80.6–106) among Schistosoma mansoni and S. haematobium, respectively. Similarly, the mean egg reduction rates of 40 mg/kg praziquantel were 90.2% and 85% among S. mansoni and S. haematobium infected subjects, respectively. The common adverse events observed after receiving praziquantel include abdominal pain, vomiting, headache, diarrhea, and bloody stool. Conclusion. This systematic review and meta-analysis has indicated that praziquantel is still an appropriate drug for the treatment of human schistosomiasis in Ethiopia.

Novel pediatric granulomatosis with polyangiitis with a marked bloody pericardial effusion and bloody stool: a case report

Background Granulomatosis with polyangiitis (GPA) is a syndrome of refractory vasculitis involving the upper respiratory tract, lungs, kidneys, and systemic small and medium-sized arteries that affects all age groups. No pediatric case with a bloody pericardial effusion resulting in cardiac tamponade and co-existing hematochezia has been reported. Case presentation A 14-year-old boy was referred for evaluation of prolonged fever, chest pain, and intermittent hematochezia. Diagnostic imaging showed a prominent pericardial effusion. Immediately after admission, his systolic blood pressure decreased. Emergent pericardiocentesis resulted in aspiration of a massive amount of bloody pericardial fluid. This was diagnosed as cardiac tamponade because his blood pressure recovered immediately after the drainage. The patient had an elevated serine proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA) level on serological examination. Head MRI showed thickening of nasal and sinusoidal mucosa and a cystic mass in the left sphenoid sinus. After ruling out malignancy based on the cytology of the effusion, chest MRI, and gallium scintigraphy, total colonoscopy showed multiple irregular-shaped aphthae from the right transverse colon to the cecum on the contralateral side of the mesenteric attachments. Biopsy specimens of aphthous lesions confirmed necrotizing granulomatous inflammation. A diagnosis of GPA was made based on these findings, and oral prednisolone (PSL) and azathioprine were started. The hematochezia disappeared rapidly, and no recurrence of pericardial effusion was seen after PSL tapering was completed. The PR3-ANCA level decreased into the normal range immediately after the initial therapy. Conclusions Pericarditis is a common cardiac complication of GPA, but there have been no reports of resultant cardiac tamponade. This is the first case of pediatric GPA with cardiac and gastrointestinal complications preceding the common symptoms such as respiratory or renal symptoms. A case of pediatric GPA with hematochezia is also extremely rare. In conclusion, serial measurement of ANCA levels is important in patients with persistent fever and bloody stool, such as in inflammatory bowel disease, to make the diagnosis of a vasculitic syndrome.

Clinical Characteristics of Pediatric Intussusception And Predictors of Surgery And Bowel Resection In Affected Patients

Surgery is required for the treatment of intussusception when enema reduction is unsuccessful, or when the patient develops peritonitis, bowel perforation, or intestinal damage. We aimed to evaluate the clinical and laboratory parameters that may be used to predict the need for bowel resection in children with intussusception. This observational retrospective study included children who were admitted to the pediatric emergency room with intussusception. Multivariate logistic regression models were used to evaluate factors associated with bowel resection. In total, 584 children with intussusception were admitted to the pediatric emergency room; 129 of these children underwent surgery. Multivariate analysis revealed the following independent predictors of surgery for intussusception: abdominal pain (odds ratio [OR] = 0.372; p = 0.013), bloody stool (OR = 3.553; p = 0.044), and hyponatremia (OR = 4.12; 95% p = 0.003). Symptoms for at least 2 days before surgery (OR = 6.863; p = 0.009), long intussusception (OR = 5.088; p = 0.014), pathological lead point (OR = 6.926; p = 0.003), and intensive care unit admission (OR = 11.777; p = 0.001) were factors independently associated with bowel resection. These findings can be used to identify patients at high risk of needing surgery and bowel resection.

Development and Validation of a Nomogram for Preoperative Prediction of Localization of Neonatal Gastrointestinal Perforation

Background: Information regarding the localization of gastrointestinal perforation is crucial for the following surgical procedure. This study was to determine the key indicators and develop a prediction model for the localization in neonates with gastrointestinal perforation.Methods: A nomogram to predict the location of neonatal gastrointestinal perforation was developed using a cohort of patients who underwent surgery between July 2009 and May 2021. Baseline variables were analyzed using logistics regression and nomogram developed using significant predictors. The predictive performance of the nomogram was assessed by the concordance index (C-index), calibration curve, and area under the receiver operating characteristic (ROC) curve (AUC). The nomogram was further validated in an integrated external cohort.Results: We investigated the data of 201 patients, of which 65 (32.3%) were confirmed with upper gastrointestinal perforation by surgery. Multivariate logistic regression analysis identified the following as independent predictors: preterm [OR: 5.014 (1.492–18.922)], time of onset [OR: 0.705 (0.582–0.829)], preoperative hemoglobin [OR:1.017 (1.001–1.033)], bloody stool: No [OR: 4.860 (1.270–23.588)], shock [OR: 5.790 (1.683–22.455)] and sepsis: No [OR 3.044 (1.124–8.581)]. Furthermore, the nomogram was effective in predicting the perforation site, with an AUC of 0.876 [95% confidence interval (CI): 0.830–0.923]. Internal validation showed that the average AUC was 0.861. Additionally, the model achieved satisfactory discrimination (AUC, 0.900; 95% CI, 0.826–0.974) and calibration (Hosmer-Lemeshow test, P = 0.4802) in external validation.Conclusions: The nomogram based on the six factors revealed good discrimination and calibration, suggesting good clinical utility. The nomogram could help surgeons predict the location of gastrointestinal perforation before surgery to make a surgical plan.

Edwardsiella ictaluri, an unusual cause of bacteraemia in a Nigerian child with acute bloody diarrhoea

Enteric septicaemia of catfish was first detected in 1976 as an economically significant disease associated with commercial catfish production. Initially, Edwardsiella ictaluri was a host specific pathogen of catfish species but has also been reported from other hosts other than the catfish such as the zebrafish. E. ictaluri has not been isolated in humans hence it is not a zoonotic infection. There has been no previous report of isolation of this organism in humans. This was a case report of a 5 year old boy who presented with fever, vomiting, passage of bloody stool of 6 days and abdominal pain of a day duration. In the case of this 5 year old boy who presented with features of dysentery, blood culture using BACTEC™ grew E. ictaluri. E. ictaluri may be a pathogen which can infect humans just like another closely related species, Edwardsiella tarda. Although, E. ictaluri has not been reported in humans, could this be the first case? Non availability of diagnostic technique appropriate for its diagnosis may explain the rare incidence of the organism in humans, hence many cases would have been treated without isolating the organism.

Efficacy and safety of Qingre-Chushi therapies in active ulcerative colitis: A network meta-analysis

Background Ulcerative colitis (UC) is a chronic inflammatory disease with an increasing incidence in the world. Qingre-Chushi therapies (QC) can alleviate clinical symptoms. Therefore, a network meta-analysis was conducted to systematically evaluate the efficacy and safety of QC in the treatment of active UC patients. Methods 7 databases were screened and relevant randomized controlled trials were selected. The tools of Cochrane Handbook and the GRADE system were conducted to assess the quality of outcomes. Pooled risk ratio or standard mean difference was calculated with 95% credible interval for outcomes measurement using the random-effects model. The surface under the cumulative ranking curve (SUCRA) was performed to rank the treatments. The larger SUCRA scores, the more effective interventions. Results A total of 3560 articles were identified and 21 studies including 1829 participants were included for further analysis. Totally, 9 therapies regimens were compared: oral mesalazine, mesalazine enema, mesalazine suppository, oral mesalazine + mesalazine enema, oral QC, oral QC + oral mesalazine, QC enema, oral QC + QC enema, and oral mesalazine + QC enema. Based on the SUCRA plot, oral QC + oral mesalazine was the best treatment in inducing clinical response; oral QC + QC enema had the best efficacy in the improvement of Mayo scores and alleviating abdominal pain; oral mesalazine + mesalazine enema was the optimal therapy in the endoscopic improvement and reducing diarrhea; QC enema + oral mesalazine was the best option in preventing bloody stool. Conclusion This study confirmed the efficacy and safety of QC in treating active UC and suggested that the combination of oral medications with topical can achieve more benefits.

Analysis of the role of the endoplasmic reticulum stress response-related molecule CHOP in intestinal epithelial cells

Inflammatory bowel diseases (IBDs) include ulcerative colitis and Crohn's disease. The symptoms experienced by people with IBD include diarrhea, bloody stool, extreme tiredness, weight loss and stomach pain. IBD is on the rise globally and it is unknown why. There is no existing cure for the condition and treatments are not always successful. In the quest to find a cure for IBD, researchers are investigating the mechanisms of the disease. Dr Yosuke Shimodaira, Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Japan, is seeking to understand more about the mechanisms involved in the development of the disease. A key part of this research is autophagy and Shimodaira and the team are working to shed light on why endoplasmic reticulum (ER) stress in the intestinal epithelial cells induces autophagy and the role this might play in the development of IBD. A key learning for the team was that C/EBP-homologous protein (CHOP) is involved in the ER stress response. An important focus for the researchers is on the role played by CHOP in intestinal epithelial cells in vivo and its involvement in the pathophysiology of IBD. Shimodaira and the team plan to conduct experiments using mice and patients samples to analyse these fundamental mechanism in intestinal homeostasis. This will enable them to determine whether CHOP plays a role in vivo and how CHOP affect intestinal immune system.

Debulking Operation, Radiation Therapy, and Sphincter-Sparing Local Wide Excision for The Lower Rectal Melanoma: A Case Report

Background Rectal melanoma is a rare disease that accounts for about 1% of rectal cancers. Abdominoperineal resection was the standard surgical intervention for local control. However, it can lead to complications and reduce the quality of life due to colostomy. Debulking surgery, radiotherapy (RT), and sphincter-sparing wide local excision (WLE) were performed on a patient with rectal melanoma.Case presentationA case of a 79-year-old woman with anal pain and bloody stool for 1 month was reported in this study. The digital examination of the rectum revealed a big polypoid mass over the lower rectum. Stage II rectal melanoma was diagnosed by colonoscopy, biopsy, magnetic resonance imaging, and positron emission tomography. The patient initially received debulking surgery to relieve the symptoms of active bleeding followed by radiotherapy for the residual tumor with partial response. Finally, a sphincter-sparing WLE was performed for the residual tumor to preserve the anal function. The postoperative course went smoothly. No local recurrence and anal symptoms were observed during the 2-years follow-up period.Conclusions: Combining debulking surgery, RT, and WLE may be a viable alternative for rectal melanoma that cannot be completely resected at the beginning and accompanied by bleeding symptoms.

The Outbreak of Foodborne Disease by Pathogenic Enterobacteriaceae Antimicrobial Resistance - A Review

Chemicals, bacteria, viruses, and parasites can cause contamination of food. The general signs and symptoms of food poisoning include vomiting, diarrhea, headache, abdominal cramps, and fever. Paralysis and death could occur in severe infection. Most cases of food poisoning in Saudi Arabia are caused by the Enterobacteriaceae family of bacteria which is comprised of Shigella, Salmonella, and Escherichia coli. Most medications that are used to treat infections that are caused by these bacteria have become ineffective due to resistance. Escherichia coli reaches intestines due to fecal-oral contamination, consuming contaminated food, animal products, and water. Affected individuals present with fever, bloody diarrhea, vomiting, kidney failure, and hemolytic uremic syndrome. Some strains do not cause fever. Food hygiene is the best way of breaking the transmission cycle of Escherichia coli. Salmonella typhi is the causative agent of typhoid fever. The clinical picture of the affected individuals includes typhoid and non-typhoid symptoms. Typhoid symptoms include high fever, stomach pain, weakness, cough, diarrhea, and loss of appetite. On the other hand, non-typhoid signs are comprised of fever, septicemia, and prostration. Food contamination by Shigella spp. culminates in fever, cramps, diarrhea, and bloody stool. The microbe gets into healthy humans through contaminated food, tools, and water or via direct contact (like in sexual intercourse). Effective management of food poisoning entails rehydration, use of antibiotics, and encouraging adequate rest for the affected patients. One challenge that is likely to hamper the current treatment modality is the microbial resistance that the microbes have gained. Thus, new drugs have to be developed. The objectives and aims are to investigate the current biohazard of these types of microbes on foods and human safety in the Kingdom of Saudi Arabia and across the world, as well as to identify mutated and antibiotic-resistant types.