Fungal brain infection—no longer a death sentence

Abstract The aim of this case series was to provide a modern cohort of patients with cerebral aspergillosis and show the effectiveness of modern treatment concepts. In a 10-year period from January 2009 to January 2019, we identified 10 patients (6 male, 4 female) who received surgery or frameless stereotactic drainage of a cerebral aspergilloma at our center. Patients’ and disease characteristics were recorded. The median age was 65 (range 45 to 83). We conducted 133 cranial surgeries in 100 patients due to cerebral brain abscess (BA) during that time, which leads to a percentage of 10% of aspergilloma within BAs in our patient sample. We performed 3.1 surgeries per patient followed by antifungal treatment for 6 months (= median) according to the microbiological findings. Regarding comorbidities, the mean Charlson comorbidity index (CCI) at the time of admission was 5, representing an estimated 10-year survival of 21%. Six (60%) of 10 patients showed conditions of immunosuppression, one suffered endocarditis after replacement of aortic valves. Four patients showed associated frontobasal bone destruction, mycotic aneurysms, or thromboses. The mean duration of hospital stay was 37 days. Mortality was much lower than in literature. Sixty percent of the patients died during the follow-up period. The outcome of the two immunocompetent patients was more favorable. Cerebral aspergillosis is a rare, but still life-threatening, condition, which predominantly occurs in immunosuppressive conditions. Due to radical surgical and antifungal therapy for several months, mortality can be reduced dramatically.

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Right ventricular thrombus, a challenge in imaging diagnostics: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab340 ◽

2021 ◽

Author(s):

Massimo Barbagallo ◽

Daryl Naef ◽

Pascal Köpfli ◽

Urs Hufschmid ◽

Tilo Niemann ◽

...

Keyword(s):

Right Ventricular ◽

Case Series ◽

General Medicine ◽

High Sensitivity ◽

Cost Effective ◽

Ventricular Thrombus ◽

Threatening Condition ◽

Life Threatening ◽

Therapeutic Decision Making ◽

Sensitivity Specificity

Abstract Background Presence of right ventricular thrombus (RVT) is a rare but life-threatening condition, thus immediate diagnosis and therapy are mandatory. Unfortunately, detection and distinction from intraventricular tumor masses or vegetations represents a complex task. Furthermore, consecutive therapy is principally led by clinical presentation without considering morphological features of the thrombus. Current literature suggests a multimodal non-invasive imaging approach. In this paper, we discuss the role of cardiac magnetic resonance (CMR) for the detection of RVT in patients with pulmonary embolism (PE). We consider the relatively expensive and not broadly available imaging procedure and weigh it up to its assumed high sensitivity, specificity and importance for differential diagnosis and therapeutic decision making. Case Summary In this case series we report three cases of RVT with concomitant PE, whereof two were missed during routine cardiac workup by transthoracic echocardiography (TTE) and computer tomography (CT). CMR led to detection and further characterization of the thrombi in both cases. These patients were diagnosed and treated at the Cantonal Hospital of Baden in the division of General Medicine. Conclusions CMR reliably detects and characterizes RVT, even under unfavourable conditions for echocardiography such as arrhythmia, adiposity or in posterior position of RVT. Obtained information could facilitate the choice of therapeutic approach (anticoagulation vs. systemic lysis, vs. surgical thrombectomy). Future risk-stratification scores will promote cost-effective use of CMR.

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COVID-19 in HIV: a Review of Published Case Reports

SN Comprehensive Clinical Medicine ◽

10.1007/s42399-020-00593-6 ◽

2020 ◽

Vol 2 (12) ◽

pp. 2647-2657

Author(s):

Zoya Morani ◽

Saumil Patel ◽

Sudeshna Ghosh ◽

Falah Abu Hassan ◽

Shriya Doreswamy ◽

...

Keyword(s):

Morbid Obesity ◽

Web Of Science ◽

Case Reports ◽

Case Series ◽

Hiv Patients ◽

High Burden ◽

Cardiovascular Comorbidities ◽

Life Threatening ◽

The Mean ◽

Immunocompromised State

AbstractPatients with COVID-19 present with a myriad of comorbidities. An immunocompromised state like HIV in patients with COVID-19 can be life-threatening. We searched PubMed/Medline, Scopus, and Web of Science for case reports and case series about COVID-19 in HIV patients. We finally reviewed 20 case reports including cases of 43 patients with HIV and COVID-19. The mean age of 43 adult patients was 51.56 ± 27.56 years (range 24–76 years). Of these, 30 were male (69.77%), 11 were female (25.58%), and 2 were transgender (4.65%). A total of 25 patients (58.14%) were above 50 years of age. The most common cardiovascular comorbidities were hypertension and hyperlipidemia (48.8%), diabetes (20.93%), and morbid obesity (11.63%). Out of 43 HIV patients with COVID-19, 6 resulted in death (13.95%). All the patients who died were elderly above 50 years and required mechanical ventilation. HIV patients infected with COVID-19 had a high mortality rate. A high burden of pre-existing comorbidities and an advanced age in these patients make them prone to disease progression and worse outcomes.

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Risks associated with oral deferiprone in the treatment of infratentorial superficial siderosis

Journal of Neurology ◽

10.1007/s00415-019-09577-6 ◽

2019 ◽

Vol 267 (1) ◽

pp. 239-243 ◽

Cited By ~ 6

Author(s):

Y. Sammaraiee ◽

G. Banerjee ◽

S. Farmer ◽

B. Hylton ◽

P. Cowley ◽

...

Keyword(s):

Side Effects ◽

Case Series ◽

Iron Chelator ◽

Superficial Siderosis ◽

Neutropenic Sepsis ◽

Favourable Safety ◽

Favourable Safety Profile ◽

Life Threatening ◽

The Mean ◽

Mean Time

Abstract Objective Deferiprone is an iron chelator that has recently been used to treat patients with infratentorial superficial siderosis (iSS). It is considered to have a generally favourable safety profile but concerns have been raised due to the risk of agranulocytosis. We aimed to evaluate the safety and tolerability of oral deferiprone as a treatment for patients with iSS. Methods We present a case series of 10 consecutive patients presenting with classical iSS treated with deferiprone. Results Ten patients were followed up for a mean period of 2.3 years (range 0.5–5.5 years). Four patients (40%) were withdrawn from treatment because of treatment-related side effects. The reasons for treatment discontinuation were neutropenic sepsis (n = 3) and fatigue (n = 1). In 2 out of the 3 cases of neutropenic sepsis, patients initially developed neutropenia without sepsis. The mean time to neutropenic sepsis following deferiprone was 1.2 years (range 0.3–2.5) with mean neutrophil count of 0.4 (range 0.3–0.5). Six patients (60%) reported no change in neurological function while on treatment, and four patients (40%) reported that their condition deteriorated. Conclusions Deferiprone was poorly tolerated, with 40% of patients withdrawing from treatment, most commonly due to neutropenic sepsis, after an average of 2 years on treatment. This study increases the number of reported cases of agranulocytosis in patients with iSS treated with deferiprone. Clinicians treating iSS patients with deferiprone should be aware that this drug has a potentially life-threatening side effect of neutropenic sepsis, and should ensure that appropriate haematological monitoring is in place.

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Tracheal development after left pulmonary artery reimplantation: an individual study

Scientific Reports ◽

10.1038/s41598-020-74890-4 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Xiaoyang Hong ◽

Ruijie Li ◽

Zhe Zhao ◽

Jiangheng Guan ◽

Hui Wang ◽

...

Keyword(s):

Pulmonary Artery ◽

Pulmonary Arteries ◽

Left Pulmonary Artery ◽

Weaning Failure ◽

Threatening Condition ◽

Ventilation Weaning ◽

Life Threatening ◽

The Mean ◽

Tracheal Carina

Abstract Pulmonary artery sling (PA sling) often presents as a life-threatening condition requiring urgent surgical correction. We reported 32 cases of PA sling in children who were followed up postoperatively in the past 6 years. All patients with PA slings who were admitted to the hospital from January 2012 to December 2017 and underwent surgery were retrospectively analyzed. The mean age of the 32 patients at repair was 16.97 months (range, 15 days to 128 months). Six patients required ventilator assistance for respiratory failure. All children underwent left pulmonary artery (LPA) reimplantation (n = 32), and 3 patients needed reimplantation slide tracheoplasty (n = 3) due to ventilation weaning failure. Four patients died, 27 patients survived until discharge, and 18 patients were followed up. Pulmonary computed tomography imaging and echocardiography were performed in 18 patients who were followed up. After LPA reimplantation, the tracheal carina area was significantly enlarged compared to that preoperation (p = 0.0002). In this follow-up cohort study, 75% of the patients who underwent LPA reimplantation survived until discharge. The survivors had subsequently well-developed pulmonary arteries and tracheas.

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Transesophageal Echocardiogram-Guided Stent Placement in Superior Vena Cava Syndrome Secondary to Granulomatous Lung Disease: A Case Series and Literature Review

Vascular and Endovascular Surgery ◽

10.1177/1538574417723157 ◽

2017 ◽

Vol 51 (8) ◽

pp. 562-566 ◽

Cited By ~ 1

Author(s):

Kaiwen Sun ◽

Rishi Batra ◽

Nicholas W. Markin ◽

Melissa Suh ◽

Iraklis I. Pipinos ◽

...

Keyword(s):

Superior Vena Cava ◽

Stent Placement ◽

Superior Vena ◽

Vena Cava ◽

Case Series ◽

Stent Migration ◽

Respiratory Compromise ◽

Svc Syndrome ◽

Threatening Condition ◽

Life Threatening

Obstruction of the superior vena cava (SVC) is an uncommon, but potentially life-threatening condition due to likely development of edema in the head and neck and potential respiratory compromise. Less than half of those affected by SVC syndrome survive more than a year. Obstruction can be from neoplasms or secondary to benign disease. Treatment for most cases of symptomatic SVC syndrome involves placement of a stent to relieve the stenosis. Serious complications such as stent migration, pulmonary embolism, and cardiac tamponade can occur in 5% to 10% of cases, and inadequate imaging of the SVC–atrial junction by fluoroscopy contributes to these problems. The overlapping contrast in the atrium makes it difficult to precisely place the distal end of the stent, potentially allowing for embolization of the stent to occur. We present a case series of 3 patients wherein transesophageal echocardiography was used for guidance of stent placement in the SVC and significantly aided in placement.

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CASE SERIES OF PREGNANCY-ASSOCIATED MYOCARDIAL INFARCTION: AN EPIDEMIC IN WAITING

10.36106/gjra/9201043 ◽

2021 ◽

pp. 28-30

Author(s):

Shree Bharathi ◽

Sasirekha Rengaraj

Keyword(s):

Myocardial Infarction ◽

Care Center ◽

Tertiary Care ◽

Case Series ◽

Fetal Outcome ◽

Therapeutic Implications ◽

Threatening Condition ◽

Life Threatening ◽

Common Etiology ◽

Artery Disease

Acute myocardial infarction during pregnancy or postpartum period is a rare but life-threatening condition associated with poor maternal and fetal outcome. Although atherosclerotic coronary artery disease is the most common etiology in general population, the causation is more diverse in pregnancy and this may have therapeutic implications. Early diagnosis and timely management with collaboration among Maternal-fetal medicine specialist, interventional cardiologist, cardiac anaesthetist, intensivist and neonatologist is essential to prevent maternal cardiac deaths. We present a case series of two patients with postpartum and antepartum acute MI, respectively and their diagnosis, management and outcomes in a tertiary care center.

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Leptospirosis in Coastal South India: A Facility Based Study

BioMed Research International ◽

10.1155/2018/1759125 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Ramesh Holla ◽

Bhagwan Darshan ◽

Latika Pandey ◽

Bhaskaran Unnikrishnan ◽

Nithin Kumar ◽

...

Keyword(s):

Multiorgan Failure ◽

Case Fatality ◽

Public Health Problem ◽

Clinical Feature ◽

Medical College ◽

Life Threatening ◽

Study Population ◽

The Mean ◽

Time Of Admission ◽

Study Setting

Background. Leptospirosis is a major neglected public health problem and is highly underreported in India. The spectrum of clinical features ranges from subclinical infection to multiorgan failure. The burden of leptospirosis is more in developing countries. Objective. The present study was designed to assess the sociodemographic characteristics, clinical feature, and outcome of leptospirosis patients. Methods. This record based retrospective study was conducted in hospitals affiliated to Kasturba Medical College, Mangalore. The registries of the leptospirosis patients during the period of four years between January 2011 and December 2014 were reviewed and the information on demographic and clinical profile of the leptospirosis patients was recorded in the data capture sheet. The information obtained was analyzed using SPSS version 11.5. Results. The study included 202 leptospirosis victims. The mean age of the study population was 40.48 (±14.8) years. Majority of the patients presented with fever (92.1%) at the time of admission. Acute renal failure was found to be the most common complication (79.2%). Case fatality rate was found to be 3.5%. Conclusion. High proportion of cases indirectly reflects the endemic nature of the disease in the study setting. The clinical presentation of the leptospirosis is highly protean and may vary from a mild illness to life-threatening complications as evident from the current study.

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Propranolol treatment for infantile hemangioma: a case series of sixty-two patients

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2016.113 ◽

2016 ◽

Vol 38 (2) ◽

Cited By ~ 4

Author(s):

Giovanna Stringari ◽

Giulia Barbato ◽

Matteo Zanzucchi ◽

Maddalena Marchesi ◽

Giuseppe Cerasoli ◽

...

Keyword(s):

Case Series ◽

Severe Hypoglycemia ◽

Infantile Hemangioma ◽

Treatment Length ◽

Endoscopic Findings ◽

Life Threatening ◽

Propranolol Treatment ◽

The Mean ◽

The Impact ◽

Oral Propranolol

Infantile hemangiomas (IH) complicated by ulceration, disfigurement, functional impairment or life-threatening conditions need early, safe and effective treatment. This study explores the impact of propranolol on complicated IH. We report our experience of 62 patients treated with oral propranolol for complicated IH. The effect of propranolol was assessed using a score on a visual analogue scale integrated with echo, magnetic resonance or endoscopic findings. The average age at the beginning of the treatment was seven months [standard deviation (SD)±8.9], with a median of four months (range 1-53 months). The average age at the end of the treatment was 15 months (SD±8.4), with a median of 13 months (range 7-59 months). The mean treatment length was eight months (SD±3.2). Oral propranolol was successful in 95.2% of the patients in reducing the volume, the intensity of color and the elevation of IH. Statistically significant improvement of IH volume was observed in the first two months of therapy (P≤0.001), and between the second month and the end of the treatment (P<0.05). No significant bradycardia or hypotension occurred. Severe hypoglycemia occurred in one patient. Mild adverse effects were observed in seven patients. Our study demonstrates that propranolol administered orally at 2 to 3 mg/kg/day has a rapid therapeutic effect leading to remarkable shortening of the natural course of IH and it is safe in the majority of patients.

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Linezolid-Associated Serotonin Syndrome

Journal of the American Podiatric Medical Association ◽

10.7547/0003-0538-105.3.244 ◽

2015 ◽

Vol 105 (3) ◽

pp. 244-248 ◽

Cited By ~ 2

Author(s):

Robert G. Frykberg ◽

Scott Gordon ◽

Edward Tierney ◽

Jaminelli Banks

Keyword(s):

Serotonin Syndrome ◽

Monoamine Oxidase Inhibitor ◽

Case Series ◽

Oxidase Inhibitor ◽

Serotonin Release ◽

Diabetic Foot Infections ◽

Complicated Skin ◽

Antibiotic Drug ◽

Threatening Condition ◽

Life Threatening

Linezolid, a mild monoamine oxidase inhibitor, is a commonly used antibiotic drug for the treatment of complicated skin and skin structure infections, including diabetic foot infections. Use of linezolid has been associated with serotonin syndrome, a potentially life-threatening condition typically caused by the combination of two or more medications with serotonergic properties, due to increased serotonin release. The goals of this article are to highlight the risk factors associated with the development of serotonin syndrome related to the use of linezolid and to aid in its prevention and early diagnosis. In this case series we report on two hospitalized patients who, while being treated with linezolid for pedal infections, developed serotonin syndrome. Both individuals were also undergoing treatment with at least one serotonergic agent for depression and had received this medication within 2 weeks of starting the antibiotic drug therapy. In these individuals, we noted agitation, confusion, tremors, and tachycardia within a few days of initiation of linezolid therapy. Owing to the risk of serotonin toxicity, care should be taken when prescribing linezolid in conjunction with any other serotonergic agent. Although serotonin syndrome is an infrequent complication, it can be potentially life threatening. Therefore, risks and benefits of therapy should be weighed before use.

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Management of Upper Airway Infantile Hemangiomas: Experience of One Italian Multidisciplinary Center

Frontiers in Pediatrics ◽

10.3389/fped.2021.717232 ◽

2021 ◽

Vol 9 ◽

Author(s):

Marialuisa Corbeddu ◽

Duino Meucci ◽

Andrea Diociaiuti ◽

Simona Giancristoforo ◽

Roberta Rotunno ◽

...

Keyword(s):

Case Series ◽

Upper Airway ◽

Duration Of Treatment ◽

Cutaneous Lesions ◽

Phaces Syndrome ◽

Threatening Condition ◽

Life Threatening ◽

Line Of Therapy ◽

Oral Propranolol

Airway infantile hemangiomas (IHs) can represent a life-threatening condition since the first months of life. They may be isolated or associated to cutaneous IHs, and/or part of PHACES syndrome. Diagnosis, staging, and indication to treatment are not standardized yet despite the presence in the literature of previous case series and reviews. The diagnosis might be misleading, especially in the absence of cutaneous lesions. Airway endoscopy is the gold standard both for diagnosis and follow-up since it allows evaluation of precise localization and entity of obstruction and/or stricture. Proliferation of IH in the infant airways manifests frequently with stridor and treatment is required as soon as possible to prevent further complications. The first line of therapy is oral propranolol, but duration of treatment is not yet well-defined. All considered, we report the experience of our multidisciplinary center from 2009 to date, on 36 patients affected by airway IHs, and successfully treated with oral propranolol. Thus, the authors propose their experience for the management of airway IHs, specifically early diagnosis, when to perform endoscopy, how to interpret its findings, and when to stop the treatment.

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