Tuberculous perihepatic abscess and neurosarcoidosis: report of 2 uncommon manifestations of 2 common granulomatous diseases in 1 patient

2021 ◽  
Vol 59 (01) ◽  
pp. 50-55
Author(s):  
Jonathan Alexander Gernert ◽  
Simon Sirtl ◽  
Lukas Macke ◽  
Elena Wittmann ◽  
Anna Katharina Strueven ◽  
...  
Keyword(s):  
Early Stage ◽  
Latent Tuberculosis ◽  
High Concentration ◽  
Azathioprine Therapy ◽  
Atypical Form ◽  
Inflammatory Parameters ◽  
Organ Systems ◽  
High Prevalence ◽  
Granulomatous Diseases ◽  
Upper Abdominal

AbstractInfections caused by pathogens of the Mycobacterium tuberculosis complex, i. e., tuberculosis (TB), and the non-infectious, autoimmune disease sarcoidosis are among the most common granulomatous diseases worldwide. Typically, the lung is the primary site of infection and manifestation, respectively which makes the two diseases important differential diagnoses. Both diseases can affect virtually all organ systems, albeit with significantly lower incidence. Case presentation We report the case of a 50-year-old Indian man presenting with a tuberculous perihepatic abscess and a systemic inflammatory response after being diagnosed with neurosarcoidosis presenting as a single granuloma in the frontal lobe with lymphadenopathy in 2014. On day of admission the patient presented with right upper abdominal pain and fever for two weeks. With increased inflammatory parameters in serum and after finding of external CT images, a perihepatic abscess was suspected. This encapsulated cave was drained percutaneously under CT control. A high concentration of acid-fast rods was detected using ZN, PCR was positive for M. tuberculosis. Several samples of sputum and urine were microscopically negative but yielded growth of Mycobacteria after four weeks. Discussion This is a case presenting with two different granulomatous diseases, each of which manifested itself in an atypical form. The tuberculous liver abscess might either be explained as a flare-up of latent tuberculosis under azathioprine therapy or as a reinfection acquired during one of several visits in the high-prevalence country India. In addition, it must be discussed whether the cerebral granuloma in 2014 could have been an early stage of tuberculous granuloma. Sensitivity of ZN staining is significantly reduced in cerebral samples, and negative PCR-results might be due to low germ load or methodical issues, e. g., decreased sensitivity in formalin fixated samples.

scholarly journals Endothelial glycocalyx degradation is associated with early organ impairment in polytrauma patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Feng Qi ◽  
Hao Zhou ◽  
Peng Gu ◽  
Zhi-He Tang ◽  
Bao-Feng Zhu ◽  
...  
Keyword(s):  
Injury Severity ◽  
Early Stage ◽  
Endothelial Glycocalyx ◽  
Control Group ◽  
Metabolic System ◽  
Metabolic Systems ◽  
Organ Systems ◽  
Severity Scores ◽  
Polytrauma Patients ◽  
Trauma Group

Abstract Background Endothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. However, data of EG degradation in multiple traumas is limited. We performed a study to assess the EG degradation and the correlation between the degradation and organ functions in polytrauma patients. Methods A prospective observational study was conducted to enroll health participants (control group) and polytrauma patients (trauma group) at a University affiliated hospital between Feb 2020 and Oct 2020. Syndecan1 (SDC1) and heparin sulfate (HS) were detected in serum sample of both groups. In trauma group, injury severity scores (ISS) and sequential organ failure assessments (SOFA) were calculated. Occurrences of acute kidney injury (AKI), trauma-induced coagulopathy (TIC) within 48 h and 28-day all-cause mortality in trauma group were recorded. Serum SDC1 and HS levels were compared between two groups. Correlations between SDC1/HS and the indicators of organ systems in the trauma group were analyzed. ROC analyses were performed to assess the predictive value of SDC1 and HS for AKI, TIC within 48 h, and 28-day mortality in trauma group. Results There were 45 polytrauma patients and 15 healthy participants were collected, totally. SDC1 and HS were significantly higher in trauma group than in control group (69.39 [54.18–130.80] vs. 24.15 [13.89–32.36], 38.92 [30.47–67.96] vs. 15.55 [11.89–23.24], P <  0.001, respectively). Trauma group was divided into high degradation group and low degradation group according to SDC1 median. High degradation group had more severe ISS, SOFA scores, worse organ functions (respiratory, kidney, coagulation and metabolic system), and higher incidence of hypothermia, acidosis and shock. The area under the receiver operator characteristic curves (AUC) of SDC1 to predict AKI, TIC occurrence within 48 h and 28-day mortality were 0.838 (95%CI: 0.720–0.957), 0.700 (95%CI: 0.514–0.885) and 0.764 (95%CI: 0.543–0.984), respectively. Conclusions EG degradation was elevated significantly in polytrauma patients, and the degradation was correlated with impaired respiratory, kidney, coagulation and metabolic systems in early stage. Serum SDC1 is a valuable predictive indicator of early onset of AKI, TIC, and 28-day mortality in polytrauma patients.

scholarly journals Differences in physical symptoms between those with and without kidney disease: a comparative study across disease stages in a UK population

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thomas J. Wilkinson ◽  
Daniel G. D. Nixon ◽  
Jared Palmer ◽  
Courtney J. Lightfoot ◽  
Alice C. Smith
Keyword(s):  
Kidney Disease ◽  
Early Stage ◽  
Symptom Burden ◽  
Final Analysis ◽  
Physical Symptoms ◽  
Disease Trajectory ◽  
High Prevalence ◽  
Comparative Group ◽  
The Difference ◽  
Disease Stages

Abstract Background Those living with kidney disease (KD) report extensive symptom burden. However, research into how symptoms change across stages is limited. The aims of this study were to 1) describe symptom burden across disease trajectory, and 2) to explore whether symptom burden is unique to KD when compared to a non-KD population. Methods Participants aged > 18 years with a known diagnosis of KD (including haemodialysis (HD) and peritoneal dialysis (PD)) and with a kidney transplant) completed the Leicester Kidney Symptom Questionnaire (KSQ). A non-KD group was recruited as a comparative group. Multinominal logistic regression modelling was used to test the difference in likelihood of those with KD reporting each symptom. Results In total, 2279 participants were included in the final analysis (age 56.0 (17.8) years, 48% male). The main findings can be summarised as: 1) the number of symptoms increases as KD severity progresses; 2) those with early stage KD have a comparable number of symptoms to those without KD; 3) apart from those receiving PD, the most frequently reported symptom across every other group, including the non-KD group, was ‘feeling tired’; and 4) being female independently increased the likelihood of reporting more symptoms. Conclusions Our findings have important implications for patients with KD. We have shown that high symptom burden is prevalent across the spectrum of disease, and present novel data on symptoms experienced in those without KD. Symptoms requiring the most immediate attention given their high prevalence may include pain and fatigue. Trial registration The study was registered prospectively as ISRCTN11596292.

The Value of HAZWOPER Medical Surveillance

AAOHN Journal ◽  
2011 ◽  
Vol 59 (11) ◽  
pp. 465-467
Author(s):  
R. Gail Huss ◽  
Kristen N. Williamson ◽  
Kimberly L. Alvis ◽  
David J. Hewitt
Keyword(s):  
Occupational Health ◽  
Early Stage ◽  
Hazardous Materials ◽  
The United States ◽  
Health Conditions ◽  
Surveillance Program ◽  
Medical Surveillance ◽  
Testing Program ◽  
Chemical Exposures ◽  
High Prevalence

Medical surveillance is mandated for workers with potential exposure to hazardous materials. However, little guidance is provided regarding the components of a medical surveillance testing program for these individuals. This article describes the medical surveillance program for a group of 72 employees who respond to hazardous material releases throughout the United States. Conditions related to chemical exposures were not identified in this group. However, several non-occupational health conditions were identified, including a relatively high prevalence of one or more signs of metabolic syndrome. Medical surveillance may provide valuable information regarding an individual's underlying health status and non-occupational health conditions to be addressed at an early stage.

scholarly journals 754. Prevalence of Latent Tuberculosis Infection Among Healthcare Workers at a Tertiary Care University Hospital

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S271-S271
Author(s):  
Eun Ju Choo ◽  
Se Yoon Park
Keyword(s):  
Risk Factors ◽  
Healthcare Workers ◽  
Latent Tuberculosis Infection ◽  
Tertiary Care ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
University Hospital ◽  
Increased Risk ◽  
High Prevalence ◽  
Univariate Analyses

Abstract Background We investigated the prevalence of latent tuberculosis infection (LTBI) among healthcare workers (HCWs) and analyzed its risk factors in a tertiary care university hospital in South Korea in a population with intermediate tuberculosis (TB) burden. Methods A standard questionnaire regarding the baseline demographics and risk factors for LTBI was given to each participant. QuantiFERON-TB GOLD In-Tube (QFT-GIT) assay and chest radiography were performed to investigate the rate of LTBI. Results A total of 1,429 participants, 213 (14.9%) doctors and 988 (69.1%) nurses and 228 (16.0%) others were enrolled. The mean age of the subjects was 33.0 years old, and 1,175 (82.2%) were female. Of the participants, 94.5% had received BCG vaccine. QFT-GIT assays were positive for 156 subjects (10.9%). Of the 213 doctors, 28 (13.1%) were positive by QFT-GIT, and among the 988 nurses, 94 (9.5%) had positive QFT-GIT results. Experience of working in hospital was significantly associated with positive LTBI test results by QFT-GIT assay. Gender and duration of employment as an HCW were significantly associated with having a positive QFT-GIT result in univariate analyses. In multivariate analyses, duration of employment as an HCW (&gt;15 years) (odds ratio, 1.98; 95% confidence interval, 1.14–3.43) was independently associated with increased risk of a positive QFT-GIT result. Conclusion A high prevalence of LTBI was found among our HCWs. Considering the association between the experience of working in hospital and high risk of LTBI. The risk for tuberculosis infection among HCWs was higher than general population, which suggests that stricter preventive strategies against nosocomial tuberculosis infection should be implemented. Disclosures All authors: No reported disclosures.

A Psychometric Study of Academic Difficulty and Psychiatric Illness in Students

1968 ◽  
Vol 114 (506) ◽  
pp. 57-62 ◽  
Author(s):  
Anthony Ryle ◽  
Martin Lunghi
Keyword(s):  
Psychiatric Disorder ◽  
Psychiatric Illness ◽  
Early Stage ◽  
High Achievement ◽  
Psychometric Study ◽  
Academic Difficulty ◽  
Emotional Factors ◽  
High Prevalence ◽  
Growing Body ◽  
The Relationship

There is a growing body of evidence which points to a high prevalence of psychiatric disorder in students and to the contribution of such disturbance to wastage and under-achievement. The relationship between psychiatric illness and academic difficulty is, however, a complex one, for severely ill individuals may be capable of high achievement while apparently mildly disturbed students may fail academically through the operation of emotional factors. The ability to predict or detect at an early stage the psychiatrically or academically vulnerable student would clearly be of great value.

Real-world data evaluating the value of PET-CT for mediastinal staging in patients diagnosed with non-small cell lung cancer in an area with high prevalence of granulomatous diseases: The LACOG-0114 study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20065-e20065
Author(s):  
Carlos Cezar Fritscher ◽  
Mara Lise Zanini ◽  
Eduardo Herz Berdichevski ◽  
Eduardo Vilas ◽  
Bruno Hochhegger ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Small Cell ◽  
Small Cell Lung ◽  
Mediastinal Staging ◽  
Pet Ct ◽  
High Prevalence ◽  
Histopathological Evaluation ◽  
Mediastinal Involvement ◽  
Granulomatous Diseases

e20065 Background: Evaluation of the mediastinum is critical for therapeutic decision in patients with operable non-small cell lung cancer. This analysis aims to evaluate specificity and positive predictive value (PPV) of PET-CT in mediastinal staging of patients diagnosed with NSCLC in South Brazil, an area with high prevalence of infectious granulomatous disease, such as tuberculosis (estimated incidence of 45 cases/100.000 and only 63.7% of cure rate) (http://www.saude.rs.gov.br/upload/1459169540_RELATÓRIO%20TUBERCULOSE%202016.pdf). Methods: Patients with stages I-III NSCLC underwent 18FDG PET-CT before invasive mediastinal staging. Different SUV cut-offs were evaluated, but for the purpose of this analysis were considered positive all PET-CTs showing any mediastinal uptake > 5 SUV. This abstract shows the specificity and the PPV associated with PET-CT when this high-uptake cut-of is considered. Results: From Aug/2014 to Aug/2016, 100 patients were enrolled, all treated at the Brazilian Public Health System, of which 85 were submitted to mediastinoscopy after PET-CT. Median age was 65 years (range 47-80). At baseline, 49 (58%) patients were male and 68 (80%) white. Current or former smokers accounted for 94% (80/85) of the sample. The prevalence of mediastinal involvement was 27% (23/85) confirmed by histopathological evaluation. PET-CT showed specificity of 79% (95% CI 67%–88%) and PPV of 54% (95% CI 40%–67%) when a SUV > 5 was used as cut-off for positivity (see table). Conclusions: These findings consolidate the clinical impression that a positive PET-CT does not confirm the diagnosis of mediastinal involvement in NSCLC patients treated in areas with high prevalence of infectious granulomatous diseases. In this scenario, all positive findings should be confirmed with histopathological evaluation to assure the diagnosis. Clinical trial information: NCT02664792. [Table: see text]

SIZE OF INOCULUM, STIMULATION, AND INHIBITION OF GROWTH IN ASPERGILLUS ORYZAE

1965 ◽  
Vol 11 (1) ◽  
pp. 67-75 ◽  
Author(s):  
J. Meyrath ◽  
A. F. McIntosh
Keyword(s):  
Aspergillus Oryzae ◽  
Early Stage ◽  
Maximum Yield ◽  
Inoculum Size ◽  
High Concentration ◽  
Stages Of Growth ◽  
Inhibition Of Growth ◽  
Deep Culture ◽  
Favorable Influence ◽  
Late Stages

Culture filtrates from surface and deep cultures of Aspergillus oryzae were tested for the presence of stimulatory and inhibitory substances, by examining the effect of the nitrates, when added with the inoculum, on growth rate and maximum yield of stationary cultures of the same organism. Filtrates were prepared from various stages of both large- and small-inoculum cultures by each method of growth.Both stimulatory and inhibitory substances were found. Inhibitory substances predominated in the filtrates from early stages of a small-inoculum culture, more especially when these were derived from a deep culture, which showed a pronounced effect of inoculum size. At other stages of growth of small-inoculum cultures and all stages of growth of large-inoculum cultures tested, stimulatory substances were found.It is emphasized that the stage of production of such substances is of crucial importance. Inhibitory substances acting at an early stage of growth of small-inoculum cultures have an adverse effect on growth of late stages. If, however, stimulatory substances are present in sufficiently high concentration at a sufficiently early age, as in large-inoculum cultures, they exert a favorable influence on later stages of growth. These phenomena explain the effects of inoculum size.

A case of encapsulating peritoneal sclerosis at the clinical early stage with high concentration of matrix metalloproteinase-2 in peritoneal effluent

2005 ◽  
Vol 9 (1) ◽  
pp. 85-89 ◽  
Author(s):  
Yoshinori Masunaga ◽  
Ichiro Hirahara ◽  
Yasumasa Shimano ◽  
Megumi Kurosu ◽  
Osamu Iimura ◽  
...  
Keyword(s):  
Matrix Metalloproteinase ◽  
Early Stage ◽  
Matrix Metalloproteinase 2 ◽  
High Concentration

scholarly journals Prevalence and follow-up of subclinical rheumatic heart disease amongst asymptomatic school children in a north-western district of India based on the World Heart Federation echocardiographic criteria

2020 ◽  
Author(s):  
Dinesh Choudhary ◽  
Sadik Panwar ◽  
Balkishan Gupta ◽  
Raja Panwar ◽  
Rajeev Gupta ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Active Surveillance ◽  
School Children ◽  
Early Stage ◽  
Significant Proportion ◽  
Screening Methods ◽  
High Prevalence ◽  
Study Population ◽  
Rheumatic Heart

Background Past active surveillance have reported prevalence of subclinical RHD amongst school children which are not comparable because of major differences in screening methods. The present study is based on the WHF criteria to assess the prevalence of subclinical carditis due to RHD and elucidate evolution of the disease when these children were placed on appropriate antibiotic prophylaxis and regular follow-up. This is the first large active surveillance study which has been conducted in a single district of India after the publication of WHF criteria and is reporting short-medium term follow-up data. Methods For active surveillance of RHD among urban and rural school children of Bikaner, a random inclusion strategy was adopted. The diagnostic labelling based on the echocardiographic criteria proposed by World Heart Federation was done by a group of experienced cardiologists. The follow up of the patients recruited in to the study was done to ascertain the early evolution of the disease in the presence of appropriate antibiotic prophylaxis. Results A high prevalence of subclinical RHD was noted in the study population. Pathological mitral and/or aortic valves regurgitation was the commonest lesion and significant proportion of cases improved on regular antibiotic prophylaxis. There was no case of fixity of leaflets/ stenosis. Conclusion The prevalence of subclinical RHD and these cases are reversible if appropriate antibiotic prophylaxis is instituted at an early stage.

Sign in / Sign up

Export Citation Format

Share Document