scholarly journals 102. A Retrospective Case Series of West Nile Neuroinvasive Disease in Two Tertiary Health Centers in Miami

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S64-S65
Author(s):  
Leopoldo Cordova ◽  
Aliya F Rehman ◽  
Shuba Balan ◽  
Folusakin Ayoade ◽  
Lizy Paniagua ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Case Series ◽  
Panel Member ◽  
Small Sample ◽  
Neurological Symptoms ◽  
Hospital Length Of Stay ◽  
West Nile ◽  
Review Panel ◽  
Neuroinvasive Disease ◽  
The Mean

Abstract Background According to the Centers for Disease Control and Prevention, Florida was the third leading state in reported West Nile Neuroinvasive Disease (WNND) infections in 2020. WNND accounts for less than 1% of all West Nile virus (WNV) infections but carries a 10% mortality rate. The clinical characteristics of WNND have not been well described in Florida, an area with high mosquito activity. We hereby describe the clinical characteristics of WNND at two large hospitals in Miami. Methods A 10-year retrospective study was performed at the University of Miami Hospital and Mount Sinai Medical Center to identify adult patients with confirmed WNV infection and neuroinvasion. Patient demographics, symptoms, neurological exam findings, laboratory diagnostics, intensive care unit (ICU), and hospital length of stay (LOS), and outcomes were described. Results Eleven patients (73% male, mean age 64.4 ± 16.3 years) were identified between January 2010 to December 2020. The most prevalent comorbidities were HTN (64%) and DM (27%). The most common positive findings on the review of symptoms were fever (100%), confusion (81.8%), and headache (63.6%). The mean hospital LOS was 15.5 ±11.3 days, while the mean ICU LOS was 7.2 ± 11.9 days. The majority of patients (75%) spent more than 2 weeks in the ICU. Subject age was correlated with hospital LOS with a Pearson correlation of 0.624 (p=0.04). The survival rate was 91%. At the time of discharge, 80% of patients continued to have neurological symptoms. Figure 1: The percentage of subjects with different types of WNND. The section titled others, includes atypical presentations such as amnesia, focal neurological deficits (ataxia, hemiparesis), and myelopathy. Figure 2: Month and year of presentation at the time of hospital admission. Figure 3: Clinical presentation (%). Conclusion This is the largest case series of WNND in Florida. Most cases occurred during summer 2020, which corresponds to the peak of the COVID-19 pandemic. Despite pandemic restrictions, we may have seen an increase in WNV cases due to higher-than-normal temperatures promoting mosquito abundance, increased outdoor activities due to the COVID-19 pandemic, and/or the redistribution of public health resources towards the pandemic rather than mosquito control. Residual neurological symptoms and impaired functional outcomes are common. Within the limitation of our small sample size, subject age appeared to correlate with hospital LOS. This correlation should be further explored in a larger case series. A high index of suspicion for WNND is suggested for patients presenting with fever and neurologic symptoms in Florida. Disclosures Cynthia Rivera, MD, Gilead Sciences (Advisor or Review Panel member)Viiv Healthcare (Advisor or Review Panel member)

scholarly journals 66. Impact of a Pharmacist-Driven Azithromycin De-escalation Protocol for Community-Acquired Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S52-S52
Author(s):  
Pegah Shakeraneh ◽  
Jeffrey Steele ◽  
Robert Seabury ◽  
Stephen J Thomas ◽  
Kristopher M Paolino ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Panel Member ◽  
Community Acquired Pneumonia ◽  
Hospital Length Of Stay ◽  
Post Intervention ◽  
Review Panel ◽  
Icu Patients ◽  
Significant Difference ◽  
Atypical Bacteria ◽  
Research Grant

Abstract Background Ceftriaxone and azithromycin are common empiric antibiotics for community-acquired pneumonia (CAP). Despite low suspicion for atypical infection, azithromycin is often continued for a full course. Negative laboratory data for atypical bacteria may assist with azithromycin de-escalation. Thus, a pharmacist-driven azithromycin de-escalation protocol was implemented for immunocompetent, non-intensive care unit (ICU) patients treated for CAP. The primary outcome was to compare azithromycin duration before and after protocol implementation. Secondary outcomes included hospital length of stay (LOS) and all-cause 30-day readmission. Methods This was a single-center, quasi-experimental study of hospitalized, non-ICU patients treated with azithromycin and a beta-lactam for CAP. The pre- and post-intervention cohorts were from 07/01/2018–04/30/2019 and 07/01/2019–04/30/2020, respectively. Patients were included if they were ≥18 years old, diagnosed with CAP, and had a negative Legionella pneumophila urinary antigen and negative nasopharyngeal swab PCR for Mycoplasma pneumoniae and Chlamydia pneumoniae. Patients were excluded if they were immunocompromised, admitted to an ICU, prescribed azithromycin for an alternative indication, or had evidence of atypical bacteria. Results After exclusion criteria were applied, 90 and 100 patients were included in the pre- and post-intervention cohorts, respectively. Demographic and clinical characteristics were mostly similar between cohorts. This initiative was associated with a statistically significant decrease in azithromycin duration (2 days (IQR 1–2.75) vs. 5 days (IQR 3–6), p < 0.001) and hospital LOS (3 days (IQR 2–5) vs. 5 days (IQR 3–8.25), p < 0.001). No statistically significant difference was observed for all-cause 30-day readmission (14 days (15.6%) vs 13 days (13.0%), p=0.614). Conclusion Implementation of a pharmacist-driven azithromycin de-escalation protocol for CAP was associated with reduced azithromycin duration and hospital LOS, but not all-cause 30-day readmission. Disclosures Jeffrey Steele, PharMD, Paratek Pharmaceuticals (Advisor or Review Panel member) Wesley D. Kufel, PharmD, Melinta (Research Grant or Support)Merck (Research Grant or Support)Theratechnologies, Inc. (Advisor or Review Panel member)

Procalcitonin measurement in West Nile virus neuroinvasive disease: a first case series

2021 ◽  
pp. e20200046
Author(s):  
Cheyanne Boehm ◽  
Christopher Doig ◽  
Justin Z Chen ◽  
Wendy I Sligl ◽  
Sean M Bagshaw ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Antimicrobial Therapy ◽  
Critically Ill Patients ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Case Series ◽  
West Nile ◽  
Neuroinvasive Disease ◽  
First Case ◽  
Low Serum

West Nile virus neuroinvasive disease (WNV-NID) is challenging to diagnose. Procalcitonin (PCT) is a useful diagnostic test to identify bacterial infections. We present four cases of WNV-NID with serum PCT measurements. Methods: Daily (days 1–7) serum PCT (bioMérieux) was examined for critically ill patients with sepsis enrolled in a provincial sepsis study. Patients with identified WNV-NID are descriptively analyzed in this case series. PCT values of ≥0.5 ng/mL were suggestive of bacterial infection. Results: Four patients with WNV-NID were identified. Those with viral infections alone had consistently low PCT values ranging from 0.09 ng/mL to 0.34 ng/mL. Those with documented bacterial co-infections had initially elevated PCT levels that decreased by more than 50% with antimicrobial therapy. Conclusion: These cases are the first to report serial PCT measurements in confirmed cases of WNV-NID and support a low serum PCT in WNV-NID.

Malignant Transformation of Mature Cystic Teratoma: Is Squamous Cell Carcinoma Different From the Other Types of Neoplasm?

2018 ◽  
Vol 28 (9) ◽  
pp. 1650-1656 ◽  
Author(s):  
Munetoshi Akazawa ◽  
Sachiko Onjo
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Malignant Transformation ◽  
Squamous Cell ◽  
Clinical Characteristics ◽  
Case Series ◽  
Cystic Teratoma ◽  
The Other ◽  
The Mean

ObjectivesMalignant transformation of mature cystic teratoma (MCT) is rare. Unlike squamous cell carcinoma (SCC) in MCT, the other types of neoplasm in MCT have not been discussed in publications. We analyzed the clinical characteristics and prognosis of the other types of neoplasm (non-SCC) compared with those of SCC.MethodsA systematic literature search of literature published from 2000 to 2017 was conducted in PubMed, Web of Science, and Scopus. We reviewed case series that included all pathological types of malignant transformation.ResultsA total of 155 cases from 15 case series, including our cases, were included. Of the cases, 90 (58%) were SCC and 65 (42%) were non-SCC, including adenocarcinoma, carcinoid tumor, thyroid carcinoma, sarcoma, adenosquamous carcinoma, melanoma, sebaceous carcinoma, oligodendroglioma, signet ring cell carcinoma, and transitional cell carcinoma, in descending order of frequency. The mean ages of patients with SCC and non-SCC were 50.5 and 48.9 years, respectively. The mean tumor sizes were 14.7 cm in SCC and 13.9 cm in non-SCC. Surgical approaches were similar. First-line chemotherapy for epithelial ovarian cancers was the most commonly used regimen in SCC and non-SCC. Overall survival did not differ significantly, showing better prognosis in stage I and poor prognosis in stages II, III, and IV. A difference in overall survival was observed among pathological types of non-SCC.ConclusionsClinical characteristics and outcomes did not differ significantly between SCC and non-SCC. However, chemotherapy regimens differed to some extent, and the possibility of difference in overall survival among pathological types of non-SCC was suggested.

scholarly journals COVID-19 Vaccination in Patients with Myasthenia Gravis: A Single-Center Case Series

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1112
Author(s):  
Zhe Ruan ◽  
Yonglan Tang ◽  
Chunhong Li ◽  
Chao Sun ◽  
Ying Zhu ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Acetylcholine Receptors ◽  
Subunit Vaccine ◽  
Clinical Characteristics ◽  
Case Series ◽  
Onset Age ◽  
Single Center ◽  
Inactivated Vaccines ◽  
Main Observation ◽  
The Mean

In this study, we report the safety of coronavirus disease 2019 (COVID-19) vaccine in patients with myasthenia gravis (MG). Patients who were vaccinated against COVID-19 were included. Demographics, clinical characteristics, medications, and vaccination information were collected. The main observation outcome is the worsening of MG symptoms within 4 weeks following COVID-19 vaccination. A total of 22 patients with MG vaccinated for COVID-19 were included. Ten (45.5%) patients had ocular MG (OMG), and 12 (55.5%) patients had generalized MG (GMG). Six (27.3%) patients were female, and the mean (SD) onset age was 45.4 (11.8) years. Nineteen (86.4%) patients were seropositive for acetylcholine receptors (AChR) antibody. Seven (31.8%) patients underwent thymectomy, and four of them confirmed thymoma pathologically. Twenty-one patients were administrated with inactivated vaccines, and the remaining one was administrated with recombinant subunit vaccine. Twenty (90.9%) patients did not present MG symptom worsening within 4 weeks of COVID-19 vaccination, and two (9.1%) patients reported slight symptom worsening but resolved quickly within a few days. Our findings suggest inactivated COVID-19 vaccines might be safe in MG patients with Myasthenia Gravis Foundation of America (MGFA) classification I to II, supporting the recommendation to promote vaccination for MG patients during the still expanding COVID-19 pandemic.

Clinical characteristics and functional outcome of patients with West Nile neuroinvasive disease in Serbia

2014 ◽  
Vol 261 (6) ◽  
pp. 1104-1111 ◽  
Author(s):  
Natasa Popovic ◽  
Branko Milosevic ◽  
Aleksandar Urosevic ◽  
Jasmina Poluga ◽  
Nada Popovic ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Clinical Characteristics ◽  
West Nile ◽  
Neuroinvasive Disease

scholarly journals COVID-19 in Brazilian children and adolescents: findings from 21 hospitals

2021 ◽  
Author(s):  
Priscila Menezes Ferri Liu ◽  
Maria do Carmo Barros de Melo ◽  
Lilian Martins Oliveira Diniz ◽  
Cristiane dos Santos Dias ◽  
Andre Soares de Moura Costa ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Clinical Laboratory ◽  
Intensive Therapy ◽  
Case Series ◽  
Hospitalized Patients ◽  
Neurological Symptoms ◽  
Hospital Length Of Stay ◽  
X Rays ◽  
Reference Limit ◽  
Initial Symptoms

Introduction: Children and adolescents with Covid-19 have been shown lower mortality less intense symptoms when compared to adults, but studies in Brazil have been based on the compulsory notifying system only. Objective: To analyse clinical, laboratory, radiological characteristics and outcomes of hospitalized patients under 20 years with Covid-19. Methods: Cases series of hospitalized patients with confirmed Covid-19 under 20 years, obtained from a cohort study in 37 hospitals from five states of Brazil. Results: From 36 patients, 20 (55.5%) were adolescentes, 20 (55.5%) were male, 18 (50.0%) had comorbidities, 2 were pregnant and in 7 (19.4%), initial symptoms occurred during hospitalization for other causes, of whom 3 were possibly infected in the hospital. Fever (61.1%), dyspnea (33.3%) and neurological symptoms (33.0%) were the most common complaints. C-reactive protein was higher than 50mg/L in 16.7% and D-dimer was above the reference limit in 22.2%. Chest X-rays were performed in 20 (55.5%) patients, 9 had abnormalities, and chest tomography in 5. Hospital length of stay ranged from 1-40 days (median 5 [interquartile range 3-10]), 16 (44.4%) needed intensive therapy, 6 (16.7%) required mechanical ventilation and one patient (2.8%) died. Conclusion: In case series patients under 20 years from hospitals from 5 states of Brazil, comorbidities were frequent, and most common symptoms were fever, dyspnea and neurological symptoms. Forty-four percent required intensive therapy, showing that the disease was not as mild as it was expected, and one patient died.

scholarly journals 105. Impact of a Multiplex Polymerase Chain Reaction Panel on Duration of Empiric Antibiotic Therapy in Suspected Bacterial Meningitis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S65-S66
Author(s):  
Justin J Choi ◽  
Lars Westblade ◽  
Lee S Gottesdiener ◽  
Kyle Liang ◽  
Han A Li ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Panel Member ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Empiric Antibiotic Therapy ◽  
Research Support ◽  
Review Panel ◽  
Empiric Antibiotic

Abstract Background Multiplex polymerase chain reaction (PCR) panels allow for rapid detection or exclusion of pathogens causing community-acquired meningitis and encephalitis (ME). However, the clinical impact of rapid multiplex PCR ME panel results on the duration of empiric antibiotic therapy is not well characterized. Methods We performed a retrospective pre-post study to evaluate the implementation of the FilmArray ME panel (BioFire Diagnostics, LLC) for diagnosis of bacterial meningitis at our institution. We included adults who presented with suspected bacterial meningitis, received empiric antibiotic therapy, and underwent cerebrospinal fluid microbiological testing in the emergency department. The primary outcome was duration of empiric antibiotic therapy. A bivariable analysis that compared baseline demographics, clinical characteristics, and study outcomes between the pre-ME panel and post-ME panel periods was performed using Mann-Whitney tests, chi-squared tests, or Fisher’s exact tests. Time-to-event analysis used the Kaplan-Meier method and log-rank statistics. Results In the pre-ME panel period, the positive detection rate of bacterial pathogens was 2.2% (3/137) by cerebrospinal fluid culture and 4.3% (3/69) in the post-ME panel period. Table 1 shows baseline characteristics of patients. Compared to the pre-ME panel period, there were significant reductions in the post-ME panel period for the duration of empiric antibiotic therapy (median 34.7 h, IQR 8.5–61.7, vs. 12.3 h, IQR 3.3–40.0, P=0.01), time to targeted therapy (59.3 h, IQR 36.5–74.6, vs 7.02 h, IQR 0.9–12.4, P< 0.001), and hospital length of stay (4 d, IQR 2–7, vs. 3 d, IQR 1–5, P=0.03), as shown in Table 2. There was also significant reduction in time to discontinuation or de-escalation of empiric antibiotic therapy (P=0.049) as shown in Figure 1. Table 1. Baseline characteristics for patients with suspected bacterial meningitis Table 2. Antimicrobial use and hospitalization outcomes Compared to the pre-ME panel period, there were significant reductions in the post-ME panel period for the duration of empiric antibiotic therapy (P=0.01), time to targeted therapy (P<0.001), and hospital length of stay (P=0.03). Figure 1. Probability of Empiric Antibiotic Therapy Between Pre- and Post-ME Panel Periods Kaplan-Meier analysis of the time from initiation of empiric antibiotic therapy to discontinuation or de-escalation of empiric antibiotic therapy between the pre- and post-ME panel periods. P value from log-rank test=0.049 (n=206). There was a significant difference in the time to discontinuation or de-escalation of empiric antibiotic therapy between the groups (sex- and immunosuppressant use-adjusted hazard ratio, 1.46 [95% confidence interval, 1.08–1.97]; P=0.01). Conclusion The implementation of the FilmArray ME panel for suspected bacterial meningitis appears to reduce the duration of empiric antibiotic therapy, time to targeted therapy, and hospital length of stay compared to traditional culture-based microbiological testing methods. Disclosures Justin J. Choi, MD, Allergan (Consultant, Grant/Research Support)Roche (Consultant, Grant/Research Support) Lars Westblade, PhD, Accelerate Diagnostics Inc (Grant/Research Support)BioFire Diagnostics (Grant/Research Support)Hardy Diagnostics (Grant/Research Support)Roche (Consultant, Advisor or Review Panel member)Shionogi Inc (Advisor or Review Panel member)Talis Biomedical (Advisor or Review Panel member) Marshall J. Glesby, MD, Enzychem (Consultant)Gilead (Grant/Research Support)ReAlta Life Sciences (Consultant)Regeneron (Consultant, Grant/Research Support)Sobi (Consultant)Springer (Other Financial or Material Support, Royalties)UpToDate (Other Financial or Material Support, Royalties)

Clinical Characteristics of a Case Series of Ocular Syphilis With 3 Cases Requiring Multiple Vitrectomies After Late Diagnosis

2020 ◽  
Vol 4 (6) ◽  
pp. 509-514
Author(s):  
Eric Nagarajan ◽  
Rusdeep Mundae ◽  
Tu M. Tran ◽  
Danny A. Mammo ◽  
Jared Murray ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Silicone Oil ◽  
Case Series ◽  
Ocular Involvement ◽  
Antibody Testing ◽  
Ocular Syphilis ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
Hiv Antibody Testing ◽  
Hiv Negative

Purpose: This work describes the characteristics and unique features of ocular syphilis. Methods: Ten serologically proven cases of ocular syphilis were retrospectively analyzed. Results: Eighteen eyes of 10 patients were affected. Nine of 10 patients were male and the mean age was 58 years (range, 36-81 years). HIV antibody testing was positive in 3 patients (30%). Five cases were first diagnosed by an ophthalmologist. One patient presented with a syphilitic rash. The most common ocular findings were panuveitis (n = 6) and cystoid macular edema (n = 4). Ocular involvement was unilateral in 2 cases and bilateral in 8. Best-corrected visual acuity improved in 13 of 18 eyes (72%) after treatment. Three cases developed recurrent retinal detachments that required repair with silicone oil. Conclusions: Most cases were HIV negative. Syphilitic uveitis can be the initial presentation of syphilis without classic systemic manifestation. Ophthalmologists play an important role in the diagnosis and treatment of syphilis.

scholarly journals Neuroinvasive West Nile Infection with an Unusual Clinical Presentation: A Single-Center Case Series

2020 ◽  
Vol 5 (3) ◽  
pp. 138 ◽  
Author(s):  
Nadia Castaldo ◽  
Elena Graziano ◽  
Maddalena Peghin ◽  
Tolinda Gallo ◽  
Pierlanfranco D’Agaro ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Case Series ◽  
Fold Increase ◽  
Neurological Symptoms ◽  
University Hospital ◽  
High Infection Rate ◽  
Single Center ◽  
West Nile ◽  
High Infection ◽  
Neurological Presentation

The 2018 West Nile Virus (WNV) season in Europe was characterized by an extremely high infection rate and an exceptionally higher burden when compared to previous seasons. Overall, there was a 10.9-fold increase in incidence in Italy, with 577 human cases, 230 WNV neuroinvasive diseases (WNNV) and 42 WNV-attributed deaths. Methods: in this paper we retrospectively reported the neurological presentation of 7 patients admitted to University Hospital of Udine with a diagnosis of WNNV, especially focusing on two patients who presented with atypical severe brain stem involvement. Conclusions: the atypical features of some of these forms highlight the necessity to stay vigilant and suspect the diagnosis when confronted with neurological symptoms. We strongly encourage clinicians to consider WNNV in patients presenting with unexplained neurological symptoms in mild climate-areas at risk.

scholarly journals Dysphasia is associated with diffusion-weighted MRI abnormalities in patients with transient neurological symptoms

2020 ◽  
Vol 41 (7) ◽  
pp. 1765-1771
Author(s):  
Zejin Jia ◽  
Yangguang Song ◽  
Wenli Hu
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Clinical Characteristics ◽  
Area Under The Curve ◽  
Neurological Symptoms ◽  
Receiver Operating Characteristic Curves ◽  
Diffusion Weighted ◽  
The Mean ◽  
Ischemic Attack

Abstract Background The clinical characteristics of diffusion-weighted imaging (DWI) abnormalities after transient neurological symptoms are of great significance for the early diagnosis and urgent intervention of transient ischemic attack (TIA). This study was aimed to investigate the clinical characteristics associated with acute DWI lesions in transient neurological symptoms. Methods We retrospectively recruited 302 patients with transient neurological symptoms. According to DWI findings, they were divided into DWI positive and DWI negative group. The clinical characteristics and the TIA-related scores such as ABCD2, ABCD3, ABCD3I, Dawson score, and the Diagnosis of TIA (DOT) score were compared between the two groups. Logistic regression analysis and receiver operating characteristic curves were used to identify the independent factors and compare the predictive value of different TIA scores for acute DWI lesions. Results A total of 302 patients were enrolled in this study. The mean age was 61.8 years, and 67.2% were male. We found 89 (29.5%) patients with DWI positivity. Logistic regression analysis showed the characteristic associated with DWI lesions was dysphasia (OR 2.226, 95% CI 1.220–4.062). The area under the curve for Dawson score and the DOT score was 0.610 (95% CI 0.543–0.678) and 0.625 (95% CI 0.559–0.691), respectively. Conclusion We found that DWI lesions were detected in 29.5% of patients with transient neurological symptoms and were associated with dysphasia. Dawson score and DOT score could have a higher predictability of DWI lesions in patients with transient neurological symptoms.

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