scholarly journals 1416. Nocardia beijingensis: A Rare and Unusual Cause of Intracranial Abscess

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S515-S516
Author(s):  
Lakshpaul Chauhan ◽  
Nirali Vassa ◽  
Elizabeth Henderson ◽  
Ateeq Mubarik ◽  
Danish Siddiq ◽  
...  
Keyword(s):  
Vasogenic Edema ◽  
Cranial Nerves ◽  
The United States ◽  
Immunocompetent Patient ◽  
Gram Positive ◽  
Scalp Lesion ◽  
Low Glucose ◽  
Cerebral Nocardiosis ◽  
Disseminated Nocardiosis

Abstract Background Nocardia species are thin, aerobic, filamentous, gram-positive bacilli that are ubiquitous in soil worldwide. Nocardia infections are divided into three main categories: pulmonary nocardiosis, disseminated nocardiosis, and cutaneous nocardiosis. Methods We present a case of cerebral nocardiosis in an immunocompetent patient caused by Nocardia beijingensis (NB). Results A 60-year-old Caucasian lady from Florida with type 2 diabetes mellitus, hypertension, hyperlipidemia, presented to the emergency room with complaints of altered mentation. Per husband, she was having episodes of emesis and diarrhea 3 days prior to admission that resolved however, her mentation significantly deteriorated to where she was unable to perform simple chores around the house. Pertinently she had resection of lung mass 2 months prior to admission which found to be benign. Vital sign at admission was stable and on examination, the patient was alert and oriented, however, lethargic appearing. Neurological examination was pertinent for expressive aphasia; however, cranial nerves II-XII were grossly intact. The patient was also found to have a 3 cm by 4 cm, tender, cystic lesion on the left-sided occipital scalp. The remainder of the physical examination was unremarkable. Admission laboratories were remarkable for leukocytosis and hyperglycemia. MRI of the brain was completed that showed multiple areas of vasogenic edema and multiple nodules with the largest being 1.8 cm suggestive of abscesses. She was started empirically on vancomycin, ceftriaxone, metronidazole, and ampicillin. Cerebral spinal fluid showed neutrophilic pleocytosis, low glucose, and high protein. Initial cultures including CSF were negative. Left-sided occipital scalp lesion was excised and sent for pathology and culture. Initial cultures showed gram-positive bacilli, so antibiotics were de-escalated to sulfamethoxazole/trimethoprim and ceftriaxone. Repeat imaging showed improving abscess, and final cultures resulted in NB. Conclusion NB is believed to have originated in Southeast Asia. NB has been associated mainly with infections in immunocompromised. In the United States, the two only other cases of NB described in immunocompetent hosts were interestingly from Florida as well. Disclosures All authors: No reported disclosures.

scholarly journals Nocardia mikamii a Novel Species Causing Disseminated Nocardiosis: A Literature Review of Disseminated Nocardiosis

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Muhammad Khan ◽  
Mohammed Muqeet Adnan ◽  
Najmi Shahbaz ◽  
Muhammad Hamza ◽  
Sufyan Abdul Mujeeb
Keyword(s):  
United States ◽  
Literature Review ◽  
Pulmonary Infection ◽  
Immunocompromised Patient ◽  
Novel Species ◽  
The United States ◽  
Common Site ◽  
Gram Positive ◽  
Disseminated Infection ◽  
Disseminated Nocardiosis

Nocardia is an uncommon Gram-positive organism. It typically appears as delicate filamentous Gram-positive branching rods. In the United States it was estimated to be approximately 500 to 1000 new cases per year. The organism causes disease in immunocompromised individuals with pulmonary infection representing the most common site of infection. Nocardia mikamii has been a recently isolated pathogen and not many cases of disseminated infection with this organism has been reported in the literature; we present a case of disseminated nocardiosis (mikamii sp.) in an immunocompromised patient. We also present a literature review on nocardiosis.

scholarly journals Suppressing or blocking Fis1 reverses diabetic endothelial dysfunction in human resistance arteries

2020 ◽  
Author(s):  
Mamatha Kakarla ◽  
John M. Egner ◽  
Jingli Wang ◽  
Megan C. Harwig ◽  
Kelsey A. Meacham ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Endothelial Dysfunction ◽  
High Glucose ◽  
Vascular Complications ◽  
The United States ◽  
Diabetic Patients ◽  
Dependent Manner ◽  
Resistance Arteries ◽  
Low Glucose

AbstractMitochondrial dysfunction drives the development of vascular endothelial dysfunction in type 2 diabetes (T2DM) with increased fragmentation of mitochondrial networks from increased Fis1 expression; whether suppressing or blocking Fis1 expression or activity can reverse endothelial dysfunction remains unknown. To address this question, resistance arterioles from healthy humans and those with T2DM were transfected with Fis1 siRNA and exposed to normal glucose, low glucose or high glucose conditions. Fis1 knockdown improved endothelium dependent vasodilation in T2DM arterioles, and blocked high- and low-glucose impairment in healthy vessels. Fis1 knockdown preserved NO bioavailability and improved endothelial layer integrity of cells exposed to high or low glucose. Fis1 knockdown had no significant effect on the expression of other mitochondrial dynamics or autophagy proteins, and had no effect on endothelial cell metabolism suggesting its suitability for pharmacological inhibition. For this, we designed pep213 to inhibit Fis1 activity (Kd ~3-7 μM) and demonstrate its specificity by NMR. Application of a cell permeant pep213 improved endothelium-dependent vasodilation in T2DM and non-T2DM vessels exposed to high glucose in an NO-dependent manner suggesting that targeting Fis1 may reduce vascular complications in T2DM.One Sentence SummaryMicro- and macro-vascular complications in type 2 diabetes mellitus (T2DM) continue to be major health burdens in the United States and we identify a new therapeutic route to treatment by showing that either a novel peptide inhibitor, or genetic silencing, of mitochondrial fission protein 1 reverses poor vasodilation of human resistance arteries from diabetic patients.

scholarly journals A complicated case of an immunocompetent patient with disseminated nocardiosis

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Chad J. Cooper ◽  
Sarmad Said ◽  
Maryna Popp ◽  
Haider Alkhateeb ◽  
Carlos Rodriguez ◽  
...  
Keyword(s):  
Tissue Sample ◽  
Vasogenic Edema ◽  
Brain Magnetic Resonance Imaging ◽  
Empiric Therapy ◽  
Immunocompetent Patient ◽  
Lung Abscess ◽  
Lower Extremity Weakness ◽  
Brain Abscesses ◽  
Disseminated Nocardiosis ◽  
Hispanic Male

Nocardia species are aerobic, gram positive filamentous branching bacteria that have the potential to cause localized or disseminated infection. Nocardiosis is a rare disease that usually affects immunocompromised patients and presents as either pulmonary, cutaneous or disseminated nocardiosis. Forty-two year-old hispanic male presented to our care with bilateral lower extremity weakness, frontal headache, subjective fever, nausea, and vomiting. Brain computed tomography (CT) revealed multiple hyperdense lesions with vasogenic edema in the frontal, parietal and left temporal lobes. Chest CT demonstrated bilateral cavitary nodules in the lung and right hilar lymphadenopathy. Brain magnetic resonance imaging revealed multiple bilateral supratentorial and infratentorial rim enhancing lesions involving the subcortical gray-white matter interface with vasogenic edema. Patient was started on empiric therapy for unknown infectious etiology with no response. He eventually expired and autopsy findings revealed a right hilar lung abscess and multiple brain abscesses. Microscopic and culture findings from tissue sample during autopsy revealed nocardia <em>wallacei</em> species with multidrug resistance. The cause of death was stated as systemic nocadiosis (nocardia pneumonitis and encephalitis). The presence of simultaneous lung and brain abscesses is a reliable indication of an underlying <em>Nocardia</em> infection. An increased awareness of the various presentations of nocardiosis and a high index of clinical suspicion can help in a rapid diagnosis and improve survival in an otherwise fatal disease. This case highlights the importance of obtaining a tissue biopsy for definitive diagnosis on the initial presentation when an infectious process is considered in the differential diagnosis and early treatment can be initiated.

1496-P: Clinical Inertia in Relation to Sociodemographic Factors among Patients with Type 2 Diabetes (T2D) in the United States

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1496-P
Author(s):  
GAIL FERNANDES ◽  
BAANIE SAWHNEY ◽  
HAKIMA HANNACHI ◽  
TONGTONG WANG ◽  
ANN MARIE MCNEILL ◽  
...  
Keyword(s):  
United States ◽  
Type 2 Diabetes ◽  
The United States ◽  
Sociodemographic Factors ◽  
Clinical Inertia

scholarly journals How Family Physicians Practice the Principle of Remission Along the Glycemic Continuum

2020 ◽  
Vol 11 ◽  
pp. 215013272097774
Author(s):  
Stephanie T. Fulleborn ◽  
Paul F. Crawford ◽  
Jeremy T. Jackson ◽  
Christy J.W. Ledford
Keyword(s):  
Type 2 Diabetes ◽  
Medical Record ◽  
The United States ◽  
Case Scenario ◽  
Cross Sectional ◽  
Normal Glucose ◽  
Normal Glucose Regulation

Introduction Recent evidence reveals that diabetes and prediabetes (preDM) can be reversed to normal glucose regulation (NGR) through significant weight loss, but how physicians clinically identify the principles of partial and complete remission of diabetes is largely unknown. Methods As part of the cross-sectional omnibus survey conducted in March 2019 at a professional annual meeting in the United States, physician participants answered case scenario questions about the diagnosis and documentation of patients with preDM and type 2 diabetes (T2DM). Results Of the registered conference attendees, 387 (72.7%) responded. When presented with the initial case of preDM, 201 physicians (70.8%) selected R73.03 Prediabetes. In a follow-up encounter with improved lab results, 118 physicians (58.7%) indicated that they would not chart any diabetes-related code and 62 (30.8%) would chart preDM again. When presented with the case of T2DM, 256 physicians (90.1%) indicated E11.0–E11.9 Type 2 Diabetes. In the follow-up encounter, only 38 (14.8%) coded a diagnosis reflecting remission from T2DM to prediabetes and 211 (82.4%) charted T2DM. Conclusion Physicians may be reluctant to document diabetes regression as there is little evidence for long-term outcomes and “downgrading” the diagnosis in the medical record may cause screenings to be missed. Documenting this regression in the medical record should communicate the accurate point on the continuum of glucose intolerance with both the patient and the care team.

scholarly journals Burden of non-alcoholic steatohepatitis among children with type 2 diabetes mellitus

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Lauren Parlett ◽  
Qinli Ma ◽  
Qian Shi ◽  
Geoffrey Crawford ◽  
Laura Herrera Scott ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
United States ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
The United States ◽  
Alcoholic Steatohepatitis ◽  
Diabetic Children

AbstractThis claims-based retrospective cohort study examined the prevalence and incremental impact of non-alcoholic steatohepatitis among children with type 2 diabetes mellitus in the United States. Although diagnoses of non-alcoholic steatohepatitis were not common among diabetic children, it was associated with significantly higher incremental healthcare cost and risk of hospitalization.

scholarly journals Motivational Application of Standardized Antimicrobial Administration Ratios Within a Healthcare System

2020 ◽  
Vol 41 (S1) ◽  
pp. s321-s321
Author(s):  
Stephanie Shealy ◽  
Joseph Kohn ◽  
Emily Yongue ◽  
Casey Troficanto ◽  
Brandon Bookstaver ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Healthcare Providers ◽  
The United States ◽  
Antimicrobial Use ◽  
Gram Positive ◽  
Specific Patient ◽  
Antimicrobial Administration

Background: Hospitals in the United States have been encouraged to report antimicrobial use (AU) to the CDC NHSN since 2011. Through the NHSN Antimicrobial Use Option module, health systems may compare standardized antimicrobial administration ratios (SAARs) across specific facilities, patient care locations, time periods, and antimicrobial categories. To date, participation in the NHSN Antimicrobial Use Option remains voluntary and the value of reporting antimicrobial use and receiving monthly SAARs to multihospital healthcare systems has not been clearly demonstrated. In this cohort study. we examined potential applications of SAAR within a healthcare system comprising multiple local hospitals. Methods: Three hospitals within Prisma Health-Midlands (hospitals A, B, and C) became participants in the NHSN Antimicrobial Use Option in July 2017. SAAR reports were presented initially in October 2017 and regularly (every 3–4 months) thereafter during interprofessional antimicrobial stewardship system-wide meetings until end of study in June 2019. Through interfacility comparisons and by analyzing SAAR categories in specific patient-care locations, primary healthcare providers and pharmacists were advised to incorporate results into focused antimicrobial stewardship initiatives within their facility. Specific alerts were designed to promote early de-escalation of antipseudomonal β-lactams and vancomycin. The Student t test was used to compare mean SAAR in the preintervention period (July through October 2017) to the postintervention period (November 2017 through June 2019) for all antimicrobials and specific categories and locations within each hospital. Results: During the preintervention period, mean SAAR for all antimicrobials in hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Notably, mean SAARs at hospitals A, B, and C in intensive care units (ICU) during the preintervention period were 0.67, 1.36, and 0.83 for broad-spectrum agents used for hospital-onset infections and 0.59, 1.27, and 0.68, respectively, for agents used for resistant gram-positive infections. After antimicrobial stewardship interventions, mean SAARs for all antimicrobials in hospital B decreased from 1.09 to 0.83 in the postintervention period (P < .001). Mean SAARs decreased from 1.36 to 0.81 for broad-spectrum agents used for hospital-onset infections and from 1.27 to 0.72 for agents used for resistant gram-positive infections in ICU at hospital B (P = .03 and P = .01, respectively). No significant changes were noted in hospitals A and C. Conclusions: Reporting AU to the CDC NHSN and the assessment of SAARs across hospitals in a healthcare system had motivational effects on antimicrobial stewardship practices. Enhancement and customization of antimicrobial stewardship interventions was associated with significant and sustained reductions in SAARs for all antimicrobials and specific antimicrobial categories at those locations.Funding: NoneDisclosures: None

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