scholarly journals Life-threatening pneumonia caused by human cytomegalovirus and Mycoplasma pneumoniae coinfection in a young, immunocompetent patient

2010 ◽  
Vol 59 (8) ◽  
pp. 980-983 ◽  
Author(s):  
C. A. Jacobi ◽  
R. Riessen ◽  
U. Schumacher ◽  
I. B. Autenrieth ◽  
G. Jahn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mycoplasma Pneumoniae ◽  
Human Cytomegalovirus ◽  
Primary Infection ◽  
Enrichment Culture ◽  
Antiviral Treatment ◽  
Immunocompetent Patient ◽  
Avidity Index ◽  
Life Threatening

A young, previously healthy and immunocompetent patient was transferred to our hospital to recover a suspected Ascaris worm from his gall bladder. Although the diagnosis of Ascaris infection could not be confirmed, the patient suffered from cholecystitis. To our surprise, the respiratory situation of the patient deteriorated within 24 h under antibiotic therapy and he had to be transferred to the intensive care unit for mechanical respiration. Human cytomegalovirus (HCMV) was isolated directly from a bronchoalveolar lavage (BAL) sample, and Mycoplasma pneumoniae DNA was detected by PCR in an enrichment culture of the same BAL sample. Serology for HCMV and M. pneumoniae clearly supported a primary/post-primary infection for both agents (IgM detection, increase of IgG titres and, in the case of HCMV, a low avidity index of only 22 %). Therefore, we assumed that a rare HCMV and M. pneumoniae coinfection was the aetiology of the fulminant pneumonia. Under broad antibiotic and antiviral treatment, the situation of the patient improved only very slowly.

scholarly journals Life-threatening COVID-19 presenting as stroke with antiphospholipid antibodies and low ADAMTS-13 activity, and the role of therapeutic plasma exchange: A case series

2020 ◽  
Vol 8 ◽  
pp. 2050313X2096408
Author(s):  
Abdulrahman Alharthy ◽  
Fahad Faqihi ◽  
Abdullah Balhamar ◽  
Ziad A Memish ◽  
Dimitrios Karakitsos
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Plasma Exchange ◽  
Plasma Volume ◽  
Antiphospholipid Antibodies ◽  
Rescue Therapy ◽  
Antiviral Treatment ◽  
Case Series ◽  
Therapeutic Plasma Exchange ◽  
Life Threatening

We present a case series of three patients with COVID-19 who were admitted to our intensive care unit due to acute respiratory distress syndrome, brain infarction, pulmonary embolism, and antiphospholipid antibodies. We applied therapeutic plasma exchange on all cases. On intensive care unit admission, all patients had low (<10) Glasgow Coma Scale, and central nervous imaging showed multiple brain infarctions. COVID-19 was confirmed by reverse transcriptase polymerase chain reaction assays. Patients underwent rescue therapeutic plasma exchange using the Spectra OptiaTM Apheresis System (Terumo BCT Inc., USA), which operates with acid-citrate dextrose anticoagulant as per Kidney Disease Improving Global Outcomes 2019 guidelines. A dose of 1.5 plasma volume was used for the first dose and then 1 plasma volume daily for a total of five doses. Plasma was replaced with Octaplas LG® (Octapharma AG, USA), which is an artificial fresh frozen plasma product that has undergone viral inactivation by prion reduction technology. We administered ARDS-net/prone positioning ventilation, empiric antiviral treatment, therapeutic anticoagulation, and intensive care unit supportive care. Laboratory tests showed lymphocytopenia; elevated levels of D-dimer, fibrinogen, total bilirubin, C-reactive protein, lactate dehydrogenase, and ferritin; as well as low levels of ADAMTS-13 activity and antibody. Serology tests depicted positive IgM and IgG antiphospholipid antibodies (anti-cardiolipin and anti-β2-glycoprotein I antibodies). No side effects of therapeutic plasma exchange were recorded. After the completion of therapeutic plasma exchange, patients improved clinically and gradually recovered neurologically (after 27–32 days). To conclude, in life-threatening COVID-19, especially when immune dysregulation features such as antiphospholipid antibodies exist, therapeutic plasma exchange could be an effective rescue therapy.

scholarly journals Clinical features of severe Mycoplasma pneumoniae pneumonia in adults admitted to an intensive care unit

2007 ◽  
Vol 56 (12) ◽  
pp. 1625-1629 ◽  
Author(s):  
Naoyuki Miyashita ◽  
Yasushi Obase ◽  
Kazunobu Ouchi ◽  
Kozo Kawasaki ◽  
Yasuhiro Kawai ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Clinical Features ◽  
Mycoplasma Pneumoniae ◽  
Severe Pneumonia ◽  
Clinical Findings ◽  
Community Acquired Pneumonia ◽  
Life Threatening ◽  
Mycoplasma Pneumoniae Pneumonia

Community-acquired pneumonia (CAP) due to Mycoplasma pneumoniae is usually mild, but some cases develop a severe life-threatening pneumonia. To investigate the clinical features of severe M. pneumoniae pneumonia in adults admitted to an intensive care unit, a multi-centre CAP surveillance study was performed. Among all hospitalized CAP cases between January 2000 and December 2004, there were 227 cases with M. pneumoniae pneumonia without the complication of other pathogens. A total of 13 of the cases required admission to an intensive care unit because of acute respiratory failure (ARF), and the remaining 214 cases (non-ARF) were low to moderately severe. The clinical features of ARF cases were compared with those of non-ARF cases. The underlying conditions in both types of case were identical, whereas clinical findings on admission clearly differed between the two groups. A regimen of an antibiotic effective against M. pneumoniae was begun on average at 9.3 days after the onset of symptoms in ARF cases, which was significantly later than for non-ARF cases (P<0.0001). However, two of the ARF cases progressed to respiratory failure despite the fact that adequate antibiotics were initially administered within 3 days after the onset of symptoms. All ARF cases received corticosteroids with adequate antibiotics, and their condition improved promptly. These results indicate that the clinical features, excluding underlying conditions, clearly differed between severe M. pneumoniae pneumonia and low to moderately severe pneumonia. The delayed administration of adequate antibiotics may contribute to the severity of M. pneumoniae pneumonia. Early corticosteroid therapy with adequate antibiotics should be considered.

scholarly journals Tick-Borne-Associated Illnesses in the Pediatric Intensive Care Unit

2020 ◽  
Vol 15 (06) ◽  
pp. 269-275
Author(s):  
Kaila Lessner ◽  
Conrad Krawiec
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Early Recognition ◽  
Spotted Fever ◽  
Pediatric Intensive Care ◽  
Rocky Mountain ◽  
Rocky Mountain Spotted Fever ◽  
Life Threatening ◽  
Human Ehrlichiosis

AbstractWhen unrecognized and antibiotic delay occurs, Lyme disease, Rocky Mountain–spotted fever, babesiosis, and human ehrlichiosis and anaplasmosis can result in multiorgan system dysfunction and potentially death. This review focuses on the early recognition, evaluation, and stabilization of the rare life-threatening sequelae seen in tick-borne illnesses that require admission in the pediatric intensive care unit.

scholarly journals Collective aeromedical evacuations of SARS-CoV-2-related ARDS patients in a military tactical plane: a retrospective descriptive study

2021 ◽  
pp. bmjmilitary-2021-001876
Author(s):  
Thibault Martinez ◽  
K Simon ◽  
L Lely ◽  
C Nguyen Dac ◽  
M Lefevre ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Selection Criteria ◽  
Distress Syndrome ◽  
Descriptive Study ◽  
Military Aircraft ◽  
Life Threatening ◽  
The Military

After the appearance of the COVID-19 pandemic in France, MEROPE system was created to transform the military tactical ATLAS A400M aircraft into a flying intensive care unit. Collective aeromedical evacuations (aero-MEDEVAC) of patients suffering from SARS-CoV-2-related acute respiratory distress syndrome was performed from June to December 2020. A total of 22 patients were transported during seven missions. All aero-MEDEVAC was performed in safe conditions for patients and crew. No life-threatening conditions occurred during flight. Biohazard controls were applied according to French guidelines and prevented crew contamination. Thanks to rigorous selection criteria and continuous in-flight medical care, the safe transportation of these patients was possible. To the best of our knowledge, this is the first description of collective aero-MEDEVAC of these kinds of patients using a tactical military aircraft. We here describe the patient’s characteristics and the flight’s challenges.

Septic Shock: Phenomenology

1971 ◽  
Vol 2 (4) ◽  
pp. 327-332
Author(s):  
Roy G. Fitzgerald
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Endotoxin Shock ◽  
Life Threatening ◽  
The Moment

This is an autobiographical account of an episode of life-threatening endotoxin shock experienced in the intensive care unit of a university-affiliated V.A. hospital. It was written within a day of the event by a psychiatrist interested in sharing with other physicians and nurses his harrowing time as a patient. He has added some afterthoughts as his perspective has broadened. The account presents the moment-to-moment events as he perceived them as well as his thoughts, feelings and fantasies. The ambiguities of being a psychiatrist-patient with its passivity-control, intellectual defenses, denial and fears of death are prominent in his thoughts.

Oncologic Emergencies

2011 ◽  
Vol 22 (4) ◽  
pp. 337-348 ◽  
Author(s):  
Regan Demshar ◽  
Rachel Vanek ◽  
Polly Mazanec
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Superior Vena ◽  
Tumor Lysis Syndrome ◽  
Vena Cava ◽  
Hemodynamic Instability ◽  
Cord Compression ◽  
Current Evidence ◽  
Oncologic Emergencies ◽  
Life Threatening

The picture of oncologic emergencies in the intensive care unit has changed over the past decade. The classic emergencies, that is, superior vena cava syndrome, spinal cord compression, tumor lysis syndrome and life-threatening hypercalcemia, are now routinely managed on the general oncology unit or in an outpatient setting. Vigilant monitoring for early signs of complications, proactive interventions to prevent complications, and aggressive management account for this change. Currently, emergent conditions that necessitate intensive care unit admission or transfer in the patient with cancer include respiratory failure, cardiac emergencies, hemorrhagic events and coagulopathies, sepsis, and hemodynamic instability. This article will present the current evidence-based management of these conditions, a brief summary of classic oncologic emergencies, and the role of the critical care nurse in meeting the multidimensional needs of the patient and family during the life-threatening episode, based on Ferrell’s quality of life model.

scholarly journals Please Don’t Use the Restraints

2015 ◽  
Vol 22 (6) ◽  
pp. 484-489 ◽  
Author(s):  
Desireé D. Rowe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Medical Records ◽  
Neonatal Intensive Care ◽  
Birth Experience ◽  
The Past ◽  
The Future ◽  
Life Threatening ◽  
New Perspective

The end of the story is all you care about. So, let’s get that out of the way first. Penelope Jane was born on March 23rd. She was healthy. The trauma of that day still resonates within my body, called into being through subsequent visits to the hospital and a review of my own medical records from that day. A life-threatening fever and 9 hours of pushing led to a powerfully negative birth experience, one that I am consistently told to just forget. After she had a weeklong stay in the neonatal intensive care unit (NICU), I have a healthy daughter. In this article, I use auto/archeology as a tool to examine my own medical records and the affective traces of my experience in the hospital to call into question Halberstam’s advocacy of forgetting as queer resistance to dominant cultural logics. While Halberstam explains that “forgetting allows for a release from the weight of the past and the menace of the future” I hold tightly to my memories of that day. This article marks the disconnects between an advocacy of forgetting and my own failure of childbirth and offers a new perspective that embraces the queer potentiality of remembering trauma.

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