scholarly journals Atypical presentation of Clostridioides difficile pseudomembranous colitis with laboratory rejection of stool specimen

2019 ◽  
Vol 12 (11) ◽  
pp. e230629 ◽  
Author(s):  
William Tung ◽  
Rachel Hays
Keyword(s):  
Pseudomembranous Colitis ◽  
Asymptomatic Carrier ◽  
Wide Spectrum ◽  
White Cell Count ◽  
Carrier State ◽  
Watery Diarrhoea ◽  
Molecular Testing ◽  
Clostridioides Difficile ◽  
The Usa ◽  
The Right

Clostridioides (formerly Clostridium) difficile is a major cause of nocosomial infection in the USA and worldwide. It has a wide spectrum of presentation, ranging from an asymptomatic carrier state to fulminant colitis. Pseudomembranous colitis is a manifestation of severe C. difficile infection (CDI), typically with progressive symptoms including watery diarrhoea, abdominal cramping and fevers and elevated white cell count and/or creatinine. It is diagnosed on three levels, including clinical assessment, stool assays and visualisation of the colonic mucosa. Laboratories will reject stools that do not meet criteria for testing. In the era of molecular testing for the presence of toxigenic C. difficile DNA, which only indicates the potential for infection, it is vital to use clinical evaluation in the diagnosis of CDI. We present an atypical case of pseudomembranous colitis affecting the right colon in a patient whose stools were rejected multiple times for C. difficile testing.

scholarly journals Optimal strategies for carrier screening and prenatal diagnosis of α- and β-thalassemia

Hematology ◽  
2021 ◽  
Vol 2021 (1) ◽  
pp. 607-613
Author(s):  
Cheryl Mensah ◽  
Sujit Sheth
Keyword(s):  
Newborn Screening ◽  
Screening Program ◽  
Asymptomatic Carrier ◽  
Wide Spectrum ◽  
Optimal Strategies ◽  
Practical Method ◽  
Population Based ◽  
Carrier State ◽  
Dependent Form ◽  
Rapid Genetic Testing

Abstract The thalassemias are inherited quantitative disorders of hemoglobin synthesis with a significant worldwide burden, which result in a wide spectrum of disease from the most severe transfusion-dependent form to the mildest asymptomatic carrier state. In this article, we discuss the importance of carrier, prenatal, and newborn screening for thalassemia. We examine the rationale for who should be screened and when, as well as the current methodology for screening. Deficiencies in the newborn screening program are highlighted as well. With the advent of inexpensive and rapid genetic testing, this may be the most practical method of screening in the future, and we review the implications of population-based implementation of this strategy. Finally, a case-based overview of the approach for individuals with the trait as well as prospective parents who have a potential fetal risk of the disease is outlined.

Trial by Triad: substituted judgment, mental illness and the right to die

2021 ◽  
pp. medethics-2020-107154
Author(s):  
Jacob M Appel
Keyword(s):  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Substituted Judgment ◽  
Diminished Capacity ◽  
Accepted Standard ◽  
The Usa ◽  
Aid In Dying ◽  
Incapacitated Patients ◽  
The Right

Substituted judgment has increasingly become the accepted standard for rendering decisions for incapacitated adults in the USA. A broad exception exists with regard to patients with diminished capacity secondary to depressive disorders, as such patients’ previous wishes are generally not honoured when seeking to turn down life-preserving care or pursue aid-in-dying. The result is that physicians often force involuntary treatment on patients with poor medical prognoses and/or low quality of life (PMP/LQL) as a result of their depressive symptoms when similarly situated incapacitated patients without such depressive symptoms would have their previous wishes honoured via substituted judgment. This commentary argues for reconsidering this approach and for using a substituted judgment standard for a subset of EMP/LQL patients seeking death.

scholarly journals P040 An unusual case of giant cell arteritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Jessica Ellis ◽  
Keziah Austin ◽  
Sarah Emerson
Keyword(s):  
Inflammatory Markers ◽  
Illicit Drugs ◽  
Unusual Case ◽  
Temporal Arteritis ◽  
White Cell Count ◽  
Healthcare Providers ◽  
Temporal Artery ◽  
Low Grade ◽  
Temporal Artery Biopsy ◽  
The Right

Abstract Background/Aims  A 49-year-old female of Nepalese heritage was referred with right-sided headache, scalp tenderness, and a painful swelling overlying the right temple. She denied any visual or claudicant symptoms but felt systemically unwell with a fever. There were no symptoms suggestive of an inflammatory arthritis, underlying connective tissue disease or vasculitis. She was normally fit and well with no past medical history. She did not take any regular medications and denied using over the counter or illicit drugs or recent travel. On review she had a low grade fever. There was a large tender, erythematous swelling overlying the right temple. Bilaterally the temporal arteries were palpable and pulsatile. Peripheral pulses were normal with no bruits. There was no evidence of shingles (HSV) or local infection. Full systemic examination revealed no other abnormalities. Laboratory tests showed: PV 2.56, CRP 101, total white cell count 14.38 (eosinophils 0.4), albumin 33, Hb 115. Urine dip was normal. Renal function, liver function and immunoglobulins were normal. ANCA was negative. Hypoechogenicity surrounding the right frontal branch of the right temporal artery was seen on ultrasound. There were no discrete masses suggestive of cysts, abscess or tumours. Temporal artery biopsy confirmed the presence of vasculitis; histology demonstrated transmural lymphohistiocytic inflammation, disruption of the elastic lamina and intimal proliferation. Prednisolone was started at 40mg daily. Four weeks after initially presenting she was asymptomatic and her inflammatory markers had normalised. Methods  The case is discussed below. Results  Temporal arteritis, or GCA, is primarily a disease of older adults; with age 50 often used as an inclusion criteria, and is more common in Caucasian populations. Limited reports exist of GCA in younger cohorts, but these are rare. An important differential in younger patients, such as ours, is juvenile temporal arteritis. This rare localised vasculitis affects almost exclusively the temporal artery. It is typically a disease of young males, who present with non-tender temporal swelling. Systemic symptoms are unusual and inflammatory markers are normal. Clinical or laboratory evidence of organ involvement, peripheral eosinophilia or fibrinoid necrosis on histology should prompt consideration of an AAV or PAN. Incidence of GCA increases in correlation with Northern latitude, with highest rates reported in Scandinavian and North American populations. GCA is rare in Asian populations. Higher diagnostic rates in countries where physicians have increased awareness of GCA proposed as an explanation for this difference; however differences in incidence are still observed between Asian and Caucasian populations presenting to the same healthcare providers. Conclusion  GCA is an uncommon diagnosis in younger and non-Caucasian patients. Thorough investigation through ultrasound and biopsy helped increase our diagnostic confidence in this unusual case. Rheumatologists must be alert to atypical presentations in order to deliver prompt and potentially sight-saving treatment. Disclosure  J. Ellis: None. K. Austin: None. S. Emerson: None.

scholarly journals Colonisation Factor CD0873, an Attractive Oral Vaccine Candidate against Clostridioides difficile

2021 ◽  
Vol 9 (2) ◽  
pp. 306
Author(s):  
Cansu Karyal ◽  
Jaime Hughes ◽  
Michelle L. Kelly ◽  
Jeni C. Luckett ◽  
Philip V. Kaye ◽  
...  
Keyword(s):  
Pseudomembranous Colitis ◽  
Vaccine Candidate ◽  
Oral Vaccine ◽  
Immunoglobulin A ◽  
Oral Route ◽  
Hamster Model ◽  
Clostridioides Difficile ◽  
Mucosal Antibody ◽  
Gut Pathogens ◽  
Secretory Immunoglobulin

Clostridioides difficile is the main cause of health-care-associated infectious diarrhoea. Toxins, TcdA and TcdB, secreted by this bacterium damage colonic epithelial cells and in severe cases this culminates in pseudomembranous colitis, toxic megacolon and death. Vaccines in human trials have focused exclusively on the parenteral administration of toxin-based formulations. These vaccines promote toxin-neutralising serum antibodies but fail to confer protection from infection in the gut. An effective route to immunise against gut pathogens and stimulate a protective mucosal antibody response (secretory immunoglobulin A, IgA) at the infection site is the oral route. Additionally, oral immunisation generates systemic antibodies (IgG). Using this route, two different antigens were tested in the hamster model: The colonisation factor CD0873 and a TcdB fragment. Animals immunised with CD0873 generated a significantly higher titre of sIgA in intestinal fluid and IgG in serum compared to naive animals, which significantly inhibited the adherence of C. difficile to Caco-2 cells. Following challenge with a hypervirulent isolate, the CD0873-immunised group showed a mean increase of 80% in time to experimental endpoint compared to naïve animals. Survival and body condition correlated with bacterial clearance and reduced pathology in the cecum. Our findings advocate CD0873 as a promising oral vaccine candidate against C. difficile.

scholarly journals Clostridioides difficile Infection, Still a Long Way to Go

2021 ◽  
Vol 10 (3) ◽  
pp. 389
Author(s):  
Eleftheria Kampouri ◽  
Antony Croxatto ◽  
Guy Prod’hom ◽  
Benoit Guery
Keyword(s):  
Fecal Microbiota Transplantation ◽  
Diagnostic Algorithm ◽  
Fecal Microbiota ◽  
Diagnostic Methods ◽  
Special Focus ◽  
Surveillance Systems ◽  
Main Question ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
The Right

Clostridioides difficile is an increasingly common pathogen both within and outside the hospital and is responsible for a large clinical spectrum from asymptomatic carriage to complicated infection associated with a high mortality. While diagnostic methods have considerably progressed over the years, the optimal diagnostic algorithm is still debated and there is no single diagnostic test that can be used as a standalone test. More importantly, the heterogeneity in diagnostic practices between centers along with the lack of robust surveillance systems in all countries and an important degree of underdiagnosis due to lack of clinical suspicion in the community, hinder a more accurate evaluation of the burden of disease. Our improved understanding of the physiopathology of CDI has allowed some significant progress in the treatment of CDI, including a broader use of fidaxomicine, the use of fecal microbiota transplantation for multiples recurrences and newer approaches including antibodies, vaccines and new molecules, already developed or in the pipeline. However, the management of CDI recurrences and severe infections remain challenging and the main question remains: how to best target these often expensive treatments to the right population. In this review we discuss current diagnostic approaches, treatment and potential prevention strategies, with a special focus on recent advances in the field as well as areas of uncertainty and unmet needs and how to address them.

A Report of Four Cases and a Review of the Literature

1974 ◽  
Vol 83 (4) ◽  
pp. 550-554 ◽  
Author(s):  
Gary D. Becker ◽  
Alexander M. Wernicke
Keyword(s):  
World Literature ◽  
Pathogenic Bacteria ◽  
Wide Spectrum ◽  
Carrier State ◽  
Penicillin G ◽  
Physical Finding ◽  
Agar Culture ◽  
Cervical Lymph Nodes ◽  
Procaine Penicillin ◽  
Moderate Elevation

Four cases of gonococcal pharyngotonsillitis have been presented, along with a review of the world literature. This entity is most commonly seen in those individuals practicing fellatio, i.e., females and homosexual males. The infection may be passed to the newborn by the infected genitals of the mother during birth, to the infant from adult molestation, or among sexually promiscuous children. Most gonococcal pharyngeal infections result in a carrier state, and as such, are possible reservoirs of propagated infections. When symptomatic, the most frequent complaint is a sore throat. Physical finding among symptomatic patients reveal a wide spectrum ranging from mild hyperemia of the pharynx or tonsils, to exudative tonsillitis with tender cervical lymph nodes and moderate elevation of temperature. Most authorities agree that the preferred treatment is 4.8 million units of procaine penicillin G I.M., with one gm of probenecid by mouth thirty minutes before the injection. If allergic to penicillin, tetracycline should be given, 1.5 gm by mouth stat, then 0.5 gm four times a day for a total of 9 gm. A routine blood agar culture of the throat will not reveal the presence of the gonococcus. Thayer-Martin (or Transgrow) media must be used. Failure to detect pathogenic bacteria in a routine culture may lead to either no treatment or improper treatment of a gonococcal pharyngotonsillar infection. This may result in a carrier state, or even worse, to a disseminated gonococcal infection.

scholarly journals Enabling Technologies for Improved Data Management: Hardware

2001 ◽  
Vol 9 (1) ◽  
pp. 11-25
Author(s):  
Kerstin van Dam-Kleese ◽  
Michael Hopewell
Keyword(s):  
Data Management ◽  
Scientific Community ◽  
Wide Spectrum ◽  
Work Force ◽  
Working Environment ◽  
Computational Techniques ◽  
Enabling Technologies ◽  
New Challenges ◽  
The Uk ◽  
The Right

The most valuable assets in every scientific community are the expert work force and the research results/data produced. The last decade has seen new experimental and computational techniques developing at an ever-faster pace, encouraging the production of ever-larger quantities of data in ever-shorter time spans. Concurrently the traditional scientific working environment has changed beyond recognition. Today scientists can use a wide spectrum of experimental, computational and analytical facilities, often widely distributed over the UK and Europe. In this environment new challenges are posed for the Management of Data every day, but are we ready to tackle them? Do we know exactly what the challenges are? Is the right technology available and is it applied where necessary? This part of enabling technologies investigates current hardware techniques and their functionalities and provides a comparison between various products.

scholarly journals Impact of Two-Step Testing Algorithm on Reducing Hospital-Onset Clostridioides difficile Infections

2021 ◽  
Vol 1 (S1) ◽  
pp. s42-s43
Author(s):  
Bhagyashri Navalkele ◽  
Wendy Winn ◽  
Sheila Fletcher ◽  
Regina Galloway ◽  
Jason Parham ◽  
...  
Keyword(s):  
Medical Center ◽  
Molecular Testing ◽  
Toxin A ◽  
Clostridioides Difficile ◽  
Contact Isolation ◽  
Academic Center ◽  
Mississippi Medical ◽  
True Infection ◽  
Testing Algorithm ◽  
The University

Clostridioides difficile infection (CDI) is one of the leading causes of hospital–onset infections. Clinically distinguishing true CDI versus colonization with C. difficile is challenging and often requires reliable and rapid molecular testing methods. At our academic center, we implemented a 2-step testing algorithm to help identify true CDI cases. The University of Mississippi Medical Center is a 700+ bed academic facility located in Jackson, Mississippi. Hospital-onset (HO) CDI was defined based on NHSN Laboratory Identified (LabID) event as the last positive C. difficile test result performed on a specimen using a multistep testing algorithm collected >3 calendar days after admission to the facility. HO-CDI data were collected from all inpatient units except the NICU and newborn nursery. HO-CDI outcomes were assessed based on standardized infection ratio (SIR) data. In May 2020, we implemented a 2-step testing algorithm (Figure 1). All patients with diarrhea underwent C. difficile PCR testing. Those with positive C. difficile PCR test were reflexed to undergo enzyme immunoassay (EIA) glutamate dehydrogenase antigen (Ag) testing and toxin A and B testing. The final results were reported as colonization (C. difficile PCR+/EIA Ag+/Toxin A/B−) or true CDI case (C. difficile PCR+/EIA +/Toxin A/B +) or negative (C. difficile PCR−). All patients with colonization or true infection were placed under contact isolation precautions until diarrhea resolution for 48 hours. During the preintervention period (October 2019–April 2020), 25 HO-CDI cases were reported compared to 8 cases in the postintervention period (June 2020–December 2020). A reduction in CDI SIR occurred in the postintervention period (Q3 2020–Q4 2020, SIR 0.265) compared to preintervention period (Q4 2019–Q1 2020, SIR 0.338) (Figure 2). We successfully reduced our NHSN HO-CDI SIR below the national average after implementing a 2-step testing algorithm for CDI. The 2-step testing algorithm was useful for antimicrobial stewardship to guide appropriate CDI treatment for true cases and for infection prevention to continue isolation of infected and colonized cases to reduce the spread of C. difficile spores.Funding: NoDisclosures: None

scholarly journals Legal Status Of The Caspian Sea: History And Present

2012 ◽  
Vol 6 ◽  
Author(s):  
Ardak Kapyshev
Keyword(s):  
Caspian Sea ◽  
Legal Status ◽  
Oil Fields ◽  
Present Stage ◽  
The Caspian Sea ◽  
Interstate Relations ◽  
The Usa ◽  
History Of ◽  
The Right ◽  
Near Future

At  the  present  stage  one  of  the  unsolved   problems in  interstate relations of  Caspian bordering countries is defining international­legal status of the Caspian Sea. It is noted in the article that this problem is not a new one at all. The history of “division” of the Caspian Sea begins in the ancient age, namely in VIII century. It is underlined that the basic stumbling block  is the position of Iran on the right to use the Caspian Sea, and also occurrence of extra regional players, such as  the USA, China, etc. First of  all, it is connected with rich oil fields and other minerals, and also with convenient geopolitical and geostrategic position. The only way to worry out the international­legal delimitation of the Caspian Sea problem is a negotiating process. By now, despite of  certain disagreements on  legal status of  the Caspian Sea, five Caspian bordering countries managed to achieve certain progress, admitting the possibility of applying the principle of sectorial sectioning on the Caspian Sea.  Clear proof  of  it is the agreements on  division of ground on the northern part of Caspian Sea signed between Kazakhstan, Russia and Azerbaijan. It is important that Kazakhstan, Russia, Azerbaijan and Turkmenistan clearly stated their positions and agreed to make a compromise in their official statements. More than likely, in the near future Iran will soften its position, considering its present  situation and   strained relations with the USA. It has been alleged that the constructive  dialog  already  started; everything depends on  the mobility,  concurrency and rationality of actions of all Caspian bordering countries.

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