Disseminated mycobacterial septicemia presented as acute abdomen: a surgeon’s perspective on Landouzy’s sepsis

2020 ◽  
Vol 13 (12) ◽  
pp. e237574
Author(s):  
Lokesh Vellore Dasarathan ◽  
Pranay Gaikwad ◽  
Ramesh Babu Telugu
Keyword(s):  
Bone Marrow ◽  
Septic Shock ◽  
Acute Abdomen ◽  
Clinical Condition ◽  
Cross Sectional ◽  
Pulse Steroid Therapy ◽  
Source Of Infection ◽  
Antituberculosis Therapy ◽  
Pulse Steroid ◽  
Multi Organ Dysfunction Syndrome

A 20-year-old man presented in emergency with fever, abdominal pain and obstipation. On evaluation, he was found to have an acute abdomen with septic shock. The cross-sectional abdominal imaging revealed hepatosplenomegaly, pleural effusion and ascites with retroperitoneal lymphadenopathy. He was resuscitated and started on broad-spectrum antibiotics. There was no other source of infection identified elsewhere. While bacterial and fungal cultures were negative, the sputum, blood, bone marrow and ascitic fluid were positive for Mycobacterium tuberculosis following which he was started on antituberculosis therapy. Despite therapy, the patient’s clinical condition continued to deteriorate requiring critical care. In view of Landouzy’s sepsis, pulse steroid therapy was started. However, the patient’s clinical condition continued to deteriorate and developed systemic inflammatory response syndrome and multi-organ dysfunction syndrome. Despite the best efforts, the patient expired.

scholarly journals Corticosteroid associated lupus pancreatitis

2020 ◽  
Vol 66 (10) ◽  
pp. 1414-1416
Author(s):  
Semra Demirli Atıcı ◽  
Ömer Engin ◽  
Göksever Akpınar ◽  
Cem Tuğmen
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Acute Abdomen ◽  
Steroid Therapy ◽  
Lupus Erythematosus ◽  
Free Fluid ◽  
Systemic Lupus ◽  
Pulse Steroid Therapy ◽  
Pulse Steroid

SUMMARY The relationship between acute pancreatitis and the administration of glucocorticoids is unclear because most reported cases have been diagnosed with systemic vascular diseases, such as systemic lupus erythematosus, which may be responsible for pancreatitis. A 22-year-old woman with eye involvement of a newly diagnosed systemic lupus erythematosus was admitted to our hospital. Pulse intravenous methylprednisolone therapy was given at 1mg/kg day for 3 days, and oral prednisolone at 40 mg/day thereafter. During pulse steroid therapy, she had abdominal pain, back pain, distention, nausea, and vomiting. Her physical examination was compatible with acute abdomen and peritonitis. Abdomen Computerized Tomography scan revealed diffuse liquid perihepatic and perisplenic area with heterogeneity around the mesentery. Due to the symptoms of acute abdomen, explorative laparotomy was performed. There was diffuse free fluid in the abdomen and edematous changes were observed around the pancreas. Amylase and lipase from intraabdominal fluid were studied and found to be high. The postoperative prednol dose was reduced carefully. On the sixth postoperative day, the drain was removed, and the patient was discharged without any problem. Physicians should keep in mind that acute pancreatitis may also be a cause of differential diagnosis of newly developed abdominal pain in patients receiving pulse steroid therapy with a normal level of serum amylase and lipase.

CLINICAL FEATURES AND COAGULATION ABNORMALITIES IN CHILDREN WITH SEPSIS AT DANANG HOSPITAL FOR WOMEN AND CHILDREN

2018 ◽  
pp. 97-103
Author(s):  
Huu Hoi Vo ◽  
Binh Bao Son Bui
Keyword(s):  
Septic Shock ◽  
Clinical Features ◽  
Cross Sectional Study ◽  
Severe Thrombocytopenia ◽  
Cross Sectional ◽  
Hematologic Tests ◽  
Coagulation Abnormalities ◽  
Women And Children ◽  
Key Words Coagulation ◽  
Coagulation Dysfunction

Objective: To determine the relationship between coagulation abnormalities and main clinical features, and hematologic tests. Methods: A descriptive cross-sectional study was conducted in 65 children with sepsis at the PICU, Da Nang Hospital for Women and Children from April 2012 to June 2013. Results: The frequency of internal hemorrhage in septic shock children was significantly higher than in children with sepsis (p < 0.001). The rate of thrombocytopenia was 30.8%, in which 10.8% of the children had severe thrombocytopenia (<50 x 109/l). Hypofibrinogenemia was observed in 30.8% of the patients, in which severe hypofibrinogenemia (≤ 1 g/l) was observed in 16.9% of the children. The frequency of reduced prothrombin ratio was 40%, in which 23.1% of the patients had prothrombin ratio < 50%. 35.4% of the patients had rAPTT > 1.15. Positive D-dimer and DIC were observed in 53.8% and 20% of the patients, respectively. Hemostatic changes showed the significant relationship with hemorrhage and the mortality of sepsis. Conclusion: Children with sepsis, especially septic shock were at high risk of coagulation dysfunction and coagulation abnormalities showed the correlation with hemorrhage and the mortality of sepsis. Key words: coagulation abnormalities, sepsis, children

The utility of strain imaging in the cardiac surveillance of bone marrow transplant patients

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319359
Author(s):  
Tejas Deshmukh ◽  
Peter Emerson ◽  
Paul Geenty ◽  
Shehane Mahendran ◽  
Luke Stefani ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Global Longitudinal Strain ◽  
Group Versus ◽  
Marrow Transplant ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Right Ventricular Free Wall ◽  
Cross Sectional ◽  
Allogenic Bone ◽  
Transplant Patients

ObjectiveTo evaluate the utility of two-dimensional multiplanar speckle tracking strain to assess for cardiotoxicity post allogenic bone marrow transplantation (BMT) for haematological conditions.MethodsCross-sectional study of 120 consecutive patients post-BMT (80 pretreated with anthracyclines (BMT+AC), 40 BMT alone) recruited from a late effects haematology clinic, compared with 80 healthy controls, as part of a long-term cardiotoxicity surveillance study (mean duration from BMT to transthoracic echocardiogram 6±6 years). Left ventricular global longitudinal strain (LV GLS), global circumferential strain (LV GCS) and right ventricular free wall strain (RV FWS) were compared with traditionl parameters of function including LV ejection fraction (LVEF) and RV fractional area change.ResultsLV GLS (−17.7±3.0% vs −20.2±1.9%), LV GCS (−14.7±3.5% vs −20.4±2.1%) and RV FWS (−22.6±4.7% vs −28.0±3.8%) were all significantly (p=0.001) reduced in BMT+AC versus controls, while only LV GCS (−15.9±3.5% vs −20.4±2.1%) and RV FWS (−23.9±3.5% vs −28.0±3.8%) were significantly (p=0.001) reduced in BMT group versus controls. Even in patients with LVEF >53%, ~75% of patients in both BMT groups demonstrated a reduction in GCS.ConclusionMultiplanar strain identifies a greater number of BMT patients with subclinical LV dysfunction rather than by GLS alone, and should be evaluated as part of post-BMT patient surveillence. Reduction in GCS is possibly due to effects of preconditioning, and is not fully explained by AC exposure.

scholarly journals Canine visceral leishmaniasis in riverside communities of the Cuiabá river watershed

2019 ◽  
Vol 40 (6Supl2) ◽  
pp. 3313
Author(s):  
Valéria Régia Franco Sousa ◽  
Álvaro Felipe de Lima Ruy Dias ◽  
Juliana Yuki Rodrigues ◽  
Mariana de Medeiros Torres ◽  
Janaína Marcela Assunção Rosa Moreira ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Visceral Leishmaniasis ◽  
Urban Areas ◽  
Axenic Culture ◽  
Antibody Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Lutzomyia Longipalpis ◽  
Cross Sectional ◽  
Mato Grosso ◽  
River Watershed

Visceral Leishmaniasis (VL) is a parasitic zoonosis expanding in Brazil. Several municipalities in the state of Mato Grosso including those on the river Cuiabá have reported the incidence of both human and canine cases and the identification of sandfly vector, Lutzomyia longipalpis and Lu. cruzi. Dogs are considered the main reservoir of Leishmania chagasi in the urban areas, hence, we devised a cross-sectional study aimed at assessing the prevalence of the infection in the dogs of riverside communities on Cuiabá River watershed by parasitological (parasitic isolation in culture), serological, and molecular methods. Of the 248 surveyed dogs, 24 were positive in enzyme linked immunosorbent assay (ELISA) or immunofluorescence antibody test (IFAT), with a prevalence of 9.7%. The riverside communities located in the town of Santo Antonio do Leverger displayed a higher prevalence of the disease than the cities of Cuiabá and Várzea Grande; however, the difference was not statistically significant (p > 0.05). Dogs born in the communities had a 3.24-fold higher risk of acquiring the infection. Promastigote were isolated in the axenic culture from the bone marrow samples and intact skin. Further, DNA of Leishmania sp. was detected in the bone marrow samples, lymph nodes, leukocyte cover, and skin of only one examined dog. These samples were sequenced and they showed 99% homology to L. infantum. To conclude, we observed a higher prevalence of infection in Riverside communities of Santo Antonio do Leverger and the confirmation of autochthony in these areas justifies the surveillance actions to minimise the risk of transmission within the riverine community itself, besides its dissemination to other areas by tourism.

scholarly journals Clinico-hematological study of pancytopenia

1970 ◽  
Vol 2 (3) ◽  
pp. 207-210 ◽  
Author(s):  
A Lakhey ◽  
OP Talwar ◽  
VK Singh ◽  
Shiva Raj KC
Keyword(s):  
Bone Marrow ◽  
Teaching Hospital ◽  
Myeloid Leukemia ◽  
Hematological Malignancies ◽  
Hematological Malignancy ◽  
Complete Blood Count ◽  
Megaloblastic Anemia ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Erythroid Hyperplasia

Background: Pancytopenia refers to a reduction in all the three cellular elements of blood. The aim of this study was to identify the various causes of pancytopenia in patients attending to Manipal teaching hospital in Pokhara. Materials and Methods: This was a cross-sectional study, carried out in Manipal teaching hospital from August 2008 to August 2010. Fifty-four patients with pancytopenia were included in the study. Complete blood count, bone marrow aspirations and trephine biopsies were performed. Data were analyzed using SPSS 11.0 version. Results: Out of 54 cases, there were 16 cases (29.60%) of hypoplastic bone marrow, 15 cases (27.78%) of hematological malignancies, 13 cases (24.10%) of megaloblastic anemia, 4 cases (11.11%) of erythroid hyperplasia and 6 cases (7.41%) of normcellular bone marrow. Acute myeloid leukemia was the commonest hematological malignancy. Conclusion: The commonest cause of pancytopenia in our study was hypoplastic bone marrow followed by hematological malignancies and megaloblastic anemia. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6023 JPN 2012; 2(3): 207-210

Sudden onset blindness treated with pulse steroid therapy in a patient with microscopic polyangiitis

Open Medicine ◽  
2011 ◽  
Vol 6 (5) ◽  
pp. 631-633
Author(s):  
Yoshiro Horai ◽  
Tomoya Miyamura ◽  
Karin Shimada ◽  
Soichiro Takahama ◽  
Rumi Minami ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Microscopic Polyangiitis ◽  
Oral Prednisolone ◽  
Sudden Onset ◽  
High Dose ◽  
Pulse Steroid Therapy ◽  
Ocular Manifestations ◽  
Dose Oral ◽  
The Right ◽  
Pulse Steroid

AbstractWe report a 71-year-old male with microscopic polyangiitis (MPA) who developed sudden-onset, progressive, bilateral visual loss associated with a relapse of MPA symptoms. The patient was referred to our hospital, and treated with intravenous pulse steroid therapy and high-dose oral prednisolone. Although the right eye remained vision deficient, visual acuity in the left eye recovered. Ocular manifestations of MPA are quite uncommon. This case emphasizes the necessity of early detection and initiation of prompt therapy where ocular manifestations of MPA occur.

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

2021 ◽  
pp. 088506662110614
Author(s):  
Mohinder R. Vindhyal ◽  
Liuqiang (Kelsey) Lu ◽  
Sagar Ranka ◽  
Prakash Acharya ◽  
Zubair Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Congestive Heart Failure ◽  
Hospital Mortality ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Cross Sectional ◽  
Increased Risk ◽  
Icd 10 ◽  
Nationwide Readmission Database

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings’ mechanisms to improve outcomes in patients with SS and underlying CHF.

Musculoskeletal MRI Findings of Haematological Diseases

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sameh Mohammed Abdelwahab ◽  
Hazem Ibrahim Abdelrahman ◽  
Pola Ibrahim Said
Keyword(s):  
Bone Marrow ◽  
Signal Intensity ◽  
Cross Sectional Study ◽  
Mr Images ◽  
University Hospitals ◽  
Mri Findings ◽  
Cross Sectional ◽  
Hematological Diseases ◽  
Musculoskeletal Mri ◽  
Normal Composition

Abstract Background Hematologic diseases are a group of prevalent and clinically diverse diseases that can affect any organ system. Hematologic disorders frequently involve bone and associated tissues causing significant alterations in the bone marrow and may have relevant side effects on the skeleton. In order to evaluate findings in bone marrow on MR imaging, it is essential to understand the normal composition and distribution of bone marrow and the changes in marrow that occur with age, as well as the basis for the MR signals from marrow and the factors that affect those signals. Aim of the Work To describe the musculoskeletal MRI findings in patients with hematological diseases. Patients and Methods cross sectional study was conducted in Ain Shams University hospitals on patients confirmed with hematological disease undergoing musculoskeletal MRI. Conclusion Magnetic resonance imaging is very beneficial noninvasive modality to evaluate bone marrow and detecting marrow lesions due to its ability to provide information at the level of cellular and chemical composition. Knowing normal marrow components and composition and their variation, as well as of factors that affect MR signal intensity, is important for optimal interpretation of MR images. The signal intensity, morphology, and location of marrow findings on MRI can be used to provide accurate diagnoses and to guide treatment of the discussed hematological diseases.

scholarly journals Correlation between tumor necrosis factor-alpha and septic shock in children

2013 ◽  
Vol 53 (1) ◽  
pp. 1 ◽  
Author(s):  
Khrisanti Dinata ◽  
Ari L. Runtunuwu ◽  
Jose M. Mandei ◽  
Julius H. Lolombulan
Keyword(s):  
Septic Shock ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis Factor Alpha ◽  
Tumor Necrosis ◽  
Strong Positive Correlation ◽  
Necrosis Factor Alpha ◽  
Cross Sectional ◽  
Positive Correlation ◽  
Factor Alpha ◽  
Necrosis Factor

Background The crucial role cytokines play in the pathophysiologyof sepsis is widely accepted. Infection stimulates the productionof cytokines in various cell types. Tumor necrosis factor-alpha(TNF-a) is one of the most extensively investigated cytokines inexperimental and clinical sepsis. Tumor necrosis factor-alpha hasbeen shown to mediate lethality in experimental sepsis.Objective To evaluate for a possible correlation between TNF-alevel and septic shock in children.Methods This cross-sectional study was conducted in Manadofrom June to September 2011. A total of 40 patients with arecent diagnosis of sepsis or septic shock were included. Plasmaspecimens were collected from subjects for measurement ofTNF-a concentration. Logistic regression analysis was used toassess the correlation between TNF-a level and sepsis, as well asthe probability of shock in children with sepsis, with P<0.05 asstatistically significant.Results There was a strong positive correlation betweenTNF-a level and the probability of shock in children with sepsis(regression coefficient = 0. 78, P = 0.002).Conclusions There is a strong positive correlation betweenTNF-a level with the probability of shock in children with sepsis.Higher plasma level ofTNF-a is associated with higher probabilityof septic shock.

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