Severe acute liver injury associated with Yersinia enterocolitica

2021 ◽  
Vol 14 (7) ◽  
pp. e242369
Author(s):  
Jessica Demes ◽  
Carl Kay ◽  
Amilcar Morales-Cardona ◽  
Stalin Subramanian
Keyword(s):  
Liver Injury ◽  
Yersinia Enterocolitica ◽  
Gastrointestinal Symptoms ◽  
Febrile Illness ◽  
Foodborne Illnesses ◽  
Positive Serology ◽  
High Grade Fever ◽  
Terminal Ileitis ◽  
Important Addition ◽  
Mesenteric Adenitis

Yersinia enterocolitica is a Gram-negative bacterium that causes foodborne illnesses, typically characterised by acute febrile gastroenteritis and is associated with a variety of manifestations. Isolated febrile illness without gastrointestinal symptoms is rare. We report a case of Y. enterocolitica infection with severe anicteric hepatitis. A 33-year-old Chinese man with no significant medical history presented on multiple occasions to the emergency department with recurrent high-grade fever and chills, but without gastrointestinal symptoms. Hepatic panel showed rising transaminases that peaked at Aspartate Aminotransferase (AST) of 991 U/L and Alanine Aminotransferase (ALT) of 1664 U/L. CT of the abdomen revealed terminal ileitis and mesenteric adenitis. As part of workup, we found positive serology for Y. enterocolitica. Ultimately, he improved with supportive care. This case highlights the importance of thorough workup of terminal ileitis and ‘Crohn’s mimics’ which ultimately revealed a unifying diagnosis; and an important addition to the workup for undifferentiated severe isolated hepatocellular liver injury.

scholarly journals Diversity of Cardiac and Gastrointestinal Presentations of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: A Case Series

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199661
Author(s):  
Anuja R. Shikhare ◽  
Rimsha M. Iqbal ◽  
Rabail Tariq ◽  
Daniel R. Turner ◽  
Bassam M. Gebara ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Asymptomatic Infection ◽  
Cardiac Monitoring ◽  
Delayed Presentation ◽  
Terminal Ileitis ◽  
Serologic Evidence ◽  
Cardiac Manifestations ◽  
Inflammatory Syndrome

COVID-19 is generally a benign or asymptomatic infection in children, but can occasionally be severe or fatal. Delayed presentation of COVID-19 with hyperinflammation and multi-organ involvement was recently recognized, designated the Multisystem Inflammatory Syndrome in Children (MIS-C). Six children with MIS-C with molecular and serologic evidence of SARS-CoV-2 infection were admitted to our hospital between May 5, 2020 and June 25, 2020. All had fever and weakness; 4/6 presented with gastrointestinal symptoms. Two children had features of complete Kawasaki disease, 3 had incomplete Kawasaki disease, while 1 had terminal ileitis with delayed onset of circulatory shock. Treatment consisted of intravenous immunoglobulin and aspirin for Kawasaki-like disease. Remdesivir, corticosteroids, and infliximab were used when indicated. Median hospitalization was 7 days. Immediate treatment resulted in rapid clinical improvement. In children presenting with hyperinflammatory syndromes without cardiac manifestations, testing for SARS-CoV-2 RNA and antibodies, with close cardiac monitoring should be pursued due to the manifold presentations of SARS-CoV-2 infection in children.

scholarly journals Klebsiella ozaenaeBacteremia in a Kidney Transplant Recipient

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Shree Kumar ◽  
Talal Alfaadhel ◽  
Meteb M. AlBugami
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Solid Organ Transplantation ◽  
Gastrointestinal Symptoms ◽  
Organ Transplant Recipient ◽  
Solid Organ Transplant Recipient ◽  
Solid Organ ◽  
High Grade Fever ◽  
Short Period

Infections remain a dreadful complication after solid organ transplantation. Almost all microorganisms could cause this complication, including unusual ones. We report a 73-year-old patient, with a history of kidney transplant for 38 years on minimum immunosuppression, who presented with high-grade fever and gastrointestinal symptoms.Klebsiella ozaenaewas isolated from blood cultures. She had a prompt response to antibiotics and recovered completely in a short period. Subsequent evaluation of her nasal cavity and sinuses did not show any abnormalities.Klebsiella ozaenaeis primarily a colonizer of the oral and nasopharyngeal mucosa, which does not usually cause severe infections. Only 12 cases ofKlebsiella ozaenaebacteremia have been reported, none of them in the context of solid organ transplant recipient.

scholarly journals The management of a pregnant patient with malaria in West Texas

2019 ◽  
Vol 7 (28) ◽  
pp. 47-52
Author(s):  
Hanna Kodeih ◽  
James Maher ◽  
Natalia Schlabritz-Lutsevich
Keyword(s):  
Endemic Area ◽  
Febrile Illness ◽  
Pregnant Patient ◽  
Acute Febrile Illness ◽  
High Grade ◽  
High Grade Fever ◽  
Diagnostic Uncertainty ◽  
Malarial Infection ◽  
West Texas ◽  
Mortality Burden

Travel associated infectious disease, such as malaria, should be considered in returningtravelers from an endemic area presenting with fever. Malaria in pregnancy has a high maternaland fetal morbidity and mortality burden. Early diagnosis is essential to improve maternal andfetal outcomes by providing maternal supportive measures and anti-malarial medication.We present a patient with severe acute febrile illness with mental status changes at 32 weeksgestation. She became acutely symptomatic including high grade fever while visiting WestTexas from Nigeria. Despite initial diagnostic uncertainty, a multidisciplinary team successfullydiagnosed and treated her severe malaria. She delivered at term with no long lasting maternal orfetal sequelae from her malarial infection. In an age of globalization, travel associated infectiousdiseases should be considered in the differential of acute febrile illness in pregnant women.

scholarly journals COVID-19, MERS and SARS with Concomitant Liver Injury—Systematic Review of the Existing Literature

2020 ◽  
Vol 9 (5) ◽  
pp. 1420 ◽  
Author(s):  
Michał Kukla ◽  
Karolina Skonieczna-Żydecka ◽  
Katarzyna Kotfis ◽  
Dominika Maciejewska ◽  
Igor Łoniewski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Injury ◽  
Clinical Course ◽  
Meta Analysis ◽  
Gastrointestinal Symptoms ◽  
Intensive Care Treatment ◽  
The Novel ◽  
Massive Necrosis ◽  
Novel Coronavirus ◽  
Elevated Transaminases

The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection has been predominantly linked to respiratory distress syndrome, but gastrointestinal symptoms and hepatic injury have also been reported. The mechanism of liver injury is poorly understood and may result as a consequence of viral hepatitis, systemic inflammatory response, gut barrier and microbiome alterations, intensive care treatment or drug toxicity. The incidence of hepatopathy among patients with coronavirus disease 2019 (COVID-19) is unclear, but studies have reported liver injury in patients with SARS and Middle East respiratory syndrome (MERS). We aimed to systematically review data on the prevalence of hepatic impairments and their clinical course in SARS and MERS Coronaviridae infections. A systematic literature search (PubMed/Embase/Cinahl/Web of Science) according to preferred reporting items for systematic review and meta-analysis protocols (PRISMA) was conducted from database inception until 17/03/2020 for studies that evaluated the incidence of hepatic abnormalities in SARS CoV-1, SARS CoV-2 and MERS infected patients with reported liver-related parameters. A total of forty-three studies were included. Liver anomalies were predominantly mild to moderately elevated transaminases, hypoalbuminemia and prolongation of prothrombin time. Histopathology varied between non-specific inflammation, mild steatosis, congestion and massive necrosis. More studies to elucidate the mechanism and importance of liver injury on the clinical course and prognosis in patients with novel SARS-CoV-2 infection are warranted.

Chronic intussusception associated with Yersinia enterocolitica mesenteric adenitis

1992 ◽  
Vol 27 (12) ◽  
pp. 1591-1592 ◽  
Author(s):  
J.A. Hervás ◽  
P. Albertí ◽  
J.I. Bregante ◽  
E. Boya ◽  
J. Reina ◽  
...  
Keyword(s):  
Yersinia Enterocolitica ◽  
Mesenteric Adenitis ◽  
Chronic Intussusception

scholarly journals New viral hepatitis caused by covid-19 virus- A case report

2021 ◽  
Vol 7 (2) ◽  
pp. 98-102
Author(s):  
R H Gobbur ◽  
Ranjima M ◽  
Aravind S Akki
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Respiratory Failure ◽  
Liver Injury ◽  
Viral Hepatitis ◽  
Pediatric Patients ◽  
Acute Abdominal Pain ◽  
Diffuse Alveolar Damage ◽  
Gastrointestinal Symptoms ◽  
Symptoms And Signs

During the current COVID-19 pandemic, the assessment, and management of patients are challenging. The clinical features of COVID-19 are heterogeneous and subtle in many cases. Although diffuse alveolar damage and acute respiratory failure are the main features of COVID-19, the impairment of other organs are also seen. Gastrointestinal symptoms are common in pediatric patients with COVID-19 as SARS-CoV-2 is able to enter gastrointestinal epithelial cells. However, these complaints can also be caused by a COVID-19-independent concomitant abdominal pathology. Therefore, patients with fever with acute abdominal pain, anorexia, nausea, vomiting and diarrhea need to be assessed very thoroughly. Previous studies reported that COVID-19 was likely to result in liver injury. Based on clinical cases, we present our approach of management of children with symptoms and signs of viral hepatitis and concomitant suspicion of ­COVID-19.

scholarly journals Gastrointestinal manifestations as the initial presentation of COVID 19 in pediatrics

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Ana Leticia Souza ◽  
Flavia Matos ◽  
Rosana Flintz ◽  
Roberta Marliere ◽  
Mariana Presti ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
Pediatric Intensive Care ◽  
Signs And Symptoms ◽  
Positive Serology ◽  
Hospital Unit ◽  
Gastrointestinal Conditions ◽  
Clinical Presentations ◽  
Starting Point ◽  
Initial Symptoms

Initial research on SARS-COV 2 (Severe Acute Respiratory Syndrome Coronavirus 2) appeared to demonstrate that children infected with the virus remained asymptomatic or had only mild to moderate conditions. The most common symptoms were fever and cough. However, in a later phase of the pandemic, numerous other aspects of clinical presentation in the pediatric public were observed, especially gastrointestinal conditions. In the present study, patients monitored at the Pediatric Intensive Care Unit of the Hospital Estadual Adão Pereira Nunes from April 17, 2020 until June 17, 2020, who had detectable PCR-RT (Polymerase Chain Reaction -Trasncriptase) or positive serology for COVID 19 (Coronavirus disease 19). This is a hospital unit that is not a reference for COVID 19, and its target audience is trauma victims.The initial symptoms of most hospitalized patients with clinical suspicion were fever and gastrointestinal symptoms, with significant abdominal pain standing out, mimicking acute abdomen. Signs and symptoms that differ from adults, who have respiratory manifestations as a starting point. Based on the recognition of the different clinical presentations of SARS-COV 2 in the pediatric population, an early diagnosis is possible, with better conduction and outcome.

scholarly journals Yersinia enterocolitica enteritis versus other bacterial enteritis in ultrasonic findings: a single-center case control study

2020 ◽  
Author(s):  
Eri Miyata ◽  
Keisuke Jimbo ◽  
Reiko Kyoudo ◽  
Takahiro Kudo ◽  
Toshiaki Shimizu
Keyword(s):  
Clinical Features ◽  
Yersinia Enterocolitica ◽  
Wall Thickness ◽  
Stool Culture ◽  
Minor Axis ◽  
Maximum Diameter ◽  
Terminal Ileitis ◽  
Abdominal Ultrasonography ◽  
Axis Ratio ◽  
Reactive Protein

Abstract Background: Yersinia enterocolitica (Ye) causes enteritis with mesenteric lymphadenitis and terminal ileitis, and can be difficult to distinguish from acute appendicitis, especially in children. In addition, because detection from stool culture is more difficult for Ye than for other bacteria causing enteritis, the diagnosis of Ye enteritis is not easy. Abdominal ultrasonography is useful for diagnosing bacterial enteritis, including Ye enteritis. This study diagnosed Ye enteritis and other bacterial enteritis by stool culture and compared and analyzed the ultrasonic findings and clinical features in children. The aims of this study are to compare and analyze ultrasonic findings and clinical features in children with Ye enteritis and other bacterial enteritis.Methods: Participants in this retrospective study comprised all 34 bacterial enteritis patients (3-18 years old) treated between 2014 and 2017. Patients were divided into the Yersinia enterocolitica enteritis (Ye) group and other bacterial enteritis (non-Ye) group from whom other pathogens were detected. Ultrasonic findings (including maximum and minimum diameters of ileocecal lymph nodes (C-LNs), mean major/minor axis ratio, wall thickness of the terminal ileum, and presence of a pericecal hyperechoic region) and blood examinations at first visit were compared between two groups. Results: The Ye group included 13 patients and the non-Ye group included 21 patients. Mean C-reactive protein level was higher in the Ye group (5.9±3.0 mg/dL) than in the non-Ye group (2.7±3.4 mg/dL, p = 0.049). No difference in mean maximum diameter of C-LNs was seen between two groups. However, mean C-LN major/minor axis ratio was lower in the Ye group than in the non-Ye group (p = 0.002) and terminal ileal wall thickness value was higher in the Ye group than in the non-Ye group (p = 0.004). Pericecal hyperechoic region was more frequent in the Ye group than in the non-Ye group (p = 0.021). Conclusion: The combination of characteristic ultrasonic findings identified in this study may improve ultrasonic differentiation of Yersinia enterocolitica enteritis and other bacterial enteritis.

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