Babesiain a Nonsplenectomized Patient Requiring Exchange Transfusion

Babesiosis is a tick born zoonosis caused by red blood cell parasites of the genusBabesia. It is caused predominantly byB. microtiandB. divergens,microtibeing more common in the US. The parasites are transmitted byIxodestick to their host but infection can also spread by blood transfusion and perinatally. Clinical manifestations vary from subclinical infection to fulminating disease depending upon the immune status of the patient. About half of patients, hospitalized with babesiosis, develop complication with fatality rates of 6 to 9% which increase up to 21% among those with immunosuppression. A case of 58-year-old previously healthy man, infected byB.microti, was reported on 2000 who presented with severe disease characterized by severe anemia, DIC, and renal and respiratory failure. First case of overwhelming septic shock without respiratory involvement due to babesiosis in a healthy patient with an intact spleen was published in a case report on 2011. Since our patient here is an immunocompetent healthy male with intact spleen presenting with severe babesiosis requiring exchange transfusion, this presentation ofBabesiais rare and warrants further study.

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Coronavirus Disease (COVID-19): Comprehensive Review of Clinical Presentation

Frontiers in Public Health ◽

10.3389/fpubh.2020.582932 ◽

2021 ◽

Vol 8 ◽

Author(s):

Om Prakash Mehta ◽

Parshal Bhandari ◽

Akshay Raut ◽

Salah Eddine Oussama Kacimi ◽

Nguyen Tien Huy

Keyword(s):

Viral Entry ◽

Clinical Presentation ◽

Early Stage ◽

Severe Disease ◽

Clinical Manifestations ◽

Endocrine System ◽

Extensive Literature ◽

First Case ◽

Clinical Presentations ◽

Organ Systems

COVID-19 is a rapidly growing pandemic with its first case identified during December 2019 in Wuhan, Hubei Province, China. Due to the rampant rise in the number of cases in China and globally, WHO declared COVID-19 as a pandemic on 11th March 2020. The disease is transmitted via respiratory droplets of infected patients during coughing or sneezing and affects primarily the lung parenchyma. The spectrum of clinical manifestations can be seen in COVID-19 patients ranging from asymptomatic infections to severe disease resulting in mortality. Although respiratory involvement is most common in COVID-19 patients, the virus can affect other organ systems as well. The systemic inflammation induced by the disease along with multisystem expression of Angiotensin Converting Enzyme 2 (ACE2), a receptor which allows viral entry into cells, explains the manifestation of extra-pulmonary symptoms affecting the gastrointestinal, cardiovascular, hematological, renal, musculoskeletal, and endocrine system. Here, we have reviewed the extensive literature available on COVID-19 about various clinical presentations based on the organ system involved as well as clinical presentation in specific population including children, pregnant women, and immunocompromised patients. We have also briefly discussed about the Multisystemic Inflammatory Syndrome occurring in children and adults with COVID-19. Understanding the various clinical presentations can help clinicians diagnose COVID-19 in an early stage and ensure appropriate measures to be undertaken in order to prevent further spread of the disease.

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Persistent intestinal dysbiosis after SARS-CoV-2 infection in Brazilian patients

10.21203/rs.3.rs-877943/v1 ◽

2021 ◽

Author(s):

Alexandre Soares Ferreira Junior ◽

Tais Fernanda Borgonovi ◽

Larissa Vedovato Vilela de Salis ◽

Aline Zazeri Leite ◽

Amanda Soares Dantas ◽

...

Keyword(s):

Gut Microbiota ◽

Intestinal Microbiota ◽

Poor Prognosis ◽

Immune Status ◽

Severe Disease ◽

Clinical Manifestations ◽

Healthy Controls ◽

Intestinal Dysbiosis ◽

Stool Samples ◽

The Impact

Abstract Background: The massive secretion of inflammatory cytokines is associated with the Coronavirus Disease 2019 (COVID-19) severity and poor prognosis, as well as, in long COVID, the pathophysiology seems to be related to immune deregulation. The patient's immune status can influence the response to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus infection, and this immunity is affected by the intestinal microbiota condition (eubiotic or dysbiotic). This study aimed to evaluate the intestinal microbiota of patients infected with SARS-CoV-2 with different clinical manifestations and post-COVID-19 (post-COV) periods, and correlate with the use of antibiotics during the acute disease. Results: According to the beta diversity, we observed significant differences between microbial communities in stool samples from post-COV patients when compared with healthy controls. Additionally, we detected four different clusters when we grouped patients into asymptomatic, mild, moderate, and severe disease. Patients who took antibiotics during the COVID-19 course showed decreased richness of the gut microbiota, even months after the disease resolution. We detected some genera possibly associated with the persistent post-COV dysbiosis, including increased Prevotella, Dialister, Haemophillus, Barnesiella, Desulfovibrio, Bilophila, Alistipes, Parabacteroides and Bacteroides, suggesting the impact of the disease in the gut microbiota. Besides that, we found some genera associated with antibiotic-induced dysbiosis in post-COV patients, including decreased Akkermansia and Bifidobacterium species. Conclusions: Therefore, we hypothesized that persistent dysbiosis and indiscriminate use of antibiotics during the COVID-19 pandemic may be associated with long COVID syndromes, suggesting the involvement of the gut-lung axis. These data suggest that intestinal microbiota modulation may represent a therapeutic approach for long COVID.

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Hurst’s encephalitis. Lecture with a description of clinical cases

L.O. Badalyan Neurological Journal ◽

10.46563/2686-8997-2021-2-2-89-93 ◽

2021 ◽

Vol 2 (2) ◽

pp. 89-93

Author(s):

Eugenia A. Komarova ◽

Alexey S. Kotov

Keyword(s):

White Matter ◽

Severe Disease ◽

Intensive Therapy ◽

Clinical Manifestations ◽

Epileptic Seizures ◽

Acute Onset ◽

Brain Hemispheres ◽

First Case ◽

The Brain ◽

Clinical Cases

Hirst’s encephalitis is a severe disease characterized by an acute onset and rapidly progressive inflammation with symmetrical multifocal lesions of the brain, less often the cerebellum, brain stem, or spinal cord, manifested by white matter necrosis and numerous hemorrhages. Cases of Hirst’s encephalitis are quite rare; by 2014, about 100 cases of the disease have been described in the literature. The mortality rate for this disease reaches 70%. Its etiology remains unclear, and in most cases, the diagnosis is made heuristically, based on the similarity of clinical manifestations in a particular patient with the “classical” descriptions available in the literature. The article presents two clinical cases of Hirst’s encephalitis. In the first case, the disease debuted at the age of 14 with mental disorders, manifested by panencephalitis, depression of consciousness, and epileptic seizures. Against the background of aggressive therapy, it was possible to achieve a positive result, however, with an outcome in gross neurological and cognitive deficits. In the second case, the disease debuted at the age of 49 with loss of consciousness, manifested itself as resistant status epilepticus and multifocal inflammatory lesions of the white matter of both brain hemispheres with foci of hemorrhagic impregnation. Despite intensive therapy, this case was fatal. In conclusion, a description of the approaches to the diagnosis and treatment of Hirst’s encephalitis based on the data of modern literature is presented.

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Does Smoking and Alcohol Increase the Risk of COVID-19? A Review

Dental Journal of Advance Studies ◽

10.1055/s-0041-1736490 ◽

2021 ◽

Author(s):

Ankit Mahajan ◽

Ujwal Singh ◽

Pankaj Kumar

Keyword(s):

Respiratory Tract ◽

Severe Disease ◽

Clinical Manifestations ◽

Severe Pneumonia ◽

Unknown Origin ◽

Capital City ◽

World Health ◽

Causative Organism ◽

First Case ◽

Tract Infections

AbstractThe first case of pneumonia of unknown origin was identified in Wuhan, the capital city of Hubei Province situated in the Republic of China. The pathogenic organism that has been identified as a causative organism is a novel enveloped RNA betacoronavirus, which has been designated as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This virus has been found to have a similar phylogeny to SARS-CoV. The novel coronavirus or COVID-19 can be symptomized through clinical manifestations like pyrexia or fever, cough, dyspnea/difficulty in breathing, myalgia/muscle pain, and constant fatigue. COVID-19 can be transmitted through respiratory tract secretions. It mainly results in respiratory tract infections and the development of severe pneumonia in infected patients. Severe disease may ultimately cause death due to progressive respiratory failure. The coronavirus disease 2019 or COVID-19 has been declared a public health emergency of international proportions by the World Health Organization (WHO). Thus, an analysis of cases might help in the identification of the disease's defining clinical characteristics, association with underlying lifestyle habits, and disease severity. This present article studied the probability of smoking and alcohol consumption in increasing the risk involved in increasing the severity of COVID-19 infection among affected subjects.

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Multiple Myeloma or Brucellosis: A Case Report

Infectious Disorders - Drug Targets ◽

10.2174/1871526519666190307123047 ◽

2020 ◽

Vol 20 (1) ◽

pp. 102-105 ◽

Cited By ~ 1

Author(s):

Hossein A. Rahdar ◽

Mansoor Kodori ◽

Mohamad R. Salehi ◽

Mahsa Doomanlou ◽

Morteza Karami-Zarandi ◽

...

Keyword(s):

Multiple Myeloma ◽

Brucella Melitensis ◽

Severe Disease ◽

Correct Diagnosis ◽

Clinical Manifestations ◽

Bone Marrow Aspiration ◽

Major Health Problem ◽

Brucella Infection ◽

Wide Range ◽

Parental Treatment

Background: Brucellosis, a major health problem in developing countries, is a multisystem infection with a broad spectrum of clinical manifestations. Hematological complications, ranging from an intravascular coagulopathy to mild homeostasis disorders (such as gammopathy), have been reported in brucella infection. These signs and symptoms may lead to misdiagnosis of brucellosis with other hematological diseases. Case: A 65-year-old male whose occupation was shepherding was referred to our hospital as a known case of multiple myeloma with continuous fever, muscle weakness, and night sweating after taking 2 courses of chemotherapy. The laboratory diagnosis of multiple myeloma had been based on the observation of a high percent of plasma cells in the bone marrow aspiration. At follow- up, the result of patient's fever workup, with 2 sets of blood cultures, was positive for Brucella melitensis. Isolated brucella was confirmed as B. melitensis by 16S rRNA sequencing. Brucellosis serologic test was performed by agglutination test and positive results were obtained. The patient was discharged with the cessation of fever and general improvement after the end of the parental treatment phase of brucella bacteremia. Conclusions: Brucella infection may cause a severe disease, mimicking a primary hematological disease, which could complicate the correct diagnosis. In brucellosis cases, due to the wide range of symptoms, in addition to cultivation and serological methods, molecular methods should also be used to prevent inappropriate diagnosis and additional costs.

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Genetic polymorphism for IFNγ +874T/A in patients with acute toxoplasmosis

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822012000600020 ◽

2012 ◽

Vol 45 (6) ◽

pp. 757-760 ◽

Cited By ~ 11

Author(s):

Elizabeth de Souza Neves ◽

André Luis Land Curi ◽

Maira Cavalcanti de Albuquerque ◽

Cassius Schnel Palhano-Silva ◽

Laura Berriel da Silva ◽

...

Keyword(s):

Single Nucleotide Polymorphism ◽

Case Control Study ◽

Severe Disease ◽

Clinical Manifestations ◽

Nucleotide Polymorphism ◽

Gene Encoding ◽

Single Nucleotide ◽

Duration Of Disease ◽

Acute Toxoplasmosis ◽

Control Study

INTRODUCTION: A single nucleotide polymorphism (SNP) in the gene encoding gamma interferon influences its production and is associated with severity of infectious diseases. This study aimed to evaluate the association of IFNγ+874T/A SNP with duration of disease, morbidity, and development of retinochoroiditis in acute toxoplasmosis. METHODS: A case-control study was conducted among 30 patients and 90 controls. RESULTS: Although statistical associations were not confirmed, A-allele was more common among retinochoroiditis cases and prolonged illness, while T-allele was more frequent in severe disease. CONCLUSIONS: Despite few cases, the results could indicate a relation between IFNγ+874T/A single nucleotide polymorphism and clinical manifestations of toxoplasmosis.

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Upbeat vertical nystagmus after brain stem cavernoma resection: a rare case of nucleus intercalatus/nucleus of roller injury

Journal of Neurology ◽

10.1007/s00415-020-09891-4 ◽

2020 ◽

Vol 267 (10) ◽

pp. 2865-2870

Author(s):

Torstein R. Meling ◽

Aria Nouri ◽

Adrien May ◽

Nils Guinand ◽

Maria Isabel Vargas ◽

...

Keyword(s):

Rare Case ◽

Vascular Malformations ◽

Clinical Manifestations ◽

Neurological Injury ◽

Medial Longitudinal Fasciculus ◽

Blurred Vision ◽

Complete Excision ◽

First Case ◽

Vertical Nystagmus ◽

Upbeat Nystagmus

Abstract Introduction CNS cavernomas are a type of raspberry-shaped vascular malformations that are typically asymptomatic, but can result in haemorrhage, neurological injury, and seizures. Here, we present a rare case of a brainstem cavernoma that was surgically resected whereafter an upbeat nystagmus presented postoperatively. Case report A 42-year old man presented with sudden-onset nausea, vomiting, vertigo, blurred vision, marked imbalance and difficulty swallowing. Neurological evaluation showed bilateral ataxia, generalized hyperreflexia with left-sided predominance, predominantly horizontal gaze evoked nystagmus on right and left gaze, slight left labial asymmetry, uvula deviation to the right, and tongue deviation to the left. MRI demonstrated a 13-mm cavernoma with haemorrhage and oedema in the medulla oblongata. Surgery was performed via a minimal-invasive, midline approach. Complete excision was confirmed on postoperative MRI. The patient recovered well and became almost neurologically intact. However, he complained of mainly vertical oscillopsia. The videonystagmography revealed a new-onset spontaneous upbeat nystagmus in all gaze directions, not suppressed by fixation. An injury of the rarely described intercalatus nucleus/nucleus of Roller is thought to be the cause. Conclusion Upbeat nystagmus can be related to several lesions of the brainstem, including the medial longitudinal fasciculus, the pons, and the dorsal medulla. To our knowledge, this is the first case of an iatrogenic lesion of the nucleus intercalatus/nucleus of Roller resulting in an upbeat vertical nystagmus. For neurologists, it is important to be aware of the function of this nucleus for assessment of clinical manifestations due to lesions within this region.

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Facial cleft? The first case of manitoba‐oculo‐tricho‐anal syndrome with novel mutations in China: a case report

BMC Pediatrics ◽

10.1186/s12887-021-02506-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shuchen Gu ◽

Yimin Khoong ◽

Xin Huang ◽

Tao Zan

Keyword(s):

Exome Sequencing ◽

Whole Exome Sequencing ◽

Clinical Manifestations ◽

Sporadic Case ◽

Facial Cleft ◽

Ocular Manifestations ◽

First Case ◽

Whole Exome ◽

Chinese Girl ◽

Low Prevalence

Abstract Background Manitoba-oculo-tricho-anal (MOTA) syndrome is a rare syndrome with only 27 cases reported worldwide so far, but none was reported in the population of Eastern Asia. Such extremely low prevalence might be contributed by misdiagnosis due to its similarities in ocular manifestations with facial cleft. In our study, we discovered the first case of MOTA syndrome in the population of China, with 2 novel FRAS1 related extracellular matrix 1 (FREM1) gene stop-gain mutations confirmed by whole exome sequencing. Case presentation A 12-year-old Chinese girl presented with facial cleft-like deformities including aberrant hairline, blepharon-coloboma and broad bifid nose since birth. Whole exome sequencing resulted in the identification of 2 novel stop-gain mutations in the FREM1 gene. Diagnosis of MOTA syndrome was then established. Conclusions We discovered the first sporadic case of MOTA syndrome according to clinical manifestations and genetic etiology in the Chinese population. We have identified 2 novel stop-gain mutations in FREM1 gene which further expands the spectrum of mutational seen in the MOTA syndrome. Further research should be conducted for better understanding of its mechanism, establishment of an accurate diagnosis, and eventually the exploitation of a more effective and comprehensive therapeutic intervention for MOTA syndrome.

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369. Clinical Characteristics of the First 177 Patients Admitted with COVID-19 at a Bronx Community Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.564 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S254-S254

Author(s):

Victoria Bengualid ◽

Maria Martinez ◽

Zhenisa Hysenaj ◽

Debra M Willner ◽

Judith Berger

Keyword(s):

Oxygen Saturation ◽

Clinical Characteristics ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Altered Mental Status ◽

Channel Blockers ◽

First Case ◽

Overall Mortality

Abstract Background The first case of COVID-19 was admitted on March 15th 2020 to our community based hospital in the Bronx, NY. The aim of this study is to describe the clinical characteristics and outcome of these first COVID-19 patients. Patient Characteristics and Outcome Methods IRB approved retrospective chart review study of all COVID-19 patients admitted during March 2020 focusing on patient characteristics, co-morbidities, clinical manifestations and outcome. Results A total of 177 patients were admitted during March 2020: 57% African American 23.1% Hispanic and 16.9% White. 44.9% female, average age 60 years, and 90% had at least one comorbidity. Outcome was available on all patients except for one who was transferred to another institution for ECMO. Overall mortality was 33%. Clinical presentation: 69.4% presented with cough or shortness of breath, 15.8% with diarrhea, nausea, vomiting or abdominal pain, and 14.6% with myalgia, dizziness or altered mental status. 6.2% presented only with fever. However 59.8% of patients presented with fever and respiratory or gastrointestinal symptoms. Mortality The table compares patients who died vs discharged (either home or to a short term facility). Those that were 65 years or older, hypertensive or presented to the ER with an oxygen saturation of 94% or lower, were more likely to die. Ventilated patients: 31.6% of patients were intubated with a mortality rate of 77%. 22% of these patients were intubated in the first 24 hours. Compared to non-intubated patients, there was no difference in BMI, diabetes, hypertension, COPD/Asthma, use of statins, aspirin or calcium channel blockers. Intubated patients older than 64 years had significantly higher mortality rates (p=0.0001). Conclusion This cohort of COVID-19 patients is unique as almost all received Hydroxychloroquine and Azithromycin. Only 9% received steroids and even fewer received an interleukin-6 inhibitor, convalescent plasma or Remdesivir. African Americans and Hispanics accounted for 80% of patients. Greater than 90% received Medicaid. Overall mortality was 33%. The most common presentation was respiratory followed by gastrointestinal symptoms. The overall mortality was 33% but increased to 77% in intubated patients. Age, hypertension, and ER oxygen saturation correlated with mortality. Disclosures All Authors: No reported disclosures

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Stereotactic Radiotherapy in the Treatment of Paraneoplastic Vasculitis in Oligometastatic Renal Cell Carcinoma

Current Oncology ◽

10.3390/curroncol28030162 ◽

2021 ◽

Vol 28 (3) ◽

pp. 1744-1750

Author(s):

Laura Burgess ◽

Marissa Keenan ◽

Alan Liang Zhou ◽

Kiefer Lypka ◽

Delvina Hasimja Saraqini ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Stereotactic Radiotherapy ◽

Renal Cell ◽

Systemic Vasculitis ◽

Primary Lesion ◽

Paraneoplastic Syndromes ◽

Healthy Male ◽

Palpable Purpura ◽

First Case

Approximately 20% of renal cell carcinoma (RCC) is diagnosed because of paraneoplastic manifestations. RCC has been associated with a large variety of paraneoplastic syndromes (PNS), but it is rarely associated with PNS vasculitis. We present a case of a previously healthy male who presented with systemic vasculitis; bitemporal headaches, diplopia, polyarthritis, palpable purpura, tongue lesion, peri-orbital edema, scleritis, chondritis and constitutional symptoms. He was subsequently found to have oligometastatic RCC. Both his primary lesion and site of oligometastasis were treated with stereotactic radiotherapy (SBRT) and resulted in the resolution of his vasculitis, as well as sustained oncologic response. This is the first case to demonstrate that effective sustained treatment for PNS vasculitis due to oligometastatic RCC is possible with SBRT.

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