scholarly journals Cryptococcal Meningitis: A Retrospective Cohort of a Brazilian Reference Hospital in the Post-HAART Era of Universal Access

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Aline Z. de Azambuja ◽  
Gustavo Wissmann Neto ◽  
Guilherme Watte ◽  
Luciana Antoniolli ◽  
Luciano Z. Goldani
Keyword(s):  
Risk Factors ◽  
Intracranial Hypertension ◽  
Amphotericin B ◽  
Opportunistic Infection ◽  
Cryptococcal Meningitis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Care Hospital ◽  
Southern Brazil

Objective.Cryptococcus neoformansis a common opportunistic infection in adults with acquired immunodeficiency syndrome worldwide. However, limited data exist for HIV-infected patients in the post-HAART (highly active antiretroviral therapy) era in Brazil. The aim of this study was to describe the clinical characteristics and outcomes of cryptococcosis in a cohort of patients attending a teaching tertiary care hospital in southern Brazil after the introduction of HAART in Brazil.Patients and Methods. A retrospective study was conducted in tertiary care hospital in southern Brazil. Detailed data on risk factors, clinical manifestations, diagnosis methods, treatment, and prognosis of patients with meningeal cryptococcosis were evaluated from January 2009 to December 2016.Results. Seventy-nine cases of cryptococcal meningitis were identified. Most of the patients presented positive CSF (cerebrospinal fluid) cultures forCryptococcus neoformans(96%). The prevalence of males and females with meningeal cryptococcosis was similar. The age of the patients ranged from 5 to 67 years. The median time of hospitalization was 28 days. The most common underlying disease was HIV (82%), followed by solid transplant (10%). Fever, nausea, vomiting, headache, and altered mental status were the most common clinical manifestations. Initial opening intracranial pressures varied from 30 to 130 cm H2O. CNS imaging abnormalities include hydrocephalus and hypodensities. Widened Virchow–Robin spaces were described in only 2 patients (2.5%). Induction treatment of the majority of the patients consisted of amphotericin B and flucytosine (67%) followed by amphotericin B and fluconazole (19%). Multivariate analysis of Cox regression identified headache at presentation, mechanical ventilation, CSF glucose <20 mg/dL, and CSF cryptococcal antigen ≥1 : 1000 for independent risk factors for death. All-cause 30-day and 60-day mortalities were 19% and 24%, respectively.Conclusions. Meningeal cryptococcosis mostly caused byC. neoformanscontinues to occur predominantly in HIV-infected adults despite HAART being widely distributed in Brazil. Cryptococcosis remains a significant opportunistic infection in solid organ transplant recipients. Despite adequate antifungal treatment and management of intracranial hypertension in a reference tertiary care hospital, mortality was high. Identification of risk factors and additional treatment modalities, especially for intracranial hypertension, are necessary to improve care for patients with cryptococcal meningitis.

scholarly journals Prevalence, susceptibility profile for fluconazole and risk factors for candidemia in a tertiary care hospital in southern Brazil

2005 ◽  
Vol 9 (5) ◽  
pp. 411-418 ◽  
Author(s):  
Valério Rodrigues Aquino ◽  
Luciano W. Lunardi ◽  
Luciano Zubaran Goldani ◽  
Afonso Luis Barth
Keyword(s):  
Risk Factors ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Southern Brazil

scholarly journals Clinical manifestations of nocardiosis: Study of risk factors and outcomes in a tertiary care hospital

2017 ◽  
Vol 9 (04) ◽  
pp. 288-295 ◽  
Author(s):  
Teena Wadhwa ◽  
Usha Baveja ◽  
Navin Kumar ◽  
Deepak Govil ◽  
Sharmila Sengupta
Keyword(s):  
Risk Factors ◽  
Retrospective Analysis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Immunosuppressive Drugs ◽  
Care Hospital ◽  
Immunocompromised Patients ◽  
Radiological Findings ◽  
Clinical Presentations

Abstract PURPOSE: The aim of this study is to evaluate the predisposing risk factors, clinical presentations, laboratory parameters, and treatments taken and outcomes in patients of nocardiosis in the span of 5 years in a tertiary care hospital. MATERIALS AND METHODS: The patients whose specimens showed Nocardia like organism in Gram-staining, Kinyoun staining and characteristic colonies in culture were included in the retrospective analysis study. Retrospective analysis of associated risk factors, clinical presentations, and radiological findings was performed. RESULTS: Of the thirteen patients, 11 (76.9%) had immunosuppressive pathologies including solid organ transplantation, autoimmune disease, use of steroids, and immunosuppressive drugs as important risk factors. Four types of clinical manifestations were observed, pulmonary (46.1%), cutaneous (23.07%), cerebral (15.3%), and bacteremia (15.3%). The most common presentation was pulmonary with steroid therapy as a significant risk factor. Consolidation and pleural effusion were the common radiological findings in these cases. In eight of the nine patients anti-nocrdial drugs were given. Cotrimoxazole as monotherapy was given in four cases (44.44%), cotrimoxazole in combination with meropenem in two cases (22.22%); minocycline and linezolid were given in one case each. The overall mortality was 36.36% and was seen in patients with pulmonary nocardiosis. CONCLUSIONS: The study indicates that Nocardial infections are re-emerging on account of an increase in numbers of immunocompromised patients due to increased organ transplants, autoimmune diseases, malignancies, and use of immunosuppressive drugs and steroids. The diagnosis is often missed/not suspected and delayed because of the clinical resemblance to many other infections. Nocardial infection should be suspected and assessed particularly in immunocompromised patients not responding to treatment/improving clinically.

scholarly journals An Observational Study on Idiopathic Intracranial Hypertension (IIH) in a Tertiary Care Hospital in Bangladesh

2022 ◽  
Vol 8 (1) ◽  
pp. 333-340
Author(s):  
Md. RashidoonNabi Khan
Keyword(s):  
Risk Factors ◽  
Brain Tumor ◽  
Observational Study ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Benign Intracranial Hypertension ◽  
Female Ratio

Background: Among the risk factors of cardiovascular diseases, hypertension is one of the major reason. Intracranial hypertension (IIH) is a pressure buildup around the brain. It can happen unexpectedly, as a result of a severe head injury, stroke, or brain abscess could be occurred. It could also be a chronic, long-term condition, known as IIH. It results in the signs and symptoms of a brain tumor. Which is also known as benign intracranial hypertension. Cerebrospinal fluid, or CSF, is the fluid that surrounds the spinal cord and brain. CSF can accumulate if too much fluid is produced or not enough is reabsorbed. This can induce symptoms similar to a brain tumor. Intracranial Hypertension can be classified into three categories, they are Acute, Chronic and Idiopathic. IIH is recognized when the increased intracranial pressure cannot be explained by any other underlying cause.Aim: The aim of the study was to observe idiopathic intracranial hypertension patients in a select tertiary care hospital of Bangladesh.Methods:This cross-sectional observational study was conducted at the Department of Neurosurgery, Sylhet M. A. G. Osmani Medical College Hospital, Sylhet, Bangladesh. The study duration was from January 2012 to December 2020. A total number of 47 participants had been recruited as study population.Results:Male: female ratio was 1:10.75, and 91% of the total participants were female. 40.43% of the participants were aged between 21-30 years. 46.81% were overweight and 34.04% were obese. Most common symptom was nausea, followed by visual impairment and double vision.Conclusion:The prevalence of Idiopathic Intracranial Hypertension is much higher among the female. Female and high BMI are significant risk factors of IIH. It is more prevalent among young adults, and results on various vision related symptoms.

scholarly journals Frequency, risk factors and materno-foetal outcomes among cases of Placenta previa at a tertiary care hospital: a two year study

2019 ◽  
Vol 8 (6) ◽  
pp. 2240
Author(s):  
Pamulaparthi Bindu Reddy ◽  
Gurram Swetha Reddy
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Tertiary Care Hospital ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Previous History ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Early Date

Background: Placenta previa refers to the presence of placental tissue that extends over the internal cervical os.  Placenta previa is linked to maternal hypovolemia, anaemia, and long hospital stay and with prematurity, low birth weight, low APGAR score in newborn. So it is very important to identify the condition at an early date to warn the condition thereby reducing the maternal and foetal morbidity and mortality. The present study was aimed to estimate the prevalence of PP, its associated predisposing risk factors and maternal morbidity, mortality and the perinatal outcome.Methods: A prospective observational study for two years was conducted at a tertiary care hospital. Pregnant mothers with >28 weeks of age with H/o ante partum haemorrhage were screened for placenta previa, confirmed by ultra sonography and included in the study. Clinical history, obstetric examination was done and followed up till the delivery. Maternal and foetal outcomes were recorded. Data analyzed by using SPSS version 20.Results: 1.4% incidence of PP was noted, mean age of group was 29.17±1.6 years. Age group of 21-30 years, multiparity Gravida 2-4, previous history of caesarean section and less number of ante natal checkups were significant risk factors and LSCS was most common outcome. Prematurity, low birth weight and APGAR <7 score for 1 minute was common foetal outcomes.Conclusions: Our study strongly suggests foetal surveillance programmes in cases of placenta previa. Measures should be made to bring awareness about PP, in urban slums and to increase medical checkups regularly. Making USG mandatory during every ANC and referral of cases of PP to tertiary care centres would definitely reduce the chances of morbidity and mortality.

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