An Intriguing Case of Multisystem Inflammatory Syndrome in an Adult Patient with Remote Infection with COVID-19 and Acute Chlamydia

Introduction. COVID-19 is associated with a broad range of immune inflammatory phenomena, with different manifestations in adults and children. We describe a case of COVID-19-related multisystem inflammatory syndrome in an adult (MIS-A), similar to that described in children (MIS-C), which may have been set off by an unrelated secondary infection. Case. A 27-year-old male patient presented with acute epididymitis secondary to acute Chlamydia infection that progressed to multisystem inflammatory failure with respiratory failure requiring endotracheal intubation and mechanical ventilation, cardiogenic shock with heart failure, and gastrointestinal and renal dysfunction. He tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase-polymerase chain reaction on a nasopharyngeal swab thrice within 4 days of presentation, but positive for SARS-CoV-2 immunoglobulin G antibody signifying remote infection. The patient was treated with tocilizumab and steroids, along with doxycycline for concurrent Chlamydia infection, resulting in dramatic improvement in all organ function. We suspect that C. trachomatis infection in this instance may have triggered an aberrant immune response that was shaped by prior exposure to SARS-CoV-2. Conclusion. We present a case of an adult patient with acute Chlamydia trachomatis infection occurring in the wake of asymptomatic (or at least unrecognized) COVID-19 resulting in MIS-A. Clinicians should be alert to the possibility of other such unusual reactions occurring in the aftermath of COVID-19. This case also highlights the importance for clinicians who care for adult patients of being familiar with the multisystem inflammatory syndrome of children, as an identical syndrome may occur in adult patients.

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The impact of Chlamydia trachomatis infection on sperm parameters and male fertility: A comprehensive study

International Journal of STD & AIDS ◽

10.1177/0956462417735245 ◽

2017 ◽

Vol 29 (5) ◽

pp. 466-473 ◽

Cited By ~ 17

Author(s):

M Moazenchi ◽

M Totonchi ◽

R Salman Yazdi ◽

K Hratian ◽

MA Mohseni Meybodi ◽

...

Keyword(s):

Chlamydia Trachomatis ◽

Elisa Test ◽

Sperm Parameters ◽

Chlamydia Infection ◽

Sperm Chromatin ◽

Chlamydia Trachomatis Infection ◽

Sperm Dna Damage ◽

Fragmentation Index ◽

Acute Epididymitis ◽

The Impact

Chlamydia trachomatis (CT), an obligate intracellular bacterium, requires living cells to replicate. Half of men infected with CT are asymptomatic. CT infection can persist for up to four years within couples and affect their fertility. Chlamydia infection in men acts as a reservoir for transmission to women and can cause urinary tract inflammation, sperm DNA damage, and acute epididymitis. Semen samples from 1080 subfertile patients with normal and abnormal spermograms were examined to detect the presence of CT. An ELISA test was used to detect the presence of anti-CT IgA in these patients’ seminal plasma. CT infection was also confirmed by molecular investigation using specific primers. In order to evaluate the effect of CT infections on the DNA Fragmentation Index (DFI), 40 CT-infected cases and 20 CT-negative controls were analyzed by a Sperm Chromatin Structure Assay using flow cytometry. Among 1080 patients with poor sperm parameters, 155 (14.3%) patients were diagnosed with CT, 11% among those with semen abnormalities and 26% among those without semen abnormalities patients. The DFI was statistically higher in cases than in controls (p < 0.05). Given the prevalence of infection and also the high frequency of asymptomatic CT infection among infertile individuals with poor sperm parameters, screening for infection in these patients is essential in order to avoid adverse sequelae. We propose that the higher rate of DFI in CT-infected infertile men might be an underlying cause of their infertility and this warrants greater attention.

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MiR-378b Modulates Chlamydia-Induced Upper Genital Tract Pathology

Pathogens ◽

10.3390/pathogens10050566 ◽

2021 ◽

Vol 10 (5) ◽

pp. 566

Author(s):

Stephanie R. Lundy ◽

Kobe Abney ◽

Debra Ellerson ◽

Joseph U. Igietseme ◽

Darin Carroll ◽

...

Keyword(s):

Host Responses ◽

Chlamydia Infection ◽

Chlamydia Trachomatis Infection ◽

Host Immune Responses ◽

Tubal Factor Infertility ◽

Evolutionarily Conserved ◽

Duration Of Infection ◽

Tubal Factor ◽

Pathologic Lesions ◽

Mammalian Gene Expression

Genital Chlamydia trachomatis infection causes severe reproductive pathologies such as salpingitis and pelvic inflammatory disease that can lead to tubal factor infertility. MicroRNAs (miRNAs) are evolutionarily conserved regulators of mammalian gene expression in development, immunity and pathophysiologic processes during inflammation and infection, including Chlamydia infection. Among the miRNAs involved in regulating host responses and pathologic outcome of Chlamydia infection, we have shown that miR-378b was significantly differentially expressed during primary infection and reinfection. In this study, we tested the hypothesis that miR-378b is involved in the pathological outcome of Chlamydia infection. We developed miR-378b knockout mice (miR-378b−/−) using Crispr/Cas and infected them along with their wild-type (WT) control with Chlamydia to compare the infectivity and reproductive pathologies. The results showed that miR-378b−/− mice were unable to clear the infection compared to WT mice; also, miR-378b−/− mice exhibited a relatively higher Chlamydia burden throughout the duration of infection. However, gross pathology results showed that miR-378b−/− mice had significantly reduced uterine dilatations and pathologic lesions after two infections compared to WT mice. In addition, the pregnancy and fertility rates for infected miR-378b−/− mice showed protection from Chlamydia-induced infertility with fertility rate that was comparable to uninfected WT mice. These results are intriguing as they suggest that miR-378b is important in regulating host immune responses that control Chlamydial replication and drive the inflammation that causes complications such as infertility. The finding has important implications for biomarkers of Chlamydial complications and targets for prevention of disease.

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Adult post COVID-19 multisystem inflammatory syndrome and thrombotic microangiopathy

10.21203/rs.3.rs-76310/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Idris Boudhabhay ◽

Marion Rabant ◽

Louis-Marie Coupry ◽

Armance Marchal ◽

Lubka T Roumenina ◽

...

Keyword(s):

Renal Function ◽

Thrombotic Microangiopathy ◽

Dramatic Improvement ◽

Case Presentation ◽

Complement Inhibition ◽

Clinical Series ◽

Long Term Consequences ◽

Inflammatory Syndrome

Abstract Background: The coronavirus disease 2019 pandemic has affected millions of people worldwide but medium and long-term consequences are unknown. Clinical series of Kawasaki-like multisystem inflammatory syndrome in children (MIS-C), occurring after SARS-Cov-2 spreading, have been recently described. Case presentation: We describe a case of post COVID-19 MIS in a 46-year-old man, with biopsy-proven renal thrombotic microangiopathy (TMA). Specific complement inhibition with Eculizumab was initiated promptly and lead to a dramatic improvement of renal function. Conclusion: Our case suggests that post COVID-19 MIS is not restricted to children and that TMA could play a central role in the pathophysiology of this syndrome

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The Gynecologic Health Consequences of Chlamydia trachomatis Infection in Military Servicewomen

Seminars in Reproductive Medicine ◽

10.1055/s-0039-1678752 ◽

2018 ◽

Vol 36 (06) ◽

pp. 340-350 ◽

Cited By ~ 1

Author(s):

Christine Nadeau ◽

Dennis Fujii ◽

Jessica Lentscher ◽

Amanda Haney ◽

Richard Burney

Keyword(s):

Chlamydia Trachomatis ◽

The United States ◽

Chlamydia Infection ◽

Tubal Infertility ◽

Military Health ◽

Vitro Fertilization ◽

Chlamydia Trachomatis Infection ◽

Sexually Transmitted ◽

The Military

Abstract Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the United States. Within the U.S. military, the age- and race-adjusted chlamydia infection rates among female service members are consistently higher than civilian rates, with a 20% annual acquisition rate among young active-duty women. The sequelae of chlamydia disproportionately impact women in terms of severity and cost. Untreated chlamydia progresses to pelvic inflammatory disease in 40% of cases, and is a leading cause of fallopian tube damage and pelvic adhesive disease resulting in ectopic pregnancy, tubal infertility, and acute and chronic pelvic pain. Tubal infertility is among the leading indications for in vitro fertilization (IVF) nationally and rates among couples undergoing IVF at military treatment centers are double the national average. Collectively, chlamydia infection represents a significant resource burden to the military health care system and, in view of the serious gynecologic health sequelae, a significant threat to the readiness of servicewomen. In this review, we discuss the gynecologic impact of chlamydia infection within the military, the critical gaps for research funding, and opportunities for intervention.

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The Challenges of Developing a Pediatric Ventricular Assist Device From a Fluid Dynamics Perspective

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19549 ◽

2010 ◽

Author(s):

Breigh N. Roszelle ◽

Benjamin T. Cooper ◽

Ning Yang ◽

Steven Deutsch ◽

Keefe B. Manning

Keyword(s):

Fluid Dynamics ◽

Adult Patient ◽

Medical Device ◽

Ventricular Assist Device ◽

Pediatric Patients ◽

Large Range ◽

Adult Patients ◽

Adult Ileocolic Intussusception from the Appendix

Case Reports in Emergency Medicine ◽

10.1155/2019/3272618 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Natalie Green ◽

William Krantz ◽

Allison Tadros

Keyword(s):

Abdominal Pain ◽

Adult Patient ◽

Pediatric Patient ◽

Adult Patients ◽

Lead Point ◽

Ileocolic Intussusception ◽

Ileocecal Intussusception

Intussusception is more commonly considered in the pediatric patient with abdominal pain, but can occur in adults as well. Adult patients are more likely to have an underlying intra-abdominal pathology leading to the condition. We present an adult patient presenting with abdominal pain with ileocecal intussusception diagnosed on imaging and confirmed surgically. In this case, appendiceal pathology served as the lead point for the intussusception.

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Case Report: Adult Post-COVID-19 Multisystem Inflammatory Syndrome and Thrombotic Microangiopathy

Frontiers in Immunology ◽

10.3389/fimmu.2021.680567 ◽

2021 ◽

Vol 12 ◽

Author(s):

Idris Boudhabhay ◽

Marion Rabant ◽

Lubka T. Roumenina ◽

Louis-Marie Coupry ◽

Victoria Poillerat ◽

...

Keyword(s):

Renal Function ◽

Case Report ◽

Thrombotic Microangiopathy ◽

Therapeutic Option ◽

Dramatic Improvement ◽

Case Presentation ◽

Complement Inhibition ◽

Clinical Series ◽

Inflammatory Syndrome

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. A clinical series of Kawasaki-like multisystem inflammatory syndrome (MIS), occurring after SARS-CoV-2 infection, have been described in children (MIS-C) and adults (MIS-A), but the pathophysiology remains unknown.Case PresentationWe describe a case of post-COVID-19 MIS-A in a 46-year-old man with biopsy-proven renal thrombotic microangiopathy (TMA). Specific complement inhibition with eculizumab was initiated promptly and led to a dramatic improvement of renal function.ConclusionOur case suggests that that TMA could play a central role in the pathophysiology of post-COVID-19 MIS-A, making complement blockers an interesting therapeutic option.

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The classical case of the treatment of an adult patient with the salt-losing form of congenital adrenal cortical dysfunction

Problems of Endocrinology ◽

10.14341/probl201157425-27 ◽

2011 ◽

Vol 57 (4) ◽

pp. 25-27

Author(s):

A I Sazonova ◽

N V Molashenko ◽

I S Iarovaia ◽

N Iu Kalinchenko ◽

E A Troshina

Keyword(s):

Case Report ◽

Adult Patient ◽

Clinical Course ◽

Classical Case ◽

Adult Patients ◽

Dynamic Observation ◽

Cortical Dysfunction ◽

Disease Analysis

This case report illustrates peculiarities of the clinical course of congenital adrenal cortical dysfunction in adult patients presenting with the salt-losing form of the disease. Analysis of this case confirmed the necessity of dynamic observation of adults with this pathology in order to avoid complications that are likely to develop in case of inadequate treatment.

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The Prevalence of Chlamydia Trachomatis Infection Among Gynecological Outpatients Attendees at Central Basra Hospitals Using One-Step Chlamydia Test

10.52916/jogs204003 ◽

2020 ◽

pp. 1-6

Author(s):

Ali Falih Al-Assadi

Keyword(s):

Chlamydia Trachomatis ◽

Prevalence Rate ◽

Significant Risk ◽

Rapid Test ◽

Chlamydia Infection ◽

P Value ◽

High Parity ◽

Chlamydia Trachomatis Infection ◽

One Step ◽

Child Hospital

Objective: The objective of this study is to estimate the prevalence rate of chlamydia infection among gynecological outpatients attendees at central Basra hospitals and assessing the predisposing factors and clinical features. Methods: This is a cross-sectional study that was conducted at central Basra hospitals during the period from 15 February 2018 to 10 May 2019. The distribution of cases according to the hospitals was 290 patients from Basra maternity and child hospital, 85 patients from Basra general hospital, 75 patients from AL Mawani hospital and 50 patients from AL Fayhaa hospital, this variation in the number depend on outpatient clinics attendees. participants were assessed according to a predesigned questionnaire and screening test for Chlamydia Trachomatis was done for all patients under study by using one-step chlamydia test (Chlamydia Rapid Test Device). Results: Among 500 patients 60% of them were from the age group 20-40 year, 62% were P2-4 and 89% from multipara and grand multipara, 60% were illiterate and 38% were having primary and secondary school, 61% from low socioeconomic class, nonusers of contraception were 23.7% and about 90% of patients were living at the central areas of Basra. Several factors have a statistically significant effect on the Chlamydia Trachomatis infection like being infertile p-value 0.000 or having high parity p-value 0.013 or non-barrier contraceptives users p-value 0.035. While other factors have no statistically significant effect like age p-value 0.506, socioeconomic state p-value 0.779, and level of education p-value 0.986. Conclusion: The prevalence rate of Chlamydia infection is low among the population in the central areas of Basra city compare to other countries. Being infertile or of high parity are among the significant risk factors. Barrier contraceptives significantly reduced the risk of infection and can be used to protect against the transmission of infection.

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A multisystem inflammatory syndrome in children associated with COVID-19 in a 11-years-old girl

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh210510078b ◽

2021 ◽

pp. 78-78

Author(s):

Milena Bjelica ◽

Gordana Vilotijevic-Dautovic ◽

Andrea Djuretic ◽

Slobodan Spasojevic

Keyword(s):

Gastrointestinal Symptoms ◽

World Health ◽

Nasopharyngeal Swab ◽

First Case ◽

Control And Prevention ◽

Inflammatory State ◽

Life Threatening ◽

History Of ◽

Health Organization ◽

Inflammatory Syndrome

Introduction. Multisystem inflammatory syndrome in children (MIS-C) is a post-viral, life-threatening, inflammatory state with multisystem involvement that typically manifests 3-4 weeks after SARS-CoV-2 infection. In this article, we present the first case of MIS-C in the Institute for Child and Youth Health Care of Vojvodina at the beginning of the COVID-19 pandemic. Case outline. A previously 11-years-old healthy girl got sick two days before admission to the hospital with a fever, headache, vomiting, abdominal pain, and fatigue. She was tested positive for COVID-19 by nasopharyngeal swab PCR with positive IgM and IgG antibodies. In the further course the illness presented with prolonged fever, laboratory evidence of inflammation, multiorgan involvement such as respiratory, gastrointestinal, cardiovascular, and dermatologic. Based on Centers for Disease Control and Prevention and World Health Organization criteria the diagnosis of MIS-C was made and IVIG and methylprednisolone were introduced with favorable clinical course. Conclusion. Every prolonged and unusual febrile state, especially if it is accompanied by gastrointestinal symptoms, in a school-age child, should be investigated in the direction of recent COVID-19 infection or exposure. In a case of a positive COVID-19 history or history of exposure, the MIS-C diagnosis should be considered.

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