scholarly journals HEMOPHAGOCYTOSIS SECONDARY TO PHARYNGEAL ABSCESS IN AN IMMUNOCOMPETENT PATIENT (case report)

2018 ◽  
Author(s):  
I. D. Khan ◽  
M. Malik ◽  
K. S. Rajmohan ◽  
P. Banerjee ◽  
S. Khan ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Immunocompetent Patient ◽  
Clinical Suspicion ◽  
Inotropic Support ◽  
Ventilator Associated Pneumonia ◽  
Patient Case ◽  
Acinetobacter Baumanii ◽  
Prompt Treatment ◽  
Healthcare Associated ◽  
Pharyngeal Abscess

Background. Hemophagocytosis is a rare, potentially fatal disorder, comprising pancytopenia, liver dysfunction, hepatosplenomegaly, hypertriglyceridemia, and hyperferritinemia presenting as fever, lympha­denopathy and skin rashes. Objective. To attract the clinicians’ attention to a problem of hemophagocytosis in Critical Care management.Methods. Hemophagocytosis secondary to pharyngeal abscess in a 58 year old male is being reported.Results. A 58-year-old immunocompetent patient presenting with hemophagocytosis secondary to pharyngeal abscess, was managed on ventilator and inotropic support, when he developed heathcare-associated urinary tract infection by Escherichia coli and ventilator-associated pneumonia by Acinetobacter baumanii. He developed neutropenic septic shock and multi-organ dysfunction and went through a downhill course leading to demise.Conclusions. Hemophagocytosis remains a sinister entity in modern intensive care despite astute clinical management. Secondary superinfections with opportunistic multidrug resistant pathogens are difficult to treat. A high index of clinical suspicion, aggressive diagnosis and prompt treatment for hemophagocytosis and polymicrobial opportunistic superinfections with multidrug-resistant healthcare-associated pathogens needs to be addressed upfront.

scholarly journals Gambaran Kejadian Pneumonia pada Pasien Pasca Kraniotomi di Ruang Rawat Intensif RSUD Arifin Achmad Provinsi Riau Periode Januari 2015 sampai Desember 2019

2021 ◽  
Vol 14 (2) ◽  
pp. 111
Author(s):  
Andrea Valentino ◽  
Rita Endriani ◽  
Fitria Ameini
Keyword(s):  
Ventilator Associated Pneumonia ◽  
Acinetobacter Baumanii ◽  
Healthcare Associated

Operasi kraniotomi merupakan tindakan membuka sebagian tulang tengkorak hingga dapat memberikan akses langsung menuju otak. Komplikasi yang paling sering terjadi merupakan Ventilator Associated Pneumonia (VAP) dan Healthcare Associated Pneumonia (HAP). Penelitian ini dilakukan untuk melihat gambaran kejadian pneumonia pada pasien pasca kraniotomi di ICU RSUD Arifin Achmad Provinsi Riau periode Januari 2015 s/d Desember 2019. Data penelitian ini didapatkan dari rekam medik pasien pasca kraniotomi di ruang ICU RSUD Arifin Achmad Provinsi Riau, dengan total rekam medik yang ditemukan sebanyak 216 rekam medik. Hasil penelitian ini berupa, didapatkan kejadian pneumonia pada 56 pasien (26%), dengan kejadian HAP 3,7% dan VAP 22,7%. Kejadian HAP lebih banyak terjadi pada pasien perempuan (62,5%) dengan kelompok usia 56-65 tahun (50%), serta lama rawatan >5 hari (75%). Kejadian VAP memiliki distribusi yang sama antara laki-laki dan perempuan (50%) dengan kelompok usia 36-45 tahun (29,2%) dan lama rawatan >5 hari (45,8%), serta lama pemakaian ventilator mekanik <96 jam (66,7%). Kejadian pneumonia paling banyak terjadi pada pasien tanpa komorbid (71,4%) atau memiliki komorbid berupa hipertensi (21,4%) dengan diagnosis meningioma (28,6%), jumlah leukosit >11.000 (76,8%), lama pembedahan ≥2 jam (55,4%), dan patogen penyebab terbanyak berupa Acinetobacter baumanii (30,3%). Angka kematian pada penelitian ini sebesar 7,1%.

scholarly journals Ventilator-Associated Pneumonia is Linked to a Worse Prognosis Than Community-Acquired Pneumonia in Children

2021 ◽  
Author(s):  
Maria Hernandez ◽  
Mònica Girona-Alarcon ◽  
Sara Bobillo-Perez ◽  
Mireia Urrea ◽  
Anna Sole-Ribalta ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Descriptive Study ◽  
Multidrug Resistant ◽  
Community Acquired Pneumonia ◽  
Inotropic Support ◽  
Resistant Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Microbiological Characteristics ◽  
Paediatric Intensive Care Units ◽  
Worse Prognosis

Abstract BackgroundAround 12-20% of patients with community-acquired pneumonia (CAP) require critical care. Ventilator-associated pneumonia (VAP) is the second cause of nosocomial infection in Paediatric Intensive Care Units (PICU). As far as we know, there are no studies comparing both types of pneumonia in children, thus it remains unclear if there are differences between them in terms of severity and outcomes. ObjectiveThe aim was to compare clinical and microbiological characteristics and outcomes of patients with severe CAP and VAP.MethodsA retrospective descriptive study, including patients diagnosed of VAP and CAP, with a positive respiratory culture and under mechanical ventilation, admitted to the PICU from 2015 to 2019.Results238 patients were included; 163 (68.4%) with CAP, and 75 (31.5%) with VAP. Patients with VAP needed longer mechanical ventilation (14 vs. 7 days, p<0.001) and more inotropic support (49.3 vs. 30.7%, p=0.006). Patients with VAP had higher mortality (12 vs. 2.5%, p=0.005).Enterobacteriaceae were more involved with VAP than with CAP (48 vs. 9%, p<0.001). Taking into account only de non-drug sensitive microorganisms, patients with VAP tended to have more multidrug-resistant bacteria (30 vs. 10.8%, p=0.141) than patients with CAP. ConclusionPatients with VAP had worse prognosis than patients with CAP, needing longer mechanical ventilation, more inotropic support and had higher mortality. Patients with VAP were mainly infected by Enterobacteriaceae and had more multidrug resistant microorganisms than patients with CAP.

Surgical Site Infections - A Hospital Havoc: Retrospective Study of Surgical Site Infections in Tertiary Health Care Centre in North East India

2018 ◽  
Vol 3 (01) ◽  
Author(s):  
V Singh ◽  
A B Khyriem, W V Lyngdoh ◽  
C J Lyngdoh
Keyword(s):  
Surgical Site Infection ◽  
Multiple Drug Resistance ◽  
Surgical Site Infections ◽  
Multidrug Resistant ◽  
Multiple Drug ◽  
Site Infection ◽  
Retrospective Case ◽  
Acinetobacter Baumanii ◽  
Health Care Centre ◽  
North East

Objectives - Surgical site infections (SSI) has turn out to be a major problem even in hospital with most modern facilities and standard protocols of pre -operative preparation and antibiotic prophylaxis. Objective of this study is to know the prevalence of surgical site infection among the postoperative patients and to identify the relationship between SSI and etiological pathogens along with their antimicrobial susceptibility at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong. Methods - A retrospective case study conducted at NEIGRIHMS, among patients admitted to the surgical departments during the period between January 1st and December 31st 2016. Swabs from the surgical sites were collected under sterile conditions and standard bacteriological tests were performed for identification and appropriate statistical methods were employed to look for association between SSI and etiological pathogens. Results - Out of the 1284 samples included in the study, 192 samples showed evidence of SSI yielding an infection rate of 14.9%. The most commonly isolated bacteria were: Escherichia coli, Acinetobacter baumanii and Staphylococcus aureus, of the gram negative isolates 6.2% were multidrug resistant of which 19% were carbapenem resistant. Conclusion - SSI with multiple drug resistance strains and polymicrobial etiology reflects therapeutic failure. The outcome of the SSI surveillance in our hospital revealed that in order to decrease the incidence of SSI we would have to: a) incorporate a proper antibiotic stewardship  b) conduct periodic surveillance to keep a check on SSI d) educate medical staffs regarding the prevention of surgical site infection.

A Rare Case of Tuberculous Prostatitis

2016 ◽  
Vol 1 (2) ◽  
pp. 33
Author(s):  
Nurul Yaqeen Mohd Esa ◽  
Mohammad Hanafiah ◽  
Marymol Koshy ◽  
Hilmi Abdullah ◽  
Ahmad Izuanuddin Ismail ◽  
...  
Keyword(s):  
Rare Case ◽  
Correct Diagnosis ◽  
Immunocompetent Patient ◽  
Clinical Suspicion ◽  
Tuberculosis Infection ◽  
Advanced Age ◽  
Immunocompromised Patients ◽  
Prostatic Biopsy ◽  
High Clinical Suspicion

Tuberculous prostatitis is an uncommon form of tuberculosis infection. It is commonly seen in immunocompromised patients and in those of middle or advanced age. The diagnosis is often not straight forward due to the nature of its presentation. We report a case of tuberculous prostatitis in a young, healthy and immunocompetent patient, who initially presented with respiratory features, followed by episodes of seizures and testicular swelling. He was finally diagnosed with tuberculous prostatitis after prostatic biopsy. This case illustrates that in a high TB prevalence environment, when symptoms warrant, there should be a high clinical suspicion coupled with a thorough approach in order to arrive at a correct diagnosis of TB prostatitis.

scholarly journals Granulomatous Hepatitis Following Intra-Vesical Instillation of Bacillus Calmette–Guérin for Treatment of Bladder Cancer

2021 ◽  
Vol 13 (3) ◽  
pp. 611-618
Author(s):  
Elsa Alves Branco ◽  
Raquel Duro ◽  
Teresa Brito ◽  
António Sarmento
Keyword(s):  
Bladder Cancer ◽  
Hepatitis A ◽  
Adverse Reactions ◽  
Superficial Bladder Cancer ◽  
Rare Complication ◽  
Immunocompetent Patient ◽  
Clinical Suspicion ◽  
Bacillus Calmette Guerin ◽  
Granulomatous Hepatitis ◽  
Appropriate Treatment

Intra-vesical instillation of bacillus Calmette–Guérin (BCG) is an important treatment modality of superficial bladder cancer. It is usually well tolerated, although some adverse reactions can occur. One possible yet rare complication is granulomatous hepatitis, that is thought to be caused either by BCG infection or a hypersensitivity reaction to the bacillus. We present a case of a 79-year-old apparently immunocompetent patient who developed granulomatous hepatitis a few months after BCG administration for bladder cancer immunotherapy. It is important to notice that acid-fast smears and cultures are often negative, and these should not exclude diagnosis nor delay treatment. Our case highlights the importance of clinical suspicion and prompt initiation of appropriate treatment.

scholarly journals Two Candida auris Cases in Germany with No Recent Contact to Foreign Healthcare—Epidemiological and Microbiological Investigations

2021 ◽  
Vol 7 (5) ◽  
pp. 380
Author(s):  
Joerg Steinmann ◽  
Thomas Schrauzer ◽  
Lisa Kirchhoff ◽  
Jacques F. Meis ◽  
Peter-Michael Rath
Keyword(s):  
South Asian ◽  
Multidrug Resistant ◽  
Health Care Facilities ◽  
Candida Auris ◽  
Contact Precautions ◽  
Asian Clade ◽  
Care Facilities ◽  
Long Time ◽  
European Health ◽  
Healthcare Associated

Candida auris has become a global fungal public health threat. This multidrug-resistant yeast is associated with nosocomial intra- and interhospital transmissions causing healthcare-associated infections. Here, we report on two C. auris cases from Germany. The two patients stayed in Germany for a long time before C. auris was detected during their hospitalization. The patients were isolated in single rooms with contact precautions. No nosocomial transmissions were detected within the hospital. Both C. auris isolates exhibited high minimum inhibitory concentrations (MICs) of fluconazole and one isolate additionally high MICs against the echinocandins. Microsatellite genotyping showed that both strains belong to the South Asian clade. These two cases are examples for appropriate in-hospital care and infection control without further nosocomial spread. Awareness for this emerging, multidrug-resistant pathogen is justified and systematic surveillance in European health care facilities should be performed.

scholarly journals Ventilation-Associated Particulate Matter Is a Potential Reservoir of Multidrug-Resistant Organisms in Health Facilities

Life ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 639
Author(s):  
Evgenia Chezganova ◽  
Olga Efimova ◽  
Vera Sakharova ◽  
Anna Efimova ◽  
Sergey Sozinov ◽  
...  
Keyword(s):  
Particulate Matter ◽  
Prevalence Ratio ◽  
Multidrug Resistant ◽  
Viable Count ◽  
Health Facilities ◽  
Hospital Environment ◽  
Bacterial Strains ◽  
Multidrug Resistant Organisms ◽  
Potential Reservoir ◽  
Healthcare Associated

Most healthcare-associated infections (HCAIs) develop due to the colonisation of patients and healthcare workers by multidrug-resistant organisms (MDRO). Here, we investigated whether the particulate matter from the ventilation systems (Vent-PM) of health facilities can harbour MDRO and other microbes, thereby acting as a potential reservoir of HCAIs. Dust samples collected in the ventilation grilles and adjacent air ducts underwent a detailed analysis of physicochemical properties and biodiversity. All Vent-PM samples included ultrafine PM capable of reaching the alveoli. Strikingly, >70% of Vent-PM samples were contaminated, mostly by viruses (>15%) or multidrug-resistant and biofilm-producing bacterial strains (60% and 48% of all bacteria-contaminated specimens, respectively). Total viable count at 1 m from the ventilation grilles was significantly increased after opening doors and windows, indicating an association between air flow and bacterial contamination. Both chemical and microbial compositions of Vent-PM considerably differed across surgical vs. non-surgical and intensive vs. elective care units and between health facilities located in coal and chemical districts. Reduced diversity among MDRO and increased prevalence ratio in multidrug-resistant to the total Enterococcus spp. in Vent-PM testified to the evolving antibiotic resistance. In conclusion, we suggest Vent-PM as a previously underestimated reservoir of HCAI-causing pathogens in the hospital environment.

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