Acute infectious purpura fulminans: a case series from India

2020 ◽  
Vol 50 (4) ◽  
pp. 330-334
Author(s):  
Sumayya Abdul Kalam ◽  
Ronald AB Carey ◽  
John Antony ◽  
OC Abraham
Keyword(s):  
Clinical Symptoms ◽  
Spotted Fever ◽  
Purpura Fulminans ◽  
Case Series ◽  
Latex Agglutination ◽  
Elevated Alkaline Phosphatase ◽  
The Mean ◽  
Polymerase Chain ◽  
Common Laboratory ◽  
Overall Mortality

Acute infectious purpura fulminans is a serious, potentially fatal condition. We present a case series of 11 patients from March 2005 to March 2017, whose clinical symptoms were fever (100%), confusion (63.6%) and headache (55%), and whose common laboratory abnormalities were thrombocytopenia (100%), elevated alkaline phosphatase (70%) and anaemia (63.6%). Three patients (27%) developed gangrene and two presented in shock. Only one grew Neisseria meningitidis in cerebrospinal fluid (CSF) culture and another confirmed by latex agglutination and polymerase chain reaction in CSF. Five others had serology confirmed spotted fever rickettsioses (SFG). All received broad spectrum antibiotics; in 9/11 patients, this included doxycycline or azithromycin. The mean hospital stay was 10.2 days and overall mortality was 18.2%.

Kingella kingae septic arthritis

2021 ◽  
Vol 103-B (3) ◽  
pp. 584-588
Author(s):  
Mohammed Khattak ◽  
Sujith Vellathussery Chakkalakumbil ◽  
Robert A. Stevenson ◽  
David J. Bryson ◽  
Michael J. Reidy ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Young Patients ◽  
Case Series ◽  
Blood Parameters ◽  
Pcr Analysis ◽  
Kingella Kingae ◽  
Patient Demographics ◽  
The Mean ◽  
Polymerase Chain ◽  
Prospective Case Series

Aims The aim of this study was to determine the extent to which patient demographics, clinical presentation, and blood parameters vary in Kingella kingae septic arthritis when compared with those of other organisms, and whether this difference needs to be considered when assessing children in whom a diagnosis of septic arthritis is suspected. Methods A prospective case series was undertaken at a single UK paediatric institution between October 2012 and November 2018 of all patients referred with suspected septic arthritis. We recorded the clinical, biochemical, and microbiological findings in all patients. Results A total of 160 patients underwent arthrotomy for a presumed septic arthritis. Of these, no organism was identified in 61 and only 25 of these were both culture- and polymerase chain reaction (PCR)-negative. A total of 36 patients did not undergo PCR analysis. Of the remaining 99 culture- and PCR-positive patients, K. kingae was the most commonly isolated organism (42%, n = 42). The knee (n = 21), shoulder (n = 9), and hip (n = 5) were the three most commonly affected joints. A total of 28 cases (66%) of K. kingae infection were detected only on PCR. The mean age of K. kingae-positive cases (16.1 months) was significantly lower than that of those whose septic arthitis was due to other organisms (49.4 months; p < 0.001). The mean CRP was significantly lower in the K. kingae group than in the other organism group (p < 0.001). The mean ESR/CRP ratio was significantly higher in K. kingae (2.84) than in other infections (1.55; p < 0.008). The mean ESR and ESR/CRP were not significantly different from those in the 'no organism identified' group. Conclusion K. kingae was the most commonly isolated organism from paediatric culture- and/or PCR-positive confirmed septic arthritis, with only one third of cases detected on routine cultures. It is important to develop and maintain a clinical suspicion for K. kingae infection in young patients presenting atypically. Routine PCR testing is recommended in these patients. Cite this article: Bone Joint J 2021;103-B(3):584–588.

Soil-borne Septicaemic Colibacillosis in Neonatal Lambs: Salient Observations

2021 ◽  
Author(s):  
S. Jegaveera Pandian ◽  
Jyoti Kumar ◽  
G.G. Sonawane ◽  
G.R. Gowane ◽  
C.P. Swarnkar ◽  
...  
Keyword(s):  
Virulence Genes ◽  
Histopathological Examination ◽  
Chain Reaction ◽  
E Coli ◽  
Escherichia Coli Infection ◽  
The Mean ◽  
Polymerase Chain ◽  
Neonatal Lambs ◽  
Overall Mortality ◽  
Heavy Mortality

Background: In sheep, Escherichia coli infection can occur as asymptomatic entity to septicaemic episode. Chiefly, it causes heavy mortality in lambs and devastates the farm economy. With an objective of documenting the salient epidemiological and clinico-pathological observations in this naturally occurred outbreak of septicaemic colibacillosis, this communication is made herewith. Methods: In February 2019, sudden death in lambs was observed in three flocks of sheep. Carcasses were subjected for necropsy and histopathological examination. Swab samples from heart, abomasum, intestines, liver and lung were examined for bacteriological and molecular confirmation. Result: The mean (±SE) age of lambs that were affected was 11.00 ±0.49 days (n=404). Lambs of native Malpura breed (87.5%) and other two crossbred sheep were affected. Overall mortality of lambs was 23.76%. Gross pathological observations were pulmonary edema, ecchymotic lesions in lungs, congestion in kidney and liver and presence soil-mixed ingesta in abomasum. From the morbid materials including stomach and intestinal swabs, 45 E. coli isolates were identified and they were also confirmed on polymerase chain reaction (PCR). Consequently, virulence genes for shiga toxin (stx2) and intimin (eae) were identified from the isolates. Although antibiotics were administered, only probiotics could control the new infection rate. 

scholarly journals Vitamin D deficiency among patients with COVID-19: case series and recent literature review

2020 ◽  
Vol 48 (1) ◽  
Author(s):  
Rizaldy Taslim Pinzon ◽  
Angela ◽  
Andryawan Wahyu Pradana
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Clinical Symptoms ◽  
Case Series ◽  
Hypovitaminosis D ◽  
Vitamin D Insufficiency ◽  
Vitamin D Status ◽  
Vitamin D Levels ◽  
Laboratory Examinations ◽  
The Mean

Abstract Background The world is now challenging the pandemic of COVID-19 infection. This is the third and most extensive pandemic. Previous studies showed the plausibility of vitamin D prophylaxis and therapy for COVID-19, particularly in settings where hypovitaminosis D is frequent. Recent study from Indonesian showed that the prevalence of vitamin D deficiency was 23.0%. The examination of vitamin D status is not a routine in the Indonesian clinical setting. Methods This study is a case series from confirmed cases of COVID-19 in Bethesda Hospital Yogyakarta Indonesia. The data of clinical symptoms, signs and laboratory examinations were obtained from the electronic medical records. The vitamin D status was measured by Enzyme-Linked Fluorescent Assay (ELFA) method. We searched PubMed and Google Scholar for studies that included terms for Vitamin D and COVID-19. Results The data were obtained from 10 participants consisting of 50% male and 50% female. The mean age was 49.6 years. The prevalence of vitamin D deficiency in this study was 90% (vitamin D levels < 20 ng/mL) and 10% of insufficiency (vitamin D levels < 30 ng/mL). Patients in this study had various symptoms such as fatigue (60%), fever (50%), dry cough (40%), non-specific headache (10%), and diarrhea (10%); have no symptoms (20%); and also had the various chronic diseases as comorbidity such as hypertension (40%), diabetes (10%), COPD (10%), and post stroke (10%). Conclusions All of the COVID-19 patients in this study had hypovitaminosis D. The prevalence of vitamin D deficiency in this case series is 90% and only 1 patient (10%) had vitamin D insufficiency. There are many health benefits of vitamin D and very few adverse effects. Randomized controlled trials need to determine and evaluate this recommendation in preventing or treating COVID-19. Clinicians should continue to treat people with vitamin D deficiency especially in managing COVID-19 patients.

scholarly journals Clinical and radiological outcomes of arthroscopic subcoracoid decompression for idiopathic coracoid impingement, a stepped approach

2021 ◽  
Vol 7 (2) ◽  
pp. 203
Author(s):  
Mohei M. Fadel ◽  
Hesham M. Gawish ◽  
Mohamed A. Elsheikh
Keyword(s):  
Shoulder Pain ◽  
Clinical Symptoms ◽  
Constant Score ◽  
Case Series ◽  
Case Series Study ◽  
Coracoid Impingement ◽  
Patient Reported ◽  
The Mean ◽  
Anterior Shoulder Pain

<p class="abstract"><strong>Background:</strong> Idiopathic subcoracoid impingement is considered now as a well-established cause of anterior shoulder pain. There are multiple techniques reported for management of subcoracoid impingement. Open decompression and reattachment of conjoint tendon as well as arthroscopic resection of coracoid tip. The aim of this study was to evaluate the results of arthroscopic stepwise approach for management of idiopathic coracoid impingment.</p><p class="abstract"><strong>Methods:</strong> This prospective therapeutic case series study included 26 consecutive patients suffering from anterior shoulder pain and were diagnosed as subcoracoid impingement. All cases were evaluated preoperatively and followed up for 12 months after surgery both clinically and radiologically. Arthroscopic subcoracoid decompression, coracoplasty and arthroscopic repair of partial subscapularis tear if present were done for all cases.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age at the time of surgery was 45.3±5.4years. At the final follow up, the mean VAS score improved significantly to 0.8±0.8points postoperatively (p&lt;0.01). The mean Constant score improved significantly to 87.8±7.8 at the final follow-up (p&lt;0.001). The mean UCLA score improved significantly to 32.1±2.4 at the end of follow-up (P&lt;0.001)</p><p class="abstract"><strong>Conclusions:</strong> Coracoid impingement should be in mind when evaluating any patient with anterior shoulder pain. The arthroscopic management in form of bone, bursal and tendon procedures (triple attack) is a good treatment to relieve clinical symptoms with excellent patient reported outcomes.</p><p class="abstract"> </p>

scholarly journals Comparative Characterization and Risk Stratification of Asymptomatic and Presymptomatic Patients With COVID-19

2021 ◽  
Vol 12 ◽  
Author(s):  
Lei Shi ◽  
Rong Ding ◽  
Tingting Zhang ◽  
Wei Wu ◽  
Ziyu Wang ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Operating Characteristic ◽  
Clinical Symptoms ◽  
Characteristic Curve ◽  
Case Series ◽  
Asymptomatic Patients ◽  
Risk Stratification Model ◽  
Significant Difference ◽  
The Mean ◽  
Cell Data

The identification of asymptomatic, non-severe presymptomatic, and severe presymptomatic coronavirus disease 2019 (COVID-19) in patients may help optimize risk-stratified clinical management and improve prognosis. This single-center case series from Wuhan Huoshenshan Hospital, China, included 2,980 patients with COVID-19 who were hospitalized between February 4, 2020 and April 10, 2020. Patients were diagnosed as asymptomatic (n = 39), presymptomatic (n = 34), and symptomatic (n = 2,907) upon admission. This study provided an overview of asymptomatic, presymptomatic, and symptomatic COVID-19 patients, including detection, demographics, clinical characteristics, and outcomes. Upon admission, there was no significant difference in clinical symptoms and CT image between asymptomatic and presymptomatic patients for diagnosis reference. The mean area under the receiver operating characteristic curve (AUC) of the differential diagnosis model to discriminate presymptomatic patients from asymptomatic patients was 0.89 (95% CI, 0.81-0.98). Importantly, the severe and non-severe presymptomatic patients can be further stratified (AUC = 0.82). In conclusion, the two-step risk-stratification model based on 10 laboratory indicators can distinguish among asymptomatic, severe presymptomatic, and non-severe presymptomatic COVID-19 patients on admission. Moreover, single-cell data analyses revealed that the CD8+T cell exhaustion correlated to the progression of COVID-19.

scholarly journals Clinical Characteristics, Treatment Patterns, and Outcomes of Primary Canaliculitis among Patients in Beijing, China

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Qin Zhang ◽  
Beibei Xu ◽  
Xiao-Xin Li ◽  
Ming-Wu Li
Keyword(s):  
Clinical Characteristics ◽  
Conservative Therapy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Treatment Patterns ◽  
Retrospective Case ◽  
The Mean ◽  
Beijing China ◽  
Symptoms And Signs

Background. Canaliculitis may cause punctal or canalicular swelling, discharge, erythema, and sometimes concretions. This study examined the clinical characteristics, treatment patterns, and outcomes of primary canaliculitis from patients at a top-rated hospital in Beijing, China.Methods. Medical records of 16 patients (retrospective case series) were studied.Results. This study included four males and twelve females with a median age of 72.5 years. The mean and the median follow-up time were 10.4 months and 6 months, respectively. The mostly observed clinical symptoms were epiphora with discharge (94%), while the mostly observed signs included pouting punctum (75%) and punctal regurgitation of concretions under syringing (75%). Only the symptoms of one patient among those with conservative therapy completely resolved within two-year follow-up. Curettage therapy was found to partly resolve the clinical symptoms and signs within the follow-up of four weeks. Fifteen patients finally received curettage with punctoplasty, and symptoms completely resolved in fourteen patients after one surgery.Conclusions. Syringing with pressing of lacrimal sac area may help better diagnosis of canaliculitis. Additionally, curettage with punctoplasty is recommended for thorough removal of concretions and complete resolution of canaliculitis.

scholarly journals Effectiveness of convalescent plasma therapy in eight non-intubated coronavirus disease 2019 patients in Indonesia: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Theresia Monica Rahardjo ◽  
Elizabeth Yogipranata ◽  
Ardian Hediyanto Naswan ◽  
Fitri Rahayu Sari ◽  
Fajar Budiono ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Clinical Symptoms ◽  
Case Series ◽  
Definitive Treatment ◽  
Chain Reaction ◽  
Plasma Therapy ◽  
Patients Âgés ◽  
Illness Onset ◽  
First Case ◽  
Polymerase Chain

Abstract Background Severe acute respiratory syndrome coronavirus 2, the cause of coronavirus disease 2019, has become a global pandemic. Currently, there is no definitive treatment for coronavirus disease 2019. Convalescent plasma therapy has become a potential specific curative method, while vaccines as protection modalities require further work. Case presentation Eight non-intubated Indonesian patients, ages ranging from 40 to 74 years old, with coronavirus disease 2019 confirmed by viral Ribonucleid Acid (RNA) real-time polymerase chain reaction tests were included. Four patients were administered two doses of 200 mL convalescent plasma, and the other four patients were administered one dose of convalescent plasma with an antibody titer of 1:320, within the first 14 days since symptoms occurred. The median times from illness onset to convalescent plasma therapy and from the first day of hospital admission to convalescent plasma therapy were 13 and 6.5 days, respectively. All patients showed improvements in clinical symptoms, laboratory parameters, thorax imaging, negative conversion of polymerase chain reaction results, and decreased oxygen supplementation within 1 week after convalescent plasma therapy. Patients with two convalescent plasma doses tended to have faster recovery than those with one convalescent plasma dose. No severe adverse effects were observed in any patient. Conclusion This is the first case series in Indonesia showing that convalescent plasma therapy is safe and well tolerated and that early convalescent plasma therapy before the patient is intubated could potentially prevent disease progression, increase the recovery rate, and shorten the inpatient time of stay.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Scrub typhus (Orientia tsutsugamushi), A rapidly spreading epidemic in Chennai - A standalone lab experience

2016 ◽  
Vol 5 (09) ◽  
pp. 4896
Author(s):  
Sripriya C.S.* ◽  
Shanthi B. ◽  
Arockia Doss S. ◽  
Antonie Raj I. ◽  
Mohana Priya
Keyword(s):  
Scrub Typhus ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Febrile Illness ◽  
Orientia Tsutsugamushi ◽  
The Past ◽  
Igm Elisa ◽  
The Mean ◽  
Specific Symptoms ◽  
Symptoms And Signs

Scrub typhus (Orientia tsutsugamushi), is a strict intracellular bacterium which is reported to be a recent threat to parts of southern India. There is re-emergence of scrub typhus during the past few years in Chennai. Scrub typhus is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure to fatal disease. This study documents our laboratory experience in diagnosis of scrub typhus in patients with fever and suspected clinical symptoms of scrub typhus infection for a period of two years from April 2014 to April 2016 using immunochromatography and IgM ELISA methods. The study was conducted on 648 patients out of whom 188 patients were found to be positive for scrub typhus. Results also showed that pediatric (0 -12 years) and young adults (20 – 39 years) were more exposed to scrub typhus infection and female patients were more infected compared to male. The study also showed that the rate of infection was higher between September to February which also suggested that the infection rate is proportional to the climatic condition. Statistical analysis showed that the mean age of the patients in this study was 37.6, standard deviation was 18.97, CV % was 50.45. 

scholarly journals 63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Lau ◽  
Z Arshad ◽  
A Aslam ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Economic Impact ◽  
Treatment Protocol ◽  
Case Series ◽  
Consecutive Series ◽  
Financial Loss ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
The Mean ◽  
Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

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