A “Terrible” Headache in a HIV Patient

Mucormycosis is a type of fungal infection more prevalent among immunosuppressed patients, requires prompt identification and surgical treatment, as it can is associated with local and distant spread. This case is aiming to highlight the importance of early identification of subtle symptoms in immunocompromised patients. The clinician should be aware of fungal sinusitis, consider it in the differential diagnosis, and seek for an ear, nose, and throat opinion.

Download Full-text

Toxoplasma Appendicitis: A Once-in-a-Lifetime Diagnosis!

International Journal of Surgical Pathology ◽

10.1177/1066896917724888 ◽

2017 ◽

Vol 26 (1) ◽

pp. 89-92 ◽

Cited By ~ 1

Author(s):

Anisha M. Fernandes ◽

Maheshkumar M. Lakhe ◽

Sanjay A. Pai

Keyword(s):

Differential Diagnosis ◽

Acute Appendicitis ◽

Muscularis Propria ◽

Immunocompromised Patients ◽

Lymphoid Follicles ◽

Negative Results ◽

Immunosuppressed Patients ◽

Life Threatening

Toxoplasmosis is generally asymptomatic in immunocompetent individuals, but it can be life-threatening in immunocompromised patients. We present a case of a 62-year-old man with clinical features of acute appendicitis. Histology showed a transmural infiltrate of eosinophils. In addition, there were reactive lymphoid follicles with histiocytes in the submucosa and tachyzoites in the muscularis propria. Immunohistochemistry confirmed the diagnosis of toxoplasma appendicitis. Serological evaluation yielded negative results. Retrospective review of the history revealed that the patient was on long-term immunosuppressive therapy with methotrexate. The patient was treated with sulfamethoxazole-trimethoprim and is asymptomatic at 7-month follow-up. Toxoplasma appendicitis must be considered in the differential diagnosis of appendicitis in immunosuppressed patients.

Download Full-text

Hemoptysis in the Immunocompromised Patient: Do Not Forget Strongyloidiasis

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed4010035 ◽

2019 ◽

Vol 4 (1) ◽

pp. 35 ◽

Cited By ~ 1

Author(s):

Prakash Shrestha ◽

Sean E. O’Neil ◽

Barbara S. Taylor ◽

Olaoluwa Bode-Omoleye ◽

Gregory M. Anstead

Keyword(s):

Developing Countries ◽

Differential Diagnosis ◽

Immunocompromised Patient ◽

Strongyloides Stercoralis ◽

Immunocompromised Patients ◽

Secondary Infections ◽

Immunosuppressed Patients ◽

Disseminated Strongyloidiasis ◽

The Tropics ◽

Candida Pneumonia

Strongyloidiasis, due to infection with the nematode Strongyloides stercoralis, affects millions of people in the tropics and subtropics. Strongyloides has a unique auto-infective lifecycle such that it can persist in the human host for decades. In immunosuppressed patients, especially those on corticosteroids, potentially fatal disseminated strongyloidiasis can occur, often with concurrent secondary infections. Herein, we present two immunocompromised patients with severe strongyloidiasis who presented with pneumonia, hemoptysis, and sepsis. Both patients were immigrants from developing countries and had received prolonged courses of corticosteroids prior to admission. Patient 1 also presented with a diffuse abdominal rash; a skin biopsy showed multiple intradermal Strongyloides larvae. Patient 1 had concurrent pneumonic nocardiosis and bacteremia with Klebsiella pneumoniae and Enterococcus faecalis. Patient 2 had concurrent Aspergillus and Candida pneumonia and developed an Aerococcus meningitis. Both patients had negative serologic tests for Strongyloides; patient 2 manifested intermittent eosinophilia. In both patients, the diagnosis was afforded by bronchoscopy with lavage. The patients were successfully treated with broad-spectrum antibiotics and ivermectin. Patient 1 also received albendazole. Strongyloidiasis should be considered in the differential diagnosis of hemoptysis in immunocompromised patients with possible prior exposure to S. stercoralis.

Download Full-text

A Fatal Case of Disseminated Intestinal Mucormycosis in a Patient with Vibrio Sepsis

JOURNAL OF ACUTE CARE SURGERY ◽

10.17479/jacs.2021.11.3.133 ◽

2021 ◽

Vol 11 (3) ◽

pp. 133-136

Author(s):

Seungwoo Chung ◽

Hyun-Jung Sung ◽

Jong Won Chang ◽

Ile Hur ◽

Ho Cheol Kim

Keyword(s):

Differential Diagnosis ◽

Intensive Care ◽

Fungal Infection ◽

Opportunistic Infections ◽

Fatal Case ◽

Diagnosis And Treatment ◽

Pathological Examination ◽

Immunocompromised Patients ◽

Prompt Diagnosis

Mucormycosis is a fungal infection that primarily causes opportunistic infections. Gastrointestinal mucormycosis is a rare infection that can occur in immunocompromised patients, nevertheless, prompt diagnosis and treatment is essential because it can be fatal. Gastrointestinal mucormycosis can only be diagnosed based on the findings of a pathological examination. Mucormycosis should be included in the differential diagnosis if the condition of patients with underlying immunocompromised conditions or diseases does not improve with general intensive care.

Download Full-text

COVID-19—Importance for Patients on the Waiting List and after Kidney Transplantation—A Single Center Evaluation in 2020–2021

Pathogens ◽

10.3390/pathogens10040429 ◽

2021 ◽

Vol 10 (4) ◽

pp. 429

Author(s):

Simone C. Boedecker ◽

Pascal Klimpke ◽

Daniel Kraus ◽

Stefan Runkel ◽

Peter R. Galle ◽

...

Keyword(s):

Kidney Transplantation ◽

Waiting List ◽

Smoking History ◽

Immunocompromised Patients ◽

Dialysis Patients ◽

Vaccination Programs ◽

Mild Disease ◽

Probability Of Survival ◽

Number Of Patients ◽

Immunosuppressed Patients

(1) Background: Dialysis patients and recipients of a kidney allograft are at high risk for infection with SARS-CoV-2. It has been shown that the development of potent neutralizing humoral immunity against SARS CoV-2 leads to an increased probability of survival. However, the question of whether immunocompromised patients develop antibodies has not yet been sufficiently investigated; (2) Methods: SARS-CoV-2 antibodies were examined in hemodialysis patients on the waiting list for kidney transplantation as well as patients after kidney transplantation. Patients were interviewed about symptoms and comorbidities, BMI, and smoking history; (3) Results: SARS-CoV-2 antibodies were found in 16 out of 259 patients (6%). The trend of infections here reflects the general course of infection in Germany with a peak in November/December of 2020. Remarkably, patients on the waiting list experienced only mild disease. In contrast, transplanted patients had to be hospitalized but recovered rapidly from COVID-19. Most interesting is that all immunosuppressed patients developed antibodies against SARS-CoV-2 after infection; (4) Conclusions: Even with extensive hygiene concepts, an above-average number of patients were infected with SARS-CoV-2 during the second wave of infections in Germany. Because SARS-CoV-2 infection triggered the formation of antibodies even in these immunocompromised patients, we expect vaccination to be effective in this group of patients. Thus, dialysis patients and patients after kidney transplantation should be given high priority in vaccination programs.

Download Full-text

Saprochaete clavata Infection in Immunosuppressed Patients: Systematic Review of Cases and Report of the First Oral Manifestation, Focusing on Differential Diagnosis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052385 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2385

Author(s):

Carlo Lajolo ◽

Rupe Cosimo ◽

Schiavelli Anna ◽

Gioco Gioele ◽

Metafuni Elisabetta ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Acute Myeloid Leukemia ◽

Differential Diagnosis ◽

Myeloid Leukemia ◽

Oral Manifestation ◽

First Case ◽

Immunosuppressed Patients ◽

Meta Analyses ◽

Acute Myeloid

Background: Saprochaete clavata infection is an emerging issue in immunosuppressed patients, causing fulminant fungaemia. The purpose of this systematic review of cases is to retrieve all cases of S. clavata infection and describe oral lesions as the first manifestation of S. clavata infection. Methods: We report the first case of intraoral S. clavata infection in Acute Myeloid Leukemia (AML) affected subject, presenting as multiple grayish rapidly growing ulcerated swellings, and provide a review of all published cases of infection caused by S. clavata, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, conducted by searching SCOPUS, Medline, and CENTRAL databases. Only articles in English were considered. Individual patient data were analyzed to identify risk factors for S. clavata infection. Results: Seventeen of 68 retrieved articles were included in the review reporting data on 96 patients (mean age 51.8 years, 57 males and 38 females). Most cases were disseminated (86) with a 60.2% mortality rate. Ninety-five were hematological patients, with AML being the most common (57 cases). Conclusions:S. clavata infection in immunosuppressed patients has a poor prognosis: middle-age patients, male gender and Acute Myeloid Leukemia should be considered risk factors. In immunosuppressed patients, the clinical presentation can be particularly unusual, imposing difficult differential diagnosis, as in the reported case.

Download Full-text

668 The Consequences to Emergency Surgery During COVID19 Pandemic in a UK District General Hospital in The North East of England

British Journal of Surgery ◽

10.1093/bjs/znab134.075 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

R Evans ◽

C Ng

Keyword(s):

Surgical Treatment ◽

General Hospital ◽

Emergency Surgery ◽

Early Identification ◽

District General Hospital ◽

Public Confidence ◽

Surgical Services ◽

North East ◽

The North ◽

Initial Reduction

Abstract Aim COVID19 pandemic has significantly affected surgical services. We aim to review its effects on our theatre output and risk of encountering COVID 19 cases. Method Serial record of operations performed locally were reviewed from start of UK COVID19 pandemic lockdown on 23rd March 2020 to 13th July 2020 after it was lifted. A weekly average by month of operations and the percentage of COVID19 cases diagnosed within 30 days of the procedure were noted. Results 733 operations performed through this period. In March, 33 operations/week performed, 88.4% emergency and 7% diagnosed with COVID19. April, 31 operations /week performed, 95.9% emergency and 10.6% diagnosed with COVID19. May 46 operations /week performed, 94.5% emergency and 3.3% diagnosed with COVID19. June 56 operations /week, 80.9% emergency and less than 0.01% diagnosed with COVID19. By July 80 operations/week, 59.4% emergency and none diagnosed with COVID 19. Since testing capacity increased, only 6 of the 27 operated were diagnosed with COVID19. Conclusions There was initial reduction to non-emergency workload. However, this has gradually shifted as protocols are in place improve public confidence to return for surgical treatment. Mandatory admission testing allows early identification and remains essential for planning of services and protecting the workforce.

Download Full-text

Occupational Exposure to Varicella Zoster in a Tertiary-Care Healthcare Setting

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.939 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s333-s334

Author(s):

Zachary Yetmar ◽

Debra Apenhorst ◽

Priya Sampathkumar ◽

Elena Beam

Keyword(s):

Occupational Exposure ◽

Varicella Zoster Virus ◽

Tertiary Care ◽

Occupational Exposures ◽

Inpatient Setting ◽

Solid Organ ◽

Immunocompromised Patients ◽

Varicella Zoster ◽

Delayed Initiation ◽

Immunosuppressed Patients

Background: Disseminated varicella zoster virus (dVZV) infection is a feared complication of varicella zoster virus (VZV) reactivation in immunocompromised patients. The CDC recommends contact and airborne precautions for localized VZV in immunocompromised patients until dissemination has been ruled out. Pre-emptive isolation can be problematic for medical centers without access to negative-pressure rooms. When we identify a case of dVZV at our facility, we perform an investigation to identify occupational exposures. Methods: We conducted a retrospective, descriptive review of occupational exposure investigations related to dVZV from January 2016 to December 2018. We collected baseline characteristics of the dVZV patient, and we evaluated whether the exposure occurred due to a delay in diagnosis or a progression from “localized” to disseminated VZV disease. Results: We identified 21 immunosuppressed patients with dVZV whose infection resulted in an occupational exposure during the specified study period. Average age was 58.6 years, with 10 males and 12 females. The immunocompromised patients included 11 with hematologic malignancy, 5 with solid-organ malignancy, 3 with rheumatologic disease on immunosuppressive therapy, and 2 with a solid-organ transplant. Most of the exposures (72.7%) occurred in an inpatient setting. The exposures resulted from either delayed recognition of dVZV or delayed initiation of appropriate precautions for all of the immunosuppressed patients. Two additional exposures occurred as a result of a change from “localized” to “disseminated” VZV. These patients whose diagnosis changed from localized to dVZV were considered previously immunocompetent, and dissemination took place 2 days after seeking healthcare evaluation. Conclusions: Most occupational exposures to varicella zoster are the result of delayed initiation of appropriate isolation precautions due to delayed diagnosis of dVZV infection or failure to recognize the need for instituting precautions in disseminated disease. Instituting preemptive airborne precautions for immunocompromised patients with localized varicella zoster would be unlikely to reduce occupational exposures.Funding: NoneDisclosures: Consulting fee- Merck Priya Sampathkumar

Download Full-text

Anorexia Nervosa

Pediatrics in Review ◽

10.1542/pir.4.4.123 ◽

1982 ◽

Vol 4 (4) ◽

pp. 123-129

Author(s):

Hans Steiner

Keyword(s):

Differential Diagnosis ◽

Anorexia Nervosa ◽

High Mortality ◽

Early Identification ◽

Aggressive Treatment ◽

Adolescent Women ◽

Benign Disorder ◽

Long Run ◽

Medical Symptoms

Anorexia nervosa is a complex, chronic, remittent disorder of mostly adolescent women. It presents with multiple psychiatric and medical symptoms which are difficult to diagnose and treat, especially in the long run. Its differential diagnosis is complex and treatment requires dedicated effort and several specialists working cooperatively. Its etiology is still unclear, although there are several promising leads. Treatment is largely empirical and nonspecific at this point. Early identification and aggressive treatment are the only hope for preventing chronicity. Its relatively high mortality attests to the fact that it is not a benign disorder.

Download Full-text

Functional ismico-cervical insufficiency and its therapy with dufastone in outpatient settings

Journal of obstetrics and women s diseases ◽

10.17816/jowd88157 ◽

1999 ◽

Vol 48 (2) ◽

pp. 82-83

Author(s):

V. V. Abramchenko

Keyword(s):

Differential Diagnosis ◽

Surgical Treatment ◽

Termination Of Pregnancy ◽

Cervical Insufficiency ◽

Surgical Interventions ◽

Outpatient Settings ◽

In Pregnancy

The role of ischemic-duodenal insufficiency (IDI) in spontaneous termination of pregnancy has not been fully elucidated. The development of various modifications of the surgical treatment of IDI is of great importance, which has led to a very wide use of surgical interventions on the cervix, including "prophylactic" interventions. The application of a circular suture to the cervix is appropriate only in cases where there is an organic variant of this pathology. Differential diagnosis of organic and functional IDI in pregnancy is difficult.

Download Full-text