Co-incidental Plasmodium Knowlesi and Mucormycosis infections presenting with acute kidney injury and lower gastrointestinal bleeding

Abstract Background Severe influenza is associated with high morbidity and mortality. The aim of this study was to investigate the factors affecting the clinical outcomes of critically ill influenza patients. Methods In this retrospective study, we enrolled critically ill adult patients with influenza at the Kaohsiung Chang Gung Memorial Hospital in Taiwan. We evaluated the demographic, clinical, and laboratory findings and examined whether any of these measurements correlated with mortality. We then created an event-based algorithm as a simple predictive tool using 2 variables with statistically significant associations with mortality. Results Between 2015 and 2018, 102 critically ill influenza patients (median age, 62 years) were assessed; among them, 41 (40.1%) patients died. Of the 94 patients who received oseltamivir therapy, 68 (72.3%) began taking oseltamivir 48 hours after the onset of illness. Of the 102 patients, the major influenza-associated complications were respiratory failure (97%), pneumonia (94.1%), acute kidney injury (65.7%), adult respiratory distress syndrome (ARDS) (51%), gastrointestinal bleeding (35.3%), and bacteremia (16.7%). In the multivariate regression model, high lactate levels, ARDS, acute kidney injury, and gastrointestinal bleeding were independent predictors of mortality in critically ill influenza patients. The optimal lactate level cutoff for predicting mortality was 33 mg/dL with an area under curve of 0.728. We constructed an event-associated algorithm that included lactate and ARDS. Fifteen (75%) of 20 patients with lactate levels ≥33 mg/dL and ARDS died, compared with only 1 (7.7%) of 13 patients with normal lactate levels and without ARDS. Conclusions We identified clinical and laboratory predictors of mortality at hospital admission that could aid in the care of critically ill influenza patients. Identification of these prognostic markers could be improved to prioritize key examinations that might be useful in determining patient outcomes.

Download Full-text

Mo1389 ACUTE KIDNEY INJURY IS AN INDEPENDENT PREDICTOR OF IN-HOSPITAL MORTALITY AND POOR OUTCOMES AMONG PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING: A NATIONWIDE ANALYSIS

Gastroenterology ◽

10.1016/s0016-5085(20)32866-3 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-872

Author(s):

Ahmad Khan ◽

Nasir Saleem ◽

srikanth r. maddika ◽

Mohammad Bilal ◽

Shailendra Singh

Keyword(s):

Acute Kidney Injury ◽

Gastrointestinal Bleeding ◽

Hospital Mortality ◽

Upper Gastrointestinal Bleeding ◽

Independent Predictor ◽

Kidney Injury ◽

Poor Outcomes ◽

Upper Gastrointestinal

Download Full-text

Gastrointestinal bleeding due to marked coagulopathy from acute kidney injury in a patient taking dabigatran

Journal of the Japanese Society of Intensive Care Medicine ◽

10.3918/jsicm.22.143 ◽

2015 ◽

Vol 22 (2) ◽

pp. 143-144

Author(s):

Takeo Matsuyoshi ◽

Nobuo Sasaki ◽

Kazumasa Yamaguchi ◽

Naoki Kojima ◽

Hiroshi Inagawa ◽

...

Keyword(s):

Acute Kidney Injury ◽

Gastrointestinal Bleeding ◽

Kidney Injury

Download Full-text

Intravascular haemolysis in severe Plasmodium knowlesi malaria: association with endothelial activation, microvascular dysfunction, and acute kidney injury

Emerging Microbes & Infections ◽

10.1038/s41426-018-0105-2 ◽

2018 ◽

Vol 7 (1) ◽

pp. 1-10 ◽

Cited By ~ 14

Author(s):

Bridget E. Barber ◽

Matthew J. Grigg ◽

Kim A. Piera ◽

Timothy William ◽

Daniel J. Cooper ◽

...

Keyword(s):

Acute Kidney Injury ◽

Plasmodium Knowlesi ◽

Kidney Injury ◽

Microvascular Dysfunction ◽

Endothelial Activation ◽

Intravascular Haemolysis

Download Full-text

Renal Localization of Plasmodium vivax and Zoonotic Monkey Parasite Plasmodium knowlesi in Malaria Associated Acute Kidney Injury

10.1101/544726 ◽

2019 ◽

Author(s):

Pragyan Acharya ◽

Atreyi Pramanik ◽

Charandeep Kaur ◽

Kalpana Sinha ◽

Amit Kumar Dinda ◽

...

Keyword(s):

Acute Kidney Injury ◽

Plasmodium Vivax ◽

Malaria Parasite ◽

Plasmodium Knowlesi ◽

Plasmodium Species ◽

Kidney Injury ◽

Renal Tissue ◽

Vascular Involvement ◽

Human Malaria Parasite ◽

Parasite Plasmodium

ABSTRACTAcute kidney injury (AKI) is a frequent presentation in Plasmodium vivax (P. vivax) associated severe malaria. However, tissue presence of P. vivax parasites in the kidney has never been demonstrated. In the present study, we show that renal biopsies from malaria associated AKI patients harbor the human malaria parasite P. vivax and, in several cases, the zoonotic monkey malaria parasite P. knowlesi in addition to P. vivax. Presence of microvascular injury in a majority of the malaria associated AKI cases suggests vascular involvement of P. vivax and P. knowlesi. This study implicates Plasmodium species as a possible pathogenic mechanism for AKI, and suggests host renal tissue interaction of P. vivax and P. knowlesi.

Download Full-text

Clinical Characteristics and Predictors of Mortality in Critically Ill Influenza Adult Patients

Journal of Clinical Medicine ◽

10.3390/jcm9041073 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1073

Author(s):

Jui-Chi Hsu ◽

Ing-Kit Lee ◽

Wen-Chi Huang ◽

Yi-Chun Chen ◽

Ching-Yen Tsai

Keyword(s):

Acute Kidney Injury ◽

Gastrointestinal Bleeding ◽

Critically Ill ◽

Kidney Injury ◽

Adult Patients ◽

Chang Gung Memorial Hospital ◽

High Morbidity ◽

Predictive Tool ◽

Predictors Of Mortality ◽

Lactate Levels

Severe influenza is associated with high morbidity and mortality. The aim of this study was to investigate the factors affecting the clinical outcomes of critically ill influenza patients. In this retrospective study, we enrolled critically ill adult patients with influenza at the Kaohsiung Chang Gung Memorial Hospital in Taiwan. We evaluated the demographic, clinical, and laboratory findings and examined whether any of these measurements correlated with mortality. We then created an event-based algorithm as a simple predictive tool using two variables with statistically significant associations with mortality. Between 2015 and 2018, 102 critically ill influenza patients (median age, 62 years) were assessed; among them, 41 (40.1%) patients died. Of the 94 patients who received oseltamivir therapy, 68 (72.3%) began taking oseltamivir 48 h after the onset of illness. Of the 102 patients, the major influenza-associated complications were respiratory failure (97%), pneumonia (94.1%), acute kidney injury (65.7%), adult respiratory distress syndrome (ARDS) (51%), gastrointestinal bleeding (35.3%), and bacteremia (16.7%). In the multivariate regression model, high lactate levels, ARDS, acute kidney injury, and gastrointestinal bleeding were independent predictors of mortality in critically ill influenza patients. The optimal lactate level cutoff for predicting mortality was 3.7 mmol/L with an area under curve of 0.728. We constructed an event-associated algorithm that included lactate and ARDS. Fifteen (75%) of 20 patients with lactate levels 3.7 mmol/L and ARDS died, compared with only 1 (7.7%) of 13 patients with normal lactate levels and without ARDS. We identified clinical and laboratory predictors of mortality that could aid in the care of critically ill influenza patients. Identification of these prognostic markers could be improved to prioritize key examinations that might be useful in determining patient outcomes.

Download Full-text