scholarly journals Cerebral abscess caused by Serratia marcescens in a premature neonate

2007 ◽  
Vol 65 (4a) ◽  
pp. 1018-1021 ◽  
Author(s):  
Tatiana Mattos Hirooka ◽  
Ricardo Braganca de Vasconcellos Fontes ◽  
Edna Maria Diniz ◽  
Fernando Campos Pinto ◽  
Hamilton Matushita
Keyword(s):  
Serratia Marcescens ◽  
Distress Syndrome ◽  
Clinical Signs ◽  
Rare Condition ◽  
Premature Neonate ◽  
Cerebral Abscess ◽  
High Dose ◽  
Diagnostic Measures ◽  
Therapeutic Measures ◽  
Male Neonate

BACKGROUND: Cerebral abscesses are extremely rare in neonates. Serratia marcescens is an unusual cause of sepsis and neurological spread is especially ominous. PURPOSE: To report the case of a 34-week neonate who developed this rare condition and to discuss diagnostic and therapeutic measures. CASE REPRT: A 34-week male neonate sequentially developed respiratory distress syndrome, early sepsis and necrotizing enterocolitis; later cultures revealed S. marcescens. After deterioration, a cerebral abscess became evident, which revealed S. marcescens. Clinical improvement ensued after high-dose amikacin and meropenem. CONCLUSION: Clinical signs are often non-specific. Proper diagnostic measures, neurosurgical consultation and aggressive antibiotic therapy are essential for these high-risk neonates.

CHEST RADIOGRAPHY OF PREMATURES

PEDIATRICS ◽  
1958 ◽  
Vol 21 (5) ◽  
pp. 813-824
Author(s):  
William Allen Bauman ◽  
Jerome Nadelhaft
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Clinical Signs ◽  
Individual Case ◽  
Routine Manner ◽  
Hyaline Membrane ◽  
Therapeutic Measures ◽  
The Individual ◽  
Symptoms And Signs

The chests of 104 unselected, newborn prematures were studied by roentgenogram in the first 72 hours of life in a routine manner which yielded satisfactory roentgenograms and involved minimal disturbance of the patients. Nineteen of the infants showed clinical signs of dyspnea sufficient to suggest that they were suffering from some degree of the respiratory distress syndrome. Thirty-five of the total number presented roentgenographic pictures compatible with hyaline membrane syndrome. Twenty-five of the infants died within the first 8 days of life. Of the 23 in this fatal group who came to necropsy, 10 had hyaline membranes: Eight of these had shown during life both respiratory distress and pulmonary roentgenographic appearance of bilateral diffuse increased reticulogranularity. In statistical analyses, this association is found to be highly significant (p < 0.006). That several infants with both these abnormalities survived indicates that prematures may recover from the respiratory distress syndrome. Until the diagnosis can be established with greater certainty during life, the possibility of spontaneous recovery must be considered in the evaluation of therapeutic measures. In the individual case, a premature who has a high retraction score and pulmonary roentgenograms demonstrating increased reticulogranularity has a greater chance of dying with hyaline membrane formation than does the infant who fails to show these symptoms and signs during life.

scholarly journals Pyogenic brain abscess caused by Serratia marcescens in a Brazilian premature neonate

2018 ◽  
Vol 23 (1) ◽  
pp. 65-68
Author(s):  
Regina Célia Ajeje Pires De Albuquerque ◽  
Lilian Beani ◽  
Raquel Siqueira Leonel De Paula ◽  
Lucas Crociati Meguins
Keyword(s):  
Antibiotic Therapy ◽  
Serratia Marcescens ◽  
Brain Abscess ◽  
Present Report ◽  
Pediatric Population ◽  
Primary Source ◽  
Premature Neonate ◽  
Diagnostic Measures ◽  
Microbiological Techniques ◽  
Brain Abscesses

Bacterial brain abscess remain a serious central nervous system infectious disorder despite advances in neurosurgical, neuroimaging, clinical support on intensive care units, microbiological techniques and availability of new antibiotics. The successful treatment of brain abscess usually requires surgery, appropriate antibiotic therapy and eradication of the primary source. Although uncommon, brain abscesses are particularly important in the pediatric population due to its devastating potential to cause severe neurologic deficits, especially in preterm newborns. The purpose of the present report is to describe the case of a Brazilian premature neonate with pyogenic brain abscesses caused by Serratia marcescens and to discuss therapeutic and diagnostic approaches. The early suspicion, proper diagnostic measures and immediate neurosurgical consultation associated with aggressive antibiotic therapy seem to be the essentials steps on themanagement for those high-risk pediatric patients.

Intensive Initial Oral Anticoagulation and Shorter Heparin Treatment in Deep Vein Thrombosis

1984 ◽  
Vol 52 (03) ◽  
pp. 276-280 ◽  
Author(s):  
Sam Schulman ◽  
Dieter Lockner ◽  
Kurt Bergström ◽  
Margareta Blombäck
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulation ◽  
Dose Group ◽  
Low Dose ◽  
Clinical Signs ◽  
Coagulation Factor ◽  
High Dose ◽  
Vein Thrombosis ◽  
Heparin Treatment ◽  
Deep Vein

SummaryIn order to investigate whether a more intensive initial oral anticoagulation still would be safe and effective, we performed a prospective randomized study in patients with deep vein thrombosis. They received either the conventional regimen of oral anticoagulation (“low-dose”) and heparin or a more intense oral anticoagulation (“high-dose”) with a shorter period of heparin treatment.In the first part of the study 129 patients were randomized. The “low-dose” group reached a stable therapeutic prothrombin complex (PT)-level after 4.3 and the “high-dose” group after 3.3 days. Heparin was discontinued after 6.0 and 5.0 days respectively. There was no difference in significant hemorrhage between the groups, and no clinical signs of progression of the thrombosis.In the second part of the study another 40 patients were randomized, followed with coagulation factor II, VII, IX and X and with repeated venograms. A stable therapeutic PT-level was achieved after 4.4 (“low-dose”) and 3.7 (“high-dose”) days, and heparin was discontinued after 5.4 and 4.4 days respectively. There were no clinical hemorrhages, the activity of the coagulation factors had dropped to the same level in both groups at the time when heparin was discontinued and no thromboembolic complications occurred.Our oral anticoagulation regimen with heparin treatment for an average of 4.4-5 days seems safe and reduces in-patient costs.

scholarly journals Acute otitis media in an infant complicated with osteoarthritis of temporomandibular joint and sub-periosteal abscess of the clavicle

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Kaoutar Cherrabi ◽  
Hind Cherrabi
Keyword(s):  
Septic Arthritis ◽  
Temporomandibular Joint ◽  
Nutritional Assessment ◽  
Acute Otitis Media ◽  
Clinical Signs ◽  
Rare Condition ◽  
Pediatric Emergency ◽  
Ear Infections ◽  
The Right

Abstract Background Otomastoiditis is a very frequent affection and a current complication of mal-treated benign ear infections in children. However, this a very rare case of the association of two rare complications of otomastoiditis in a newborn. On the one hand, septic arthritis of the temporomandibular joint which is a very rare condition that is difficult to diagnose, and when unrecognized or not treated accordingly, it can resolve in serious infectious complication and or definitive injury to the temporomandibular joint. On the other hand, osteomyelitis of the clavicle is also very rare, and only a few cases have been cited in the literature concerning infants. Case presentation This 46-day-old infant was brought to pediatric emergency consultation for 2 swelling inflammatory bulges, one in the right mastoid and pre-auricular regions, and another in the right basi-cervical area. The infant was hypertrophic febrile, hypotonic, and pale. He had preserved archaic reflexes. Besides, blood test showed an inflammatory syndrome, inflammatory anemia, and no other abnormalities. Upon supplementary computed tomodensitometry exam, the diagnosis of a combination of septic arthritis of the right temporomandibular joint and sub-periosteal abscess of the ipsilateral clavicle in a context of hypotrophy and malnutrition was suspected. A pus sample was obtained for bacteriological evaluation, after which the infant had a course of intravenous associated antibiotics, along with nutritional assessment and management. Surgical drainage of both collections was performed. The 6-month follow-up was satisfactory, without clinical signs of functional impact on temporomandibular joint, or acromioclavicular joint. Conclusion This work stresses the necessity of thorough clinical examination of infants even in cases of benign ear infections, as well as the importance of adapted treatment and follow-up, which could allow early diagnosis, appropriate treatment, or even prevention of severe complications that can be associated with such benign conditions.

scholarly journals Precision therapeutic targets for COVID-19

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Zachary A. Krumm ◽  
Grace M. Lloyd ◽  
Connor P. Francis ◽  
Lith H. Nasif ◽  
Duane A. Mitchell ◽  
...  
Keyword(s):  
Distress Syndrome ◽  
Replication Cycle ◽  
Spike Protein ◽  
Small Subset ◽  
High Dose ◽  
Drug Cocktail ◽  
Proteolytic Activation ◽  
Main Protease ◽  
Clinical Drugs ◽  
Length Of Hospitalization

AbstractBeginning in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as a novel pathogen that causes coronavirus disease 2019 (COVID-19). SARS-CoV-2 has infected more than 111 million people worldwide and caused over 2.47 million deaths. Individuals infected with SARS-CoV-2 show symptoms of fever, cough, dyspnea, and fatigue with severe cases that can develop into pneumonia, myocarditis, acute respiratory distress syndrome, hypercoagulability, and even multi-organ failure. Current clinical management consists largely of supportive care as commonly administered treatments, including convalescent plasma, remdesivir, and high-dose glucocorticoids. These have demonstrated modest benefits in a small subset of hospitalized patients, with only dexamethasone showing demonstrable efficacy in reducing mortality and length of hospitalization. At this time, no SARS-CoV-2-specific antiviral drugs are available, although several vaccines have been approved for use in recent months. In this review, we will evaluate the efficacy of preclinical and clinical drugs that precisely target three different, essential steps of the SARS-CoV-2 replication cycle: the spike protein during entry, main protease (MPro) during proteolytic activation, and RNA-dependent RNA polymerase (RdRp) during transcription. We will assess the advantages and limitations of drugs that precisely target evolutionarily well-conserved domains, which are less likely to mutate, and therefore less likely to escape the effects of these drugs. We propose that a multi-drug cocktail targeting precise proteins, critical to the viral replication cycle, such as spike protein, MPro, and RdRp, will be the most effective strategy of inhibiting SARS-CoV-2 replication and limiting its spread in the general population.

SLC25A19 deficiency and bilateral striatal necrosis with polyneuropathy: a new case and review of the literature

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Francesco Porta ◽  
Barbara Siri ◽  
Nicoletta Chiesa ◽  
Federica Ricci ◽  
Lulash Nika ◽  
...  
Keyword(s):  
Axonal Neuropathy ◽  
Clinical Signs ◽  
Leigh Syndrome ◽  
High Dose ◽  
New Variant ◽  
Long Term Follow Up ◽  
Basal Ganglia Involvement ◽  
Biallelic Mutations ◽  
Thiamine Treatment ◽  
Striatal Necrosis

AbstractObjectivesBiallelic mutations in the SLC25A19 gene impair the function of the thiamine mitochondrial carrier, leading to two distinct clinical phenotypes. Homozygosity for the c.530G > C mutation is invariably associated to Amish lethal microcephaly. The second phenotype, reported only in 8 patients homozygous for different non-Amish mutations (c.373G > A, c.580T > C, c.910G > A, c.869T > A, c.576G > C), is characterized by bilateral striatal necrosis and peripheral polyneuropathy. We report a new patient with the non-Amish SLC25A19 phenotype showing compound heterozygosity for the new variant c.673G > A and the known mutation c.373G > A.Case presentationThe natural history of non-Amish SLC25A19 deficiency is characterized by acute episodes of fever-induced encephalopathy accompanied by isolated lactic acidosis and Leigh-like features at magnetic resonance imaging (MRI). Acute episodes are prevented by high-dose thiamine treatment (600 mg/day). As shown in the new case, both mild clinical signs and basal ganglia involvement can precede the acute encephalopathic onset of the disease, potentially allowing treatment anticipation and prevention of acute brain damage. Peripheral axonal neuropathy, observed in 7 out of 9 patients, is not improved by thiamine therapy. In two early treated patients, however, peripheral neuropathy did not occur even on long-term follow-up, suggesting a potential preventive role of treatment anticipation also at the peripheral level.ConclusionsNon-Amish SLC25A19 deficiency is an extra-rare cause of Leigh syndrome responsive to thiamine treatment. Ex adiuvantibus thiamine treatment is mandatory in any patient with Leigh-like features.

scholarly journals Double Pylorus in Upper Gastrointestinal Bleeding

2021 ◽  
pp. 332-337
Author(s):  
Heasty Oktaricha ◽  
Muhammad Miftahussurur
Keyword(s):  
Duodenal Bulb ◽  
Rare Condition ◽  
High Dose ◽  
Protective Agent ◽  
Gastrointestinal Fistula ◽  
Double Pylorus ◽  
History Of ◽  
Inflammatory Drugs ◽  
H Pylori ◽  
Upper Gastrointestinal

Double pylorus, also known as acquired double pylorus, is a rare condition defined as a gastrointestinal fistula connecting stomach antrum and duodenal bulb. The prevalence of double pylorus ranges from 0.001 to 0.4% by esophagogastroduodenoscopy (EGD). Although the etiology is unknown, the formation of double pylorus is related to Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs (NSAID). The development of the occurrence of double pylorus is still unknown, but many systemic diseases play a role. We present the case of a 59-year-old man who was admitted to Dr. Soetomo General Hospital with hematemesis and melena. The patient had a history of diabetes mellitus since 3 years and consumption of medicinal herbs for myalgia, which was suspected of NSAIDs for the past 5 months. The patient had anemia with hemoglobin at 8.3 g/dL, enterogenous azotemia with blood urea nitrogen 28 mg/dL and serum creatinine 1.14 mg/dL. At EGD, double pylorus was found and accompanied by gastric ulcer, a giant white base ulcer, part of it covered by clotting without any sign of active bleeding. Biopsy revealed chronic inactive gastritis, and no H. pylori was found. Treatment mainly depends on gastrointestinal acid suppression through a proton pump inhibitor (PPI). The patient was given a high-dose PPI and a mucosal protective agent. He was treated for 1 week and had improved complaints.

scholarly journals Clinical presentation and immunological features of Post-Malaria Neurologic Syndrome: a case report and review of literature

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Nadia Castaldo ◽  
Carlo Tascini ◽  
Paola Della Siega ◽  
Maddalena Peghin ◽  
Davide Pecori
Keyword(s):  
Unmet Need ◽  
Specific Treatment ◽  
Rare Condition ◽  
Acute Disseminated Encephalomyelitis ◽  
Intravenous Immunoglobulins ◽  
Neurological Involvement ◽  
Systematic Research ◽  
High Dose ◽  
Microbiological Analysis ◽  
Randomized Controlled Studies

Abstract Background Malaria still represents a major health threat, in terms of both morbidity and mortality. Complications of malaria present a diversified clinical spectrum, with neurological involvement leading to the most serious related-conditions. The authors recently encountered a case of a 60-year old Italian man presenting with confusion, language disturbances and Parkinson-like syndrome 3 weeks after complete remission from severe Plasmodium falciparum cerebral malaria. Chemical and microbiological analysis revealed aseptic meningitis, diffuse encephalitis and abnormal immune-activation. Re-infection and recrudescence of infection were excluded. Further analysis excluded paraneoplastic and autoimmune causes of encephalitis. A diagnosis of Post-Malaria Neurological Syndrome (PMNS) was finally formulated and successfully treated with high dose of steroids. Methods A systematic research of current literature related to PMNS was performed. Results 151 cases of PMNS were included, the majority of which occurred after severe P. falciparum infections. Four main clinical pattern were identified: 37% of the cases presented as “classical” PMNS, 36% presented as delayed cerebellar ataxia (DCA), 18% resembled acute inflammatory demyelinating polyneuropathy (AIDP), and 8% presented as acute disseminated encephalomyelitis (ADEM)-like form. Differentiation between different forms was not always simple, as clinical and radiological findings frequently overlap. Overall, in almost all of the tested cases, cerebrospinal fluid was found pathological; EEG revealed nonspecific encephalopathy in 30% of classical PMNS and 67% ADEM; imaging tests were found abnormal in 92% of ADEM-like forms. Pathogenesis remains unclear. An autoimmune mechanism is the most corroborated pathogenic hypothesis. Overall, the majority of PMNS cases revert without specific treatment. In most severe forms, high dose steroids, intravenous immunoglobulins, and plasmapheresis have been shown to improve symptoms. Conclusions PMNS is a disabling complication of malaria. The overall incidence is not known, due to frequent misdiagnosis and under-reporting. Pathogenesis is not also fully understood, but rapid response to immune-modulating treatment along with similarities to auto-immune neurological disease, strongly support a dysregulated immunological genesis of this condition. The lack of randomized controlled studies regarding therapeutic approaches is a major unmet need in this setting. A systematic collection of all the PMNS cases would be desirable, in order to increase awareness of this rare condition and to prospectively investigate the most appropriate management.

scholarly journals Deletion of the L7L-L11L Genes Attenuates ASFV and Induces Protection against Homologous Challenge

Viruses ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 255
Author(s):  
Jingyuan Zhang ◽  
Yanyan Zhang ◽  
Teng Chen ◽  
Jinjin Yang ◽  
Huixian Yue ◽  
...  
Keyword(s):  
African Swine Fever Virus ◽  
Clinical Signs ◽  
African Swine Fever ◽  
Biological Properties ◽  
High Dose ◽  
Swine Industry ◽  
Epidemic Disease ◽  
Intramuscular Inoculation ◽  
Homologous Challenge

African swine fever (ASF), caused by the African swine fever virus (ASFV), is a major epidemic disease endangering the swine industry. Although a number of vaccine candidates have been reported, none are commercially available yet. To explore the effect of unknown genes on the biological characteristics of ASFV and the possibility of a gene-deleted isolate as a vaccine candidate, the strain SY18ΔL7-11, with deletions of L7L–L11L genes from ASFV SY18, was constructed, and its biological properties were analyzed. The results show that deletion of genes L7L-L11L did not affect replication of the virus in vitro. Virulence of SY18△L7-11 was significantly reduced, as 11 of the 12 pigs survived for 28 days after intramuscular inoculation with a low dose (103 TCID50) or a high dose (106 TCID50) of SY18ΔL7-11. All 11 surviving pigs were completely protected against challenge with the parental ASFV SY18 on 28 days postinoculation (dpi). Transient fever and/or irregularly low levels of genomic DNA in the blood were monitored in some pigs after inoculation. No ASF clinical signs or viremia were monitored after challenge. Antibodies to ASFV were induced in all pigs from 14 to 21 days postinoculation. IFN-γ was detected in most of the inoculated pigs, which is usually inhibited in ASFV-infected pigs. Overall, the results demonstrate that SY18ΔL7-11 is a candidate for further constructing safer vaccine(s), with better joint deletions of other gene(s) related to virulence.

Burning of a Neonate due to a Pulse Oximeter: Arterial Saturation Monitoring

PEDIATRICS ◽  
1992 ◽  
Vol 89 (1) ◽  
pp. 154-155
Author(s):  
DANIEL B. SOBEL
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Case Report ◽  
Pulse Oximeter ◽  
Distress Syndrome ◽  
Pediatric Intensive Care ◽  
Supplemental Oxygen ◽  
Premature Neonate ◽  
Skin Development ◽  
Pulse Oximeter Probe

Monitoring of arterial hemoglobin saturations by pulse oximetry has become a fixture in neonatal and pediatric intensive care units, operating rooms, and in other hospital settings. Use with extremely premature neonates is especially beneficial because of their immature skin development and vulnerability to topical damage—whether due to chemicals, tape, or temperature.1,2 This report documents a case of a burn due to a presumed shorting of a pulse oximeter probe cable in an extremely premature neonate. CASE REPORT The patient was a 690-g Hispanic female neonate born prematurely at approximately 25 weeks' gestation with respiratory distress syndrome requiring mechanical ventilation and supplemental oxygen.

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