scholarly journals Ophthalmic manifestations of Cryptococcus gattii species complex: a case series and review of the literature

2022 ◽  
Vol 15 (1) ◽  
pp. 119-127
Author(s):  
Grace A. McCabe ◽  
◽  
Todd Goodwin ◽  
Douglas F. Johnson ◽  
Anthony Fok ◽  
...  
Keyword(s):  
Literature Review ◽  
Intracranial Hypertension ◽  
Species Complex ◽  
Visual Loss ◽  
Case Series ◽  
The United States ◽  
Cryptococcus Gattii ◽  
Complication Rates ◽  
Presenting Symptoms ◽  
Ophthalmic Manifestations

AIM: To report 4 cases of Cryptococcus gattii (C. gattii) species complex infection with diverse ophthalmic manifestations, and to review the literature to examine pathobiology of disease, classical ophthalmic presentations and outcomes, and treatment modalities for this emerging pathogen. METHODS: Cases of C. gattii meningoencephalitis with ophthalmic manifestations were identified via chart review at two institutions in Australia and one institution in the mid-west region of the United States and are reported as a case series. Additionally, a MEDLINE literature review was conducted to identify all reported cases of C. gattii with ophthalmic manifestations from 1990-2020. Cases were reviewed and tabulated, together with our series of patients, in this report. RESULTS: Four cases of C. gattii with ophthalmic manifestations are presented; three from Australia and one from the USA. A literature review identified a total of 331 cases of C. gattii with visual sequelae. The majority of cases occurred in immunocompetent individuals. Blurred vision and diplopia were the most common presenting symptoms, with papilloedema the most common sign, reported in 10%-50% of cases. Visual loss was reported in 10%-53% of cases, as compared to rates of visual loss of 1%-9% in C. neoformans infection. Elevated intracranial pressure, cerebrospinal fluid (CSF) fungal burden, and abnormal neurological exam at presentation correlated with poor visual outcomes. The mainstays of treatment are anti-fungal agents and aggressive management of intracranial hypertension with serial lumbar punctures. CSF diversion procedures should be considered for refractory cases. Acetazolamide and mannitol are associated with high complication rates, and adjuvant corticosteroids have demonstrated higher mortality rates; these treatments should be avoided. CONCLUSION: Permanent visual loss represents a devastating yet potentially preventable sequelae of C. gattii infection. Intracranial hypertension needs to be recognised early and aggressively managed. Referral to an ophthalmologist/neuro-ophthalmologist in all cases of cryptococcal infection independent of visual symptoms at time of diagnosis is recommended.

scholarly journals 696. Bartonella quintana Endocarditis, A Case Series

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S400-S400
Author(s):  
Thomas D Dieringer ◽  
Glen Huang ◽  
Paul R Allyn ◽  
Jeffrey Klausner
Keyword(s):  
Renal Failure ◽  
Infective Endocarditis ◽  
Los Angeles ◽  
Aortic Valve ◽  
Literature Review ◽  
Case Series ◽  
The United States ◽  
Aortic Insufficiency ◽  
Homeless Population ◽  
Bartonella Quintana

Abstract Background Homelessness has been a growing issue in the United States and worldwide. Bartonella quintana, the causative agent of “Trench fever”, is a well known illness among homeless populations in urban centers. While many cases of B. quintana are self limited, the disease can have advanced presentations including endocarditis. We present a short case series of three cases of B. quintana infective endocarditis (IE) in homeless individuals in Los Angeles and review the literature of cases of B. quintana IE in the homeless population. Methods Here we report three cases of B. quintana IE encountered in homeless individuals at the University of California, Los Angeles (UCLA) hospital system. A literature review was also conducted. PubMed was searched for published cases of human IE secondary to B. quintana in homeless individuals. Results All three patients were male with ages ranging from 39 to 57 years old with a history of homelessness and alcohol use. Presentations were subacute to chronic in nature consisting of constitutional symptoms as well as a range of symptoms corresponding with heart and renal failure. Each patient was found to have varying degrees of aortic insufficiency with either identified aortic valve vegetation or valvular thickening. Diagnosis was made with a combination of Bartonella serologies and whole genome sequencing PCR. All three patient’s courses were complicated by renal failure at varying points limiting the use of gentamicin for the full treatment course. Two patients ultimately underwent aortic valve replacement due to severe aortic insufficiency and completed therapy with doxycycline and rifampin. A single patient was discharged with plan to complete doxycycline and rifampin therapy however was lost to follow up. A literature review of 10 manuscripts describing 13 cases of B. quintana IE were identified. All the patients were male and the median age was 45. Six of the cases were in Europe and eight were in North America. All cases had left sided valve involvement (10 aortic, 6 mitral, 3 both valves). No cases of right sided IE were identified. Conclusion B. quintana IE should be considered in homeless patients with a clinical presentation concerning for IE. A combination of serology and PCR testing can be useful in diagnosis of this uncommon cause of infective endocarditis. Disclosures Jeffrey Klausner, MD, MPH, Nothing to disclose

Pediatric Bacterial Tracheitis—A Variable Entity: Case Series with Literature Review

2018 ◽  
Vol 160 (3) ◽  
pp. 546-549 ◽  
Author(s):  
Geoffrey Casazza ◽  
M. Elise Graham ◽  
Douglas Nelson ◽  
David Chaulk ◽  
David Sandweiss ◽  
...  
Keyword(s):  
Literature Review ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Respiratory Arrest ◽  
Prolonged Intubation ◽  
Children's Hospital ◽  
Presenting Symptoms ◽  
Bacterial Tracheitis ◽  
Children’S Hospital ◽  
Viral Illness

Objective To review the presentation and treatment of children diagnosed with bacterial tracheitis at our institution and to review the available literature focusing on key presenting symptoms and clinical outcomes of children diagnosed with bacterial tracheitis. Study Design Case series with literature review. Setting Tertiary children’s hospital and available literature. Subjects and Methods Case series of children with bacterial tracheitis retrospectively reviewed at a tertiary children’s hospital. Those with a tracheostomy or those who developed bacterial tracheitis as a complication of prolonged intubation were excluded. Results Thirty-six children were identified (mean ± SD age, 6.7 ± 4.5 years). The most common presenting symptom was cough (85%), followed by stridor (77%) and voice changes/hoarseness (67%). A concurrent viral illness was found for 55%, and the most common bacteria cultured was methicillin-sensitive Staphylococcus aureus. Pediatric intensive care admission occurred for 69%, and 43% required intubation. No patient required tracheostomy. One patient (2.7%) died secondary to airway obstruction and subsequent respiratory arrest. Four patients had recurrence of bacterial tracheitis 4 to 12 months following their initial presentation. Conclusion Bacterial tracheitis is an uncommon condition with an atypical presentation and variable clinical course but serious consequences if left unrecognized. Staphylococcus is the most common bacteria identified, and many patients will have a prodromal viral illness. Changes in patient epidemiology and presentation may have occurred over time.

Acute Annular Outer Retinopathy: Literature Review and a Report of 2 Cases

2019 ◽  
Vol 3 (3) ◽  
pp. 172-182
Author(s):  
R. Rishi Gupta ◽  
Douglas S.M. Iaboni ◽  
Mark E. Seamone ◽  
Cyril Archambault ◽  
David E. Lederer
Keyword(s):  
Literature Review ◽  
English Literature ◽  
Fundus Autofluorescence ◽  
Case Series ◽  
Complete Recovery ◽  
Visual Field Defects ◽  
Disease Evolution ◽  
Presenting Symptoms ◽  
Uncommon Disease ◽  
Sd Oct

Purpose: Acute annular outer retinopathy (AAOR) is an uncommon disease. We present 2 illustrative cases and demonstrate disease evolution using multimodal imaging. The 18 previously reported cases in the peer-reviewed English literature are also reviewed. Methods: We conducted a case series and literature review. Results: We observed complete structural resolution by spectral-domain optical coherence tomography (SD-OCT) and ultra-widefield fundus autofluorescence in 1 case. In the literature review, 20 cases of AAOR were identified, including the 2 we have presented. Fifteen cases were unilateral and 5 bilateral, resulting in a total of 25 eyes with AAOR. Presenting symptoms included visual field defects (72%), decreased vision (48%), and photopsia (36%). Sixty-eight percent had a final visual acuity better than or equal to 20/40, while a minority (14%) were 20/200 or worse. Clinically, all eyes had a peripapillary annular band of gray-white opacification of the deep retina. Conclusions: We have reviewed and summarized the 18 previously reported cases of AAOR in the English literature and have shown for the first time that AAOR may undergo complete recovery of the external limiting membrane and ellipsoid zone on SD-OCT with resolution of disease. There is still much to be understood regarding the pathogenesis of and optimal management of AAOR.

Intermediate-term Experience With the STAR Total Ankle in the United States

2018 ◽  
Vol 40 (3) ◽  
pp. 268-275 ◽  
Author(s):  
Evan M. Loewy ◽  
Thomas H. Sanders ◽  
Arthur K. Walling
Keyword(s):  
United States ◽  
Perioperative Complications ◽  
Case Series ◽  
Major Complication ◽  
The United States ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean

Background: Limited intermediate and no real long-term follow-up data have been published for total ankle arthroplasty (TAA) in the United States. This is a report of clinical follow-up data of a prospective, consecutive cohort of patients who underwent TAA by a single surgeon from 1999 to 2013 with the Scandinavian Total Ankle Replacement (STAR) prosthesis. Methods: Patients undergoing TAA at a single US institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination, and radiographs; American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Primary outcomes included implant survivability and functional outcomes scores. Secondary outcomes included perioperative complications such as periprosthetic or polyethylene fracture. Between 1999 and 2013, a total of 138 STAR TAAs were performed in 131 patients; 81 patients were female. The mean age at surgery was 61.5 ± 12.3 years (range, 30-88 years). The mean duration of follow-up for living patients who retained both initial components at final follow-up was 8.8±4.3 years (range 2-16.9 years). Results: The mean change in AOFAS Ankle-Hindfoot scores from preoperative to final follow-up was 36.0 ± 16.8 ( P < .0001). There were 21 (15.2%) implant failures that occurred at a mean 4.9 ± 4.5 years postoperation. Ten polyethylene components in 9 TAAs (6.5%) required replacement for fracture at an average 8.9 ± 3.3 years postoperatively. Fourteen patients died with their initial implants in place. Conclusion: This cohort of patients with true intermediate follow-up after TAA with the STAR prosthesis had acceptable implant survival, maintenance of improved patient-reported outcome scores, and low major complication rates. Level of Evidence: Level IV, case series.

A Unique Subset: Idiopathic Intracranial Hypertension Presenting as Spontaneous CSF Leak of the Anterior Skull Base

2021 ◽  
Author(s):  
Christopher S. Hong ◽  
Adam J. Kundishora ◽  
Aladine A. Elsamadicy ◽  
Eugenia M. Vining ◽  
R. Peter Manes ◽  
...  
Keyword(s):  
Literature Review ◽  
Intracranial Hypertension ◽  
Skull Base ◽  
Idiopathic Intracranial Hypertension ◽  
Empty Sella ◽  
Csf Leak ◽  
Presenting Symptoms ◽  
History Of ◽  
Sinus Stenosis ◽  
Csf Leaks

Abstract Background Spontaneous cerebrospinal fluid (CSF) leaks represent a unique clinical presentation of idiopathic intracranial hypertension (IIH), lacking classical features of IIH, including severe headaches, papilledema, and markedly elevated opening pressures. Methods Following a single-institution retrospective review of patients undergoing spontaneous CSF leak repair, we performed a literature review of spontaneous CSF leak in patients previously undiagnosed with IIH, querying PubMed. Results Our literature review yielded 26 studies, comprising 716 patients. Average age was 51 years with 80.8% female predominance, and average body mass index was 35.5. Presenting symptoms included headaches (32.5%), visual disturbances (4.2%), and a history of meningitis (15.3%). Papilledema occurred in 14.1%. An empty sella was present in 77.7%. Slit ventricles and venous sinus stenosis comprised 7.7 and 31.8%, respectively. CSF leak most commonly originated from the sphenoid sinus (41.1%), cribriform plate (25.4%), and ethmoid skull base (20.4%). Preoperative opening pressures were normal at 22.4 cm H2O and elevated postoperatively to 30.8 cm H2O. 19.1% of patients underwent shunt placement. CSF leak recurred after repair in 10.5% of patients, 78.6% involving the initial site. A total of 85.7% of these patients were managed with repeat surgical intervention, and 23.2% underwent a shunting procedure. Conclusion Spontaneous CSF leaks represent a distinct variant of IIH, distinguished by decreased prevalence of headaches, lack of visual deficits, and normal opening pressures. Delayed measurement of opening pressure after leak repair may be helpful to diagnose IIH. Permanent CSF diversion may be indicated in patients exhibiting significantly elevated opening pressures postoperatively, refractory symptoms of IIH, or recurrent CSF leak.

scholarly journals Multi-Modal Treatment Approach to Painful Rib Syndrome: Case Series and Review of the Literature

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E465-E471 ◽  
Author(s):  
Andrew Germanovich
Keyword(s):  
Literature Review ◽  
Chest Wall ◽  
Treatment Plan ◽  
Case Series ◽  
Intercostal Nerve ◽  
Pain Clinic ◽  
Review Of The Literature ◽  
Presenting Symptoms ◽  
Modal Treatment ◽  
Manual Manipulation

Background: Mechanical chest wall pain is a common presenting complaint in the primary care office, emergency room, and specialty clinic. Diagnostic testing is often expensive due to similar presenting symptoms that may involve the heart or lungs. Since the chest wall biomechanics are poorly understood by many clinicians, few effective treatments are offered to patients with rib-related acute pain, which may lead to chronic pain. Objective: This case series and literature review illustrates biomechanics involved in the pathogenesis of rib-related chest wall pain and suggests an effective multi-modal treatment plan using interventional techniques with emphasis on manual manipulative techniques. Study Design: Case series and literature review. Setting: Pain clinic in an academic medical center. Results: This is a case series of 3 patients diagnosed with painful rib syndrome using osteopathic palpatory physical examination techniques. Ultrasound-guided intercostal nerve blocks were followed by manual manipulation of mechanically displaced ribs as a part of our multi-modal treatment plan. A review of the literature was undertaken to clarify nomenclature used in the description of rib-related pain, to describe the biomechanics involved in the pathogenesis of mechanical rib pain, and to illustrate the use of effective manual manipulation techniques. Limitation: This review is introductory and not a complete review of all manual or interventional pain management techniques applicable to the treatment of mechanical ribrelated pain. Conclusions: Manual diagnostic and therapeutic skills can be learned by physicians to treat biomechanically complex rib-related chest wall pain in combination with interventional imageguided techniques. Pain physicians should learn certain basic manual manipulation skills both for diagnostic and therapeutic purposes.: Key words: Chest wall pain, rib pain, intercostal neuralgia, slipping rib syndrome, chest pain, intercostal nerve block, chest trauma

Hearing impairment as an unusual presenting sign of Cryptococcus gattii meningoencephalitis

2021 ◽  
Vol 14 (4) ◽  
pp. e239040
Author(s):  
Sophie Gong ◽  
Pirathaban Sivabalan ◽  
Damon P Eisen
Keyword(s):  
Hearing Loss ◽  
Literature Review ◽  
Hearing Impairment ◽  
Case Series ◽  
Cryptococcus Gattii ◽  
Persistent Headache ◽  
Hiv Negative

Hearing loss is an unusual presenting feature of Cryptococcus gattii meningoencephalitis. Two cases of HIV-negative patients who presented with hearing loss are discussed and a literature review of published cases was conducted. Possible mechanisms for hearing loss with C. gattii infection are explored. This case series aims to raise awareness among clinicians that hearing loss can be a concerning feature in patients with persistent headache necessitating further investigation.

scholarly journals Idiopathic intracranial hypertension: 120-day clinical, radiological, and manometric outcomes after stent insertion into the dural venous sinus

2018 ◽  
Vol 129 (3) ◽  
pp. 723-731 ◽  
Author(s):  
Hasan Asif ◽  
Claudia L. Craven ◽  
Almas H. Siddiqui ◽  
Syed N. Shah ◽  
Samir A. Matloob ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Case Series ◽  
Outcome Data ◽  
Venous Sinus ◽  
Stent Insertion ◽  
Complication Rates ◽  
Considerable Uncertainty ◽  
Dural Venous Sinus

OBJECTIVEIdiopathic intracranial hypertension (IIH) is commonly associated with venous sinus stenosis. In recent years, transvenous dural venous sinus stent (DVSS) insertion has emerged as a potential therapy for resistant cases. However, there remains considerable uncertainty over the safety and efficacy of this procedure, in particular the incidence of intraprocedural and delayed complications and in the longevity of sinus patency, pressure gradient obliteration, and therapeutic clinical outcome. The aim of this study was to determine clinical, radiological, and manometric outcomes at 3–4 months after DVSS in this treated IIH cohort.METHODSClinical, radiographic, and manometric data before and 3–4 months after DVSS were reviewed in this single-center case series. All venographic and manometric procedures were performed under local anesthesia with the patient supine.RESULTSForty-one patients underwent DVSS venography/manometry within 120 days. Sinus pressure reduction of between 11 and 15 mm Hg was achieved 3–4 months after DVSS compared with pre-stent baseline, regardless of whether the procedure was primary or secondary (after shunt surgery). Radiographic obliteration of anatomical stenosis correlating with reduction in pressure gradients was observed. The complication rate after DVSS was 4.9% and stent survival was 87.8% at 120 days. At least 20% of patients developed restenosis following DVSS and only 63.3% demonstrated an improvement or resolution of papilledema.CONCLUSIONSReduced venous sinus pressures were observed at 120 days after the procedure. DVSS showed lower complication rates than shunts, but the clinical outcome data were less convincing. To definitively compare the outcomes between DVSS and shunts in IIH, a randomized prospective study is needed.

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