scholarly journals Cryptococcal meningitis in young adults: clinical characteristics and therapeutic outcomes

2019 ◽  
Author(s):  
Che-Wei Hsu ◽  
Chia-Yi Lien ◽  
Jun-Jun Lee ◽  
Wen-Neng Chang ◽  
Wan-Chen Tsai
Keyword(s):  
Young Adults ◽  
Prognostic Factors ◽  
Young Adult ◽  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Laboratory Data ◽  
Adult Group ◽  
Laboratory Findings ◽  
Therapeutic Outcomes

Abstract Background: The clinical characteristics of cryptococcal meningitis (CM) in young adults (≤ 40 years old) have not been reported. The purpose of this study was to delineate the clinical characteristics, laboratory findings and therapeutic outcomes of young adults with CM, and compare them with older adults (> 40 years old) with CM. Methods: Ninety-nine adult patients with CM (64 men, 35 women) were enrolled from 2002-2016, of whom 26 were ≤ 40 years old (young adult group) and 73 were > 40 years old (non-young adult group). The clinical characteristics, laboratory data and therapeutic outcomes of these two groups were compared. The prognostic factors of the young adult CM patients were analyzed, and the clinical characteristics and laboratory data between the young adult CM patients with and without acquired immune-compromised syndrome (AIDS) were compared. The modified Rankin scale (mRS) was used to evaluate the outcomes of the survivors at the time of discharge and at 1 year of follow-up. Results: The young adult CM patients had a significantly higher incidence of headache as the clinical presentation. There were no significant clinical differences between the young adult CM patients with and without AIDS. There were no significant prognostic factors in the young adult CM patients, but the young adult survivors had better outcomes (mRS score 0-2) than the non-young adult group. Conclusion: The young adult CM patients had a higher incidence of headache as the clinical presentation, and the young adult CM survivors had better clinical outcomes.

Prediction of hospital discharge outcome from changes in cerebrospinal fluid/serum albumin quotient and cerebrospinal fluid lactate dehydrogenase in patients with cryptococcal meningitis

2021 ◽  
Author(s):  
Yue Huang ◽  
Jun Zou ◽  
Ke-ming Zhang ◽  
Hang Li ◽  
Dong-ying Hu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Prognostic Factors ◽  
Lactate Dehydrogenase ◽  
Serum Albumin ◽  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Leukocyte Count ◽  
Laboratory Findings ◽  
Csf Lactate ◽  
Hiv Negative

Aim: This study aims to provide reliable prognostic factors for patients with cryptococcal meningitis (CM). Patients & methods: Clinical characteristics and laboratory findings of CM patients were retrospectively reviewed. Results: Sixty-three patients with CM were enrolled and 38/63 were confirmed to be HIV serology positive. Among clinical characteristics, headache, nausea and/or vomiting, and fever were the most common symptoms. Among cerebrospinal fluid (CSF) parameters, changes in leukocyte count, lactate dehydrogenase and chloride were significantly associated with the outcome. An increased CSF/serum albumin quotient (QAlb) was indicative of an unfavorable outcome in HIV-negative patients. Conclusion: CSF lactate dehydrogenase and QAlb may improve the prediction of outcomes in patients with CM.

scholarly journals 398. Description of a Large Pediatric Lyme Arthritis Cohort in an Endemic Region

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S203-S204
Author(s):  
Ancil J Abney ◽  
Megan Reinhard ◽  
Bazak Sharon
Keyword(s):  
Clinical Setting ◽  
Clinical Presentation ◽  
Laboratory Data ◽  
Chronic Arthritis ◽  
Lyme Arthritis ◽  
Steady Increase ◽  
Medical Organization ◽  
Endemic Region ◽  
Laboratory Findings ◽  
High Index Of Suspicion

Abstract Background In endemic areas, Lyme arthritis (LA) is a leading cause of joint swelling. Due to the shared inflammatory nature and common clinical features, acute LA is often misdiagnosed as septic arthritis (SA) while recurrent disease is at times difficult to differentiate from other causes of chronic arthritis. In Minnesota, there has been a steady increase in cases of Lyme disease. This has not been met by a clear guideline and there is no consensus for the management of pediatric arthritis. In this context, we sought to characterize the epidemiology and clinical presentation of a large local cohort. Methods This is a retrospective review of medical charts from children with confirmed LA, presented at a large academic medical organization in the Upper Midwest between January 2011 to December 2017. Demographic, clinical, and laboratory data were collected and analyzed. Results Lyme arthritis was confirmed in 109 children. Acute presentation was more common (67) while the rest (42) had either persistence or reoccurrence of symptoms [Figure 1]. Elevated inflammatory markers and synovial pleocytosis were common, unlike fever and refusal to bear weight which were seen occasionally [Figure 2]. Seasonal distribution and the clinical setting for initial presentation as well as admissions are summarized in Figure 3. The knee was involved in all but 2 patients, both had acute monoarthritis (elbow and hip) [Figure 4]. Conclusion LA causes a spectrum of disease, is seen year round, and across the clinical setting continuum. Acute knee monoarthritis is the most common presentation (54% in our cohort) and is often misdiagnosed as SA leading to unnecessary hospitalizations and aggressive interventions. This occurs more frequently at the ED setting and for children with significant synovial pleocytosis. When evaluating a child with arthritis, laboratory findings are none specific and should be used in caution. Pediatric providers in endemic regions, especially those in primary, hospital, or emergency care must be familiar with the clinical presentation and have a high index of suspicion for LA in order to prevent mismanagement. Disclosures All authors: No reported disclosures.

scholarly journals Older adults show a more sustained pattern of effortful listening than young adults

2020 ◽  
Author(s):  
Ronan McGarrigle ◽  
Sarah Knight ◽  
Lyndon Rakusen ◽  
Jason Geller ◽  
Sven Mattys
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Young Adult ◽  
Sentence Processing ◽  
Daily Life ◽  
Recognition Task ◽  
Adult Group ◽  
Listening Effort ◽  
Age Related ◽  
Listening Task

Listening to speech in adverse conditions can be challenging and effortful, especially for older adults. This study examined age-related differences in effortful listening by recording changes in the task-evoked pupil response (TEPR; a physiological marker of listening effort) both at the level of sentence processing and over the entire course of a listening task. A total of 65 (32 young adults; 33 older adults) participants performed a speech recognition task in the presence of a competing talker, while moment-to-moment changes in pupil size were continuously monitored. Participants were also administered the Vanderbilt Fatigue Scale; a questionnaire assessing daily life listening fatigue within four domains (social, cognitive, emotional, physical). Normalized TEPRs were overall larger and more steeply rising and falling around the peak in the older versus the young adult group during sentence processing. Additionally, mean TEPRs over the course of the listening task were more stable in the older versus the young adult group, consistent with a more sustained recruitment of compensatory attentional resources to maintain task performance. No age-related differences were found in terms of total daily life listening fatigue; however, older adults reported higher scores than young adults within the social domain. Overall, this study provides evidence for qualitatively distinct patterns of physiological arousal between young and older adults consistent with age-related upregulation in resource allocation during listening. A more detailed understanding of age-related changes in the subjective and physiological mechanisms that underlie effortful listening will ultimately help to address complex communication needs in aging listeners.

scholarly journals Clinical characteristics and antibody response to SARS-CoV-2 spike 1 protein using the VITROS Anti-SARS-CoV-2 antibody tests in COVID-19 patients in Japan

2020 ◽  
Author(s):  
Mayu Nagura-Ikeda ◽  
Kazuo Imai ◽  
Katsumi Kubota ◽  
Sakiko Noguchi ◽  
Yutaro Kitagawa ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Laboratory Data ◽  
Igg Antibody ◽  
Laboratory Findings ◽  
Humoral Immune ◽  
Disease Prognosis ◽  
Antibody Assays ◽  
Clinical Background ◽  
Clinical Records ◽  
Antibody Tests

Abstract Background: We evaluated clinical characteristics and the clinical utility of VITROS SARS-CoV-2 antibody tests according to COVID-19 severity in patients in Japan. Methods: We analyzed 255 serum specimens from 130 COVID-19 patients and examined clinical records and laboratory data. Presence of total (IgA, IgM, and IgG) and specific IgG antibody for the spike 1 antigen of SARS-CoV2 was determined using VITROS Anti-SARS-CoV-2 antibody tests. Findings: Overall, 98 (75.4%) and 32 (24.6%) patients had mild and severe COVID-19, respectively. On admission, 76 (58.5%) and 45 (34.6%) patients were positive for total and IgG antibody assays. Among 91 patients at discharge, 90 (98.9%) and 81 (89.0%) patients were positive for total and IgG antibody, respectively. Clinical background and laboratory findings on admission, but not the prevalence or concentration of total or IgG antibody, were associated with disease prognosis. Total and IgG antibody intensity were significantly higher in severe cases than in mild cases in serum collected after 11 days from onset, but not within 10 days. Conclusion: VITROS Anti-SARS-CoV-2 Total and IgG assays will be useful as supporting diagnostic and surveillance tools and for evaluation of humoral immune response to COVID-19. Clinical background and laboratory findings are preferable predictors of disease prognosis.

scholarly journals High in-hospital mortality due to COVID-19 in a community hospital in Spain: a prospective observational study

2020 ◽  
Author(s):  
Joan Carles Trullàs ◽  
Eva Ruiz ◽  
Clara Weisweiler ◽  
Gemma Badosa ◽  
Alba Serra ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Characteristics ◽  
Prospective Observational Study ◽  
Community Hospital ◽  
Clinical Presentation ◽  
Lung Ultrasound ◽  
Case Series ◽  
Hospitalized Patients ◽  
Laboratory Findings ◽  
Old Patients

Abstract Background To describe the clinical characteristics and outcome of patients with COVID-19 in a community hospital in SpainMethods Prospective, single-centre case series of the first 100 consecutive hospitalized patients with COVID-19 at a community hospital in Spain, from March 16 to April 20, 2020. Demographics, comorbidities, clinical presentation, radiologic and laboratory findings, treatment and clinical outcome were collected.Results Of the 100 patients included in the study, the median age (IQR; range) was 75 years (20; 28–96) and 52% were men. The most common comorbidities were hypertension (63%), diabetes (22%) and cardiovascular diseases (28%). The most common symptoms were fever (80%), cough (69%), fatigue (59%) and dyspnea (52%) and 64% had respiratory insufficiency. Bilateral interstitial infiltrates (65/100, 65%) and bilateral vertical “B-kerley” lines (38/46, 82.6%) were the most common imaging manifestations in chest radiographs and lung ultrasound, respectively. All patients received supplementary oxygen, 69 (69%) received medical treatment (the most common regimen being hydroxychloroquine plus azithromycin in 66 patients) and 12% were treated with glucocorticoids. During hospitalization, 26 patients (26%) died, 10 (10%) were transferred to ICU and 64 (64%) were discharged at home. Mortality or ICU admission was more frequent in advanced age and with comorbidities.Conclusions This case series provides clinical characteristics and outcome of consecutively hospitalized patients with COVID-19 admitted to a community hospital in Spain. The majority were old patients, with comorbidities and in-hospital mortality was high (26%).

scholarly journals Clinical Characteristics and Predictors of Mortality for Young Adults with Severe COVID-19: A Retrospective Study

2020 ◽  
Author(s):  
Yanjiao Lu ◽  
Zhenli Huang ◽  
Meijia Wang ◽  
Kun Tang ◽  
Shanshan Wang ◽  
...  
Keyword(s):  
Young Adults ◽  
Logistic Regression ◽  
Elevated Level ◽  
Clinical Characteristics ◽  
Troponin I ◽  
Multivariate Logistic Regression Analysis ◽  
Laboratory Findings ◽  
Predictors Of Mortality ◽  
Hs Crp ◽  
D Dimer

Abstract Background and objective: Little is yet known whether pathogenesis of COVID-19 is different between young and elder patients. Our study aimed to investigate the clinical characteristics and provide predictors of mortality for young adults with severe COVID-19.Methods: A total of 77 young adults with confirmed severe COVID-19 were recruited retrospectively at Tongji Hospital. Clinical characteristics, laboratory findings, treatment and outcomes were obtained from electronic medical records. The prognostic effects of variables were analyzed using logistic regression model.Results: In this retrospective cohort, non-survivors showed higher incidence of dyspnea and co-existing laboratory abnormalities, compared with young survivals in severe COVID-19. Multivariate logistic regression analysis showed that lymphopenia, elevated level of d-dimer, hypersensitive cardiac troponin I (hs-CTnI) and high sensitivity C-reactive protein (hs-CRP) were independent predictors of mortality in young adults with severe COVID-19. Further analysis showed that severely young adults with two or more factors abnormalities above would be more prone to death. The similar predictive effect of above four factors had been observed in all-age patients with severe COVID-19.Conclusion: Lymphopenia, elevated level of d-dimer, hs-CTnI and hs-CRP predicted clinical outcomes of young adults with severe COVID-19.

scholarly journals Clinical Characteristics and Predictors of Mortality in Young Adults with Severe COVID-19. A Retrospective Observational Study

2021 ◽  
Author(s):  
Yanjiao Lu ◽  
Zhenli Huang ◽  
Meijia Wang ◽  
Kun Tang ◽  
Shanshan Wang ◽  
...  
Keyword(s):  
Young Adults ◽  
Logistic Regression ◽  
Elevated Level ◽  
Clinical Characteristics ◽  
Troponin I ◽  
Multivariate Logistic Regression Analysis ◽  
Laboratory Findings ◽  
Predictors Of Mortality ◽  
Hs Crp ◽  
D Dimer

Abstract Background and objective: Little is yet known whether pathogenesis of COVID-19 is different between young and elder patients. Our study aimed to investigate the clinical characteristics and provide predictors of mortality for young adults with severe COVID-19.Methods: A total of 77 young adults with confirmed severe COVID-19 were recruited retrospectively at Tongji Hospital. Clinical characteristics, laboratory findings, treatment and outcomes were obtained from electronic medical records. The prognostic effects of variables were analyzed using logistic regression model.Results: In this retrospective cohort, non-survivors showed higher incidence of dyspnea and co-existing laboratory abnormalities, compared with young survivals in severe COVID-19. Multivariate logistic regression analysis showed that lymphopenia, elevated level of d-dimer, hypersensitive cardiac troponin I (hs-CTnI) and high sensitivity C-reactive protein (hs-CRP) were independent predictors of mortality in young adults with severe COVID-19. Further analysis showed that severely young adults with two or more factors abnormalities above would be more prone to death. The similar predictive effect of above four factors had been observed in all-age patients with severe COVID-19.Conclusion: Lymphopenia, elevated level of d-dimer, hs-CTnI and hs-CRP predicted clinical outcomes of young adults with severe COVID-19.

Malignancy in non-HIV infected patients with cryptococcal meningitis: a retrospective study

2020 ◽  
Author(s):  
Xiaofeng Xu ◽  
Liping Cao ◽  
Yijie Wang ◽  
Jia Liu ◽  
Qing Dong ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Emission Computed Tomography ◽  
Positron Emission ◽  
Therapeutic Outcomes ◽  
Solid Malignancies ◽  
Pet Ct ◽  
Immunodeficiency Virus ◽  
Positron Emission Computed Tomography ◽  
Increase Rate

Abstract Background: Cryptococcal meningitis (CM) was found to be coexist with malignancy in non-human immunodeficiency virus (HIV) infected patients. The purpose of this study was to evaluate the clinical characteristics and therapeutic outcomes of CM in non-HIV infected patients with malignancy.Methods: A total of 320 CM patients were enrolled for analysis from January 2013-May 2019. One hundred and four patients underwent positron emission computed tomography (PET-CT) examination. The demographics, clinical characteristics, microbiological, radiological, therapeutic outcomes were analyzed in CM patients with and without malignancy.Results: Twelve patients with malignancy were found, of which 7 malignancy before CM (MBC), 5 malignancy after CM (MAC). CM patients with malignancy were older than non-malignancy ones. The prognosis of MBC patients was comparable to that of non-malignancy patients, but was extremely poor in MAC patients. Four out of 5 CM patients, who was suggested diagnosis as malignancy by PET-CT, were finally confirmed.Conclusions: This study found an increase rate of solid malignancies in CM patients. Screening malignancy in older CM patients was very important because it is closely related to prognosis and might affect treatment strategy. PET-CT might be a useful tool for early malignancy screening in CM.

scholarly journals Emergence of Cytomegalovirus Mononucleosis Syndrome Among Young Adults in Hong Kong Linked to Falling Seroprevalence: Results of a 14-Year Seroepidemiological Study

2018 ◽  
Vol 5 (10) ◽  
Author(s):  
Siddharth Sridhar ◽  
Tom W H Chung ◽  
Jasper F W Chan ◽  
Vincent C C Cheng ◽  
Susanna K P Lau ◽  
...  
Keyword(s):  
Young Adults ◽  
Hong Kong ◽  
Adult Population ◽  
Antiviral Treatment ◽  
Laboratory Data ◽  
Unknown Origin ◽  
Liver Function Tests ◽  
Tertiary Hospital ◽  
Cmv Infection ◽  
Laboratory Findings

Abstract Background Cytomegalovirus (CMV) mononucleosis is a manifestation of primary CMV infection. This study aims to establish the link between long-term population CMV seroepidemiological trends and incidence of CMV mononucleosis requiring hospitalization. Furthermore, by analyzing serial laboratory data of patients hospitalized with CMV mononucleosis, we aim to provide insights into the natural history of this syndrome. Methods We conducted a 14-year observational study in a tertiary hospital in Hong Kong. Cytomegalovirus immunoglobulin G data of 2349 adults were analyzed for trends in CMV susceptibility during the study period. The clinical features, risk factors, antiviral treatment data, and laboratory findings of 25 adult patients presenting with CMV mononucleosis during this period were retrieved. Results Susceptibility to CMV infection among the adult population aged 18–45 in Hong Kong increased from 14.5% in 2004 to 32.2% in 2012–2017 (P < .001), and this led to doubling of observed CMV mononucleosis incidence among inpatients in our center during the study period. All patients with CMV mononucleosis were hospitalized for investigation of fever of unknown origin. Household contact with young children was the most common risk factor followed by recent overseas travel. Derangement of liver function tests was universally observed and was more severe than in previously published western CMV mononucleosis patient cohorts. Most patients showed clinical improvement within the third week of illness. Conclusions We conclude that increasing CMV susceptibility among young adults in Hong Kong has resulted in a rising observed incidence of CMV mononucleosis, which is typically a self-limited illness characterized by anicteric hepatitis.

scholarly journals Clinical characteristics and outcome of neonates with neonatal mastitis: a hospital based study

2021 ◽  
Vol 9 (1) ◽  
pp. 58
Author(s):  
Mohmad S. Chesti ◽  
Shilakha Chaman ◽  
Naveed Shahzad ◽  
Sheenam Gazala
Keyword(s):  
Clinical Characteristics ◽  
Demographic Data ◽  
Laboratory Data ◽  
Purulent Discharge ◽  
Total Leucocyte Count ◽  
Coagulase Negative Staphylococci ◽  
Laboratory Findings ◽  
Medical College ◽  
Csf Analysis ◽  
Mrsa Strains

Background: Neonatal mastitis is not an uncommon condition, mostly occurs due to Staphylococcus aureus (S. aureus), sometimes leading to breast abscess with detrimental effects.Methods: Our study was retrospective, hospital based observational study carried out at Government Medical College, Baramulla from August 2017 to August 2019, all cases with features of neonatal mastitis were included in the study and also admitted in hospital. Clinical and laboratory data along with demographic data was recorded and analysed.Results: 23 cases were included with age of presentation 8 to 28 days. Babies particularly male babies received breast massage (N=10), besides this pain (15) and redness (N=23) was most common clinical characteristics purulent discharge seen in 2 cases and 7 cases were febrile. Laboratory findings include decreased total leucocyte count (TLC) and positive C-reactive protein (CRP), pus culture from samples revealed S. aureus in 11 cases, coagulase-negative staphylococci (CONS) in 3 cases, E. coli in 2 cases and sterile in 7 cases. Most of cases were sensitive to penicillin (N=14) and in two cases were methicillin resistant S. aureus (MRSA) strains resistant to methicillin. All patients responded well to intravenous (IV) antibiotics while as 8 cases required (I and D), blood cultured showed growth in 19 cases while cerebrospinal fluid (CSF) analysis was sterile in all patients. Above all babies were discharged successfully without any complications.Conclusions: We concluded from our study that neonatal mastitis if treated early has better outcome rather than practicing misbeliefs like breast massage to express so called witch’s milk, in addition we conclude that neonatal mastitis is not an uncommon problem.

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