scholarly journals Klebsiella Pneumoniae-related Brain Abscess and Meningitis in Adults: Case Report and Literature Review

2021 ◽  
Author(s):  
Jingru Zhao ◽  
Tiantian Huo ◽  
Xintong Luo ◽  
Litao Li ◽  
Baoming Yang
Keyword(s):  
Klebsiella Pneumoniae ◽  
Brain Abscess ◽  
Imaging Techniques ◽  
Sudden Onset ◽  
Antimicrobial Treatment ◽  
Cns Infection ◽  
Klebsiella Species ◽  
Common Cause ◽  
New Antibiotics ◽  
The Right

Abstract Background: Despite the progress of modern neurosurgical techniques, new antibiotics and modern imaging techniques, brain abscess is still a potentially fatal infection. Streptococci have always been the common organisms resulting in brain abscess. Nevertheless, Klebsiella species, once thought to be a less common cause of brain abscess in adults, have become an increasingly important cause of brain abscess, especially in Asia. Case presentation: A 64-year-old woman felt sudden onset severe continuous headache, accompanied by intermittent nausea, vomiting and fever. Meanwhile, she felt tinnitus and had a feeling of swelling in the right ear. Electroencephalogram (EEG) examination showed mild abnormality. A neurological examination revealed obvious nuchal rigidity with four transverse fingers under the chin. Cranial magnetic resonance imaging (MRI) revealed abnormal hyperintensities signals in the left head of caudate nucleus. The cerebral spinal fluid (CSF) common results indicated bacterial infection The next generation sequencing (NGS) of CSF showed the infection of K pneumoniae. The patient was diagnosed with Klebsiella pneumoniae-related brain abscess and meningitis. After positive antimicrobial treatment for nearly two months. The patient got a good recovery.Conclusion: K pneumoniae is once thought to be a less common cause of brain abscess in adults and mainly hospital-acquired. Community-acquired CNS infection (brain abscess and meningitis) caused by K pneumoniae without other metastatic septic abscesses is exceedingly rare. Therefore, we present a rare adult patient with invasive cerebral abscess and meningitis without other invasive abscesses related to K pneumoniae.

Acute Type-A Aortic Dissection with Obstruction of the Right Coronary Artery

2014 ◽  
Vol 17 (4) ◽  
pp. 196
Author(s):  
Erhan Kaya ◽  
Halit Yerebakan ◽  
Daniel Spielman ◽  
Omer Isik ◽  
Cevat Yakut
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Right Coronary Artery ◽  
Type A ◽  
Sudden Onset ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Coronary Syndrome ◽  
Bentall Procedure ◽  
The Right

Occlusion of a coronary artery by an acute type A aortic dissection presents a life-threatening emergency that is rarely seen and easy to misdiagnose. We present the case of a 75-year-old male who experienced sudden onset of severe left-sided chest pain due to an acute type A aortic dissection that obstructed the right coronary artery. Following an initial misdiagnosis of acute coronary syndrome, imaging revealed the presence of an aortic dissection. An emergency modified Bentall procedure was performed, in which the damaged aorta and aortic valve were replaced.

scholarly journals Meat Hook Injury Leading to Brain Abscess: A Rare Occurrence

2021 ◽  
Author(s):  
Batuk Diyora ◽  
Gagan Dhall ◽  
Mehool Patel ◽  
Mazharkhan Mulla ◽  
Nilesh More ◽  
...  
Keyword(s):  
Brain Abscess ◽  
Signs And Symptoms ◽  
Penetrating Injury ◽  
Perilesional Edema ◽  
Delayed Complications ◽  
The Right ◽  
Time Of Presentation ◽  
Local Examination ◽  
Abscess Wall ◽  
Primary Injury

AbstractTransorbital orbitofrontal penetrating injury by a nonmissile object is uncommon. The presentation of this injury varies. This injury can be easily missed during the initial clinical presentation, because the foreign body is sometimes not visible on local examination, the wound on the orbital skin is small, and very subtle signs are present. The patient can present with delayed complications of the primary injury. Our patient was a 33-year-old male who presented with an orbitofrontal injury with a meat hook. He had minor symptoms at the time of presentation, which were overlooked. Three weeks later, he developed signs and symptoms of raised intracranial pressure (ICP). Brain imaging revealed a peripheral rim of contrast-enhancing mass lesion in the right frontal lobe, extending into the right orbit with perilesional edema suggestive of posttraumatic brain abscess. Via right frontal craniotomy, pus was drained out and abscess wall was excised. The patient made good clinical recovery. A higher index of suspicion and sound knowledge of occult penetrating injury patterns is required in the cases of orbital injuries. Appropriate radiological imaging can lead to an earlier and accurate diagnosis, and can prevent its delayed sequela like brain abscess.

scholarly journals Myopic Simple Hemorrhage Presenting as Radial Hemorrhage in Henle’s Fiber Layer

2021 ◽  
pp. 446-450
Author(s):  
Marco Mazzola ◽  
Laura Premoli ◽  
Cristian Metrangolo ◽  
Jennifer Cattaneo ◽  
Elias Premi ◽  
...  
Keyword(s):  
High Myopia ◽  
Sudden Onset ◽  
Fiber Layer ◽  
Characteristic Finding ◽  
Macular Telangiectasia ◽  
Complete Restoration ◽  
Retinal Capillary ◽  
Capillary Plexus ◽  
Specific Sign ◽  
The Right

This case report describes a simple hemorrhage (SH) presenting as radial hemorrhage in Henle’s fiber layer (HFL) in a patient with high myopia. A 26-year-old girl with high myopia was referred to our center for sudden onset of decreased vision and a central scotoma in the right eye (OD). Best corrected visual acuity (BCVA) was 20/100 OD. Fundus examination showed a stellate intraretinal hemorrhage in the fovea of the OD. The hemorrhage was organized in a peculiar petaloid pattern with feathery distal edges, suggesting localization within the radially oriented HFL. The presence of both choroidal neovascularization and microvascular abnormalities consistent with macular telangiectasia type 2 (MacTel 2) were excluded. Based on these findings, a diagnosis of myopic SH was made. At 4-month follow-up BCVA OD spontaneously improved to 20/40, without any treatment been ever administered to the patient. Spectral-domain optical coherence tomography OD showed reabsorption of the hemorrhage and almost complete restoration of the foveal architecture. The intraretinal location and spread of the hemorrhage into the HFL in our patient are an unusual presentation of SH, which vividly highlights the anatomy of the fovea. Since fibers in HFL are quite delicate and loosely arranged, this layer is very susceptible to deposition of transudates, exudates, hemorrhage, and other products. Radial hemorrhage in HFL has been originally reported in 4 patients as complication of MacTel 2. It has been previously postulated that it may represent a characteristic finding in MacTel 2 that may develop as a result of microvascular abnormalities of the deep retinal capillary plexus. On the contrary, our data suggest that radial hemorrhage in the HFL does not represent a characteristic finding of MacTel 2, but must rather be considered a non-specific sign with multiple possible etiologies.

US-guided percutaneous microwave ablation (MWA) of submandibular gland: A new minimal invasive and effective treatment for refractory sialorrhea and treatment response evaluation with contrast-enhanced imaging techniques

2021 ◽  
pp. 1-12
Author(s):  
Hui-Li Zhang ◽  
Jing-E Zhu ◽  
Jia-Xin Li ◽  
Xiao-Long Li ◽  
Li-Ping Sun ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Submandibular Gland ◽  
Microwave Ablation ◽  
Imaging Techniques ◽  
Symptom Relief ◽  
Minimal Invasive ◽  
Whole Saliva ◽  
Patient Reported ◽  
The Right ◽  
Percutaneous Microwave Ablation

A 33 years’ old male complained of excessive salivation with frequent swallowing and spitting, which resulted in communication disturbance, reduced quality of life, and social embarrassment for 19 years. He had been diagnosed as sialorrhea and submandibular gland hyperfunction by stomatologist, then had unilateral submandibular gland resection 13 years ago, but the symptom relief was not satisfactory. After that, he had been treated with glycopyrrolate for less than a year, which was withdrawn because of the short duration of symptomatic control after each tablet take-in and intolerable side effects. With the wish to receive a new treatment with long term effectiveness, low re-operation risk and normal preserved saliva secretion function, the patient was subject to MWA for the right submandibular gland. After systematic clinical evaluation, US-guided percutaneous MWA was successfully performed with an uneventful post-operative course. The volume of the right submandibular gland and ablated area were measured precisely by an ablation planning software system with automatic volume measurement function based on three-dimensional reconstruction of the pre-operative and post-operative enhanced magnetic resonance imaging (MRI) raw data. Finally, the ablated volume was calculated as 62.2% of the whole right submandibular gland. The patient was discharged 1 day after the operation, with symptoms relieved significantly, the mean value of whole saliva flow rate (SFR) decreased from 11 ml to 7.5 ml per 15 minutes. During the follow up by phone three months after operation, the patient reported that the treatment effect was satisfactory, whereas the SFR value became stable as 7 ml per 15 minutes, drooling frequency and drooling severity (DFDS) score decreased from 6 to 5, drooling impact scale (DIS) score decreased from 43 to 26. US-guided percutaneous MWA of submandibular gland seems to be an alternative, minimal invasive, and effective treatment for refractory sialorrhea. We described a patient with refractory sialorrhea treated successfully with ultrasound (US) guided percutaneous microwave ablation (MWA).

Kawasaki disease complicated by cerebral infarction

2003 ◽  
Vol 13 (1) ◽  
pp. 103-105 ◽  
Author(s):  
Kenji Suda ◽  
Masahiko Matsumura ◽  
Shigeru Ohta
Keyword(s):  
Kawasaki Disease ◽  
Cerebral Infarction ◽  
Clinical Situation ◽  
Sudden Onset ◽  
X Ray ◽  
Coronary Aneurysms ◽  
Intracoronary Thrombolysis ◽  
Tissue Plasminogen ◽  
X Ray Computed ◽  
The Right

An 8-month-old boy presented with right hemiplegia of sudden onset after 20 days of Kawasaki disease, which was not initially treated by gamma globulin. Cranial X-ray computed tomography confirmed cerebral infarction as the cause of the right hemiplegia. In subsequent weeks, he developed multiple thromboses in coronary aneurysms. He successfully underwent intracoronary thrombolysis using tissue plasminogen activator without haemorrhagic complications. Cerebral infarction as a complication of Kawasaki disease is rare, and is a difficult clinical situation to manage.

Spontaneous perforation of cervical oesophagus: a rare variant of Boerhaave's syndrome

2009 ◽  
Vol 123 (12) ◽  
pp. 1378-1380 ◽  
Author(s):  
S Mittal ◽  
A Rohatgi ◽  
R P Sutcliffe ◽  
A Botha
Keyword(s):  
Vocal Folds ◽  
Sudden Onset ◽  
Water Soluble ◽  
Uneventful Recovery ◽  
Oesophageal Perforation ◽  
Nasogastric Feeding ◽  
Computed Tomography Scanning ◽  
Difficulty Breathing ◽  
The Right ◽  
False Vocal

AbstractBackground:A 29-year-old man presented with sudden onset of severe pain in his throat, difficulty breathing and a hoarse voice, following an episode of vomiting.Investigations:Initial laboratory tests were normal. The patient underwent fibre-optic nasendoscopy, which demonstrated a haematoma in the piriform fossa. Lateral neck radiography and subsequent computed tomography scanning confirmed a 2 cm, loculated, gas-containing collection at the level of the vallecula in the right posterolateral wall, extending to the false vocal folds and communicating between the right parapharyngeal space and the right carotid sheath. Water-soluble contrast swallow confirmed the diagnosis.Diagnosis:Contained oesophageal perforation.Management:Conservative treatment was adopted involving nil orally, intravenous antibiotics and nasogastric feeding. The patient made an uneventful recovery.

Sudden onset blindness treated with pulse steroid therapy in a patient with microscopic polyangiitis

Open Medicine ◽  
2011 ◽  
Vol 6 (5) ◽  
pp. 631-633
Author(s):  
Yoshiro Horai ◽  
Tomoya Miyamura ◽  
Karin Shimada ◽  
Soichiro Takahama ◽  
Rumi Minami ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Microscopic Polyangiitis ◽  
Oral Prednisolone ◽  
Sudden Onset ◽  
High Dose ◽  
Pulse Steroid Therapy ◽  
Ocular Manifestations ◽  
Dose Oral ◽  
The Right ◽  
Pulse Steroid

AbstractWe report a 71-year-old male with microscopic polyangiitis (MPA) who developed sudden-onset, progressive, bilateral visual loss associated with a relapse of MPA symptoms. The patient was referred to our hospital, and treated with intravenous pulse steroid therapy and high-dose oral prednisolone. Although the right eye remained vision deficient, visual acuity in the left eye recovered. Ocular manifestations of MPA are quite uncommon. This case emphasizes the necessity of early detection and initiation of prompt therapy where ocular manifestations of MPA occur.

HETEROTOPIC PREGNANCY WITH INEVITABLE ABORTION (RIGHT ADNEXAL LIVE ECTOPIC AND COEXISTING INTRAUTERINE TRIPLETS WITH ABSENT FETAL CARDIAC ACTIVITY)

2021 ◽  
pp. 58-59
Author(s):  
Jayanta Sarkar ◽  
Mini Sengupta
Keyword(s):  
Ectopic Pregnancy ◽  
Abdominal Cavity ◽  
Lower Abdominal Pain ◽  
Cardiac Activity ◽  
Exploratory Laparotomy ◽  
Sudden Onset ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Short Period ◽  
The Right

Heterotopic pregnancy describes the occurrence of two or more pregnancies in different implantation sites simultaneously, intrauterine pregnancy coexists withectopic pregnancies (ampullary in 80%). A 27-year-old women (P ,L1) presented to the emergency department with a complaint of sudden onset of right-sided lower abdominal pain with 1+1 vaginal bleeding and had a short period of Amenorrhea. Ultrasonography demonstrated three intrauterine gestational sacwith foetal pole noted but Cardiac activity was absent . The right adnexa showed a heteroechoic area andmoderate amount of free uid was present in the lower abdominal cavity. Ectopic pregnancy was disturbed. An emergency exploratory laparotomy was performed under general anesthesia. Haemoperitoneum was found with a ruptured righttubal ectopic pregnancy as well. Both the ovaries appeared normaland a corpus luteal cyst was presentin right ovary. Right sided salpingectomy was performed with removal of the ectopic mass,heamostasis secured ,on table blood transfusion had been given.Suction evacuation had also been performed by manual vacuum aspirationon same sitting.Both the specimen send for histopathology. Histology conrmedGestational sac suggestive of an intra uterine pregnancy coexists with ectopic pregnancy. Left tube and both ovaries were found healthy. Episodes of PID also have a strong correlation with occurrence of ectopic gestation. Once diagnosis of heterotrophic pregnancy has been made the management is essentially surgical.

An Infant with COVID-19-Associated Intussusception

2021 ◽  
pp. 000313482110474
Author(s):  
Gwyneth A. Sullivan ◽  
Nicholas J. Skertich ◽  
Kody B. Jones ◽  
Michael Williams ◽  
Brian C. Gulack ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Lymphoid Hyperplasia ◽  
Computed Tomography Scan ◽  
Ileocolic Intussusception ◽  
Common Cause ◽  
Caregiver Education ◽  
Intermittent Abdominal Pain ◽  
The Right ◽  
Tomography Scan

Intussusception is the most common cause of bowel obstruction in infants four to ten months old and is commonly idiopathic or attributed to lymphoid hyperplasia. Our patient was a 7-month-old male who presented with two weeks of intermittent abdominal pain associated with crying, fist clenching and grimacing. Ultrasound demonstrated an ileocolic intussusception in the right abdomen. Symptoms resolved after contrast enemas, and he was discharged home. He re-presented similarly the next day and was found to be COVID-19 positive. Computed tomography scan demonstrated a left upper quadrant ileal-ileal intussusception. His symptoms spontaneously resolved, and he was discharged home. This suggests that COVID-19 may be a cause of intussusception in infants, and infants presenting with intussusception should be screened for this virus. Additionally, recurrence may happen days later at different intestinal locations. Caregiver education upon discharge is key to monitor for recurrence and need to return.

An Important Public Health Problem "Carbapenem Resistant Enterobacteriaceae Frequency": An Example From A Training And Research Hospital

2021 ◽  
Vol 6 (14) ◽  
pp. 51-55
Author(s):  
Ülkü VERANYURT ◽  
Betül AKALIN
Keyword(s):  
Public Health ◽  
Klebsiella Pneumoniae ◽  
Klebsiella Oxytoca ◽  
Public Health Problem ◽  
Important Public Health Problem ◽  
Klebsiella Species ◽  
Research Hospital ◽  
Control Programs ◽  
Carbapenem Resistant ◽  
Training And Research

Background: Carbapenem-resistant Enterobacterales (CRE) infections are a significant threat to public health due to the limited availability of antibiotics and the effect on mortality. This study was conducted retrospectively to determine the prevalence of CRE in a teaching and research hospital in Istanbul. Materials and Methods: In 2016, 2017 and in the first half of 2018 Klebsiella species were evaluated retrospectively in culture samples that were sent to Microbiology Laboratory in an educational hospital. The typing of Klebsiella species were performed with MALDITOF-MS device (Biomerieux, France). Imipenem, merapenem, ertapenem susceptibilities of the strains were evaluated with VITEC2 Compact (Biomerieux, France) according to EUCAST (European Committee on Antimicrobial Susceptibility Testing). If the strains were found to be resistant, the results were confirmed by the antibiotic gradient test. Results: In our study, 257 samples; Klebsiella oxytoca 9 (3.49%) and Klebsiella pneumoniae 248 (96.51%) were detected. 130 endotracheal aspirates, 57 wounds, 34 blood, 15 urine, 9 sputum, 3 catheters, 4 tissue biopsies, 2 mediastinum, 2 peritoneal fluid and 1 pleural fluid strains were identified. While none of the Klebsiella oxytoca strains were resistant to carbapenems, the percentages of Klebsiella pneumoniae resistance against imipenem, merapenem and ertapenem were found to be 23.29%, 16.94% and 29.44% respectively. Conclusion: The increasing problem of carbapenem-resistant (CR) Klebsiella pneumoniae in the last decade has been observed in our hospital for the last 2 years. CR strains often show increased resistance to other antibiotics and their treatment possibilities are limited. It increases the importance of controlling this factor. The application of effective infection control programs and the use of rational antibiotics are of great importance.

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