scholarly journals Typhoid Fever Complicated with Bowel Perforation in an HIV Patient

2021 ◽  
Author(s):  
Parackrama Karunathilake ◽  
Thilak Jayalath ◽  
Shamali Abeygunawardena ◽  
Udaya Ralapanawa
Keyword(s):  
Hiv Infection ◽  
Typhoid Fever ◽  
Opportunistic Infections ◽  
Epigastric Pain ◽  
Bowel Perforation ◽  
Delayed Diagnosis ◽  
Case Fatality ◽  
Severe Pneumonia ◽  
Exploratory Laparotomy ◽  
Full Blood Count

Abstract Background Patients with HIV infection often develop multiple complications and comorbidities, including malignancies and opportunistic infections. The association of HIV infection with typhoid fever remains unclear, though there is a clear risk of typhoid in HIV infected persons. Therefore, the diagnosis of typhoid should be considered in HIV infected individuals, mainly when they present with severe ulcerative diarrhoea. Case Presentation A 38-year-old gentleman presented with fever with significant weight loss and anorexia for eight months. He had worked abroad in a middle east country and had recently returned to Sri Lanka. On examination, he was thinly built with a BMI of 18 kg/m2. The initial full blood count revealed lymphopenia, anaemia and thrombocytopenia. He also had mild hyponatremia. His HIV Ag/Ab combo assay became positive, and he was found to have a low CD4 count. While on antiretroviral therapy, he developed nausea, vomiting and diarrhoea while continuing the preexisting fever followed by severe dyspnoea and epigastric pain and tenderness associated with tachypnoea, tachycardia and hypotension. The urgent chest X-ray revealed gas under the diaphragm. An urgent exploratory laparotomy was done, and he was found to have distal ileal perforation with a typhoid ulcer which was histologically confirmed later. During the postoperative period, the patient developed severe pneumonia, scummed despite all the resuscitation care given. Conclusion Fever in HIV patients could be due to HIV itself, opportunistic infections or malignancies. The diagnosis of typhoid should be considered in HIV infected individuals, mainly when they present with severe ulcerative diarrhoea, constipation or bowel perforation. Salmonella typhi infection in HIV/AIDS patients may cause life-threatening complications, where the case fatality rate of typhoid significantly increase when present concurrently with HIV, and the mortality further increases with delayed diagnosis.

scholarly journals Intestinal Perforations Associated With a High Mortality and Frequent Complications During an Epidemic of Multidrug-resistant Typhoid Fever in Blantyre, Malawi

2020 ◽  
Vol 71 (Supplement_2) ◽  
pp. S96-S101
Author(s):  
Franziska Olgemoeller ◽  
Jonathan J Waluza ◽  
Dalitso Zeka ◽  
Jillian S Gauld ◽  
Peter J Diggle ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Low Income ◽  
Intestinal Perforation ◽  
Bowel Perforation ◽  
Temporal Trends ◽  
Case Fatality ◽  
Salmonella Typhi ◽  
Outcome Data ◽  
Morbidity And Mortality ◽  
Abdominal Viscus

Abstract Background Typhoid fever remains a major source of morbidity and mortality in low-income settings. Its most feared complication is intestinal perforation. However, due to the paucity of diagnostic facilities in typhoid-endemic settings, including microbiology, histopathology, and radiology, the etiology of intestinal perforation is frequently assumed but rarely confirmed. This poses a challenge for accurately estimating burden of disease. Methods We recruited a prospective cohort of patients with confirmed intestinal perforation in 2016 and performed enhanced microbiological investigations (blood and tissue culture, plus tissue polymerase chain reaction [PCR] for Salmonella Typhi). In addition, we used a Poisson generalized linear model to estimate excess perforations attributed to the typhoid epidemic, using temporal trends in S. Typhi bloodstream infection and perforated abdominal viscus at Queen Elizabeth Central Hospital from 2008–2017. Results We recruited 23 patients with intraoperative findings consistent with intestinal perforation. 50% (11/22) of patients recruited were culture or PCR positive for S. Typhi. Case fatality rate from typhoid-associated intestinal perforation was substantial at 18% (2/11). Our statistical model estimates that culture-confirmed cases of typhoid fever lead to an excess of 0.046 perforations per clinical typhoid fever case (95% CI, .03–.06). We therefore estimate that typhoid fever accounts for 43% of all bowel perforation during the period of enhanced surveillance. Conclusions The morbidity and mortality associated with typhoid abdominal perforations are high. By placing clinical outcome data from a cohort in the context of longitudinal surgical registers and bacteremia data, we describe a valuable approach to adjusting estimates of the burden of typhoid fever.

scholarly journals Suicidal overdose of dolutegravir: A case report

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Rahul Daimari ◽  
Lawrence Kwape ◽  
Anthony A. Oyekunle
Keyword(s):  
Hiv Infection ◽  
Epigastric Pain ◽  
Clinical Stage ◽  
Integrase Inhibitor ◽  
Liver Function Tests ◽  
Progressive Increase ◽  
Full Blood Count ◽  
First Line ◽  
Treat All ◽  
Stage 1

Dolutegravir (DTG) is the most recently introduced integrase inhibitor for the treatment of HIV infection and is preferred for its superior tolerability and efficacy in both new and pre-treated patients, and infrequent drug interactions. Since January 2017, Botswana has adopted a ‘treat-all’ approach with a DTG-based antiretroviral (ARV) regimen as first-line treatment. We report a 29-year-old man with clinical stage 1 HIV infection who had been started on DTG, tenofovir and emtricitabine eight months prior, and who was admitted following a suicidal overdose of 1500 mg of DTG. He reported only minor symptoms including vomiting, epigastric pain and dizziness; which promptly resolved following supportive treatment. On admission, full blood count, liver function tests and electrocardiography were unremarkable. However, there was a non-progressive increase in serum creatinine. After a month off ARVs, he was successfully restarted on antiretroviral therapy without any serious adverse effect.

scholarly journals Isolated Rectal Perforation Presenting as Peritonitis in a Child with Enteric Fever

2017 ◽  
Vol 07 (01) ◽  
pp. e120-e122
Author(s):  
Digamber Chaubey ◽  
Ajay Verma ◽  
Anand Pandey ◽  
Archika Gupta
Keyword(s):  
Developing Countries ◽  
Typhoid Fever ◽  
Enteric Fever ◽  
Bowel Perforation ◽  
Relevant Literature ◽  
Exploratory Laparotomy ◽  
Rectal Perforation ◽  
Rectosigmoid Junction ◽  
Perforation Peritonitis ◽  
Frequent Site

AbstractTyphoid fever is common in developing countries. It may lead to bowel perforation. Terminal ileum is the most frequent site of perforation. However, perforation at uncommon sites such as rectosigmoid junction may occur occasionally. In this study we report a patient who we treated for perforation peritonitis; on exploratory laparotomy, it turned out to be a rectal perforation. The patient was operated successfully. As an unusual presentation, it is being reported with a review of the relevant literature.

scholarly journals Delayed bowel perforation after instilling over warmed peritoneal dialysate

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xueli Lai ◽  
Mingming Nie ◽  
Xiaodong Xu ◽  
Yuanjie Chen ◽  
Zhiyong Guo
Keyword(s):  
Peritoneal Dialysis ◽  
Bowel Perforation ◽  
Exploratory Laparotomy ◽  
Peritoneal Dialysis Patient ◽  
Case Presentation ◽  
Abdominal Organs ◽  
Home Based ◽  
Dialysis Solution ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Peritoneal dialysis (PD) is a safe and home-based treatment for end-stage renal disease (ESRD) patients. The direct thermal damage of abdominal organs is very rare. Case presentation We report a peritoneal dialysis patient presented abdominal pain and feculent effluent 3 weeks after he instilled hot dialysis solution. In spite of emergency exploratory laparotomy and active treatment, the patient died of septic shock. Biopsy revealed necrosis and perforation of the intestines. Conclusions Delayed bowel perforation by hot fluid is very rare. Standardized performance is of the first importance for peritoneal dialysis patients.

scholarly journals All That Coughs Is Not Covid-19: A Delayed Diagnosis of Disseminated Coccidioidomycosis Following SARS-CoV-2

2021 ◽  
Author(s):  
Joshua C Chen ◽  
Darren Wong ◽  
Sina Rabi ◽  
Scott Worswick ◽  
Brittney DeClerck ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Delayed Diagnosis ◽  
Severe Pneumonia ◽  
Coccidioides Immitis ◽  
Cutaneous Lesions ◽  
Additional Risk ◽  
Northern Mexico ◽  
The Central Nervous System ◽  
Endemic Fungi ◽  
Respiratory Complaints

Abstract Coccidioides immitis (and C. posadasii) are endemic fungi of the southwestern United States and northern Mexico. Uncomplicated, symptomatic Coccidioides infection most commonly causes a self-limited pneumonia; however, immunocompromised patients can manifest severe pneumonia with an additional risk of dissemination to bone, joints, soft tissues, and in the most severe the cases, the central nervous system. In the year 2020 clinicians are challenged with a previously unseen volume of acute respiratory complaints as a result of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. We present a patient with respiratory failure secondary to SARS-CoV-2 who experienced prolonged hypoxia and neurologic deterioration, eventually leading to a diagnosis of occult disseminated coccidiomycosis involving meningitis, miliary-pattern pneumonia, and cutaneous lesions.

Stridor in patients with HIV infection

1995 ◽  
Vol 109 (12) ◽  
pp. 1197-1199 ◽  
Author(s):  
R. B. S. Laing ◽  
P. J. C. Wardrop ◽  
P. D. Welsby ◽  
R. P. Brettle
Keyword(s):  
Hiv Infection ◽  
Broad Spectrum ◽  
Antifungal Agents ◽  
Opportunistic Infections ◽  
Upper Airways ◽  
Airway Intervention ◽  
Advanced Immunodeficiency ◽  
Laryngeal Tumours ◽  
Antibacterial And Antifungal

AbstractThe immunodeficiency which results from HIV infection is associated with a range of opportunistic infections and tumours which may present with the symptoms of upper airways disease. This paper presents three cases of stridor from different causes in patients with HIV infection, all of whom recovered following treatment. The management of this problem requires consideration of the likely aetiology which, in those with advanced immunodeficiency, includes bacterial and fungal laryngitis and epiglottitis as well as rapidly growing laryngeal tumours. Recommendations for the treatment of those with HIV infection who present with severe or rapidonset stridor should include a combination of aggressive airway intervention and broad-spectrum antibacterial and antifungal agents. Laryngeal biopsy for histology and culture is particularly important for those patients who fail to respond to the aforementioned treatment.

Idiopathic CD4+ T-Lymphocytopenia -- Four Patients with Opportunistic Infections and No Evidence of HIV Infection

1993 ◽  
Vol 328 (6) ◽  
pp. 393-398 ◽  
Author(s):  
Robert A. Duncan ◽  
C. Fordham von Reyn ◽  
George M. Alliegro ◽  
Zahra Toossi ◽  
Alan M. Sugar ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Opportunistic Infections

Perforazione ileale da febbre tifoide

2021 ◽  
Vol 24 (9) ◽  
pp. 280-282
Author(s):  
Margherita Piqué ◽  
Elisabetta Ladisa ◽  
Luca Brasili ◽  
Giovanni Putoto ◽  
Lorenzo Iughetti
Keyword(s):  
Typhoid Fever ◽  
Public Health Problem ◽  
Wound Dehiscence ◽  
Exploratory Laparotomy ◽  
Watery Diarrhoea ◽  
Pelvic Cavity ◽  
Major Public Health Problem ◽  
General Malaise ◽  
X Ray ◽  
Clinical Conditions

Typhoid fever continues to be a major public health problem in developing countries and mortality is mainly related to its most frequent complication, namely: intestinal perforation. The paper presents the case of a 12-year-old girl with abdominal pain associated with watery diarrhoea, vomiting, fever and general malaise for two weeks. Typhoid fever was suspected, therefore therapy with ceftriaxone was started. Clinical conditions were worsening, so X-ray of the abdomen was performed with evidence of hydro-aerial levels and ultrasound showing abundant non-homogeneous echogenic material in the pelvic cavity, consistent with purulent ascites. Exploratory laparotomy was performed showing an isolated perforation of the ileus, which was sutured. In the postoperative period, antibiotic therapy was boosted with metronidazole and gentamicin. Due to the wound dehiscence, surgical revision with secondary tension sutures was necessary.

Granulomatosis with polyangiitis presenting as pancreatic disease

2021 ◽  
Vol 14 (3) ◽  
pp. e241033
Author(s):  
Jessie Jia Tao ◽  
Arnav Agarwal ◽  
Ari Benjamin Cuperfain ◽  
Christian Pagnoux
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Epigastric Pain ◽  
Delayed Diagnosis ◽  
Pancreatic Disease ◽  
Small Vessel Vasculitis ◽  
High Dose ◽  
Rapid Progression ◽  
Radiographic Evidence ◽  
High Index Of Suspicion ◽  
Parenchymal Lung

Granulomatosis with polyangiitis (GPA) is a rare necrotising small vessel vasculitis typically associated with oronasal, pulmonary and renal manifestations. Pancreatic disease is an exceedingly rare initial presentation and is associated with delayed diagnosis and rapid progression. We discuss a 66-year-old woman presenting with epigastric pain, elevated lipase and radiographic evidence of focal pancreatitis. She had no relevant medical history and no lithiasis seen on imaging. Pertinent findings include strawberry gingivitis, positive proteinase-antineutrophil cytoplasm antibody (98% specificity) and focal nodular parenchymal lung lesions on CT chest—all of which are consistent with a diagnosis of GPA. She was promptly started on high-dose steroids which resulted in significant clinical and biochemical improvement. Cyclophosphamide was added once biopsy confirmed the absence of malignancy. In order to optimise the clinical outcomes of GPA, physicians must keep a wide differential and high index of suspicion in the setting of unexplained pancreatitis with systemic features.

scholarly journals Genotypical diversity of HIV clades and central nervous system impairment

2011 ◽  
Vol 69 (6) ◽  
pp. 964-972 ◽  
Author(s):  
Indianara Rotta ◽  
Sérgio Monteiro de Almeida
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Hiv Infection ◽  
Opportunistic Infections ◽  
Regulatory Protein ◽  
Viral Meningitis ◽  
Neurological Involvement ◽  
Subtype C ◽  
Vacuolar Myelopathy ◽  
The Central Nervous System

The central nervous system (CNS) and the immune system are considered major target organs for HIV infection. The neurological manifestations directly related to HIV are acute viral meningitis, chronic meningitis, HIV associated dementia, vacuolar myelopathy and involvement of the peripheral nervous system. Changes in diagnosis and clinical management have changed the aspect of HIV infection so that it is no longer a fatal disease, and has become a chronic disease requiring sustained medical management. After HAART the incidence of most opportunistic infections, including those affecting the CNS, has dropped markedly. Some studies suggest that neurological involvement of infected patient occur with different frequency, depending on HIV subtype involved in the infection. Subtype C may have reduced neuroinvasive capacity, possibly due to its different primary conformation of HIV transactivating regulatory protein (Tat), involved in monocyte chemotaxis. This review focus on physiopathologic aspects of HIV infection in CNS and its correlation with HIV clades.

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