scholarly journals Clinical features and management strategies of Meningitis in adult patients: A hospital based study from Kuwait

2021 ◽  
Vol 11 (3-S) ◽  
pp. 53-60
Author(s):  
Suhail Al Shammri ◽  
Arpita Chattopadhyay ◽  
Geeti Chadha ◽  
Ahmed Zayada ◽  
Faisal Al Shaifan ◽  
...  
Keyword(s):  
Clinical Features ◽  
Clinical Presentation ◽  
Management Strategies ◽  
Positive Culture ◽  
Viral Meningitis ◽  
Antimicrobial Treatment ◽  
Clinical Suspicion ◽  
Adult Patients ◽  
Diagnostic Challenge ◽  
Neisseria Meningitides

Introduction: High mortality rate of meningitis has been reported in Kuwait, however, limited data is available describing this disease in adult patients. With this background, we conducted a prospective study on patients admitted with meningitis, with an objective to describe the risk factors, clinical presentation, disease course and outcome; focus given on diagnostic problems and consequent management difficulties. Methods: Our team diagnosed, managed and documented hospital records of patients (n=44) admitted with suspected meningitis at a referral hospital during 2010-12. Detailed information was collected regarding clinical presentation, CSF analysis, treatment, hospital course and outcome as per Glasgow Outcome Scale (GOS). Results: Bacterial, viral, and tuberculosis (TB) meningitis were seen in 22.8%, 52.3%, and 15.9% of patients. Clinical features of our cohort were consistent with available literature. Positive identification of organism by culture, gram stain, or antigen test was possible in only 6 patients i.e. Streptococcus pneumonae-(n=3), Streptococcus agalactiae-(n=2), Neisseria meningitides-(n=1). CSF polymerase chain reaction was detected positive for Enterovirus RNA, and Herpes simplex virus DNA for one patient each. Empirical antimicrobial treatment directed against common causative organisms was the mainstay of management of bacterial meningitis. Viral meningitis was managed symptomatically. TB meningitis patients were administered anti-tubercular treatment. As per GOS, 38(85.4%) patients recovered with no neurological deficit. Six patients recovered with mild to moderate deficit. Conclusion: Low positive culture rates and inability to identify pathogens have been a diagnostic challenge faced by our team. Strong clinical suspicion, early empiric antibiotic and dexamethasone therapy perhaps contributed to very good recovery in our study. Keywords: Meningitis, Kuwait, Clinical Suspicion, Antibiotic, Dexamethasone

scholarly journals Clinical and epidemiological aspects of the incidence of nonpolio enteroviral infections in Primorsky Krai

2013 ◽  
Vol 18 (6) ◽  
pp. 16-21
Author(s):  
S. L. Kolpakov ◽  
A. F. Popov ◽  
N. V. Mirgorodskaya
Keyword(s):  
Clinical Presentation ◽  
Viral Meningitis ◽  
Adult Patients ◽  
Primorsky Krai ◽  
Seasonal Incidence ◽  
Enteroviral Infection ◽  
Modes Of Transmission ◽  
Minor Illness ◽  
Dramatic Shift ◽  
A Minor

There are considered problems of epidemiology and clinical presentation of enteroviral infections in the territory of Primorsky Krai. Among the hospitalized adult patients during the period from 2006 to 2012 persons aged from 18 to 39 years (49,3%) prevailed. The main clinicalforms of enteroviral infection (EVI) are a "minor" illness (55.6 %) and serous meningitis (21.7 %). In the study of a series of cytokines the differences in patients with the "minor" illness and serous viral meningitis have been identified. From 2009 to 2012 the incidence of EVI has a sporadic seasonal character (previously there was epidemic seasonal incidence). Adults are mainly affected. The epidemic process is formed owing to corporate and school-university types, with a dominated contact-community-acquired pathway of transmission. The dramatic shift in the nature of EVI rate in recent years, likely due to the exchange of the leading modes of transmission pathway, nutritional, which determined the carrying non-typical for the Primorsky Krai pathogen variants (ECHO - 30), by the contact-community-acquired pathway of transmission.

scholarly journals Central Neurilemmoma of Mandible

2013 ◽  
Vol 4 (2) ◽  
pp. 134-137
Author(s):  
Anjana Bagewadi ◽  
Vaishali Keluskar ◽  
Raghavendra Byakodi ◽  
Arvind Shetti
Keyword(s):  
Clinical Features ◽  
Medical Literature ◽  
Clinical Presentation ◽  
Neurogenic Tumor ◽  
Benign Tumors ◽  
Diagnostic Challenge ◽  
Posterior Aspect ◽  
Radiographic Appearance ◽  
Rare Tumors ◽  
Tumors Of Bone

ABSTRACT Neurilemmomas involving bones are rare tumors constituting less than 1% of central benign tumors of bone. Only few cases of neurilemmomas occurring in the mandible have been reported in the medical literature so far. Here, we report a case of neurilemmoma involving the posterior aspect of mandible in a 15 years old male child. This case was a diagnostic challenge as the clinical features and radiographic features mimicked that of an odontogenic cyst but histologically turned out to be a neurilemmoma. Discussion on the incidence, clinical presentation, radiographic appearance, histopathological features and treatment of this benign neurogenic tumor is presented here. How to cite this article Byakodi R, Keluskar V, Bagewadi A, Shetti A. Central Neurilemmoma of Mandible. World J Dent 2013;4(2):134-137.

Isquemia intestinal por trombosis mesentérica en paciente geriátrico, resuelta por intervencionismo. Reporte de caso

2020 ◽  
Vol 63 (2) ◽  
pp. 24-32
Author(s):  
Bianca Eunice López Zenteno ◽  
Georgina Cornelio Rodríguez ◽  
Eduardo Amador Mena
Keyword(s):  
Emergency Department ◽  
Intestinal Ischemia ◽  
Clinical Case ◽  
Clinical Presentation ◽  
Imaging Study ◽  
Clinical Suspicion ◽  
Imaging Diagnosis ◽  
Diagnostic Challenge ◽  
Mesenteric Thrombosis ◽  
Diagnostic Imaging Study

Mesenteric thrombosis represents a vascular urgency caused by the abrupt interruption of blood flow, whether arterial or venous; clinical presentation can be nonspecific, which can represent a diagnostic challenge. According to its vascular etiology, a different therapeutic approach is required. If there is clinical suspicion or signs of peritonitis, the imaging diagnosis can support to identify the presented pathology. On this occasion, there is a clinical case of an 84-year-old http://doi.org/10.22201/fm.24484865e.2020.63.2.04 | Vol. 63, n.o 2, Marzo-Abril 2020 25 patient who goes to the emergency department for generalized abdominal pain, which led to a diagnostic imaging study, to confirm this finding. Key words: Intestinal ischemia; atherosclerosis; Mesenteric thrombosis; catheterization

scholarly journals L-DOPA therapy interferes with urine catecholamine analysis in children with suspected neuroblastoma: a case series

2017 ◽  
Vol 54 (5) ◽  
pp. 616-621 ◽  
Author(s):  
Alison U Kelly ◽  
Rajeev Srivastava ◽  
Ellie Dow ◽  
D Fraser Davidson
Keyword(s):  
Clinical Features ◽  
Metastatic Disease ◽  
Clinical Presentation ◽  
Case Series ◽  
Clinical Suspicion ◽  
First Line ◽  
Urinary Catecholamines ◽  
Drug History ◽  
Diagnostic Confusion ◽  
Catecholamine Analysis

Neuroblastoma is the most common solid extracranial malignancy diagnosed in childhood. Clinical presentation is variable, and metastatic disease is common at diagnosis. Analyses of urinary catecholamines and their metabolites are commonly requested as a first-line investigation when clinical suspicion exists. Levodopa (L-Dopa) therapy is utilized as a treatment for a number of disorders in childhood, including Dopa-responsive dystonia. Neuroblastoma may mimic some of the clinical features of this disorder. L-Dopa can interfere with analysis of urinary catecholamines and their metabolites and complicate the interpretation of results. We present the cases of three children who were prescribed L-dopa at the time of analysis of urinary catecholamines and metabolites as a screen for neuroblastoma, but who did not have the disease. Comparison of their results with those from cases with true neuroblastoma reveal that it is impossible to reliably distinguish true neuroblastoma from L-Dopa therapy using these tests. We recommend that patients should be off L-dopa therapy, if possible when these tests are performed. These cases illustrate the importance of providing clinical details and drug history to the laboratory in order to avoid diagnostic confusion.

scholarly journals Microbial aspects and potential markers for differentiation between bacterial and viral meningitis among adult patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0251518
Author(s):  
Sultan F. Alnomasy ◽  
Bader S. Alotaibi ◽  
Ahmed H. Mujamammi ◽  
Elham A. Hassan ◽  
Mohamed E. Ali
Keyword(s):  
Bacterial Meningitis ◽  
Leucocyte Count ◽  
Predictive Accuracy ◽  
Viral Meningitis ◽  
Adult Patients ◽  
Medical Emergency ◽  
Varicella Zoster ◽  
Glucose Levels ◽  
Neisseria Meningitides ◽  
Acute Meningitis

Objectives Meningitis is a medical emergency with permanent disabilities and high mortality worldwide. We aimed to determine causative microorganisms and potential markers for differentiation between bacterial and viral meningitis. Methodology Adult patients with acute meningitis were subjected to lumber puncture. Cerebrospinal fluid (CSF) microorganisms were identified using Real-time PCR. PCT and CRP levels, peripheral and CSF-leucocyte count, CSF-protein and CSF-glucose levels were assessed. Results Out of 80 patients, infectious meningitis was confirmed in 75 cases; 38 cases were bacterial meningitis, 34 cases were viral meningitis and three cases were mixed infection. Higher PCT, peripheral and CSF-leukocytosis, higher CSF-protein and lower CSF-glucose levels were more significant in bacterial than viral meningitis patients. Neisseria meningitides was the most frequent bacteria and varicella-zoster virus was the most common virus. Using ROC analyses, serum PCT and CSF-parameters can discriminate bacterial from viral meningitis. Combined ROC analyses of PCT and CSF-protein significantly improved the effectiveness in predicting bacterial meningitis (AUC of 0.998, 100%sensitivity and 97.1%specificity) than each parameter alone (AUC of 0.951 for PCT and 0.996 for CSF-protein). Conclusion CSF-protein and serum PCT are considered as potential markers for differentiating bacterial from viral meningitis and their combination improved their predictive accuracy to bacterial meningitis.

scholarly journals CHRONIC BREAST INFECTIONS: CHALLENGING CONDITION TO DIAGNOSE AND TREAT; AN OVERVIEW OF 70 CASES

2021 ◽  
Vol 71 (2) ◽  
pp. 401-04
Author(s):  
Razia Bano ◽  
Sohail Saqib Chatha ◽  
Faiza Sana ◽  
Humaira Latif ◽  
Umar Farooq Chatha ◽  
...  
Keyword(s):  
Clinical Features ◽  
Clinical Presentation ◽  
Management Strategies ◽  
Case Series ◽  
Military Hospital ◽  
Granulomatous Mastitis ◽  
Idiopathic Granulomatous Mastitis ◽  
Diverse Range ◽  
Incision And Drainage ◽  
Common Clinical Presentation

Objective: To share our experience of clinical features and management strategies for treatment of chronic breast infections. Study Design: Case series. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Feb 2016 to Feb 2018. Methodology: We prospectively enrolled patients with diagnosis of chronic breast infections over a period of two years. All patients with infections (less than one month old) were excluded from the study. We studied the demographic characteristics like age, clinical presentation, histopathological features, treatment given and response to the treatment. Results: A total of 70 patients were enrolled in the study. Patients age was between 21-75 years with mean age of 42 ± 5 years. Most common clinical presentation was lump and in duration with abscess in 23 (33%) cases, mass with discharging sinuses in 16 (23%) cases, while 7 (10%) cases had recurrent abscess. Diagnosis was made on core biopsy in 21 cases and in remaining cases with incision and drainage. Histopathology confirmed diagnosis of Idiopathic Granulomatous mastitis in 30 (43%) cases, acute on chronic mastitis in 27 (38%) and chronic granulomatous mastitis in 13 (18%) cases. Out of all cases 29 (41%) showed response to antibacterial treatment while 27 (38%) cases responded to anti tuberculous treatment. Spontaneous resolution occurred in 11 (16%) cases while 3 (4%) cases responded to antifungal treatment. Conclusion: Chronic breast infections are a challenging condition to diagnose and treat for breast surgeons and can present with diverse range of clinical features.

Reconsidering NMIHBA Core Features: Macrocephaly Is Not a So Unusual Sign in PRUNE1-Related Encephalopathy

2020 ◽  
Author(s):  
Roberta Battini ◽  
Enrico Bertini ◽  
Roberta Milone ◽  
Chiara Aiello ◽  
Rosa Pasquariello ◽  
...  
Keyword(s):  
Nervous System ◽  
Differential Diagnosis ◽  
Clinical Features ◽  
Neurodevelopmental Disorder ◽  
Recurrent Mutation ◽  
Clinical Suspicion ◽  
Alexander Disease ◽  
Brain Anomalies ◽  
Progressive Encephalopathy ◽  
Core Features

Abstract PRUNE1-related disorders manifest as severe neurodevelopmental conditions associated with neurodegeneration, implying a differential diagnosis at birth with static encephalopathies, and later with those manifesting progressive brain damage with the involvement of both the central and the peripheral nervous system.Here we report on another patient with PRUNE1 (p.Asp106Asn) recurrent mutation, whose leukodystrophy, inferior olives hyperintensity, and macrocephaly led to the misleading clinical suspicion of Alexander disease. Clinical features, together with other recent descriptions, suggest avoiding the term “microcephaly” in defining this disorder that could be renamed “neurodevelopmental disorder with progressive encephalopathy, hypotonia, and variable brain anomalies” (NPEHBA).

Cervical Spine Aneurysmal Bone Cysts: A Meta-Analysis of 114 Cases and Comparison of Clinical Features between Pediatric and Adult Patients

2017 ◽  
Vol 1 (1) ◽  
pp. 21-29
Author(s):  
Matthew Protas ◽  
Henry Wingfield ◽  
Basem Ishak ◽  
Rong Li ◽  
Rod J. Oskouian ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Clinical Features ◽  
Meta Analysis ◽  
Adult Patients ◽  
Bone Cysts ◽  
Aneurysmal Bone Cysts

scholarly journals Clinical features and prognostic analysis of patients with Aspergillus isolation during acute exacerbation of chronic obstructive pulmonary disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu Gu ◽  
Xianping Ye ◽  
Yu Wang ◽  
Kunlu Shen ◽  
Jinjin Zhong ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Clinical Features ◽  
Antifungal Therapy ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Positive Culture ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background Lower respiratory tract (LRT) specimen culture is widely performed for the identification of Aspergillus. We investigated the clinical features and prognosis of patients with Aspergillus isolation from LRT specimens during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This is a 6-year single-center, real-world study. 75 cases out of 1131 hospitalized AECOPD patients were positive for Aspergillus. These patients were carefully evaluated and finally diagnosed of pulmonary aspergillosis (PA, 60 cases, 80%) or colonization (15 cases, 20%). Comparisons of clinical data were performed between these two groups. A cox regression model was used to confirm prognostic factors of Aspergillus infection. Results The PA group had worse lung function and higher rates of systemic corticosteroid use and broad-spectrum antibiotic use before admission than the colonization group. The PA group had significantly higher in-hospital mortality and 180-day mortality than the colonization group (45% (27/60) vs. 0% (0/15), p = 0.001, and 52.5% (31/59) vs. 6.7% (1/15), p < 0.001, respectively). By multivariable analysis among Aspergillus infection patients, antifungal therapy (HR 0.383, 95% CI 0.163–0.899, p = 0.027) was associated with improved survival, whereas accumulated dose of systemic steroids > 700 mg (HR 2.452, 95% CI 1.134–5.300, p = 0.023) and respiratory failure at admission (HR 5.983, 95% CI 2.487–14.397, p < 0.001) were independently associated with increased mortality. Significant survival differential was observed among PA patients without antifungals and antifungals initiated before and after Aspergillus positive culture (p = 0.001). Conclusions Aspergillus isolation in hospitalized AECOPD patients largely indicated PA. AECOPD patients with PA had worse prognosis than those with Aspergillus colonization. Empirical antifungal therapy is warranted to improve the prognosis for Aspergillus infection.

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