scholarly journals Epidemiological Distribution of Reported West Nile cases in Houston, Texas, 2014-2017

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Razina Khayat ◽  
Alex Nguyen ◽  
Sudipa Biswas ◽  
Hafeez Rehman ◽  
Kirstin Short ◽  
...  
Keyword(s):  
Mental Status ◽  
Disease Surveillance ◽  
Clinical Symptoms ◽  
White Male ◽  
Altered Mental Status ◽  
West Nile ◽  
Limb Weakness ◽  
Infected People ◽  
Vector Borne Diseases ◽  
Disease Surveillance System

ObjectiveTo demonstrate an overview of the epidemiological and clinical distribution of reportable West Nile cases in Houston, Texas, from 2015-2017.IntroductionWest Nile virus (WNV) is considered the leading cause of domestically acquired arboviral disease and is spread through mosquitoes. In general, the majority of the cases are asymptomatic. One in five people infected will display mild symptoms like fever, headache, body ache, nausea, and vomiting. Only about 1 in 150 people infected will develop serious neurologic complications such as encephalitis and meningitis. According to CDC, in 2017, there were 133 confirmed cases including 5 deaths and 14 presumptive blood donors reported in the State of Texas. Out of the confirmed cases, there were 85 neuroinvasive and 48 non-neuroinvasive disease cases.MethodsData were extracted from Houston’s Electronic Disease Surveillance System (HEDSS) from January 1, 2014, to December 31, 2017. A total of 45 confirmed cases are included in this analysis to examine the epidemiologic characteristics of the WNV cases.A confirmed case is an illness with onset of acute focal limb weakness and an MRI showing a spinal cord lesion largely restricted to gray matter and spanning one or more spinal segments.ResultsAmong the confirmed cases, 67% of were males. Age group 60 and above (47%) had the highest proportion of WNV cases. Whites (26%) represented the highest number of confirmed cases followed by Hispanics (24%).Seventy six percent of the cases were hospitalized. Non-neuroinvasive clinical presentations found among confirmed WNV cases were fever (94%), headache (76%) followed by chills and rigors (68%). Among the neuroinvasive presentations, altered mental status had the highest proportion (24%), followed by stiff necks (18%), Ataxia (12%), and seizure (9%).ConclusionsWNV is mostly prevalent in White male adults over 60 years of age, with majority of cases have common neuroinvasive symptoms like altered mental status, stiff necks, and Ataxia. For non-neuroinvasive cases clinical symptoms were fever, headache, chills and rigors.WNV infection is a markedly underreported disease as most of the infected people do not seek medical care due to mild or no symptoms. Currently there are no specific treatments available. Thus, continued monitoring and surveillance activities are warranted for prevention and control of WNV complications as well as decreasing the risk of infection.ReferencesCDC: West Nile Virus [Internet]. Atlanta: Center for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), and Division of Vector-Borne Diseases (DVBD); Last reviewed: September 19, 2018.Available from: https://www.cdc.gov/westnile/index.html

scholarly journals Unusual Presentation of Myxedema Coma in Type 1 Diabetes Mellitus With Hyperglycemia and Polysubstance Abuse

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A971-A972
Author(s):  
Yumna Hamid ◽  
Steven Douedi ◽  
Johnathan Nold ◽  
Raquel Kristin Ong ◽  
Jennifer Cheng ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Mortality Rate ◽  
Mental Status ◽  
White Male ◽  
Altered Mental Status ◽  
Close Monitoring ◽  
Urine Drug Screen ◽  
Metabolic Encephalopathy ◽  
Myxedema Coma

Abstract Background: Myxedema coma is a severe manifestation of hypothyroidism that typicallypresents with altered mental status and requires close monitoring in the intensive care unit dueto 30-60% mortality rate. Clinical Case: A 56 year old white male with type 1 diabetes with recurrent DKA, polysubstanceabuse, Bipolar disorder on lithium and post surgical hypothyroidism presented due to change inmental status after being brought in by sister. Patient was found to be lethargic with confusionthat worsened over the last week. The patient was admitted several times in the past monthsecondary to pneumonia, sepsis, and recurrent DKA. On physical examination, he found to have lethargy, macroglossia, hyporeflexia, and periorbitaledema. Patient had acute respiratory failure with metabolic encephalopathy, bradycardia,tachypnea, severe hyperglycemia, hypotension of 77/51, tachypnea of 31 breaths per minuteand hyponatremia. Laboratory findings showed T4 levels 2.87(n=5.28-9.87ug/dL) withundetectable FT4 and elevated TSH (>50, n=0.300-4.500uIU/mL). Electrolyte panel showedhyponatremia (133, n=136-145mmol/L), hyperglycemia up to 532mg/dL and lithium levels werewithin normal limits (n=0.5-1.5 mmol/L). Urine drug screen was positive for cocaine. A CT scanof the head was negative. His myxedema score was diagnostic (>60). The patient wasdiagnosed with myxedema coma and admitted to the ICU. Patient was treated with IV LT4 400mcg, LT3 10mcg and hydrocortisone 100mg and started onIV LT4 100mcg daily, LT3 2.5mcg daily and hydrocortisone 100mg Q8 hours. There was wideglycemic variation from 46-532 mg/dL on POCT. The patient improved clinically, with resolutionof lethargy, confusion, fatigue, improved appetite, and improved lab work of FT3 2.30 (n=2.28-3.96pg/mL), FT4 at 0.76 (n=0.50-1.26ng/dL) and was downgraded from the ICU. On hospitalday four, he was transitioned to oral levothyroxine and discharged home. Conclusion: It is important to diagnose early and promptly manage decompensatedhypothyroidism in the setting of other comorbidities such as hyperglycemia in diabetes andpolysubstance abuse. The cocaine in the system may cause tachypnea and tachycardia. Manyconditions may have altered mental status, but with a history of hypothyroidism, Myxedemacoma should be on the differential due to its high mortality rate.

scholarly journals Evaluation of Mortality and Morbidity According to Initial Symptoms in COVID-19 Patients Using Clinical Epidemiologic Data from the Korea Centers for Disease Control & Prevention

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 688
Author(s):  
So Young Kim ◽  
Dae Myoung Yoo ◽  
Chanyang Min ◽  
Joo-Hee Kim ◽  
Hyo Geun Choi
Keyword(s):  
Disease Control ◽  
Mental Status ◽  
Respiratory Symptoms ◽  
Clinical Symptoms ◽  
Altered Mental Status ◽  
High Morbidity ◽  
Shortness Of Breath ◽  
Mortality And Morbidity ◽  
Initial Symptoms ◽  
Centers For Disease Control

Background and Objectives: This study aimed to investigate whether initial symptoms of COVID-19 are associated with mortality and morbidity. Materials and Methods: The data of 5628 laboratory-confirmed COVID-19 patients were collected by the Korea Centers for Disease Control and Prevention. The maximum level of morbidity during hospital admission was classified as mild or severe, and patient mortality was recorded. Clinical symptoms were categorized as respiratory, gastrointestinal, general, and neurologic symptoms. The hazard ratios (HRs) for clinical symptoms associated with mortality were analyzed using the Cox proportional hazards model. The odds ratios (ORs) for clinical symptoms associated with morbidity were analyzed using the logistic regression model. Results: Of the included COVID-19 patients, 15.4% (808/5253) were classified as having severe morbidity. Morbidity was related to the clinical symptoms of cough, sputum, shortness of breath, vomiting/nausea, diarrhea, fever, and altered mental status or confusion. According to the symptom categories, respiratory and general symptoms were related to high morbidity (OR = 1.41, 95% CI = 1.30–1.53, p < 0.001 for respiratory symptom and OR = 1.37, 95% CI = 1.18–1.59, p < 0.001 for general symptom). Mortality was associated with the clinical symptoms of shortness of breath, fever, and altered mental status or confusion. Among the symptom categories, respiratory symptoms were associated with a 1.17-fold increased HR for mortality (95% CI = 1.04–1.32, p = 0.008). Conclusions: Initial respiratory symptoms were related to high morbidity and mortality in COVID-19 patients.

Adaptation of Animal and Human Health Surveillance Systems for Vector-Borne Diseases Accompanying Climate Change

2020 ◽  
Vol 48 (4) ◽  
pp. 694-704
Author(s):  
Sam F. Halabi
Keyword(s):  
Climate Change ◽  
Infectious Diseases ◽  
Human Health ◽  
Disease Surveillance ◽  
Surveillance Systems ◽  
Climate Conditions ◽  
Vector Borne Diseases ◽  
Disease Surveillance System ◽  
Vector Borne ◽  
Inspection Service

Anthropogenic climate change is causing temperature rise in temperate zones resulting in climate conditions more similar to subtropical zones. As a result, rising temperatures increase the range of disease-carrying insects to new areas outside of subtropical zones, and increased precipitation causes flooding that is more hospitable for vector breeding. State governments, the federal government, and governmental agencies, like the Animal and Plant Health Inspection Service (APHIS) of USDA and the National Notifiable Disease Surveillance System (NNDSS) of the U.S. Centers for Disease Control and Prevention, lack a coordinated plan for vector-borne disease accompanying climate change. APHIS focuses its surveillance primarily on the effect of illness on agricultural production, while NNDSS focuses on the emergence of pathogens affecting human health. This article provides an analysis of the current framework of surveillance of, and response to, vector-borne infectious diseases, the impacts of climate change on the spread of vector-borne infectious diseases, and recommends changes to federal law to address these threats.

Abstract TP295: Predictability of Stroke Symptoms in Acute Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Maria J Bruzzone ◽  
Luka Vlahovic ◽  
Ramon Durazo ◽  
Sean Ruland
Keyword(s):  
Acute Stroke ◽  
Mental Status ◽  
Healthcare Providers ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Final Diagnosis ◽  
Facial Weakness ◽  
Stroke Patients ◽  
Accurate Identification ◽  
Limb Weakness

Background: Prompt signs and symptoms recognition and intervention are essential to achieve the best outcome after stroke. Stroke codes were developed to expedite assessment and treatment. Their optimal use requires accurate identification of stroke patients. In order to improve diagnostic accuracy in our institution, we analyzed the predictive value of individual stroke signs and symptoms in patients in whom stroke codes were activated from the emergency department (ED) by physicians and nurses and from inpatient wards by nurses, residents and hospitalists. Methods: We retrospectively analyzed 501 consecutive stroke codes in our stroke log from May 2013 to May 2015. Age, gender, presenting signs and symptoms, medical history and final diagnosis were assessed. Patients were classified as stroke (ischemic and hemorrhagic) or non-stroke based on the final impression after the completed work-up. X2 statistic was utilized to assess associations. Results: Overall, 202 (40.3%) patients were classified as stroke and 299 (59.7%) non-stroke. 78% of stroke codes were activated from ED and 22% from the inpatient wards. Unilateral limb weakness, aphasia and facial weakness were associated with stroke (p<0.05) with PPVs of 0.57 (95%CI 50-64%), 0.56 (43-68%), 0.51 (43-60%), respectively. Altered mental status (AMS) and sensory symptoms were associated with non-stroke (p<0.05). The PPV and NPV for stroke were 0.21 (95%CI 13-31%) and 0.55 (50-60%) for AMS respectively and 0.25 (14-39%) and 0.58 (43-63%) for sensory symptoms. Location of the stroke code (ED or inpatient ward) did not impact the results. Conclusion: Previous studies, based on evaluation of acute stroke by paramedics and ED physicians, demonstrated that some signs or symptoms are more likely to be present in patients experiencing acute stroke. In our experience, unilateral limb weakness, aphasia, and facial weakness as identified by diverse provider disciplines and experience levels are associated with a final diagnosis of acute stroke. However, isolated altered mental status or sensory symptoms seldom result in a final diagnosis of stroke. These data can assist healthcare providers, to more accurately identify stroke patients, thus improving outcomes as well as resources utilization.

scholarly journals West Nile encephalitis mimicking neuropsychiatric lupus in a patient with systemic lupus erythematosus

2019 ◽  
Vol 12 (7) ◽  
pp. e229537 ◽  
Author(s):  
Neena R Iyer ◽  
W Joseph McCune ◽  
Beth I Wallace
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Mental Status ◽  
Lupus Erythematosus ◽  
Altered Mental Status ◽  
Systemic Lupus ◽  
West Nile ◽  
Acute Viral Infection ◽  
Pulse Dose ◽  
Neuropsychiatric Sle ◽  
Active Lupus

A man in his 70s with known systemic lupus erythematosus (SLE) was admitted with confusion, worsening proteinuria and cutaneous vasculitis despite adherence to his home immunosuppressive regimen. Admission laboratories were consistent with active lupus. Despite treatment with pulse–dose glucocorticoids and intravenous immunoglobulin, he developed worsening mental status and meningeal signs. Investigations revealed cerebrospinal fluid (CSF) neutrophilic and plasmacytic pleocytosis and negative cultures. Empiric treatment for SLE flare with potential neuropsychiatric involvement was continued while workup for altered mental status was ongoing. Ultimately, West Nile encephalitis was diagnosed by CSF serologies, and steroids were tapered. Altered mental status in a patient with SLE has a broad differential, and primary neuropsychiatric SLE should be considered only after exclusion of secondary causes. Although evidence of end-organ SLE activity usually lends support to a neuropsychiatric SLE diagnosis, in this case, serological and clinical evidence of SLE activity may have been triggered by acute viral infection.

Meropenem for management of valproic acid overdose: a case report

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Daniel Muñoz-Pichuante ◽  
Lorenzo Villa-Zapata ◽  
Russi Lolas
Keyword(s):  
Valproic Acid ◽  
Case Report ◽  
Mental Status ◽  
Clinical Symptoms ◽  
Significant Risk ◽  
Altered Mental Status ◽  
Pharmacological Interaction ◽  
Case Presentation ◽  
Concurrent Use ◽  
Clinical Scenarios

AbstractObjectivesValproic acid (VPA) is an anticonvulsant used in several clinical scenarios. VPA has been increasingly associated with intentional or unintentional overdose. In patients presenting with severe VPA overdose, supportive care and airway protection are cornerstones of treatment, while levocarnitine is suggested in patients with hyperammonemia and hemodialysis is recommended in patients with VPA serum concentrations (SC) >1,300 mg/L and presence of cerebral edema or shock. Meropenem is a carbapenem antibiotic with a broad spectrum of activity. The pharmacological interaction between VPA and meropenem is characterized by a rapid decrease in VPA concentrations, which contraindicates concurrent use.Case presentationThe following case report describes the use of meropenem to enhance the clearance of VPA in the case of severe VPA overdose. A patient with altered mental status was transported to the emergency department (ED) after VPA overdose. Meropenem was prescribed for significant elevated VPA SC. An important decline in SC was observed with short-term meropenem dosing, and an improvement in mental status occurred shortly after administration.ConclusionsCarbapenem therapy has the potential to be used as last line strategy in the management of severe VPA overdose in patients where SC represent a significant risk of toxicity and clinical symptoms suggest difficulty managing the patient.

Use of laboratory reports as predictors of West Nile virus disease cases, Texas, 2008–2012

2014 ◽  
Vol 143 (2) ◽  
pp. 419-426 ◽  
Author(s):  
S. J. YENDELL ◽  
J. TAYLOR ◽  
B. J. BIGGERSTAFF ◽  
L. TABONY ◽  
J. E. STAPLES ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Disease Surveillance ◽  
Virus Disease ◽  
Case Reports ◽  
Health Department ◽  
Base System ◽  
West Nile ◽  
Disease Surveillance System ◽  
Laboratory Report ◽  
Lag Times

SUMMARYWe evaluated laboratory reports as early indicators of West Nile virus (WNV) disease cases in Texas. We compared WNV laboratory results in the National Electronic Disease Surveillance System Base System (NBS) to WNV disease cases reported to the state health department from 2008 to 2012. We calculated sensitivity and positive predictive value (PPV) of NBS reports, estimated the number of disease cases expected per laboratory report, and determined lead and lag times. The sensitivity and PPV of NBS laboratory reports were 86% and 77%, respectively. For every 10 positive laboratory reports, we expect 9·0 (95% confidence interval 8·9–9·2) reported disease cases. Laboratory reports preceded case reports with a lead time of 7 days. Electronic laboratory reports provided longer lead times than manually entered reports (P < 0·01). NBS laboratory reports are useful estimates of future reported WNV disease cases and may provide timely information for planning public health interventions.

scholarly journals Prospects of leveraging an existing mosquito-borne disease surveillance system to monitor other emerging mosquito-borne diseases: a systematic review of West Nile Virus surveillance in Canada (2000–2016)

2019 ◽  
Vol 62 (3) ◽  
pp. 82-91 ◽  
Author(s):  
Luckrezia Awuor ◽  
Richard Meldrum ◽  
Eric N. Liberda
Keyword(s):  
Public Health ◽  
West Nile Virus ◽  
Disease Surveillance ◽  
West Nile ◽  
Disease Surveillance System ◽  
Virus Surveillance ◽  
Health Authorities ◽  
Regional Health Authorities ◽  
Google Search

The objective of this paper was to characterize the role of the current West Nile Virus (WNV) surveillance in supporting the identification of and public health preparedness for other emerging mosquito-borne diseases in Canada. We systematically reviewed publicly accessible WNV surveillance records published within the federal, provincial (n = 10), territorial (n = 3), and regional health authorities (n = 95) between 2000 and 2016. We describe the strategic approaches and activities to WNV surveillance from 124 websites, four public health databases, and three custom Google search engines. WNV surveillance in Canada can address emerging mosquito-borne diseases. However, surveillance practices are likely to underestimate the true risks. Prioritizing and strengthening WNV surveillance by all levels of the Canadian Government through timely surveillance measures, consistent and representative data for accurate prediction of trends and risks are recommended.

scholarly journals Epidemiology of Measles in Sudan

2019 ◽  
pp. 1-9
Author(s):  
Taha Hussein Musa ◽  
Hassan Hussein Musa ◽  
Layla Ahmed Mohammed ◽  
Abdelkareem Abdallah Ahmed ◽  
Rehab Ibrahim Kambo ◽  
...  
Keyword(s):  
Civil Wars ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Clinical Symptoms ◽  
Immunization Coverage ◽  
Epidemiological Studies ◽  
Childhood Diseases ◽  
Disease Surveillance System ◽  
Run Up ◽  
And Control

Few epidemiological studies have been undertaken of measles disease among Sudanese, although measles is the third leading cause of death since 1995 among childhood diseases that can be prevented by immunization. The measles vaccine was introduced into the EPI program in 1985. In the run-up to the introduction of the vaccine, the country suffered from measles epidemics periodically and extensively, ranging from 50,000 to 75,000 cases and from 15,000 to 30,000 deaths per year. Simple actions can save a million lives of children through immunization coverage, eye care programs, maternal and child health education, maintaining and improving the general nutritional status of Sudanese children. Continuous surveillance and monitoring systems and evaluation are essential tasks at all levels to improve performance, identify and address problems throughout establishing and increasing the surveillance system. This review highlights a brief overview of measles epidemiology in Sudan and determinants of a measles outbreak, clinical symptoms, complications, and surveillance sites and the ways for prevention and control of measles disease. The review established that it is crucial to enforce coordination between governmental and non-governmental agencies for an effective disease surveillance system in the area, especially in those affected by civil wars.

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