scholarly journals Gram negative rod meningitis due to Strongyloides stercoralis

2017 ◽  
Vol 4 (2) ◽  
pp. 28
Author(s):  
Nicholas S. Hendren ◽  
Shahzad Chindhy ◽  
Kaylee Shepard
Keyword(s):  
Strongyloides Stercoralis ◽  
Altered Mental Status ◽  
Chronic Infections ◽  
Travel History ◽  
Gram Negative ◽  
Immunosuppressive Medications ◽  
Dexamethasone Therapy ◽  
Immunosuppressed Patients ◽  
High Doses ◽  
One Year

A 57-year-old male Mexican immigrant living in Dallas presented with altered mental status, progressive confusion, mild headache and fevers. He was diagnosed with embryonal liver sarcoma one year prior to admission and had recently started dexamethasone therapy for metastatic spinal lesions. Blood and cerebrospinal fluid cultures from a lumbar puncture were both positive for Escherichia coli. He was diagnosed with spontaneous gram negative rod (GNR) meningitis. Given his travel history, immunosuppression and GNR meningitis, a stool ova and parasite sample was obtained to screen for Strongyloides stercoralis. His stool was markedly positive for Strongyloides stercoralis larvae and he was further diagnosed with Strongyloides hyperinfection syndrome. Strongyloides is capable of chronically re-infecting human hosts without an external life cycle via autoinfection. In chronic infections, hyperinfection can be triggered with immunosuppressive medications, especially steroids. Disseminated Strongyloides should be considered as the source for unexplained GNR bacteremia or meningitis especially in immunosuppressed patients. Our patient likely had a chronic asymptomatic Strongyloides infection acquired in Mexico that became a hyperinfection resulting in GNR meningitis after starting high doses of dexamethasone.

scholarly journals Strongyloides Hyperinfection Associated with Enterococcus faecalis Bacteremia, Meningitis, Ventriculitis and Gas-Forming Spondylodiscitis: A Case Report

2020 ◽  
Vol 5 (1) ◽  
pp. 44 ◽  
Author(s):  
Liang En Wee ◽  
Su Wai Khin Hnin ◽  
Zheyu Xu ◽  
Lawrence Soon-U Lee
Keyword(s):  
Enterococcus Faecalis ◽  
Strongyloides Stercoralis ◽  
Altered Mental Status ◽  
Early Morning ◽  
Peripheral Eosinophilia ◽  
Imaging Evaluation ◽  
Steroid Use ◽  
Travel History ◽  
History Of ◽  
Stool Specimens

An elderly Singaporean male with no travel history was hospitalized for fever and altered mental status. Blood cultures grew Enterococcus faecalis, and given a preceding history of steroid use and peripheral eosinophilia, Strongyloides hyperinfection was suspected. Stool specimens were positive for Strongyloides stercoralis larvae over four days, and larvae were also isolated in an early morning nasogastric aspirate specimen prior to initiation of ivermectin. A cerebrospinal fluid examination was consistent with partially treated bacterial meningitis and ventriculitis was demonstrated on neuroimaging. In view of a persistent fever, a further imaging evaluation was performed, which demonstrated bilateral pneumonia as well as the unusual finding of gas-forming emphysematous spondylodiscitis and left psoas abscesses. Despite the early suspicion of Strongyloides hyperinfection, commencement of appropriate antibiotics and anti-helminthics, microbiological clearance of bacteremia as well as clearance of S. stercoralis from the stool, the patient still succumbed to infection and passed away 11 days after admission.

scholarly journals Cancer immunotherapy in special challenging populations: recommendations of the Advisory Committee of Spanish Melanoma Group (GEM)

2021 ◽  
Vol 9 (3) ◽  
pp. e001664
Author(s):  
Maria Gonzalez-Cao ◽  
Teresa Puertolas ◽  
Mar Riveiro ◽  
Eva Muñoz-Couselo ◽  
Carolina Ortiz ◽  
...  
Keyword(s):  
Cancer Immunotherapy ◽  
Multidisciplinary Approach ◽  
Checkpoint Inhibitors ◽  
Solid Organ Transplantation ◽  
Latent Tuberculosis ◽  
Solid Organ ◽  
Chronic Infections ◽  
Immunosuppressed Patients ◽  
History Of ◽  
Evidence Based Guidelines

Cancer immunotherapy based on the use of antibodies targeting the so-called checkpoint inhibitors, such as programmed cell death-1 receptor, its ligand, or CTLA-4, has shown durable clinical benefit and survival improvement in melanoma and other tumors. However, there are some special situations that could be a challenge for clinical management. Persons with chronic infections, such as HIV-1 or viral hepatitis, latent tuberculosis, or a history of solid organ transplantation, could be candidates for cancer immunotherapy, but their management requires a multidisciplinary approach. The Spanish Melanoma Group (GEM) panel in collaboration with experts in virology and immunology from different centers in Spain reviewed the literature and developed evidence-based guidelines for cancer immunotherapy management in patients with chronic infections and immunosuppression. These are the first clinical guidelines for cancer immunotherapy treatment in special challenging populations. Cancer immunotherapy in chronically infected or immunosuppressed patients is feasible but needs a multidisciplinary approach in order to decrease the risk of complications related to the coexistent comorbidities.

Cognitive impairment in long-term benzodiazepine users

1988 ◽  
Vol 18 (2) ◽  
pp. 365-374 ◽  
Author(s):  
Susan Golombok ◽  
Parimala Moodley ◽  
Malcolm Lader
Keyword(s):  
Neuropsychological Tests ◽  
Matched Control ◽  
Control Group ◽  
Therapeutic Practice ◽  
The Past ◽  
Visual Spatial ◽  
Wide Range ◽  
High Doses ◽  
One Year

SynopsisIn view of the very extensive and often prolonged use of benzodiazepines in therapeutic practice, this study was designed to investigate whether or not cognitive ability is impaired in longterm benzodiazepine users, and to determine the nature and extent of any deficit. Fifty patients currently taking benzodiazepines for at least one year, thirty-four who had stopped taking benzodiazepines, and a matched control group of subjects who had never taken benzodiazepines or who had taken benzodiazepines in the past for less than one year were administered a battery of neuropsychological tests designed to measure a wide range of cognitive functions. It was found that patients taking high doses of benzodiazepines for long periods of time perform poorly on tasks involving visual-spatial ability and sustained attention. This is consistent with deficits in posterior cortical cognitive function.

scholarly journals P045 Nothing is too 'cagey' for the rheumatologist

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Muhammad F Kazmi
Keyword(s):  
Weight Loss ◽  
Inflammatory Markers ◽  
Low Grade ◽  
Careful Monitoring ◽  
Chronic Infections ◽  
Asian Origin ◽  
Travel History ◽  
Chest Clinic ◽  
History Of ◽  
Inflammatory Changes

Abstract Background/Aims  Rheumatological conditions can present with a number of non-specific features like arthralgia, fever, fatigue, weight loss along with raised inflammatory markers and positive antibodies. Due to this, when similar symptoms are referred for input it is very important to consider other ‘mimics’. We report a case of Pigeon fancier’s lung presenting with these symptoms which was referred as likely connective tissue disease. Methods  A 52-year-old lady of South Asian origin was referred by her GP with six month history of 3kg weight loss, arthralgia, fatigue, low grade fever and persistently raised inflammatory markers (ESR ranging from 50-64 mm/hr, CRP 10-14 mg/L, normal BMI). On further questioning there was history of mouth ulcers, non-specific rash, occasional cough but no Raynaud’s or joint swelling. Blood investigations showed weakly positive ANA and RF but negative ENA, DNA, antiCCP , CK, C3,C4. C-ANCA was positive but PR3 negative. CXR was clear and tests for chronic infections including TB were negative. Due to lack of objective CTD signs, plan was to take a careful monitoring approach to see if clinical features evolved. A month later due to worsening cough, a CT chest/abdomen arranged by GP showed ground-glass changes consistent with pneumonitis and hence her rheumatology appointment was expedited to see if there was an autoimmune unifying diagnosis. She was also referred by her GP to the chest clinic in view of CT report and mild shortness of breath. Results  On further review, again there were no objective CTD signs. On direct questioning there was history of travelling before worsening chest symptoms to South Asia. Also around a year before her symptoms started she was given an African grey parrot. Based on this, serology for Avian precipitin was checked which showed strongly positive IgG antibodies to avian antigens (Budgerigar droppings and feathers, Pigeon feathers IgG Abs) confirming the diagnosis of pigeon fanciers lung. She fulfilled the diagnostic criteria and was asked to avoid the trigger. Urgent respiratory input was arranged where diagnosis was agreed with and disease was deemed sub-acute in presentation. Due to PFTs showing low transfer factor of 38%, Prednisolone was started with significant improvement within few days. Review of CT chest only showed inflammatory changes and no established fibrosis predicting excellent prognosis as delay in treatment can cause irreversible pulmonary fibrosis. Conclusion  A number of conditions can mimic rheumatological conditions which usually turn out to be either infectious or malignant in origin. This case highlights the importance of considering other differentials and along with taking a travel history also asking for other possible triggers like pets. In similar scenarios the diagnosis may be ‘cagey’ but as rheumatologists we are expected to answers questions which others can’t. Disclosure  M.F. Kazmi: None.

scholarly journals Characteristic of infectious status in patients with acutely decompencated chronic heart failure and its impact on annual prognosis

Kardiologiia ◽  
2019 ◽  
Vol 59 (8S) ◽  
pp. 56-62
Author(s):  
V. A. Kostenko ◽  
M. Yu. Sitnikova ◽  
E. A. Skorodumova ◽  
E. G. Skorodumova ◽  
A. N. Fedorov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intestinal Bacteria ◽  
Mycoplasma Hominis ◽  
Chronic Obstructive ◽  
Infectious Agents ◽  
Gram Negative ◽  
Inflammatory Stress ◽  
Barr Virus ◽  
Epstein Barr ◽  
One Year

Aim. The assessment of infectious status in patients with acutely decompensated chronic heart faiure (ADCHF) without evident signs of acute inflammatory stress and its impact on the 1 year prognosis.Material and methods. Totally, 65 patients with ADCHF of ischemic origin investigated, age 67,3±2,3 y.o. All patients were taken markers of phagocytosis and inflammatory stress as well as antibodies to Streptococcus, Cytomegalovirus (CMV), Epstein-Barr virus (VEB), Candida albicans, Toxoplasma gondii, Aspergillus, Mycoplasma hominis and pneumonia and also level of lipopolysaccharids (LPS) of gram-negative bacteriae.Results. More often LPS of gram-negative bacteriae were revealed in patients with ADCHF and further in decreasing order – antibodies to CMV, VEB, Streptococcus, Candida, Aspergillus and LPS. All patients have been infected by at least 2 pathogens, more than 90 % of them had 3 ones or more. Mortality in first 12 months observation correlated with quantity of patient`s pathogenic patterns (r=0,52, p=0,004). Dependency of one-year mortality from degree of viral-bacterial mixt contamination was almost linear. CMV was a monopathogen with strongest correlation with mortality (r=0,39, p=0,001). In patients with more significant infection bigger rate of re-hospitalizations about new ADCHF correlated with number of pathogens was observed (r=0,61, p=0,001).Conclusion. Chronic latent infection with a significant number of pathogens is characteristic of patients with low-ejection ADCHF of ischemic genesis with a significant number of pathogens: more than 90 % of patients had three or more. The most common exogenous pathogens in the study sample of patients with chronic obstructive heart failure were CMV, EBV, and hemolytic streptococcus, of the potentially endogenous ones, gram-negative intestinal bacteria. The number of infectious agents in patients with chronic obstructive heart failure has a direct correlation with deaths and re-admission to hospital with total heart failure within 1 year after discharge from the hospital.

Proteeae Groin Skin Carriage in Ambulatory Geriatric Outpatients

1989 ◽  
Vol 10 (4) ◽  
pp. 150-154 ◽  
Author(s):  
N. Joel Ehrenkranz ◽  
Debra G. Eckert ◽  
Blanca C. Alfonso ◽  
Lee B. Moskowitz
Keyword(s):  
Nursing Home ◽  
Chronic Disease ◽  
Nursing Homes ◽  
Gram Negative ◽  
Negative Bacillus ◽  
Annual Prevalence ◽  
Skin Ulcers ◽  
Gram Negative Bacillus ◽  
One Year ◽  
Private Homes

AbstractAerobic gram-negative bacillus (AGNB) groin skin carriage was prospectively studied in ambulatory geriatric outpatients: 42 from three nursing homes and 44 from private homes. Initially, 12 (28.6%) Proteeae carriers were in the former group and 3 (6.8%) were in the latter (P=0.01). At one year, 6 of 7 surviving nursing home carriers remained Proteeae carriers while none from private homes remained carriers (P=0.007). The annual prevalence of Proteeae carriage was 14 (33.3%) in nursing homes and 4 (9.1%) in private homes (P=0.008); of non-Proteeae AGNB carriage, the annual prevalence was 2 (4.8%) and 4 (11.4%), respectively. Nursing home subjects had similar initial health characteristics; however, by one year, 5 of 12 carriers in contrast to 3 of 30 noncarriers were dead of chronic disease (P=0.03). These nursing homes included persons with chronic diseases that apparently facilitated Proteeae carriage. Urethral catheters, skin ulcers, and recent antibiotics were not factors.

Gentamicin and Tobramycin Resistant Gram-Negative Bacilli in a Community Hospital

1980 ◽  
Vol 1 (4) ◽  
pp. 249-252 ◽  
Author(s):  
C. Richard Magnussen ◽  
Maria Sammartino
Keyword(s):  
Community Hospital ◽  
Gram Negative ◽  
Recent Treatment ◽  
One Year

AbstractThe incidence and spectrum of resistance to gentamicin and tobramycin among gram-negative bacilli (GNB) isolated in a community hospital over a one-year period were studied. The overall incidence of resistance was 3.7%. Pseudomonads constituted almost half of the resistant organisms. The majority of resistant GNB was isolated from the respiratory and urinary tracts. Acquisition of resistance was correlated with both the total use of gentamicin in the hospital and recent treatment of individual patients with gentamicin plus tobramycin. The overall incidence of resistant isolates (3.7%) and the incidence of resistance for the enterobacteriaceae (1.9%) were lower than rates reported by comparable studies at several university or municipal hospitals.

scholarly journals 84. Over-Utilization of Prehospital Rapid Blood Glucose Measurements

1996 ◽  
Vol 11 (S2) ◽  
pp. S48-S48
Author(s):  
Edward A. Michelson ◽  
Kenneth S. Pearlman
Keyword(s):  
Abdominal Pain ◽  
Blood Glucose ◽  
Test Performance ◽  
Urban Population ◽  
Altered Mental Status ◽  
Level Of Consciousness ◽  
History Of ◽  
One Year ◽  
Not At Risk

Purpose: Determination of rapid blood glucose (RGB) by colorimetric stick test aids in the prehospital identification and treatment of hypoglycemia. The test may be applied unnecessarily to patients not at risk for, and in clinical situations not associated with hypoglycemia. We attempted to estimate the rate of over-utilization of RGB in a large urban EMS setting.Methods: All run sheets during a one week period from 7 sites providing radio command to both city and private EMS units serving a large urban population were screened. Those runs including RGB determination were further classified for presence or absence of a test indication. RGB was considered indicated with history or finding of: altered mental status, decreased level of consciousness, seizure, syncope and near syncope, generalized weakness or dizziness, with or without a history of diabetes.Results: 613 RGB determinations were identified during one week (annual rate = 31,876). 371 (61%) met indication criteria for test performance, and 242 (39%) failed to meet criteria. The patient complaint in cases not meeting criteria included; cardiac - 80, respiratory distress - 66, trauma - 38, abdominal pain -15, burns - 12, OB - 8, CVA - 6. Moreover, among these patients fewer than half had a history of diabetes. If this rate of over-utilization were maintained for one year, in excess of 12,500 extra tests would be performed in this system.

scholarly journals 1771. Donor-derived Ureaplasma Infection Increases Mortality in Lung Transplant Recipients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S653-S653 ◽  
Author(s):  
Scott C Roberts ◽  
Ankit Bharat ◽  
Chitaru Kurihara ◽  
Sangeeta M Bhorade ◽  
Michael G Ison
Keyword(s):  
Retrospective Cohort ◽  
Lung Transplant ◽  
Altered Mental Status ◽  
Empiric Therapy ◽  
Screening Tests ◽  
Donor Screening ◽  
High Concern ◽  
Lung Transplant Recipients ◽  
One Year ◽  
Ureaplasma Spp

Abstract Background Infection with Ureaplasma species has been linked to fatal hyperammonemia syndrome (HS) in lung transplant (LTx) recipients (R). In this retrospective cohort, we sought to characterize the epidemiology of Ureaplasma spp in both candidates and donors and describe outcomes of antimicrobial therapy in preventing and treating HS. Methods We performed a retrospective cohort study of patients who received LTx at Northwestern Memorial Hospital from July 2014 to October 2018. Candidate testing for Ureaplasma spp. was performed with urine culture and PCR testing before LTx but after listing. Positive candidates were treated with levofloxacin for 14 days prior to undergoing LTx. Donor testing was performed with bronchoalveolar lavage (BAL) culture and PCR testing at organ implantation. From July 2014 to February 2017 LTxR were treated according to result; from February 2017 to October 2018 LTxR received empiric levofloxacin and azithromycin at the time of LTx until testing returned negative. HS was defined as new-onset altered mental status (AMS) after LTx with ammonia > 100; if no ammonia was tested, LTxR was classified as not developing HS. Summary and comparative statistics were performed using IBM® SPSS Statistics version 25.0. Results 66 patients who underwent LTx and had candidate screening, donor screening, or both were included. 81.8% (n = 54) of patients had negative screening tests in donor and candidate pre-LTx, 7.5% (n = 5) had positive Ureaplasma spp. testing pre-LTx, and 12.1% (n = 8) had positive donor BAL testing at the time of LTx. One had positive candidate and donor screening (see Table 1). 3 patients developed HS a median of 6 days post-transplant; 2 died with HS as attributed cause. None received empiric therapy. LTxR with confirmed donor-derived infection were more likely to have mortality at 1 year when compared with LTxR with negative testing and candidates with positive testing pre-LTx (P = 0.019). LTxR with donor-derived infection were more likely to have AMS, higher peak ammonia, and require renal replacement therapy, although none reached significance (Table 2). Conclusion Donor-derived Ureaplasma spp. in LTxR was associated with increased mortality at one-year. Pre-transplant screening and treatment had no effect on the outcome. There is high concern for donor transmission and we advocate testing in all LTxR. Disclosures All authors: No reported disclosures.

scholarly journals Bacteraemia in Intensive Care Unit: Clinical, Bacteriological, and Prognostic Prospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Zineb Lachhab ◽  
Mohammed Frikh ◽  
Adil Maleb ◽  
Jalal Kasouati ◽  
Nouafal Doghmi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Common Source ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamases ◽  
Gram Negative Organisms ◽  
One Year

Objectives.We conducted a one-year observational study from December 2012 to November 2013 to describe the epidemiology of bacteraemia in intensive care units (ICU) of Mohammed V Military Teaching Hospital of Rabat (Morocco).Methods.The study consisted of monitoring all blood cultures coming from intensive care units and studying the bacteriological profile of positive blood cultures as well as their clinical significance.Results.During this period, a total of 46 episodes of bacteraemia occurred, which corresponds to a rate of 15,4/1000 patients. The rate of nosocomial infections was 97% versus 3% for community infections. The most common source of bacteraemia was the lungs in 33%, but no source was identified in 52% of the episodes. Gram negative organisms were isolated in 83,6% of the cases withAcinetobacter baumanniibeing the most frequent. Antibiotic resistance was very high with 42,5% of extended-spectrum beta-lactamases (ESBLs) in Enterobacteriaceae and 100% of carbapenemase inAcinetobacter baumannii. The antibiotherapy introduced in the first 24 hours was adequate in 72% of the cases.Conclusions.Bloodstream infections in ICU occur most often in patients over 55 years, with hypertension and diabetes. The bacteria involved are mainly Gram negative bacteria multiresistant to antibiotics. Early administration of antibiotics significantly reduces patients mortality.

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