Infective endocarditis involving native aortic valve due to Burkholderia cepacia presenting as refractory heart failure in immunocompetent host: A case report

A 44-year-old previously healthy gentle man presented with dyspnoea for three weeks which was more severe over 7 days. He had anaemia, sinus tachycardia, wide pulse pressure of 100 mmHg, heaving displaced apex beat, and features of aortic regurgitation with occasional crackles over both lung base. Echocardiogram revealed vegetations at aortic valve. He was initially treated as a case of infective endocarditis and left ventricular failure with amoxicillin, gentamycin and anti-failure treatment. However, heart failure was very refractory and even worsening; he expired five days after arrival to our hospital. Blood culture obtained after his death showed a growth of unusual organism Burkholderia cepacia. Keywords: infective endocarditis; aortic regurgitation; refractory heart failure; Burkholderia cepacia.

Re-initiation of CT colonography services during the COVID-19 pandemic: Preliminary evaluation of safety

Objective: The COVID-19 pandemic has led to cancellation and deferral of many cancer investigations, including CT colonography (CTC). In May 2020, BSGAR and SCoR issued guidelines outlining steps for conduct of CTC in the early recovery phase. We evaluated the implementation of these in four English hospital trusts. Methods: Ethical permission was not required for this multicentre service evaluation. We identified patients undergoing CTC over a 2-month period from May to July 2020 at four Trusts. We recorded demographics, scan indications, colonic findings, and incidental lung base changes compatible with COVID-19. A subset of patients were contacted via telephone to document new symptoms 2 weeks following their scan. Staff were contacted to determine if any acquired COVID-19 during the period. Results: 224 patients (118 male, 52.7%) were scanned during the period. In 55 patients (24.6%), CTC showed a ≥6 mm polyp. 33 of 224 (14.7%) scans showed incidental lung base changes felt unrelated to COVID-19, and only one patient had changes indeterminate for COVID-19; no classic COVID-19 pulmonary changes were found. Of 169 patients with telephone follow-up, none reported any new symptoms of COVID-19 (cough, fever, anosmia, ageusia) within 14 days of CTC. None of the 86 staff contacted developed COVID-19. Conclusion: We found no cases of patients or staff acquiring COVID-19 infection following CTC; and no evidence of significant asymptomatic COVID-19 patients attending for CTC appointments based on lung base changes. Advances in knowledge: Our findings suggest that current practice is unlikely to contribute significantly to spread of SARS-nCOV2. Cancer and significant polyp detection rates were high, underlining the importance of maintaining service provision.

Percutaneous drainage of a fluid-containing emphysematous bulla

We present the case of a 38-year-old man, with congenital bullous emphysema, who presented with unilateral pleuritic chest pain, rigors and a non-productive cough. A chest X-ray on admission demonstrated extensive bilateral bullous lung disease with left-sided lung collapse. There were fluid levels present within several bullae, with the largest bulla compromising most of the posterior aspect of the left lung base. We suspected infected emphysematous bullae. Despite prolonged conservative management with antibiotics the patient deteriorated clinically, consistently spiking temperatures and desaturating. Repeat imaging demonstrated further accumulation of fluid in the largest bulla. A small bore chest drain was inserted into this bulla under ultrasound guidance, draining 550 mL of pulmonary fluid. The patient stabilised clinically and was discharged. He remained well after completing six weeks of intravenous antibiotics in the community.

Incidence of Missed Diagnosed COVID-19 Pneumonia on Patients Who Admitted Urology Outpatient Clinic

Purpose: The novel coronavirus disease 2019 (COVID-19) has spread all over the world. The diagnosis of COVID-19 in asymptomatic patients and patients with non-respiratory symptoms remains a big concern. In this study, we aimed to evaluate the incidence of missed diagnosed COVID-19 pneumonia on abdominal computed tomography (CT) performed in patients admitted to our urology outpatient clinic. Methods: We reviewed the files of patients who were admitted to the urology outpatient clinic from 1 April to 1 November retrospectively. We included the patients who performed abdominal CT at the urology outpatient clinic for any reason and recorded demographic data and abdominal CT findings. We excluded patients with pulmonary symptoms and previously diagnosed with COVID-19. Also, patients without abdominal CT were excluded. We evaluated the rates of missed diagnosed COVID-19 pneumonia detection on the lung base images of abdominal CT. Results: 1024 patients were included in this study. We observed that 99 (9.7%) of these patients had findings related to COVID-19 pneumonia on the lung base images of abdominal CT. Although 885 (86.4%) patients had no pathological pulmonary findings, 40 (3.9%) patients had other pathological pulmonary findings. Conclusion: COVID-19 disease has become a pandemic all over the world. All healthcare professionals, including urologists, play an active role in the diagnosis and treatment of this disease. So, it should be kept in mind that COVID-19 pneumonia should be evaluated in patients admitted to the urology outpatient clinic with renal colic or abdominal pain.

Staphylococcal pneumonia as a complication of cellulitis

Introduction: Cellulitis is less common local infection caused by staphylococci but may be accompanied by severe symptoms. Aim: The authors present a case of a 25-year-old woman with cellulitis in the lower jaw area, who had a complication in the form of purulent pneumonia with numerous abscesses and pleurisy. Case study: The patient, 25-year-old woman, was admitted to Clinic of Dermatology in Olsztyn due to painful swelling of her cheek, jaw and chin on the right side. The physical examination revealed crackles in the lung base and the chest X-ray image showed numerous circular shadows in the lung fields. In addition, there was fluid in the left pleural cavity. Intensive antibiotic therapy was used in the treatment for 14 days and improvement in the skin lesion was achieved. Cough and radiological changes also subsided. Results and discussion: Pneumonia usually develops as a result of the aspiration of the microorganism from the upper respiratory tract or through the bloodstream. Staphylococcal methicillin resistant Staphylococcus aureus (MRSA) infections are a particular problem. Poor hygiene conditions, close contact, contaminated material and damaged skin are some of the risk factors for the spread of MRSA infection in the population of non-hospitalized patients. In this patient, such a predisposing factor was alcohol and an attempt to remove a purulent lesion on her own in unsanitary conditions. Conclusions: It should be remembered that skin infections may lead to complications in the form of staphylococcal pneumonia.

The Abnormal and Rapid Movement of Sewing Needle From Chest Toward Heart

: We herein introduced a 3 years old girl, who is a rare case of penetrating intracardiac damage severely induced by the abnormal movement of a sewing needle form the right lung toward the heart and entering in the right ventricle, which created Right Pneumothorax and right side bleeding. In clinical examinations, all vital symptoms were normal, and there was no sign of Cardiac tamponade, except reduced sound in the right lung base. Also, the external object was retained in the midclavicular line between the third rib, which was significant. In the Simple posterior-anterior and lateral graphics of chest radio opacity linear image on the lower part of the heart, the shadow was also significant. This is a rare case of abnormal needle movement from the right thorax to the right ventricular apex, which caused pulmonary problems. Following necessary diagnostic tests, a surgery was performed to remove the needle from the patient’s chest without open-heart surgery and CPB. Finally, 3 days after the operation, the patient was discharged from the cardiac surgery service in good general condition.