RESUMEN
We present a case report of a potentially lethal post-COVID complication. A 65-year-old male presented with shortness of breath and fever with chills. He had recently recovered from COVID pneumonia. Contrast enhanced CT scan chest gave the suspicion of pulmonary pseudoaneurysm. CT aortogram revealed a well-defined rounded mass in the right lung mainly occupying the lower lobe of the right lung. Angiography through the right common femoral vein was performed and it confirmed a huge pseudoaneurysm arising from the posteromedial branch of the right descending interlobar artery. As the artery was not found suitable for endovascular embolization, the patient was referred to a thoracic surgeon.
Asunto(s)
Aneurisma Falso , COVID-19 , Arteria Pulmonar , Anciano , Humanos , Masculino , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , COVID-19/complicaciones , COVID-19/diagnóstico por imagen , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Tomografía Computarizada por Rayos X , Disnea/etiología , Fiebre/etiología , Escalofríos/etiología , Angiografía por Tomografía ComputarizadaAsunto(s)
Escalofríos , Fiebre , Masculino , Humanos , Escalofríos/etiología , Fiebre/etiología , Diagnóstico DiferencialAsunto(s)
Escalofríos/etiología , Eikenella corrodens/aislamiento & purificación , Fiebre/etiología , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones Relacionadas con Prótesis/complicaciones , Escalofríos/diagnóstico , Diagnóstico Diferencial , Femenino , Fiebre/diagnóstico , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , RecurrenciaRESUMEN
BACKGROUND: Rapid detection, isolation, and contact tracing of community COVID-19 cases are essential measures to limit the community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to identify a parsimonious set of symptoms that jointly predict COVID-19 and investigated whether predictive symptoms differ between the B.1.1.7 (Alpha) lineage (predominating as of April 2021 in the US, UK, and elsewhere) and wild type. METHODS AND FINDINGS: We obtained throat and nose swabs with valid SARS-CoV-2 PCR test results from 1,147,370 volunteers aged 5 years and above (6,450 positive cases) in the REal-time Assessment of Community Transmission-1 (REACT-1) study. This study involved repeated community-based random surveys of prevalence in England (study rounds 2 to 8, June 2020 to January 2021, response rates 22%-27%). Participants were asked about symptoms occurring in the week prior to testing. Viral genome sequencing was carried out for PCR-positive samples with N-gene cycle threshold value < 34 (N = 1,079) in round 8 (January 2021). In univariate analysis, all 26 surveyed symptoms were associated with PCR positivity compared with non-symptomatic people. Stability selection (1,000 penalized logistic regression models with 50% subsampling) among people reporting at least 1 symptom identified 7 symptoms as jointly and positively predictive of PCR positivity in rounds 2-7 (June to December 2020): loss or change of sense of smell, loss or change of sense of taste, fever, new persistent cough, chills, appetite loss, and muscle aches. The resulting model (rounds 2-7) predicted PCR positivity in round 8 with area under the curve (AUC) of 0.77. The same 7 symptoms were selected as jointly predictive of B.1.1.7 infection in round 8, although when comparing B.1.1.7 with wild type, new persistent cough and sore throat were more predictive of B.1.1.7 infection while loss or change of sense of smell was more predictive of the wild type. The main limitations of our study are (i) potential participation bias despite random sampling of named individuals from the National Health Service register and weighting designed to achieve a representative sample of the population of England and (ii) the necessary reliance on self-reported symptoms, which may be prone to recall bias and may therefore lead to biased estimates of symptom prevalence in England. CONCLUSIONS: Where testing capacity is limited, it is important to use tests in the most efficient way possible. We identified a set of 7 symptoms that, when considered together, maximize detection of COVID-19 in the community, including infection with the B.1.1.7 lineage.
Asunto(s)
COVID-19/complicaciones , COVID-19/diagnóstico , Modelos Biológicos , Ageusia/diagnóstico , Ageusia/etiología , Ageusia/virología , Anosmia/diagnóstico , Anosmia/etiología , Anosmia/virología , Apetito , Área Bajo la Curva , COVID-19/virología , Escalofríos/diagnóstico , Escalofríos/etiología , Escalofríos/virología , Control de Enfermedades Transmisibles , Tos/diagnóstico , Tos/etiología , Tos/virología , Inglaterra , Reacciones Falso Positivas , Femenino , Fiebre/diagnóstico , Fiebre/etiología , Fiebre/virología , Humanos , Masculino , Tamizaje Masivo , Mialgia/diagnóstico , Mialgia/etiología , Mialgia/virología , Faringitis/diagnóstico , Faringitis/etiología , Faringitis/virología , Reacción en Cadena de la Polimerasa , SARS-CoV-2/genética , Medicina EstatalAsunto(s)
Anticoagulantes/efectos adversos , Vacunas contra la COVID-19/administración & dosificación , COVID-19/prevención & control , Hemorragia/prevención & control , Trastornos Hemorrágicos/complicaciones , SARS-CoV-2/inmunología , Adulto , Anticuerpos Neutralizantes/biosíntesis , Anticuerpos Antivirales/biosíntesis , Autoexperimentación , Vacuna BNT162 , Vacunas contra la COVID-19/efectos adversos , Escalofríos/etiología , Contraindicaciones de los Procedimientos , Fatiga/etiología , Hemorragia/inducido químicamente , Hemorragia/etiología , Humanos , Inyecciones Intramusculares/efectos adversos , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Punciones/efectos adversos , Rivaroxabán/efectos adversosRESUMEN
BACKGROUND: In late December 2019, a novel coronavirus SARS-CoV-2 started to spread around the world in different populations. Its clinical and laboratory characteristics and outcome in kidney transplant recipients are little known. Therefore, we describe 22 kidney transplant recipients with SARS-CoV-2-induced pneumonia. METHODS: All kidney transplant recipients who referred to the Razi Hospital of Rasht with a diagnosis of SARS-CoV-2 infection from February 20 to 19th of April 2020 have been included in this observational study. RESULTS: We present 22 cases of COVID-19 in kidney transplant recipients (median age 52 years [interquartile range 40.75-62.75 years]) and baseline eGFR 60 (mL/min/1.73 m2 ) (44.75-86.75). Patients complained of cough (72.7%), dyspnea (63.6%), fever (68.2%), and chill (72.7%) with greater prevalence. We decreased the dose of immunosuppression and started stress dose of intravenous hydrocortisone or equivalent oral prednisolone. Each patient received antiviral therapy based on the latest updated version of local protocol at the time of admission. CT scan findings in 90.9% of patients showed bilateral multifocal lesions. Acute kidney injury (AKI) was observed in 12 patients during hospitalization. Six patients died after a median of 12 days from admission (IQR, 1-21). CONCLUSIONS: In this small observational study, we observed high AKI occurrence and mortality rate in kidney transplant recipients with COVID-19.
Asunto(s)
Lesión Renal Aguda/complicaciones , COVID-19/diagnóstico , Trasplante de Riñón , Receptores de Trasplantes , Adulto , COVID-19/complicaciones , COVID-19/mortalidad , Escalofríos/etiología , Tos/etiología , Disnea/etiología , Femenino , Fiebre/etiología , Hospitalización , Hospitales , Humanos , Hidrocortisona/administración & dosificación , Huésped Inmunocomprometido/efectos de los fármacos , Terapia de Inmunosupresión , Inmunosupresores/administración & dosificación , Irán , Masculino , Persona de Mediana Edad , Prednisolona/administración & dosificación , SARS-CoV-2/aislamiento & purificación , Tratamiento Farmacológico de COVID-19Asunto(s)
Infecciones por Coronavirus/diagnóstico , Coronavirus/aislamiento & purificación , Trasplante de Corazón , Huésped Inmunocomprometido , Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico , Betacoronavirus , COVID-19 , Prueba de COVID-19 , Escalofríos/etiología , China , Técnicas de Laboratorio Clínico , Coronavirus/genética , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico por imagen , Diarrea/etiología , Fatiga/etiología , Fiebre/etiología , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico por imagen , SARS-CoV-2 , Tomografía Computarizada por Rayos XRESUMEN
We sought to assess the role of procalcitonin in discriminating severe bacterial infections requiring antibiotic treatment from non-bacterial causes of fever or chills in chronic dialysis patients. Chronic hemodialysis patients who were admitted to the emergency room due to fever and/or chills were recruited to the study. The presence or absence of bacterial infection was defined after recruitment conclusion by an infectious disease specialist who was blinded to procalcitonin results. Procalcitonin levels were compared between infected and non-infected patients. Out of 54 patients recruited, 22 (41%) patients eventually diagnosed with infection. Mean (± SD) procalcitonin values were 4.3 (± 5.5) ng/ml among cases, 1.0 (± 2.0) ng/ml among controls with no infection (p = 0.02). A cutoff PCT value of 1 ng/ml or higher had 77% sensitivity and 59% specificity for the diagnosis of severe infection. Procalcitonin cannot usefully identify hemodialysis patient with bacterial infection.
Asunto(s)
Bacteriemia/diagnóstico , Polipéptido alfa Relacionado con Calcitonina/análisis , Diálisis Renal/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Bacteriemia/sangre , Bacteriemia/complicaciones , Biomarcadores/análisis , Biomarcadores/sangre , Escalofríos/sangre , Escalofríos/etiología , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Fiebre/sangre , Fiebre/etiología , Humanos , Masculino , Persona de Mediana Edad , Polipéptido alfa Relacionado con Calcitonina/sangre , Curva ROC , Diálisis Renal/métodosRESUMEN
Post-orgasmic illness syndrome (POIS) is a rare condition characterized by post-ejaculatory symptoms. Here is reported the first Brazilian POIS patient. Immunological investigation did not confirm the previous hypothesis of a hypersensitivity reaction. Cell immunophenotyping comparing healthy individuals produced evidence of abnormalities not associated to clinical manifestations. The patient was submitted to specific immunotherapy with transient clinical response and was referred to a psychologist but did not demonstrate clinical improvement of symptoms. Therefore, etiology of POIS remains unclear.
Asunto(s)
Eyaculación , Inmunofenotipificación , Orgasmo , Trastornos Somatomorfos/inmunología , Adulto , Ansiedad/etiología , Escalofríos/etiología , Depresión/etiología , Fatiga/etiología , Fiebre/etiología , Humanos , Masculino , Náusea/etiología , SíndromeRESUMEN
Fever and chills. Diffuse abdominal pain. Shortness of breath.
Asunto(s)
Dolor Abdominal/etiología , Bacteriemia/diagnóstico , Escalofríos/etiología , Disnea/etiología , Fiebre/etiología , Infecciones Estreptocócicas/diagnóstico , Streptococcus agalactiae/aislamiento & purificación , Bacteriemia/complicaciones , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico , Femenino , Humanos , Dispositivos Intrauterinos Medicados/efectos adversos , Dispositivos Intrauterinos Medicados/microbiología , Persona de Mediana Edad , Infecciones Estreptocócicas/complicacionesAsunto(s)
Pielonefritis/diagnóstico por imagen , Pielonefritis/terapia , Tuberculosis Urogenital/diagnóstico por imagen , Tuberculosis Urogenital/terapia , Anciano , Escalofríos/diagnóstico por imagen , Escalofríos/etiología , Escalofríos/terapia , Cistoscopía/métodos , Humanos , Masculino , Náusea/diagnóstico por imagen , Náusea/etiología , Náusea/terapia , Pielonefritis/genética , Tuberculosis Urogenital/complicaciones , Vómitos/diagnóstico por imagen , Vómitos/etiología , Vómitos/terapiaAsunto(s)
Absceso Hepático/complicaciones , Antibacterianos/uso terapéutico , Escalofríos/etiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/fisiopatología , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Fiebre/etiología , Humanos , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/fisiopatología , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/patogenicidad , Absceso Hepático/fisiopatología , Masculino , Persona de Mediana Edad , Vena Porta/anomalías , Vena Porta/diagnóstico por imagen , Vena Porta/fisiopatología , Tomografía Computarizada por Rayos X/métodosAsunto(s)
Antibacterianos/uso terapéutico , Ceftriaxona/uso terapéutico , Pneumocystis carinii/aislamiento & purificación , Neumonía Bacteriana/tratamiento farmacológico , Prednisolona/uso terapéutico , Choque Hemorrágico/mortalidad , Antiinflamatorios , Antígenos Virales/sangre , Proteínas de la Cápside/sangre , Escalofríos/etiología , Diagnóstico Diferencial , Disnea/etiología , Resultado Fatal , Fiebre/etiología , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Endocarditis/diagnóstico , Antibacterianos , Escalofríos/etiología , Diagnóstico Diferencial , Ecocardiografía , Endocarditis/microbiología , Endocarditis/terapia , Exantema/etiología , Fiebre/etiología , Humanos , Masculino , Persona de Mediana Edad , Mialgia/etiología , Resultado del TratamientoRESUMEN
Inactivated quadrivalent influenza vaccine (IIV4) has been used as seasonal influenza vaccine since 2016 in Japan. This study examined the safety of IIV4 in comparison with the AH1pdm monovalent vaccine used for novel influenza in 2009. Questionnaire surveillance associated with adverse events (AEs) was conducted at Chiba University Hospital, Japan. After being vaccinated, all health care workers (HCWs) were given a daily AEs check sheet on which they recorded solicited events, the same surveillance program used after AH1pdm vaccination in 2009. The frequency of injection site AEs with IIV4 was significantly higher than with the monovalent vaccine, but there was no significant difference with systemic AEs. Injection site and systemic AEs were reported as 83.7% and 25.5%, respectively, with IIV4. The grades of AE, mild, moderate and severe, were 67.2%, 16.4% and 0.1% with IIV4, respectively, indicating that almost all of the AEs reported with IIV4 were mild or moderate. Systemic AEs with IIV4 and monovalent vaccine were reported to be 25.5% and 23.1%, respectively, with the difference not being significant. The grade of AEs with IIV4, mild, moderate and severe, was 19.1%, 5.6% and 0.9%, respectively. The ratio of HCWs reporting AEs peaked at around 80% on day 1, then decreasing to less than 5% by day 7. AEs with IIV4 were reported more frequently compared with the AH1pdm monovalent vaccine. However, in consideration of the grade and duration of AEs, IIV4 was a well-tolerated, safe vaccine.
Asunto(s)
Vacunas contra la Influenza/efectos adversos , Reacción en el Punto de Inyección/epidemiología , Reacción en el Punto de Inyección/etiología , Adulto , Anciano , Anafilaxia/epidemiología , Anafilaxia/etiología , Escalofríos/epidemiología , Escalofríos/etiología , Femenino , Fiebre/epidemiología , Fiebre/etiología , Cefalea/epidemiología , Cefalea/etiología , Hospitales Universitarios/estadística & datos numéricos , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Mialgia/epidemiología , Náusea/epidemiología , Náusea/etiología , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Factores de Tiempo , Adulto JovenRESUMEN
The burden of chronic kidney disease (CKD) is increasing worldwide. Renal replacement therapy is the lifesaving treatment modality in end-stage renal disease. Among various renal replacement modalities, hemodialysis (HD) is widely preferred one. Intradialytic complications are common and mostly inevitable. This study was conducted to determine pattern of intradialytic complications and its associated factors. This is a cross-sectional study conducted for six months duration among all CKD patients who were undergoing maintenance HD in B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Of 228 patients, most were male 141 (61.8%) with median age 50 years (22-77). In this study, diabetic nephropathy (38.2%) was the most common etiology of CKD. Among 228 patients, complications were noted in 133 (58.3%) patients. Common complications were chills and rigor (44.3%), backache (30.7%), and hypotension (27.2%) in the study patients. Intradialytic complications were significantly associated with increasing age (P <0.001) and irregular HD (P <0.001). The common complications among CKD patient undergoing maintenance HD were chills, backache, and hypotension. Increasing age and irregular HD were significantly associated with intradialytic complications.
Asunto(s)
Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica , Adulto , Anciano , Dolor de Espalda/epidemiología , Dolor de Espalda/etiología , Escalofríos/epidemiología , Escalofríos/etiología , Estudios Transversales , Femenino , Humanos , Hipotensión/epidemiología , Hipotensión/etiología , Masculino , Persona de Mediana Edad , Nepal , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/terapia , Centros de Atención Terciaria , Adulto JovenRESUMEN
We report a case of Pseudomonas stutzeri endocarditis in Lebanon. The patient had a recent history of prosthetic aortic valve replacement and presented to the emergency department with fever and chills. Transesophageal echocardiography confirmed the presence of a vegetation on the prosthetic valve and blood cultures yielded P. stutzeri. The patient was treated with surgery and antibiotics but deteriorated and passed away four days after admission. To our knowledge, this is the fifth case of P. stutzeri endocarditis reported in the literature, and the first case with early presentation and mortality.