RESUMO
ABSTRACT: Epstein-Barr virus (EBV) is frequently reactivated by coronavirus 2019 (COVID-19), and a high incidence of EBV viremia has been reported in patients with severe COVID-19. However, the impact of EBV viremia on progression to severe COVID-19 is unclear. Therefore, we conducted a study to evaluate the effect of EBV on COVID-19 progression.We investigated EBV viremia at the time of admission in COVID-19 patients hospitalized between February 1, 2020, and April 11, 2021. A cross-sectional study was performed to compare the severity of COVID-19 according to the presence or absence of EBV viremia. However, since it is difficult to analyze the influence of EBV viremia on COVID-19 progression with cross-sectional studies, a retrospective cohort study, limited to patients with mild COVID-19, was additionally conducted to observe progression to severe COVID-19 according to the presence or absence of EBV viremia.Two hundred sixty-nine COVID-19 patients were tested for EBV viremia. In a cross-sectional study that included patients with both mild and severe COVID-19, the EBV viremia group had more severe pneumonia than the EBV-negative group. However, in the cohort study limited to mild cases (Nâ=â213), EBV viremia was not associated with COVID-19 progression.COVID-19 severity may affect EBV viremia; however, there was no evidence that EBV viremia was a factor in exacerbating pneumonia in patients with mild COVID-19.
Assuntos
COVID-19 , Infecções por Vírus Epstein-Barr , Estudos de Coortes , Estudos Transversais , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/epidemiologia , Herpesvirus Humano 4 , Humanos , Estudos Retrospectivos , Viremia/epidemiologiaRESUMO
BACKGROUND: The spleen contains immune cells and exhibits a pattern of infarction different from other organs; as such, splenic infarction (SI) may provide important clues to infection. However, the nature of the relationship between SI and infectious disease(s) is not well understood. Accordingly, this retrospective study investigated the relationship between SI and infection. METHODS: Hospital records of patients with SI, who visited Inha University Hospital (Incheon, Republic of Korea) between January 2008 and December 2018, were reviewed. Patient data regarding clinical presentation, causative pathogens, risk factors, and radiological findings were collected and analyzed. RESULTS: Of 353 patients with SI, 101 with infectious conditions were enrolled in this study, and their data were analyzed to identify associations between SI and infection. Ten patients were diagnosed with infective endocarditis (IE), and 26 exhibited bacteremia without IE. Twenty-seven patients experienced systemic infection due to miscellaneous causes (negative result on conventional automated blood culture), including the following intracellular organisms: parasites (malaria [n = 12], babesiosis [n = 1]); bacteria (scrub typhus [n = 5]); viruses (Epstein-Barr [n = 1], cytomegalovirus [n = 1]); and unidentified pathogen[s] (n = 7). Splenomegaly was more common among patients with miscellaneous systemic infection; infarction involving other organs was rare. Thirty-eight patients had localized infections (e.g., respiratory, intra-abdominal, or skin and soft tissue infection), and most (35 of 38) had other risk factors for SI. CONCLUSIONS: In this study, various infectious conditions were found to be associated with SI, and intracellular organisms were the most common causative pathogens. Further studies are needed to examine other possible etiologies and the underlying pathophysiological mechanisms.
Assuntos
Bacteriemia/epidemiologia , Infecções por Citomegalovirus/epidemiologia , Citomegalovirus/isolamento & purificação , Endocardite/epidemiologia , Infecções por Vírus Epstein-Barr/epidemiologia , Herpesvirus Humano 4/isolamento & purificação , Malária Vivax/epidemiologia , Orientia tsutsugamushi/isolamento & purificação , Plasmodium vivax/isolamento & purificação , Tifo por Ácaros/epidemiologia , Infarto do Baço/epidemiologia , Adulto , Idoso , Hemocultura , Comorbidade , Infecções por Citomegalovirus/virologia , Endocardite/microbiologia , Infecções por Vírus Epstein-Barr/virologia , Feminino , Hospitais Universitários , Humanos , Malária Vivax/parasitologia , Masculino , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Tifo por Ácaros/microbiologiaRESUMO
RATIONALE: Sternoclavicular joint septic arthritis is an unusual disease in healthy adults, and Staphylococcus aureus is the most common causative pathogen. The current treatment of choice is surgery with sternoclavicular joint resection and pectoralis flap closure, especially when the disease is complicated by osteomyelitis and abscess. PATIENT CONCERNS: Here, we report a 76-year-old woman without risk factors who visited our hospital for pain and redness, swelling on the left anterior chest wall. DIAGNOSIS: Magnetic resonance imaging showed infectious arthritis in the left SCJ, with multiple abscess pockets at the subcutaneous layer of anterior chest wall communicating with the joint cavity. Streptococcus agalactiae was isolated from blood culture. INTERVENTION: She was treated with 6 weeks of antibiotic therapy. OUTCOMES: After antibiotic treatment, she was successfully treated without recurrence. LESSONS: Besides surgery, medical treatment should also be considered for sternoclavicular joint septic arthritis, depending on patient status and the causative pathogen. Physicians should be aware of this rare disease to facilitate its prompt diagnosis and management.
Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Articulação Esternoclavicular , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus agalactiae , Idoso , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/microbiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Testes de Sensibilidade Microbiana , Articulação Esternoclavicular/microbiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/diagnóstico por imagem , Streptococcus agalactiae/efeitos dos fármacosRESUMO
BACKGROUND: Henoch-Schönlein purpura (HSP) may be caused by several allergens. However, to date, HSP caused by Orientia tsutsugamushi has not been reported. Here, we report an unusual rash with features of HSP caused by Orientia tsutsugamushi. CASE PRESENTATION: A man visited a tertiary hospital with bilateral symmetrical purpura and fever. He presented with an eschar in the left popliteal fossa and proteinuria. He was diagnosed with tsutsugamushi disease by indirect fluorescent antibody and positive polymerase chain reaction tests. Purpura biopsy demonstrated a feature of leukocytoclastic vasculitis and IgA deposition in dermal vessels, indicative of HSP. CONCLUSIONS: When examining patients with unique rashes, such as in this case, we suggest investigating out-door activities and evidence of mite bites. Furthermore, differential diagnosis of tsutsugamushi disease should be considered when necessary.
Assuntos
Vasculite por IgA/diagnóstico , Orientia tsutsugamushi/isolamento & purificação , Tifo por Ácaros/diagnóstico , Antibacterianos/uso terapêutico , Biópsia , Diagnóstico Diferencial , Humanos , Vasculite por IgA/tratamento farmacológico , Vasculite por IgA/microbiologia , Vasculite por IgA/patologia , Masculino , Pessoa de Meia-Idade , Orientia tsutsugamushi/genética , Orientia tsutsugamushi/imunologia , Tifo por Ácaros/tratamento farmacológico , Tifo por Ácaros/microbiologia , Tifo por Ácaros/patologia , Pele/patologia , Resultado do TratamentoAssuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções por HIV/imunologia , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Imunossupressores/uso terapêutico , Leucoencefalopatia Multifocal Progressiva/diagnóstico , Meningite Criptocócica/diagnóstico , Prednisolona/uso terapêutico , Talidomida/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Edema Encefálico/diagnóstico , Relação Dose-Resposta a Droga , Infecções por HIV/tratamento farmacológico , Humanos , Síndrome Inflamatória da Reconstituição Imune/complicações , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Splenic infarction caused by malaria can be fatal, but its incidence and clinical presentation are not well-known. Thus, we investigated the prevalence and characteristics of splenic complications in patients with vivax malaria from 2005 to 2017 in a university hospital. Among 273 patients who were diagnosed with Plasmodium vivax infection by blood smear, 92 underwent abdominal computed tomography or ultrasonography. Twelve patients had splenic infarction. All patients with splenic infarction recovered after treatment with antimalarial drugs, without surgery and intervention. Although anemia and prolonged fever may be risk factors for splenic infarction, the incidence of these events was insufficient for a detailed analysis.
Assuntos
Antimaláricos/uso terapêutico , Malária Vivax/epidemiologia , Plasmodium vivax/isolamento & purificação , Infarto do Baço/epidemiologia , Abdome/diagnóstico por imagem , Adulto , Feminino , Hospitais Universitários , Humanos , Incidência , Malária Vivax/diagnóstico por imagem , Malária Vivax/tratamento farmacológico , Malária Vivax/parasitologia , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Baço/diagnóstico por imagem , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/tratamento farmacológico , Infarto do Baço/parasitologia , Tomografia Computadorizada por Raios X , Ultrassonografia , Adulto JovemRESUMO
BACKGROUND: Actinomycosis is a rare, chronic granulomatous disease caused by Gram-positive anaerobic bacteria that colonize the oral cavity. Cervicofacial actinomycosis is the most frequent clinical presentation of actinomycosis, but hematogenous osteomyelitis at distant sites can occur in rare instance in immunocompromised or pediatric patients, only a few cases have been reported in healthy patients. Here we described a new case of distal femur osteomyelitis caused by Actinomyces in an adult patient who was immunocompetent and had no predisposing factors. CASE PRESENTATION: A woman aged 52 years with no history of trauma presented with severe pain, swelling, and increased local heat in the proximal area of the right knee 3 weeks after she first noticed discomfort. Magnetic resonance imaging showed persistent osteomyelitis of the distal metaphysis and diaphysis of the femur with a multifocal intraosseous abscess pocket. An incision and drainage of the abscess were conducted. The tissue culture, fungus culture, acid fast bacillus (AFB) culture, AFB smear, and tuberculosis polymerase chain reaction test results were negative. A pathologic examination confirmed the presence of actinomycosis. The patient was successfully treated with intravenous penicillin G for 8 weeks followed by oral amoxicillin-clavulanate for 6 weeks with repeated surgical debridement and drainage. After a 5-year follow up, the patient had no signs of recurring infection or complications and she had full range of movement in the affected knee. CONCLUSIONS: Although rare, actinomycotic osteomyelitis can occur in healthy people. Furthermore, actinomycotic osteomyelitis is easily misdiagnosed as tuberculosis in areas with a high prevalence of tuberculosis. To detect and identify the bacteria accurately, pathologic examination should be performed as well as culture tests, because the probability for culture confirmation of actinomycosis is quite low. The initial treatment is vital to a successful outcome without ostectomy or amputation.
Assuntos
Actinomyces/isolamento & purificação , Actinomicose/complicações , Antibacterianos/administração & dosagem , Drenagem , Osteomielite/microbiologia , Actinomyces/imunologia , Actinomicose/imunologia , Actinomicose/microbiologia , Actinomicose/terapia , Biópsia , Feminino , Fêmur/diagnóstico por imagem , Fêmur/microbiologia , Fêmur/patologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/imunologia , Osteomielite/terapia , Resultado do TratamentoRESUMO
BACKGROUND/AIMS: Fecal microbiota transplantation (FMT) is a highly effective therapy for refractory and recurrent Clostridium difficile infection (CDI). Despite its excellent efficacy and recent widespread use, FMT has not been widely used in South Korea thus far. We describe our experience with FMT to treat refractory/recurrent CDI. METHODS: We conducted a chart review of patients who underwent FMT for refractory/recurrent CDI at Inha University Hospital, between March 2014 and June 2016. The demographic information, treatment data, and adverse events were reviewed. FMT was administered via colonoscopy and/or duodenoscopy. All stool donors were rigorously screened to prevent infectious disease transmission. RESULTS: FMT was performed in nine patients with refractory/recurrent CDI. All patients were dramatically cured. Bowel movement was normalized within one week after FMT. There were no procedure-related adverse events, except aspiration pneumonia in one patient. During the follow-up period (mean 11.4 months), recurrence of CDI was observed in one patient at one month after FMT due to antibiotics. CONCLUSIONS: FMT is a safe, well-tolerated and highly effective treatment for refractory/recurrent CDI. Although there are many barriers to using FMT, we expect that FMT will be widely used to treat refractory/recurrent CDI in South Korea.
Assuntos
Infecções por Clostridium/terapia , Enterocolite Pseudomembranosa/terapia , Transplante de Microbiota Fecal , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , Colonoscopia , Duodenoscopia , Enterocolite Pseudomembranosa/diagnóstico , Enterocolite Pseudomembranosa/tratamento farmacológico , Transplante de Microbiota Fecal/efeitos adversos , Fezes/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Aspirativa/etiologia , RecidivaAssuntos
Síndrome de Behçet/complicações , Doenças da Medula Óssea/etiologia , Edema/etiologia , Articulações do Pé , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Síndrome de Behçet/diagnóstico , Doenças da Medula Óssea/diagnóstico , Doenças da Medula Óssea/tratamento farmacológico , Edema/diagnóstico , Edema/tratamento farmacológico , Feminino , Articulações do Pé/efeitos dos fármacos , Articulações do Pé/patologia , Humanos , Imageamento por Ressonância Magnética , Valor Preditivo dos Testes , Recidiva , Fatores de Risco , Síndrome , Resultado do TratamentoRESUMO
Epithelial growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have been widely used for non-small-cell lung cancer patients. Its untoward cutaneous effects are largely well known and developed in many patients treated with EGFR TKIs. However trichomegaly of eyelash is rarely reported. Although trichomegaly is not a drug-limiting side effect, it could be troublesome of continuing the treatment because of cosmetic issue or eyeball irritation by long eyelashes. Therefore clinicians are needed to pay attention to this uncommon effect. We herein describe erlotinib induced trichomegaly of eyelashes in a woman with adenocarcinoma of the lung.