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1.
J Med Virol ; 95(4): e28699, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36951318

RESUMEN

Early in the 2022 Mpox (MPX) global outbreak, caseloads in the New York Metropolitan area climbed rapidly before other US urban areas. This case series summarizes the authors' clinical experience detecting and treating MPX, during a quickly evolving outbreak. Clinical outcomes were recorded with a focus on varied clinical presentation and outcomes such as complications and response to experimental tecovirimat therapy. A focal or multifocal rash was the most common presenting symptom in 91% of patients. Almost two-thirds (62%) of patients had anogenital involvement. Proctitis was one of the most painful presentations with 75% requiring antiviral treatment and three patients needing hospitalization for pain management. Most patients responded promptly to antiviral treatment with tecovirimat. Five out of 10 patients treated with tecovirimat reported symptom resolution within 48-72 h of therapy and another three saw resolution within first 96 h. Two patients had poor response to tecovirimat. This series includes the only reported case of an HIV positive, immunocompetent patient who experienced recurrent anal ulcers due to Mpox and required a second course of tecovirimat. Other unique presentations included urethritis, abscess formation and MPX infection postvaccination. Control of this current Mpox outbreak was possible due to timely diagnosis and the availability of both a licensed vaccine and an investigational drug.


Asunto(s)
Mpox , Humanos , New York , Antivirales/uso terapéutico , Benzamidas , Isoindoles
2.
J Card Surg ; 35(2): 514-517, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31872897

RESUMEN

BACKGROUND: Clostridium septicum aortitis is a lethal infection. C. septicum has a strong association with an underlying malignancy, most commonly in the colon. AIM: Early identification methods and management strategies of C. Septicum infection. MATERIALS AND METHODS: We present a 64-year-old man with aortic aneurysm and C. septicum bacteremia with unknown malignancy who passed away on the fourth day of hospitalization despite emergent endovascular intervention. Computed tomography showed periaortic gas which is the hallmark of infection. DISCUSSION: This case report highlights the need of prompt surgical treatment and its different modalities along with the early use of appropriate antibiotics due to the rapid spread of infection associated with high fatality. The authors also discuss the association of C. septicum aortitis with underlying occult malignancies. CONCLUSION: Delay in identification and treatment of C. Septicum is associated with very high mortality rates.


Asunto(s)
Aorta/cirugía , Aortitis/microbiología , Aortitis/terapia , Infecciones por Clostridium , Clostridium septicum , Antibacterianos/administración & dosificación , Aortitis/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Urgencias Médicas , Procedimientos Endovasculares/métodos , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Stents , Tomografía Computarizada por Rayos X
3.
Emerg Infect Dis ; 25(4): 748-752, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30882316

RESUMEN

In certain regions of New York state, USA, Ixodes scapularis ticks can potentially transmit 4 pathogens in addition to Borrelia burgdorferi: Anaplasma phagocytophilum, Babesia microti, Borrelia miyamotoi, and the deer tick virus subtype of Powassan virus. In a prospective study, we systematically evaluated 52 adult patients with erythema migrans, the most common clinical manifestation of B. burgdorferi infection (Lyme disease), who had not received treatment for Lyme disease. We used serologic testing to evaluate these patients for evidence of co-infection with any of the 4 other tickborne pathogens. Evidence of co-infection was found for B. microti only; 4-6 patients were co-infected with Babesia microti. Nearly 90% of the patients evaluated had no evidence of co-infection. Our finding of B. microti co-infection documents the increasing clinical relevance of this emerging infection.


Asunto(s)
Babesia microti , Enfermedad de Lyme , Enfermedades por Picaduras de Garrapatas , Babesia microti/aislamiento & purificación , Babesiosis/epidemiología , Coinfección , Humanos , New York/epidemiología , Estudios Prospectivos , Enfermedades por Picaduras de Garrapatas/epidemiología , Enfermedades por Picaduras de Garrapatas/microbiología , Enfermedades por Picaduras de Garrapatas/parasitología
5.
Cureus ; 16(1): e52321, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38357041

RESUMEN

INTRODUCTION: Human metapneumovirus (HMPV) is an important cause of seasonal respiratory tract infections, mainly in children and immunocompromised adults. The use of the Charlson Comorbidity Index (CCI) to predict outcomes in hospitalized patients has been validated in several settings. OBJECTIVE: This study aims to describe the clinical characteristics of adult patients with HMPV infection and evaluate the value of the CCI in predicting outcomes in patients with acute HMPV infections requiring hospitalization. METHOD: This is a single-center case-series study of hospitalized patients with HMPV infection in 2017. RESULTS: Twenty-two adult patients with a mean age of 65 years were reviewed. The mean CCI was 4.6±2.6. The overall mortality was 22%. An abnormal chest X-ray (CXR) was reported in 15 patients. CCI was not different between survivors and non-survivors. Non-survivors were more likely to have abnormal CXR and a higher fever at the time of diagnosis, required mechanical ventilation, or had other concomitant infections. CONCLUSION: The average CCI was 4.5, which was not significantly different between survivors and non-survivors. The mortality rate was elevated by 22% and was likely associated with admission to the ICU as well as the presence of another concomitant infection.

6.
Clin Infect Dis ; 56(4): e40-7, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23166187

RESUMEN

BACKGROUND: Deer tick virus (DTV) is a tick-borne flavivirus that has only recently been appreciated as a cause of viral encephalitis. We describe the clinical presentation of a patient who had DTV encephalitis diagnosed before death and survived for 8 months despite severe neurologic dysfunction. METHODS: Diagnosis was made from a cerebrospinal fluid specimen, using a flavivirus-specific polymerase chain-reaction assay followed by sequence confirmation, and the phylogeny was analyzed. Serologic testing, including plaque reduction neutralization testing, was also performed. RESULTS: Molecular analysis indicated that the virus was closely related to 2 strains of DTV that had been detected in Ixodes scapularis ticks from Massachusetts in 1996 and in the brain of a patient from New York in 2007. CONCLUSIONS: DTV encephalitis should be considered in the differential diagnosis of encephalitis in geographic areas that are endemic for Lyme disease.


Asunto(s)
Virus de la Encefalitis Transmitidos por Garrapatas/aislamiento & purificación , Encefalitis Transmitida por Garrapatas/líquido cefalorraquídeo , Ixodes , Anciano , Animales , Antibacterianos/uso terapéutico , Cefepima , Cefalosporinas/uso terapéutico , Diagnóstico Diferencial , Encefalitis Transmitida por Garrapatas/tratamiento farmacológico , Resultado Fatal , Humanos , Imagen por Resonancia Magnética , Masculino , New York , Filogenia , Reacción en Cadena de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa
7.
Emerg Infect Dis ; 19(12): 1926-33, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24274334

RESUMEN

Powassan virus, a member of the tick-borne encephalitis group of flaviviruses, encompasses 2 lineages with separate enzootic cycles. The prototype lineage of Powassan virus (POWV) is principally maintained between Ixodes cookei ticks and the groundhog (Marmota momax) or striped skunk (Mephitis mephitis), whereas the deer tick virus (DTV) lineage is believed to be maintained between Ixodes scapularis ticks and the white-footed mouse (Peromyscus leucopus). We report 14 cases of Powassan encephalitis from New York during 2004-2012. Ten (72%) of the patients were residents of the Lower Hudson Valley, a Lyme disease-endemic area in which I. scapularis ticks account for most human tick bites. This finding suggests that many of these cases were caused by DTV rather than POWV. In 2 patients, DTV infection was confirmed by genetic sequencing. As molecular testing becomes increasingly available, more cases of Powassan encephalitis may be determined to be attributable to the DTV lineage.


Asunto(s)
Virus de la Encefalitis Transmitidos por Garrapatas/clasificación , Encefalitis Transmitida por Garrapatas/epidemiología , Enfermedad de Lyme/epidemiología , Adolescente , Adulto , Anciano , Animales , Antiinfecciosos/administración & dosificación , Antiinfecciosos/uso terapéutico , Niño , Preescolar , Encefalitis Transmitida por Garrapatas/diagnóstico , Encefalitis Transmitida por Garrapatas/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Geografía Médica , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , New York/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
8.
Parasitol Res ; 112(12): 4015-9, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24022127

RESUMEN

Balamuthia mandrillaris is an emerging cause of subacute granulomatous amebic encephalitis (GAE). The diagnosis of this infection has proven to be difficult and is usually made postmortem. Early recognition and treatment may offer some benefit. This report describes a previously healthy woman who died from GAE due to B. mandrillaris.


Asunto(s)
Amebiasis , Balamuthia mandrillaris , Encefalitis/parasitología , Granuloma/parasitología , Animales , Autopsia , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad
9.
Cureus ; 15(6): e40655, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37476124

RESUMEN

BACKGROUND:  Post-COVID-19 syndrome has emerged as a long-term complication in adults and children; its effect on adolescents' performance in school is not well studied. OBJECTIVES: To study the physical/psychological impact of prolonged post-COVID-19 symptoms on school performance. METHODS:  This is a cross-sectional study using Google Forms, a web-based fully anonymized survey of children in grades 10-12. RESULTS:  The study included 54 students with a mean age of 16 years of whom 32 had COVID-19. Two were hospitalized and 10 had symptoms lasting more than four weeks. Commonly reported chronic symptoms were fatigue and cough. Seven students quit sports; eight had a decrease in their academic performance. Adolescents being infected more than once or not being fully vaccinated were more likely to develop prolonged symptoms and quit sports while academic performance in school was not affected. Three out of 10 (30%) students who had COVID-19 and responded to the questionnaire reported not seeking help. CONCLUSION: Post-COVID-19 syndrome is associated with a decline in physical but not mental performance in school. Being infected more than once with SARS-CoV-2 seems to play an important role in the persistence of post-COVID-19 symptoms despite the fact that some adolescents are hesitant to seek medical or psychological care.

10.
Future Cardiol ; 19(4): 197-202, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37313836

RESUMEN

We present a case of a 54-year-old gentleman with a history of hypertension and chronic HIV who presented with fever and epigastric pain, found to have elevated troponin-I levels and diffuse ST-segement elevations on ECG without clinical evidence of ischemia concerning for myopericarditis. Initial laboratory findings also included thrombocytopenia and elevated aminotransferases as well as computed tomography imaging revealing splenic infarcts. Given plausible exposure to ticks, this led to the eventual diagnosis of anaplasmosis confirmed on PCR assay. Cardiac MRI images confirmed myocardial involvement, which resolved with antibiotic treatment. While rare, cardiac involvement is possible sequelae of anaplasmosis infection as illustrated by this case.


Asunto(s)
Anaplasmosis , Miocarditis , Pericarditis , Masculino , Animales , Humanos , Persona de Mediana Edad , Anaplasmosis/complicaciones , Anaplasmosis/diagnóstico , Pericarditis/diagnóstico , Pericarditis/etiología , Pericarditis/terapia , Miocarditis/diagnóstico , Miocarditis/etiología , Miocarditis/terapia , Troponina I
11.
J Neurol Sci ; 451: 120670, 2023 08 15.
Artículo en Inglés | MEDLINE | ID: mdl-37392505

RESUMEN

Infective Endocarditis (IE) patients are known to have a variety of complications with one of the rarest, but serious being cerebral mycotic aneurysm, which can result in subarachnoid hemorrhage (SAH). Using the National In-Patient Sample database, we sought to determine the rate of acute ischemic stroke (AIS) and outcomes in IE- patients with and without SAH. In total, we identified 82,844 IE-patients from 2010 to 2016, of which 641 had a concurrent diagnosis of SAH. IE patients with SAH had a more complicated course, higher mortality rate (OR 4.65 CI 95% 3.9-5.5, P < 0.001), and worse outcomes. This patient population also had a significantly higher rate of AIS (OR 6.3 CI 95% 5.4-7.4, P < 0.001). Overall, 41.5% of IE-patients with SAH had AIS during their hospitalization as compared to 10.1% of IE only patients. IE-patients with SAH were more likely to undergo endovascular treatment (3.6%) with 0.8% of the IE patients with AIS undergoing mechanical thrombectomy. While IE-patients are at risk for various complications, our study suggests a significant increase in the mortality and risk of AIS in those with SAH.


Asunto(s)
Aneurisma Infectado , Endocarditis Bacteriana , Endocarditis , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Hemorragia Subaracnoidea , Humanos , Hemorragia Subaracnoidea/complicaciones , Aneurisma Infectado/complicaciones , Endocarditis Bacteriana/complicaciones , Endocarditis/complicaciones , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/epidemiología
12.
Am Surg ; 77(3): 345-7, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21375849

RESUMEN

Babesiosis is an emerging infection most commonly acquired from a tick bite. We describe three hospitalized patients with fever attributable to babesiosis after a splenectomy. Splenectomy was done because of splenic enlargement due to unsuspected babesia infection in one patient and because of splenic perforation due to babesiosis in a second patient. The third patient underwent splenectomy for trauma and acquired babesiosis postoperatively from a blood transfusion. Our cases demonstrate the need to be vigilant for babesiosis in patients undergoing splenectomy.


Asunto(s)
Babesiosis/diagnóstico , Fiebre/parasitología , Esplenectomía/efectos adversos , Enfermedades del Bazo/parasitología , Enfermedades del Bazo/cirugía , Reacción a la Transfusión , Babesiosis/etiología , Babesiosis/terapia , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Bazo/diagnóstico , Adulto Joven
13.
Cardiol Rev ; 29(5): 259-262, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32976125

RESUMEN

Corynebacterium jeikeium is a gram-positive, aerobic, pleomorphic, nonspore forming bacillus, commonly present on the skin surface. Infective endocarditis secondary to C. jeikeium most commonly affects left-sided heart valves and has a higher likelihood to require valve replacement compared to other Corynebacterium endocarditis. C. jeikeium endocarditis is extremely difficult to treat as it is characteristically resistant to penicillin, cephalosporins and aminoglycosides, and sensitivity to quinolones, macrolides, tetracyclines and rifampin is variable. Despite treatment, mortality rates as high as 33% have been reported. We hereby review the literature regarding the epidemiology, diagnosis and treatment of this deadly microorganism.


Asunto(s)
Infecciones por Corynebacterium , Corynebacterium , Endocarditis Bacteriana , Antibacterianos/uso terapéutico , Infecciones por Corynebacterium/diagnóstico , Infecciones por Corynebacterium/tratamiento farmacológico , Infecciones por Corynebacterium/epidemiología , Infecciones por Corynebacterium/microbiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/microbiología , Humanos
14.
Postgrad Med ; 131(2): 138-143, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30585748

RESUMEN

OBJECTIVES: The characteristics of patients with Acute Respiratory Distress Syndrome (ARDS) as a complication of Babesia microti infection have not been systematically described. METHODS: Adult patients admitted to the medical intensive care unit (MICU) of a tertiary care hospital in the Lower Hudson Valley of New York from 1/1/2008 to 8/1/2016 were evaluated for ARDS complicating babesiosis. RESULTS: Of 22 patients with babesiosis in the MICU, eight (36.4%; 95% CI: 19.7-57.0%) had ARDS. Six patients (75%) developed ARDS following initiation of anti-babesia drug therapy; however, the mean duration of symptoms in these patients exceeded that of patients who developed ARDS prior to initiation of treatment (7.50 ± 3.83d vs. 4.50 ± 0.71d, p = 0.34). Three patients (37.5%; 95% CI: 13.7-69.4%) expired without recovery from ARDS. In comparison, the mortality rate for the 14 MICU babesiosis patients without ARDS was 14.3% (p = 0.31). There was a trend toward younger age in survivors relative to non-survivors (mean age 54.6 ± 13.8y vs. 74.0 ± 6.24y, p = 0.07). Three of the five survivors did not require mechanical ventilation. The mean sequential organ failure assessment score of non-survivors was significantly higher than that of survivors (12.3 ± 1.15 vs. 6.0 ± 1.4, p = 0.0006). CONCLUSION: Among 22 critically ill adult patients with B. microti infection, ARDS developed in eight (35.4%), and three (37.5%) expired without resolution of the ARDS. ARDS often followed the initiation of anti-babesia drug therapy, raising the question of whether the death of the parasite per se contributed to its development. However, this observation was confounded by the longer duration of symptoms preceding initiation of drug therapy.


Asunto(s)
Babesiosis/complicaciones , Síndrome de Dificultad Respiratoria/etiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Babesiosis/mortalidad , Babesiosis/terapia , Femenino , Humanos , Unidades de Cuidados Intensivos , Enfermedades Pulmonares Parasitarias , Masculino , Persona de Mediana Edad , New York , Respiración Artificial , Síndrome de Dificultad Respiratoria/mortalidad , Síndrome de Dificultad Respiratoria/terapia
15.
Case Rep Infect Dis ; 2018: 3183805, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30425866

RESUMEN

Osteomyelitis is commonly caused by Staphylococci, Streptococci, Escherichia coli, and anaerobes. There have been cases of rare organisms like Klebsiella pneumoniae (Kp) being initially overlooked as causes of osteomyelitis. We report a case of an elderly cirrhotic adult male transferred for further management of liver failure, who was subsequently diagnosed with Kp osteomyelitis and sepsis. He had a history of blunt leg trauma, and MRI of the leg revealed osteomyelitis, with a negative workup for other sources of infection. Kp osteomyelitis is reported in less than 100 cases, mainly in pediatric and sickle-cell patients. There are no pathognomonic imaging findings. Lesions may be metastatic, with rapid widespread destruction and exuberant periosteal reaction. Kp is a rare, under recognized cause of osteomyelitis in immune-suppressed adults. Given its pathogenicity, early identification is critical.

16.
Med Mycol Case Rep ; 1(1): 9-12, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-24371725

RESUMEN

We report a rare case of orbital apex syndrome following epidural steroid injections of the lumbar spine in an immunocompetent individual with osteomyelitis and discitis caused by Aspergillus fumigatus. We suspect that the craniospinal venous system, also known as the Batson's plexus, was the main route for steroid-facilitated disease propagation from the spine to intracranial structures.

17.
Ticks Tick Borne Dis ; 2(4): 235-8, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22108020

RESUMEN

Babesiosis is an emerging tick-borne infection. We describe 2 hospitalized patients from the United States with spontaneous splenic rupture attributable to Babesia microti infection. The first patient was a 36-year-old previously healthy man with a low-grade splenic rupture not requiring surgical intervention. The second was a 70-year-old healthy man whose splenic rupture required proximal splenic artery embolization. Since the spleen is an important organ involved in controlling Babesia infection, management of splenic rupture in an infected patient using an organ preserving approach when appropriate may be preferred.


Asunto(s)
Babesia microti/aislamiento & purificación , Babesiosis/complicaciones , Rotura del Bazo/parasitología , Adulto , Anciano , Babesiosis/parasitología , Babesiosis/terapia , Embolización Terapéutica , Hemoperitoneo , Hospitalización , Humanos , Masculino , New York , Rotura Espontánea , Bazo/lesiones , Bazo/parasitología , Rotura del Bazo/patología , Rotura del Bazo/terapia , Tomografía Computarizada por Rayos X
18.
Heart Lung ; 39(6): 529-36, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20561881

RESUMEN

PURPOSE: We sought to determine the predictive value of the PaO2:FiO2 ratio (PFR), both independently and in combination with the standard Rapid Shallow Breathing Index (RSBI), for successful extubations in patients with primary hypoxemic respiratory failure (HRF). MATERIALS AND METHODS: A retrospective chart review of 154 patients with HRF requiring mechanical ventilation for ≥24 hours was performed. The primary outcome was reintubation within 48 hours. RESULTS: 142 (92%) patients were successfully extubated. Pre-extubation PFR and RSBI values among reintubated and successfully extubated patients were similar. The areas under the curve of the receiver operating characteristic curves using RSBI and PFR were .5 and .62, respectively. A PFR < 200 or RSBI ≥ 70 when the PFR was ≥200 indicated a higher risk of reintubation, with .7 sensitivity and .56 specificity (area under the curve, .69), using a classification and regression tree model. CONCLUSIONS: Neither the PFR independently nor the PFR in combination with the RSBI in a classification and regression tree model accurately predicted successful extubation in patients with HRF.


Asunto(s)
Hipoxia/diagnóstico , Intubación Intratraqueal , Insuficiencia Respiratoria/diagnóstico , Desconexión del Ventilador/métodos , Área Bajo la Curva , Femenino , Humanos , Hipoxia/patología , Unidades de Cuidados Intensivos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oximetría , Pronóstico , Curva ROC , Análisis de Regresión , Respiración Artificial , Pruebas de Función Respiratoria , Insuficiencia Respiratoria/patología , Estudios Retrospectivos , Sensibilidad y Especificidad , Resultado del Tratamiento
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