RESUMO
Coccidioidomycosis is a fungal infection caused by Coccidioides immitis and Coccidioides posadasii. While infections are usually mild, severe disease occurs in immunocompromised patients. Dissemination is associated with severe morbidity and mortality. Because of the tendency of this disease to imitate many diseases, diagnosis may be difficult on presentation. We present a case of disseminated coccidioidomycosis in a patient who was initially managed as miliary tuberculosis. In endemic areas, coccidioidomycosis is one of the two top differentials for miliary micronodular distribution on chest imaging. The patient was a recently diagnosed HIV positive patient and presented to the hospital with multiorgan failure, septic shock, and acute respiratory distress syndrome. He rapidly deteriorated and died within three days of presentation at the emergency department.
RESUMO
An acute COVID-19 infection can result in cystic lung changes that have a unique presentation and are inherently difficult to manage with or without preexisting conditions. Even though reportedly very few COVID-19 patients develop secondary bacterial infections due to unclear mechanisms, a postviral sequela with typical and atypical organisms can prolong the course of lung damage. The long-term effects of COVID-19 lung damage are still unclear, as the morbidity of the disease process is yet to be fully understood. This report presents a rare complication of COVID pneumonia with bilateral necrotizing pneumatoceles presenting with hemoptysis and bilateral pneumothoraces with positive sputum cultures for Enterobacter aerogenes and Pseudomonas aeruginosa. It highlights rare complications of COVID-19 requiring multiple hospital admissions and ongoing home oxygen therapy.
RESUMO
Splenic rupture due to any cause is a life-threatening complication and commonly attributed to trauma. Atraumatic splenic rupture is very rarely reported, and the incidence is currently unknown. Anticoagulants and dual anti-platelet medication can increase the chances of a splenic rupture. Surgical removal of the spleen may be warranted to prevent a life-threatening bleeding. Early identification and intervention are required for most patients as only a few qualify for medical management.
Assuntos
Inibidores da Agregação Plaquetária , Ruptura Esplênica , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Pirazóis , Piridonas/efeitos adversos , Ruptura Espontânea , Ruptura Esplênica/induzido quimicamente , Ruptura Esplênica/diagnóstico por imagemAssuntos
Antibacterianos/farmacocinética , Ciprofloxacina/farmacocinética , Estado Terminal , Diálise Renal/métodos , Idoso , Antibacterianos/sangue , Antibacterianos/uso terapêutico , Área Sob a Curva , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/mortalidade , Ciprofloxacina/sangue , Ciprofloxacina/uso terapêutico , Estado Terminal/mortalidade , Relação Dose-Resposta a Droga , Resistência Microbiana a Medicamentos , Feminino , Humanos , Masculino , Taxa de Depuração Metabólica , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos ProspectivosAssuntos
Estado Terminal/terapia , Cálculos da Dosagem de Medicamento , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Imipenem/farmacocinética , Diálise Renal/efeitos adversos , Tienamicinas/farmacocinética , Antibacterianos/farmacocinética , Feminino , Humanos , Masculino , Erros de Medicação/prevenção & controle , Meropeném , Taxa de Depuração Metabólica , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND OBJECTIVES: Infection is the most common cause of death in severe AKI, but many patients receiving continuous RRT do not reach target antibiotic concentrations in plasma. Extended infusion of ß-lactams is associated with improved target attainment in critically ill patients; thus, we hypothesized that extended infusion piperacillin-tazobactam would improve piperacillin target attainment compared with short infusion in patients receiving continuous RRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted an institutional review board-approved observational cohort study of piperacillin-tazobactam pharmacokinetics and pharmacodynamics in critically ill patients receiving continuous venovenous hemodialysis and hemodiafiltration at three tertiary care hospitals between 2007 and 2015. Antibiotic concentrations in blood and/or dialysate samples were measured by liquid chromatography, and one- and two-compartment pharmacokinetic models were fitted to the data using nonlinear mixed effects regression. Target attainment for piperacillin was defined as achieving four times the minimum inhibitory concentration of 16 µg/ml for >50% of the dosing cycle. The probabilities of target attainment for a range of doses, frequencies, and infusion durations were estimated using a Monte Carlo simulation method. Target attainment was also examined as a function of patient weight and continuous RRT effluent rate. RESULTS: Sixty-eight participants had data for analysis. Regardless of infusion duration, 6 g/d piperacillin was associated with ≤45% target attainment, whereas 12 g/d was associated with ≥95% target attainment. For 8 and 9 g/d, target attainment ranged between 68% and 85%. The probability of target attainment was lower at higher effluent rates and patient weights. For all doses, frequencies, patient weights, and continuous RRT effluent rates, extended infusion was associated with higher probability of target attainment compared with short infusion. CONCLUSIONS: Extended infusions of piperacillin-tazobactam are associated with greater probability of target attainment in patients receiving continuous RRT.