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1.
BMC Infect Dis ; 20(1): 669, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928130

RESUMO

BACKGROUND: The parasite Entamoeba histolytica is the causal agent of amoebiasis, a worldwide emerging disease. Amebic brain abscess is a form of invasive amebiasis that is both rare and frequently lethal. This condition always begins with the infection of the colon by E. histolytica trophozoites, which subsequently travel through the bloodstream to extraintestinal tissues. CASE PRESENTATION: We report a case of a 71-year-old female who reported an altered state of consciousness, disorientation, sleepiness and memory loss. She had no history of hepatic or intestinal amoebiasis. A preliminary diagnosis of colloidal vesicular phase neurocysticercosis was made based on nuclear magnetic resonance imaging (NMRI). A postsurgery immunofluorescence study was positive for the 140 kDa fibronectin receptor of E. histolytica, although a serum analysis by ELISA was negative for IgG antibodies against this parasite. A specific E. histolytica 128 bp rRNA gene was identified by PCR in biopsy tissue. The final diagnosis was cerebral amoebiasis. The patient underwent neurosurgery to eliminate amoebic abscesses and was then given a regimen of metronidazole, ceftriaxone and dexamethasone for 4 weeks after the neurosurgery. However, a rapid decline in her condition led to death. CONCLUSIONS: The present case of an individual with a rare form of cerebral amoebiasis highlights the importance of performing immunofluorescence, NMRI and PCR if a patient has brain abscess and a poorly defined diagnosis. Moreover, the administration of corticosteroids to such patients can often lead to a rapid decline in their condition.


Assuntos
Abscesso Encefálico/diagnóstico , Abscesso Encefálico/parasitologia , Infecções Parasitárias do Sistema Nervoso Central/diagnóstico , Entamebíase/diagnóstico , Idoso , Animais , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Ceftriaxona/administração & dosagem , Infecções Parasitárias do Sistema Nervoso Central/tratamento farmacológico , Infecções Parasitárias do Sistema Nervoso Central/patologia , Infecções Parasitárias do Sistema Nervoso Central/cirurgia , Terapia Combinada , DNA de Protozoário/análise , Dexametasona/administração & dosagem , Quimioterapia Combinada , Entamoeba histolytica/genética , Entamoeba histolytica/imunologia , Entamoeba histolytica/isolamento & purificação , Entamebíase/tratamento farmacológico , Entamebíase/patologia , Entamebíase/cirurgia , Evolução Fatal , Feminino , Humanos , Metronidazol/administração & dosagem , Procedimentos Neurocirúrgicos , Testes Sorológicos
2.
Respir Res ; 21(1): 236, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938445

RESUMO

BACKGROUND: Spontaneous pneumothorax is an uncommon complication of COVID-19 viral pneumonia. The exact incidence and risk factors are still unknown. Herein we review the incidence and outcomes of pneumothorax in over 3000 patients admitted to our institution for suspected COVID-19 pneumonia. METHODS: We performed a retrospective review of COVID-19 cases admitted to our hospital. Patients who were diagnosed with a spontaneous pneumothorax were identified to calculate the incidence of this event. Their clinical characteristics were thoroughly documented. Data regarding their clinical outcomes were gathered. Each case was presented as a brief synopsis. RESULTS: Three thousand three hundred sixty-eight patients were admitted to our institution between March 1st, 2020 and June 8th, 2020 for suspected COVID 19 pneumonia, 902 patients were nasopharyngeal swab positive. Six cases of COVID-19 patients who developed spontaneous pneumothorax were identified (0.66%). Their baseline imaging showed diffuse bilateral ground-glass opacities and consolidations, mostly in the posterior and peripheral lung regions. 4/6 cases were associated with mechanical ventilation. All patients required placement of a chest tube. In all cases, mortality (66.6%) was not directly related to the pneumothorax. CONCLUSION: Spontaneous pneumothorax is a rare complication of COVID-19 viral pneumonia and may occur in the absence of mechanical ventilation. Clinicians should be vigilant about the diagnosis and treatment of this complication.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pneumotórax/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/patogenicidade , Causas de Morte , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Evolução Fatal , Feminino , Interações Hospedeiro-Patógeno , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Philadelphia/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Pneumotórax/diagnóstico , Pneumotórax/terapia , Pneumotórax/virologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
3.
BMC Pediatr ; 20(1): 429, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907595

RESUMO

BACKGROUND: Central and peripheral nervous system symptoms and complications are being increasingly recognized among individuals with pandemic SARS-CoV-2 infections, but actual detection of the virus or its RNA in the central nervous system has rarely been sought or demonstrated. Severe or fatal illnesses are attributed to SARS-CoV-2, generally without attempting to evaluate for alternative causes or co-pathogens. CASE PRESENTATION: A five-year-old girl with fever and headache was diagnosed with acute SARS-CoV-2-associated meningoencephalitis based on the detection of its RNA on a nasopharyngeal swab, cerebrospinal fluid analysis, and magnetic resonance imaging findings. Serial serologic tests for SARS-CoV-2 IgG and IgA showed seroconversion, consistent with an acute infection. Mental status and brain imaging findings gradually worsened despite antiviral therapy and intravenous dexamethasone. Decompressive suboccipital craniectomy for brain herniation with cerebellar biopsy on day 30 of illness, shortly before death, revealed SARS-CoV-2 RNA in cerebellar tissue using the Centers for Disease Control and Prevention 2019-nCoV Real-Time Reverse Transcriptase-PCR Diagnostic Panel. On histopathology, necrotizing granulomas with numerous acid-fast bacilli were visualized, and Mycobacterium tuberculosis complex DNA was detected by PCR. Ventricular cerebrospinal fluid that day was negative for mycobacterial DNA. Tracheal aspirate samples for mycobacterial DNA and culture from days 22 and 27 of illness were negative by PCR but grew Mycobacterium tuberculosis after 8 weeks, long after the child's passing. She had no known exposures to tuberculosis and no chest radiographic findings to suggest it. All 6 family members had normal chest radiographs and negative interferon-γ release assay results. The source of her tuberculous infection was not identified, and further investigations by the local health department were not possible because of the State of Michigan-mandated lockdown for control of SARS-CoV-2 spread. CONCLUSION: The detection of SARS-CoV-2 RNA in cerebellar tissue and the demonstration of seroconversion in IgG and IgA assays was consistent with acute SARS-CoV-2 infection of the central nervous infection. However, the cause of death was brain herniation from her rapidly progressive central nervous system tuberculosis. SARS-CoV-2 may mask or worsen occult tuberculous infection with severe or fatal consequences.


Assuntos
Betacoronavirus/genética , Coinfecção/diagnóstico , Infecções por Coronavirus/epidemiologia , DNA Bacteriano/análise , Mycobacterium tuberculosis/genética , Pandemias , Pneumonia Viral/epidemiologia , Tuberculose do Sistema Nervoso Central/diagnóstico , Pré-Escolar , Coinfecção/microbiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Evolução Fatal , Feminino , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , RNA Viral/análise , Tuberculose do Sistema Nervoso Central/microbiologia
5.
Medicine (Baltimore) ; 99(33): e21736, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872060

RESUMO

RATIONALE: Pilot studies have reported that patients with systemic lupus erythematosus (SLE) appear more likely to develop into neoplasia, especially lymphatic hyperplasia diseases. To our knowledge, this is the first case report of the concomitant onset of SLE and primary breast diffuse large B-cell lymphoma (PB-DLBCL). PATIENT CONCERNS: We reported an unusual case of the occurrence of primary breast diffuse large B-cell lymphoma in a 25-year-old female patient who had been diagnosed with SLE and treated with immunosuppressive drugs for about 4 years. She presented a 7-week history of a painless mass above the left breast and no history suggestive of any nipple discharge, fever, and weight loss. DIAGNOSIS: Ultrasonography of the breast showed that there was 1 mass in the left breast. After breast mass surgical resection, histopathological examinations were performed and revealed that it was primary breast diffuse large B-cell lymphoma. INTERVENTIONS: Treatment strategy with vincristine and dexamethasone was used to improve symptoms. However, the patient's renal function deteriorated and the blood potassium rose continuously and she and their family members refused the follow-up treatments. OUTCOMES: The patient died 8 months after she was discharged from the hospital. LESSONS: PB-DLBCL is a rare occurrence in SLE patients. Therefore, a careful examination is very important in SLE cohort, as activity of the disease and malignancy may mimic each other. Meanwhile, when symptoms cannot be explained or insensitive to treatment, the occurrence of malignant tumors must be highly considered.


Assuntos
Neoplasias da Mama/complicações , Mama/patologia , Falência Renal Crônica/etiologia , Lúpus Eritematoso Sistêmico/complicações , Linfoma Difuso de Grandes Células B/complicações , Adulto , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Evolução Fatal , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/terapia , Radiografia , Ultrassonografia
6.
BMJ Case Rep ; 13(9)2020 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-32907873

RESUMO

A 71-year-old man presented to the emergency department (ED) with low oxygen saturations and symptoms consistent with COVID-19 infection. Apart from a small left-sided ischaemic stroke 10 years prior with very minor residual deficit, he had been well and in full-time employment until development of symptoms. Within minutes of commencing non-invasive ventilation (NIV) in the ED, he developed a complete left-sided paralysis and hemineglect. This case highlights the significance of the prothrombotic complications associated with COVID-19 infection. It also raises the question whether pressure changes upon commencing NIV could lead to clot migration.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Ventilação não Invasiva/métodos , Pneumonia Viral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Doença Aguda , Idoso , Infecções por Coronavirus/terapia , Evolução Fatal , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pandemias , Pneumonia Viral/terapia , Respiração com Pressão Positiva/métodos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Tomografia Computadorizada por Raios X/métodos
7.
Rev Paul Pediatr ; 38: e2020165, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32876282

RESUMO

OBJECTIVE: Recently, there have been reports of children with severe inflammatory syndrome and multiorgan dysfunction associated with elevated inflammatory markers. These cases are reported as presenting the Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. In this study, we describe with parental permission a case of MIS-C in an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CASE DESCRIPTION: A seven-month-old infant, with SARS-CoV-2 infection and a history of extreme preterm birth and very low weight at birth, with an initial course of mild respiratory symptoms and abrupt progression to vasoplegic shock, myocarditis and hyperinflammation syndrome, shown by high levels of troponin I, ferritin, CRP, D-dimer and hypoalbuminemia. Despite the intensive care provided, the child developed multiple organ dysfunction and died. COMMENTS: Patients with a history of extreme prematurity may present with MIS-C in the presence of COVID-19 and are a group of special concern.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Insuficiência de Múltiplos Órgãos , Pandemias , Pneumonia Viral , Ressuscitação , Choque , Síndrome de Resposta Inflamatória Sistêmica , Deterioração Clínica , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Evolução Fatal , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Recém-Nascido , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Pneumonia Viral/sangue , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Nascimento Prematuro , Respiração Artificial/métodos , Ressuscitação/métodos , Fatores de Risco , Choque/etiologia , Choque/terapia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Síndrome de Resposta Inflamatória Sistêmica/virologia , Tomografia Computadorizada por Raios X/métodos
8.
Ann Ital Chir ; 91: 235-238, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877383

RESUMO

The present pandemic caused by the SARS COV-2 coronavirus is still ongoing, although it is registered a slowdown in the spread for new cases. The main environmental route of transmission of SARS-CoV-2 is through droplets and fomites or surfaces, but there is a potential risk of virus spread also in smaller aerosols during various medical procedures causing airborne transmission. To date, no information is available on the risk of contagion from the peritoneal fluid with which surgeons can come into contact during the abdominal surgery on COVID-19 patients. We have investigated the presence of SARS-CoV-2 RNA in the peritoneal cavity of patients affected by COVID-19, intraoperatively and postoperatively. KEY WORDS: Covid-19, Laparotomy, Surgery.


Assuntos
Líquido Ascítico/virologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Perfuração Intestinal/cirurgia , Laparotomia , Pandemias , Pneumonia Viral/transmissão , Doenças do Colo Sigmoide/cirurgia , Viremia/transmissão , Aerossóis , Idoso de 80 Anos ou mais , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Divertículo/complicações , Evolução Fatal , Feminino , Humanos , Perfuração Intestinal/sangue , Perfuração Intestinal/complicações , Perfuração Intestinal/virologia , Período Intraoperatório , Nasofaringe/virologia , Pandemias/prevenção & controle , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Período Pós-Operatório , Estudos Prospectivos , RNA Viral/isolamento & purificação , Risco , Soro/virologia , Doenças do Colo Sigmoide/sangue , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/virologia , Viremia/virologia
9.
J Stroke Cerebrovasc Dis ; 29(10): 105111, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912557

RESUMO

INTRODUCTION: Since the emergence of Coronavirus Disease 19 (COVID-19) pandemic, multiple neurologic complications in infected patients have been reported. Despite these reports, the mechanism of COVID-19 nervous system injury is not well understood. We report the case of a COVID-19 patient with diffuse microhemorrhages on brain MRI, positive anticardiolipin antibodies, and purpuric rash with biopsy showing a thrombotic vasculopathy, all features suggestive of secondary microangiopathy. CASE REPORT: A 69-year-old male with history of hypertension, chronic kidney disease, and hypothyroidism presented with one week of dyspnea, cough, diarrhea, and fevers. Chest x-ray demonstrated bibasilar consolidations and nasopharyngeal reverse transcriptase polymerase chain reaction confirmed SARS-CoV-2 infection. He had subsequent respiratory decline requiring intubation the day after admission. He developed a truncal morbilliform rash and diffuse purpura, a biopsy of which showed small dermal blood vessels with intraluminal microthrombi consistent with thrombotic vasculopathy. He was found to have elevated aCL IgM and IgG and equivocal lupus anticoagulant study. Brain MRI obtained for persistent encephalopathy showed innumerable areas of susceptibility weighted imaging changes throughout the bilateral juxtacortical white matter, corpus callosum, basal ganglia, and brainstem, as well as multiple small areas of FLAIR hyperintensities, consistent with microhemorrhage DISCUSSION: While there have been several reported cases of neurologic manifestations of COVID-19, the pathophysiology may not be related to neurotropism of the virus itself. The new development of antiphospholipid antibodies and thrombotic vasculopathy in dermal blood vessels in this patient suggest a secondary microangiopathy potentially related to a virally-induced inflammatory state.


Assuntos
Betacoronavirus/patogenicidade , Hemorragia Cerebral/virologia , Doenças de Pequenos Vasos Cerebrais/virologia , Infecções por Coronavirus/virologia , Pneumonia Viral/virologia , Púrpura/virologia , Idoso , Betacoronavirus/isolamento & purificação , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/terapia , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/terapia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Progressão da Doença , Evolução Fatal , Interações Hospedeiro-Patógeno , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Púrpura/diagnóstico , Púrpura/terapia
10.
BMJ Case Rep ; 13(8)2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32843475

RESUMO

SARS-CoV-2 has wreaked havoc globally and has claimed innumerable lives all over the world. Apart from the characteristic respiratory illness, this disease has been associated with florid extrapulmonary manifestations and complications. A 59-year-old female healthcare worker presented with features of acute-onset non-compressive myelopathy with a sensory level at T10 segment along with high-grade fever for 4 days. MRI of dorsal spine was suggestive of myelitis at T7 vertebral level. She was initiated on injectable steroids and did show some initial signs of recovery. A day later, she developed an acute-onset respiratory failure but could not be revived despite our best efforts. Her nasopharyngeal and oropharyngeal swab turned out to be positive for SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR). We hereby report a case of acute transverse myelitis with COVID-19 as a probable aetiology.


Assuntos
Infecções por Coronavirus/complicações , Mielite Transversa/virologia , Pneumonia Viral/complicações , Vértebras Torácicas/virologia , Betacoronavirus , Diagnóstico Diferencial , Evolução Fatal , Feminino , Glucocorticoides/uso terapêutico , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/tratamento farmacológico , Pandemias , Insuficiência Respiratória/virologia , Vértebras Torácicas/diagnóstico por imagem
11.
BMC Infect Dis ; 20(1): 583, 2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32762676

RESUMO

BACKGROUND: Dengue fever is endemic and a leading health problem in Sri Lanka. Increased incidence of concurrent bacteremia in patients with dengue infection is a recognized complication. However, Staphylococcal endocarditis following dengue fever is uncommon. Quadricuspid aortic valve (QAV) is a rare congenital anomaly and few cases of infective endocarditis have been reported in QAV. CASE PRESENTATION: A 32-year-old Sri Lankan male presented to the National Hospital of Sri Lanka with recurrence of fever and acute left hemiplegia following an uncomplicated recovery of dengue fever. He was diagnosed to have Staphylococcal infective endocarditis of quadricuspid aortic valve, with septic emboli to brain and spleen. He was managed with intravenous vancomycin initially, however, due to inadequate response, intravenous linezolid was added. He developed rhabdomyolysis with very high creatine phosphokinase leading to acute kidney injury, which settled with the cessation of linezolid. The patient succumbed to his illness despite aggressive antimicrobial therapy and maximum supportive care while being assessed for aortic valve replacement. CONCLUSIONS: This case illustrates three clinical issues that a clinician should be aware of. Firstly, the possibility of a serious secondary bacterial infection as a cause for recurrence of fever following dengue infection. Secondly, this case highlights the importance of identifying QAV as a cause for complicated infective endocarditis of increased severity. The report also denotes the value of being vigilant of linezolid induced rhabdomyolysis which had a causal relationship with the commencement of the drug and its cessation.


Assuntos
Valva Aórtica/anormalidades , Dengue/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/etiologia , Doenças das Valvas Cardíacas/diagnóstico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/etiologia , Staphylococcus aureus/isolamento & purificação , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Hemocultura , Dengue/tratamento farmacológico , Dengue/virologia , Vírus da Dengue , Endocardite Bacteriana/tratamento farmacológico , Evolução Fatal , Febre/tratamento farmacológico , Humanos , Linezolida/farmacologia , Linezolida/uso terapêutico , Masculino , Rabdomiólise/induzido quimicamente , Rabdomiólise/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Acidente Vascular Cerebral/mortalidade
12.
Am J Case Rep ; 21: e925641, 2020 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-32799213

RESUMO

BACKGROUND Acute hemorrhagic necrotizing encephalitis (AHNE) is a rare manifestation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. AHNE usually involves the subcortical white matter but not the cortical grey matter. This study describes the disruptive effects of AHNE associated with SARS-CoV-2 on cognitive function in a previously healthy and sound middle-aged woman resulting from alterations in cortical areas involved in the cognitive network. CASE REPORT A 44-year-old previously healthy woman with a history of inter-state travel developed a flu-like illness, followed by acute, steadily progressive cognitive impairment. She was admitted in a comatose state after a first tonic-clonic seizure. Blood tests were non-informative. Cerebral magnetic resonance imaging (MRI) was indicative of AHNE. Cerebrospinal fluid analysis showed mild lymphocytosis with normal protein and normal glucose but an elevated IgG index. After testing positive for SARS-CoV-2, she was administered steroids. Treatment was ineffective, and the patient died. CONCLUSIONS SARS-CoV-2 is a potential central nervous system (CNS) pathogen, which may manifest as AHNE. These patients may present with generalized tonic-clonic seizures and frontal dysexecutive syndrome, with cognitive impairment being the presenting feature of neuro-coronavirus disease-2019 (COVID-19). The patient described in this report is unique for acute-onset and isolated cognitive impairments due to SARS-CoV-2 infection in the absence of clinical or radiological respiratory manifestations. These findings may help in the early detection and diagnosis of neuro-COVID-19, especially among clinicians and neurologists working in areas of endemic SARS-CoV-2 infection.


Assuntos
Betacoronavirus , Hemorragia Cerebral/virologia , Disfunção Cognitiva/virologia , Infecções por Coronavirus/diagnóstico , Encefalite/virologia , Pneumonia Viral/diagnóstico , Adulto , Hemorragia Cerebral/diagnóstico por imagem , Encefalite/diagnóstico por imagem , Evolução Fatal , Feminino , Humanos , Imunoglobulina G/líquido cefalorraquidiano , Imagem por Ressonância Magnética , Pandemias , Convulsões/virologia
13.
Am J Case Rep ; 21: e926464, 2020 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-32799217

RESUMO

BACKGROUND Although coronavirus disease 2019 (COVID-19) manifests primarily as a lung infection, its involvement in acute kidney injury (AKI) is gaining recognition and is associated with increased morbidity and mortality. Concurrent infection, which may require administration of a potentially nephrotoxic agent, can worsen AKI and lead to poor outcomes. Stenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus associated with nosocomial infections, especially in severely immunocompromised and debilitated patients. Trimethoprim/sulfamethoxazole combination (TMP/SMX) is considered the treatment of choice but can itself lead to AKI, posing a significant challenge in the management of patients with concomitant COVID-19 and S. maltophilia pneumonia. CASE REPORT A 64-year-old male with end-stage renal disease and post renal transplant presented with severe respiratory symptoms of COVID-19 and was intubated upon admission. His renal functions were normal at the time of admission. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia requiring administration of TMP/SMX. However, TMP/SMX led to the development of AKI, which continued to worsen despite appropriate management including hemodialysis. This coincided with and most likely resulted in the patient's clinical deterioration and ultimate death. CONCLUSIONS The etiology of kidney disease involvement in patients with COVID-19 is still evolving and appears to be multifactorial. The condition can significantly worsen especially when nephrotoxic agents are given, probably due to a cumulative or synergistic effect. Great caution should be taken when administering nephrotoxic agents in the setting of COVID-19 as it can lead to adverse patient outcomes.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Infecções por Coronavirus/complicações , Infecções por Bactérias Gram-Negativas/complicações , Pneumonia Bacteriana/microbiologia , Pneumonia Viral/complicações , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Betacoronavirus , Deterioração Clínica , Coinfecção , Infecções por Coronavirus/tratamento farmacológico , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Stenotrophomonas maltophilia , Transplantados , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem
14.
BMJ Case Rep ; 13(8)2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32843381

RESUMO

A 66-year-old man was admitted to hospital with a right frontal cerebral infarct producing left-sided weakness and a deterioration in his speech pattern. The cerebral infarct was confirmed with CT imaging. The only evidence of respiratory symptoms on admission was a 2 L oxygen requirement, maintaining oxygen saturations between 88% and 92%. In a matter of hours this patient developed a greater oxygen requirement, alongside reduced levels of consciousness. A positive COVID-19 throat swab, in addition to bilateral pneumonia on chest X-ray and lymphopaenia in his blood tests, confirmed a diagnosis of COVID-19 pneumonia. A proactive decision was made involving the patients' family, ward and intensive care healthcare staff, to not escalate care above a ward-based ceiling of care. The patient died 5 days following admission under the palliative care provided by the medical team.


Assuntos
Infecções por Coronavirus/complicações , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Anterior/virologia , Pneumonia Viral/complicações , Idoso , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Evolução Fatal , Humanos , Infarto da Artéria Cerebral Anterior/complicações , Masculino , Oxigenoterapia , Cuidados Paliativos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Radiografia , Tomografia Computadorizada por Raios X
15.
BMC Infect Dis ; 20(1): 614, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32811466

RESUMO

BACKGROUND: The most common aetiological agents of mucormycosis are Rhizopus, Mucor, Apophysomyces and Lichtheimia. Apophysomyces is comparatively rare, as it has been reported in less than 3% of mucormycosis cases. The genus Apophysomyces includes six species, and only A. elegans, A. mexicanus, A. variabilis and A. ossiformis have been reported to cause infections in both immunocompetent and immunocompromised patients. CASE PRESENTATION: We present a case of a 46-year-old male patient with bilateral blepharoedema, corneal opacity in the left eye and poorly controlled diabetes mellitus. The patient was subjected to total maxillectomy, exenteration of the left orbit and treatment with liposomal amphotericin B. Direct mycological analysis with KOH 10% revealed hyaline, coenocytic, long and wide hyphae. Apophysomyces ossiformis was identified from maxillary biopsy using 18S-ITS1-5.8S-ITS2-28S rRNA gene amplification and sequencing. The patient requested to be transferred to another hospital to continue treatment, where he died on the ninth day after admittance. CONCLUSION: To the best of our knowledge, this is the first case of rhino-orbital mucormycosis due to A. ossiformis with a fatal outcome. This case reveals the need to identify the fungus causing mucormycosis with molecular methods to identify adequate treatment therapies for patients with this infection.


Assuntos
Complicações do Diabetes/microbiologia , Mucorales/genética , Mucormicose/complicações , Doenças Orbitárias/complicações , Rinite/complicações , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Biópsia , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/cirurgia , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , Masculino , Maxila/microbiologia , Maxila/patologia , Maxila/cirurgia , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Mucormicose/cirurgia , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/microbiologia , Doenças Orbitárias/cirurgia , RNA Ribossômico 28S/genética , Rinite/tratamento farmacológico , Rinite/microbiologia , Rinite/cirurgia
16.
J Investig Med High Impact Case Rep ; 8: 2324709620948407, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32762368

RESUMO

Recent reports have suggested an increased risk of QT prolongation and subsequent life-threatening ventricular arrhythmias, particularly torsade de pointes, in patients with coronavirus disease-2019 (COVID-19) treated with hydroxychloroquine and azithromycin. In this article, we report the case of a 75-year-old female with a baseline prolonged QT interval in whom the COVID-19 illness resulted in further remarkable QT prolongation (>700 ms), precipitating recurrent self-terminating episodes of torsade de pointes that necessitated temporary cardiac pacing. Despite the correction of hypoxemia and the absence of reversible factors, such as adverse medication effects, electrolyte derangements, and usage of hydroxychloroquine/azithromycin, the QT interval remained persistently prolonged compared with the baseline with subsequent degeneration into ventricular tachycardia and death. Thus, we highlight that COVID-19 illness itself can potentially lead to further prolongation of QT interval and unmask fatal ventricular arrhythmias in patients who have a prolonged QT and low repolarization reserve at baseline.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Síndrome do QT Longo/fisiopatologia , Pneumonia Viral/fisiopatologia , Taquicardia Ventricular/fisiopatologia , Idoso , Azitromicina/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/dietoterapia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/metabolismo , Evolução Fatal , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Síndrome do QT Longo/tratamento farmacológico , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/dietoterapia , Taquicardia Ventricular/etiologia
17.
Medicine (Baltimore) ; 99(30): e21377, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791748

RESUMO

RATIONALE: It is recommended that patients with Rheumatic diseases that are at high risk of developing active infections be screened for Tuberculosis, Hepatitis B, and Hepatitis C before receiving second-line immunosuppressive therapies. With the emergence 2019 novel coronavirus (SARS-CoV-2), expanded guidelines have not been proposed for screening in these patients before starting advanced therapy. PATIENT CONCERNS: We present an unique circumstance whereas a patient with a 5 year history of inflammatory muscle disease, diagnosed by clinical history and muscle biopsy with elevated creatine kinase levels, suffered a hypoxemic cardiopulmonary arrest due to asymptomatic SARS-CoV-2 after receiving advanced immunosuppressive therapy. DIAGNOSES: The patient presented with an acute exacerbation of inflammatory muscle disease with dysphagia, muscle weakness, and elevated creatine kinase. INTERVENTIONS: After no improvement with intravenous immunoglobulin the patient received mycophenolate and plasma exchange therapy. OUTCOMES: Subsequently the patient suffered a fatal hypoxemic cardiopulmonary arrest. Polymerase chain reaction test was positive for SARS-CoV-2 RNA. LESSONS: We conclude that rheumatic patients, asymptomatic for SARS-CoV-2 infection, be screened and tested before initiating second-line immunosuppressive treatment.


Assuntos
Betacoronavirus , Infecções por Coronavirus/induzido quimicamente , Parada Cardíaca/virologia , Doenças Musculares/tratamento farmacológico , Pneumonia Viral/induzido quimicamente , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Evolução Fatal , Parada Cardíaca/induzido quimicamente , Humanos , Imunossupressores , Masculino , Pessoa de Meia-Idade , Doenças Musculares/virologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia
18.
Medwave ; 20(7): e7984, 2020 Aug 03.
Artigo em Espanhol | MEDLINE | ID: mdl-32804920

RESUMO

There are limited reports of neurological symptoms in the pediatric population with COVID-19. We report a 13-year-old girl with three days of illness characterized by headache, non-explosive vomiting, fever, and sudden-onset sensory disorder associated with difficulty in standing and hemiparesis in limbs without evidence of meningeal signs. Brain tomography revealed diffuse brain edema, and the cerebrospinal fluid study was consistent with a viral infection. COVID-19 was diagnosed based on serology. The patient had an untoward clinical course despite treatment with hydroxychloroquine, azithromycin, and corticosteroids, dying on the third day of hospitalization. Encephalitis in a patient with COVID-19 is not frequently reported in the pediatric population. It should be considered in the differential diagnosis in patients who arrives at the emergency with a sensory disorder or neurological symptomatology in the context of the COVID-19 pandemic.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Encefalite/diagnóstico , Pneumonia Viral/complicações , Adolescente , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Diagnóstico Diferencial , Encefalite/virologia , Evolução Fatal , Feminino , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico
19.
Ideggyogy Sz ; 73(7-08): 275-285, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32750245

RESUMO

Background and aims - Description of two cases of rare intravascular large B-cell lymphoma and secondary T-cell lymphoma diagnosed postmortem, that manifested clinically as longitudinally extensive transverse myelitis (LETM). We discuss causes of diagnostic difficulties, deceptive radiological and histological investigations, and outline diagnostic procedures based on our and previously reported cases. Case reports - Our first case, a 48-year-old female was admitted to the neurological department due to paraparesis. MRI suggested LETM, but the treatments were ineffective. She died after four weeks because of pneumonia and untreatable polyserositis. Pathological examination revealed intravascular large B-cell lymphoma (IVL). Our second case, a 61-year-old man presented with headache and paraparesis. MRI showed small bitemporal lesions and lesions suggesting LETM. Diagnostic investigations were unsuccessful, including tests for possible lymphoma (CSF flow cytometry and muscle biopsy for suspected IVL). Chest CT showed focal inflammation in a small area of the lung, and adrenal adenoma. Brain biopsy sample from the affected temporal area suggested T-cell mediated lymphocytic (paraneoplastic or viral) meningoencephalitis and excluded diffuse large B-cell lymphoma. The symptoms worsened, and the patient died in the sixth week of disease. The pathological examination of the presumed adenoma in the adrenal gland, the pancreatic tail and the lung lesions revealed peripheral T-cell lymphoma, as did the brain and spinal cord lesions. Even at histological examination, the T-cell lymphoma had the misleading appearance of inflammatory condition as did the MRI. Conclusion - Lymphoma can manifest as LETM. In cases of etiologically unclear atypical LETM in patients older than 40 years, a random skin biopsy (with subcutaneous adipose tissue) from the thigh and from the abdomen is strongly recommended as soon as possible. This may detect IVL and provide the possibility of prompt chemotherapy. In case of suspicion of lymphoma, parallel examination of the CSF by flow cytometry is also recommended. If skin biopsy is negative but lymphoma suspicion remains high, biopsy from other sites (bone marrow, lymph nodes or adrenal gland lesion) or from a simultaneously existing cerebral lesion is suggested, to exclude or prove diffuse large B-cell lymphoma, IVL, or a rare T-cell lymphoma.


Assuntos
Encéfalo/patologia , Linfoma/patologia , Mielite Transversa/patologia , Biópsia , Evolução Fatal , Feminino , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraparesia/etiologia
20.
Medicine (Baltimore) ; 99(31): e21513, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756189

RESUMO

BACKGROUND: Cardiac injury and coagulation disorders have been two increasing concerns in the management of patients with severe coronavirus disease (COVID-19). Coagulation disorders in COVID-19 patients with cardiac injury have not been characterized. METHODS: We analyzed the data of five COVID-19 patients with cardiac injury who had D-dimer surge (defined as a rapid increase in the D-dimer level in 72 h, from <5-21 µg/mL) during hospitalization, which were extracted from a registered retrospective study (ChiCTR2000031301). Clinical data and data on changes in coagulation parameters were collected, verified, and characterized. RESULTS: Among these five patients, four had pre-existing cardiovascular or cerebrovascular diseases. D-dimer surge was accompanied with prolonged prothrombin time (PT) and reduced platelet count (PLT) and fibrinogen level. Three patients had an ISTH DIC score of 5 and met the criteria for overt DIC. All five patients needed invasive ventilation support and were incubated 0 to 6 days after the first D-dimer upper reference limit (URL) was reached. All five patients died within 10 days after the first D-dimer URL was reached. All five patients had observed D-dimer URL results 1 to 3 days before death. CONCLUSION: D-dimer surge in COVID-19 patients with cardiac injury surely leads to worse in-hospital outcome. D-dimer surge and concomitant DIC can be the leading causes of in-hospital death. Pre-existing cardiovascular or cerebrovascular diseases might pose a higher risk for developing these coagulation disorders. These findings can serve as hypothesis generating and need further clinical trials to confirm.


Assuntos
Betacoronavirus , Transtornos da Coagulação Sanguínea/virologia , Doenças Cardiovasculares/virologia , Infecções por Coronavirus/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Pneumonia Viral/sangue , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Estudos Retrospectivos
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