Acute Influenza B Infection Presenting as Cardiac Tamponade: A Case Report.

Influenza A and B acute infections usually affect primarily the respiratory system. In rare cases, however, the cardiovascular system is also compromised either via the direct effect of the virus or via the worsening of preexisting cardiac conditions. We present a rare case of acute Influenza B infection presenting as pericardial effusion and cardiac tamponade. A healthy 32-year-old female was presented to the emergency room with influenza-like symptoms for four days, where she was monitored for a few hours and was subsequently discharged to home after testing positive for Influenza B by polymerase chain reaction (PCR). On the fifth day, she returned to the emergency room with worsening symptoms, primarily exertional dyspnea. She was hypotensive and tachycardic and temporarily improved with fluid administration. She was transferred to the intensive care unit, where a bedside point of care ultrasound (POCUS) and later a formal transthoracic echocardiogram revealed that she had pericardial effusion with sonographic signs of cardiac tamponade. Emergent pericardiocentesis was performed and resulted in hemodynamic and symptomatic improvement. The pericardial drain that was initially left in place and continued to drain pericardial fluid (700 ccs in total), was removed 3 days later, after echocardiographic confirmation of the resolution of the pericardial effusion. She completed a five-day course of Oseltamivir and was subsequently discharged home safely. In summary, our case describes an acute Influenza B infection that was complicated by pericardial effusion and cardiac tamponade. It also highlights the importance of bedside POCUS and echocardiography in the early diagnosis and treatment of cardiac tamponade cases, frequently with pericardiocentesis as in our case.

Respuesta a Factores Estimulantes de Colonias de Granulocitos en eventos de Neutropenia Febril en pacientes Oncológicos del Instituto del Cáncer Solca-Cuenca / Response to Stimulating Factors of Granulocyte Colonies in Febrile Neutropenia Events in Oncological Patients of the Cancer Institute Solca-Cuenca

Introducción: La Neutropenia Febril es una complicación potencialmente fatal del tratamiento del cáncer, relacionada con mayor morbilidad, mortalidad, disminución de dosis o retardo en los ciclos de quimioterapia, y resultados finales pobres. Estudios anteriores han demostrado el beneficio de Factor Estimulante de Colonias de Granulocitos en la reducción de tiempo de hospitalización, antibióticos intravenosos, fiebre y recuperación del conteo absoluto de neutrófilos. Se decide realizar el presente reporte ya que no existen datos respecto al manejo y respuesta al tratamiento en nuestro medio. Métodos: El presente estudio descriptivo, retrospectivo, fue realizado en el Instituto del Cáncer SOLCA ­ Cuenca. Se revisaron las historias clínicas del período 2010 ­ 2011. Las variables analizadas fueron: número de días de hospitalización, fiebre, uso de antibióticos intravenosos, y días de recuperación de neutropenia a >500/mm3 y >1000/mm3. Resultados: La estancia hospitalaria tuvo una mediana de 6 días, los días de terapia antibiótica intravenosa fueron iguales a los días de hospitalización. 79 eventos se recuperaron a un conteo absoluto de neutrófilos >500/mm3, en una mediana de 4 días; 72 eventos se recuperaron a >1000 /mm3 en una mediana de 4 días. La mayoría de los eventos se volvieron afebriles en una mediana de 1 día. Conclusión: Los resultados de las variables estancia hospitalaria, uso de antibióticos intravenosos y la duración de la fiebre fueron similares a los ya descritos en estudios anteriores, la recuperación del conteo absoluto de neutrófilos, fue más tardía, mostrando diferencias importantes con la bibliografía.

Introduction: Febrile Neutropenia is a potentially fatal complication of cancer treatment, related to higher morbidity, mortality, dose reduction or retard in chemotherapy cycles, and poor final outcomes. Previous studies have demonstrated the benefit of G-CSF (Granulocyte ­ Colony Stimulating Factors) in reduction of hospital stay, the use of intravenous antibiotics, fever and absolute neutrophil count (ANC) recovery. There is no data about the management and treatment response in our population. Methods: This is a retrospective descriptive study, developed in SOLCA ­ Cuenca Cancer Institute. 83 febrile neutropenia events met the inclusion and exclusion criteria, medical records from years 2010 to 2011 were reviewed. The analyzed variables were: days of hospital stay, fever, intravenous antibiotics use, and neutropenia recovery to a level >500/mm3 and >1000/mm3. Results: The median of hospital stay was 6 days, the duration of IV antibiotic therapy was the same as the days of hospital stay. 79 events recovered to an ANC >500/mm3, with a median of 4 days; 72 events recovered to >1000 /mm3 with a median of 4 days. The majority of events became afebrile with a median of 1 day. Conclusion: The results in the variables hospital stay, use of intravenous antibiotics and fever duration, were similar to those described in previous studies. The ANC recovery was delayed, showing important differences with cited references.