RESUMO
BACKGROUND: Strongyloidiasis is usually a chronic infection but it can develop into a fatal disease in immunosuppressed patients. CASE SUMMARY: A 68-year-old male with rheumatoid arthritis was treated with a variety of immunosuppressants for the past 3 years. Recently, the patient presented with a partial small-bowel obstruction, petechia, coughing and peripheral neuropathy. The diagnosis was difficult to clarify in other hospitals. Our hospital found Strongyloides stercoralis larvae with active movement in the routine stool and sputum smears. The diagnosis of disseminated strongyloidiasis was established. Ivermectin combined with albendazole was used for treatment. The patient responded to therapy and was discharged. CONCLUSION: This case underscores the importance of comprehensive differential diagnosis in immunocompromised patients.
RESUMO
BACKGROUND: This study describes the use of a moisture chamber to treat corneal ulceration due to temporary lagophthalmos in a critically ill patient. CASE SUMMARY: A 46-year-old woman was admitted to the intensive care unit after a car accident. She suffered multiple injuries that included brain injury and presented with moderately decreased consciousness and lagophthalmos in her right eye. Within 6 d, her consciousness improved considerably; at which time, exposure keratopathy occurred and worsened to corneal ulceration. Lubricating gel, antibiotic ointment, and bandage contact lens were all ineffective in preventing or treating the exposure keratopathy. Instead of tarsorrhaphy, a moisture chamber was applied which successfully controlled the corneal ulceration. The moisture chamber was discontinued when complete eyelid closure recovered a week later. CONCLUSION: A moisture chamber may be an effective, noninvasive alternative to tarsorrhaphy for treating severe exposure keratopathy due to temporary lagophthalmos.
RESUMO
Ventilator-associated pneumonia (VAP) is a major complication among critically ill patients who depend on mechanical ventilation. Few reports have focused on intracerebral hemorrhage patients with VAP. Our main objective was to investigate the bacteria distribution characteristics and the impact of ventilator-associated pneumonia mortality in critical cerebral hemorrhage patients. This retrospective study included 89 cases of cerebral hemorrhage patients with VAP admitted to the ICU of Huashan Hospital. We used the chi-square test to compare qualitative variables and Student's t-test to compare means between groups of normally distributed quantitative variables. Multiple logistic regression analysis was used to assess mortality-independent predictors in the ICU. A total of 42% patients with cerebral hemorrhage were diagnosed with VAP in the ICU during the study period, and the mortality rate was 18%. Acinetobacter baumannii (n=58), Klebsiella pneumoniae (n=52), and Pseudomonas aeruginosa (n=21) were the most common pathogenic bacteria. Blood volume >30ml, tracheal ventilation mode and head of bed elevation were independent factors associated with increased mortality. Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the time from bleeding to intubation were other potentially important factors. While the number of infecting bacteria may not be directly related to death, it can increase antibiotic consumption and length of intensive care unit (ICU) stays. Blood volume >30ml, tracheal ventilation mode and head of bed elevation were directly related to the death of critical cerebral hemorrhage patients with ventilator-associated pneumonia.
Assuntos
Acinetobacter baumannii , Pneumonia Associada à Ventilação Mecânica , Hemorragia Cerebral/complicações , Humanos , Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Respiração Artificial , Estudos Retrospectivos , Fatores de RiscoRESUMO
Ventilator-associated pneumonia (VAP) is a major complication among critically ill patients who depend on mechanical ventilation. Few reports have focused on intracerebral hemorrhage patients with VAP. Our main objective was to investigate the bacteria distribution characteristics and the impact of ventilator-associated pneumonia mortality in critical cerebral hemorrhage patients. This retrospective study included 89 cases of cerebral hemorrhage patients with VAP admitted to the ICU of Huashan Hospital. We used the chi-square test to compare qualitative variables and Student's t-test to compare means between groups of normally distributed quantitative variables. Multiple logistic regression analysis was used to assess mortality-independent predictors in the ICU. A total of 42% patients with cerebral hemorrhage were diagnosed with VAP in the ICU during the study period, and the mortality rate was 18%. Acinetobacter baumannii (n=58), Klebsiella pneumoniae (n=52), and Pseudomonas aeruginosa (n=21) were the most common pathogenic bacteria. Blood volume >30ml, tracheal ventilation mode and head of bed elevation were independent factors associated with increased mortality. Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the time from bleeding to intubation were other potentially important factors. While the number of infecting bacteria may not be directly related to death, it can increase antibiotic consumption and length of intensive care unit (ICU) stays. Blood volume >30ml, tracheal ventilation mode and head of bed elevation were directly related to the death of critical cerebral hemorrhage patients with ventilator-associated pneumonia
La neumonía asociada a ventilación mecánica (NAV) es una complicación mayor entre los pacientes críticos que dependen de la ventilación mecánica. Pocos artículos se han centrado en los pacientes de hemorragia cerebral con NAV. Nuestro objetivo principal fue investigar las características de la distribución bacteriana y el impacto de la mortalidad de la neumonía asociada a ventilación mecánica en pacientes críticos de hemorragia cerebral. Este estudio retrospectivo incluyó 89 casos de pacientes de hemorragia cerebral con NAV ingresados en la unidad de cuidados intensivos (UCI) del Hospital Huashan. Utilizamos la prueba χ2 para comparar las variables cualitativas, y la t de Student para comparar las medias entre grupos de las variables cuantitativas normalmente distribuidas. Utilizamos análisis de regresión logística múltiple para valorar los factores predictivos independientes de la mortalidad en la UCI. Diagnosticamos NAV en el 42% de los pacientes con hemorragia en la UCI durante el periodo de estudio, y la tasa de mortalidad fue del 18%. Acinetobacter baumannii (n=58), Klebsiella pneumoniae (n=52) and Pseudomonas aeruginosa (n=21) fueron las bacterias patogénicas más comunes. El volumen sanguíneo >30ml, el modo de ventilación traqueal y la inclinación del cabecero de la cama fueron factores independientes asociados al incremento de la mortalidad. La Glasgow Coma Scale (GCS) y el Acute Physiology and Chronic Health EvaluationII (APACHE II), así como el tiempo transcurrido entre el sangrado y la intubación, fueron otros factores potencialmente importantes. A pesar de que el número de bacterias infecciosas puede no estar directamente relacionado con la muerte, puede incrementar el consumo de antibióticos y la duración de la estancia en la UCI. El volumen sanguíneo >30ml, el modo de ventilación traqueal y la inclinación del cabecero de la cama guardaron una relación directa con la muerte de los pacientes críticos de hemorragia cerebral con neumonía asociada a ventilación mecánica