An Unusual Case of Group B Streptococcal Meningitis with Concomitant Varicella-Zoster Virus Infection in a Previously Healthy Male.

Group B Streptococcus (GBS) is a well-known organism that can be part of the normal gastrointestinal and genital tract flora. However, it can cause various infections, mostly in neonates, pregnant women, and patients with predisposing factors. Meningitis caused by GBS, though common in neonates, is uncommon in adults, especially those with no previous health issues. Here, we present an unusual case of GBS meningitis in a 22-year-old previously healthy man. He came to the emergency room with complaints of acute headache and an altered level of consciousness, and his cerebrospinal fluid analysis was consistent with bacterial meningitis due to Streptococcus agalactiae. Later, vesicular lesions on his face caused by varicella-zoster virus (VZV) infection complicated his situation. He received intravenous ceftriaxone and dexamethasone and oral acyclovir. He had a complete recovery and was discharged without any sequelae. Though uncommon, this serious condition needs prompt diagnosis and treatment due to its high mortality rate. To our knowledge, this is one of the few known cases of GBS meningitis in a previously healthy adult and the only one to report VZV infection as a possible complication.

Moderately hyperglycemia as an independent prognostic factor for the worse outcome of COVID-19.

BACKGROUND: Blood sugar (BS) has been proposed as a prognostic factor for COVID-19. In this historical cohort study we evaluated the association between admission time BS and COVID-19 outcome. METHODS: First, hospitalized COVID-19 patients were divided into three groups; Non-diabetic patients with BS < 140 mg/dl (N = 394), non-diabetic patients with BS ≥ 140 mg/dl (N = 113) and diabetic patients (N = 315). Mortality, ICU admission, and length of hospital stay were compared between groups and odds ratio was adjusted using logistic regression. RESULTS: After adjustment with pre-existing conditions and drugs, it was shown that non-diabetic patients with BS ≥ 140 mg/dl are at increased risk of mortality (aOR 1.89 (0.99-3.57)) and ICU admission (aOR 2.62 (1.49-4.59)) even more than diabetic patients (aOR 1.72 (1.07-2.78) for mortality and aOR 2.28 (1.47-3.54) for ICU admission. CONCLUSIONS: Admission time hyperglycemia predicts worse outcome of COVID-19 and BS ≥ 140 mg/dl is associated with a markedly increase in ICU admission and mortality.

Can laboratory tests at the time of admission guide us to the prognosis of patients with COVID-19?

INTRODUCTION: To enhance the COVID-19 patients' care and to optimize utilizing medical resources during the pandemic, relevant biomarkers are needed for prediction of the disease's progression. The current study was aimed to determine the factors that affect the mortality of COVID-19 patients admitted in Baharloo hospital in Iran. METHODS: in the current retrospective study, 56 survived patients and 56 patients who were died (a total of 112 cases) because of COVID-19 infection were randomly selected from those who were admitted to Baharloo hospital. Each patient who was diagnosed with COVID-19 and had recovered from it matched with each non-survived patient in the term of age. Laboratory tests of all these patients at the time of admission were recorded and compared. All analyses performed using spss version 22 by considering α = 0.05 as a significant level. RESULTS: There was no statistical difference in the age and gender distribution between the two groups (p > 0.05). The prevalence of diabetes among survived patients was 37.5% and among non-survived patients was 26.8% and there was no statistical difference between two groups regarding this comorbidity (p = 0.22). Also, there was no statistical difference in the prevalence of hypertension and coronary heart diseases between two groups (p > 0.05). Lymphocyte percentage, blood oxygen level, and platelet (PLT) count was significantly higher in patients who had recovered (P < 0.05). CONCLUSIONS: LDH level, Lymphocyte percentage, PLT count, and blood Oxygen saturation have associations with severe forms of COVID-19 infection and can be used as predictors to assess the patients who are suspected of infection with COVID-19 at the time of admission.

Concurrent emphysematous pyelonephritis and thigh necrotizing fasciitis after intramuscular administration of diclofenac.

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection. NF may result from any injury to the skin or from hematogenous spread. However, con-current emphysematous pyelonephritis and necrotizing fasciitis of the left thigh has not been reported. We report a case of emphysematous pyelonephritis and necrotizing fasciitis of the left thigh after intramuscular administration of diclofenac that improved with aggressive management including broad-spectrum antibiotics, nephrectomy and surgical intervention.