Meningitis is an infrequent and serious cause of postpartum fever that requires early diagnosis and treatment to prevent serious complications and to reduce the high mortality rate
Abstract—In Italy the hydatid disease is more prevalent and new cases are highlighted more frequently in Sicily, Sardinia, (Italy). Aim of this study is to put the indication in search of iaditea nature in both spleen swelling and muscle tendon.
Material and Method Patients observed during the period 2007-2009 at the Surgical Clinic III and Digestive Surgery, Policlinico G Rodolico were explored for Hydatid cyste at various sites. Diagnosis of cysts ecchinococcus occurred primarily for various four reasons either for compression of bodies involved or for eosinophilia or for instrumental investigation or for anaphylactic reaction to rupture of cysts. Biological diagnosis is based on serology rather than isolation of the parasite (indirect diagnosis);
Results Patients attended during the period 2007-2009 Hydatid cyst was found in 0.5% of all cases in liver along with 4 in the lung, 3 in splenic, 2 in the mammary and 2 in the chest wall No 2. The Surgical treatment with the complete removal of the cyst with a satisfactory postoperative course in the absence of cases of relapse of the disease and by following the therapeutic act, the assumption of mebendazole 50mg / kg / day for 3 weeks at a dose of 400mg for 4 months
Conclusions There is a need to define diagnostic methods with high specificity and sensitivity, which can provide a valid diagnostic aid for the cases clinically difficult to diagnose. And the final diagnosis must then also be based on the development of immunological methods that allow the determination of specific antibodies in the serum and their titration and / or the circulating antigen determination.
Empiema subdural en meningitis bacteriana aguda 2012Residentes1hun
This document describes a study of 28 cases of subdural empyema that occurred as a complication of community-acquired bacterial meningitis in adults. The main findings were:
1) Subdural empyema occurred in 2.7% of bacterial meningitis cases and was usually caused by Streptococcus pneumoniae spreading from a predisposing condition like otitis or sinusitis.
2) Patients with subdural empyema often presented with focal neurological deficits, seizures, or altered mental status and were more likely to have complications affecting outcome.
3) Neurosurgical evacuation of large empyemas causing significant midline shift was associated with a more favorable outcome in
Transverse myelitis is a pathology, whose etiology is associated with autoimmune or infectious diseases, which directly affects the spinal cord, coursing with motor, sensory and acute or subacute dysfunction9. We report a case of a 32-year-old multiparous woman who, after the first postpartum day, reported pain and paresthesia in the lumbar and lower limbs with progressive worsening. Patient started clinical investigation, with orthopedic causes ruled out, together with the neurology and neurosurgery team. She underwent magnetic resonance imaging of the thoracic and lumbar spine where infectious neuropathy was evidenced at L4-L5. Patient was transferred to a referral hospital where Mycobacterium tuberculosis was evidenced as the cause and, when performing a rapid test for SARS-CoV-2, it was positive.
Diagnostic Approaches to Chronic Fungal and Tuberculous Meningitisinventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This document provides information on meningitis, including:
- Meningitis is an inflammation of the meninges (membranes covering the brain and spinal cord) that can be caused by bacteria, viruses, fungi, or other causes.
- Common symptoms include fever, headache, and neck stiffness.
- Bacterial meningitis requires immediate treatment with antibiotics to prevent disability or death. Viral meningitis is generally less severe but still requires supportive care.
- Complications can include hearing loss, seizures, learning difficulties, and even death if not properly treated.
Case presentation, meningitis and treatment, Moh'd SharshirMoh'd sharshir
Meningitis is an inflammation of the meninges, the membranes surrounding the brain and spinal cord. It is caused by bacterial, viral, or fungal infections. The classic symptoms are fever, headache, and neck stiffness. Diagnosis involves examination of cerebrospinal fluid which shows increased white blood cells and decreased glucose levels in bacterial meningitis. Treatment depends on the identified pathogen but generally involves antibiotics. Adjunctive steroids may reduce complications for some types of bacterial meningitis. Outcomes vary depending on the cause, but bacterial meningitis can have mortality rates around 20% even with treatment.
Abstract—In Italy the hydatid disease is more prevalent and new cases are highlighted more frequently in Sicily, Sardinia, (Italy). Aim of this study is to put the indication in search of iaditea nature in both spleen swelling and muscle tendon.
Material and Method Patients observed during the period 2007-2009 at the Surgical Clinic III and Digestive Surgery, Policlinico G Rodolico were explored for Hydatid cyste at various sites. Diagnosis of cysts ecchinococcus occurred primarily for various four reasons either for compression of bodies involved or for eosinophilia or for instrumental investigation or for anaphylactic reaction to rupture of cysts. Biological diagnosis is based on serology rather than isolation of the parasite (indirect diagnosis);
Results Patients attended during the period 2007-2009 Hydatid cyst was found in 0.5% of all cases in liver along with 4 in the lung, 3 in splenic, 2 in the mammary and 2 in the chest wall No 2. The Surgical treatment with the complete removal of the cyst with a satisfactory postoperative course in the absence of cases of relapse of the disease and by following the therapeutic act, the assumption of mebendazole 50mg / kg / day for 3 weeks at a dose of 400mg for 4 months
Conclusions There is a need to define diagnostic methods with high specificity and sensitivity, which can provide a valid diagnostic aid for the cases clinically difficult to diagnose. And the final diagnosis must then also be based on the development of immunological methods that allow the determination of specific antibodies in the serum and their titration and / or the circulating antigen determination.
Empiema subdural en meningitis bacteriana aguda 2012Residentes1hun
This document describes a study of 28 cases of subdural empyema that occurred as a complication of community-acquired bacterial meningitis in adults. The main findings were:
1) Subdural empyema occurred in 2.7% of bacterial meningitis cases and was usually caused by Streptococcus pneumoniae spreading from a predisposing condition like otitis or sinusitis.
2) Patients with subdural empyema often presented with focal neurological deficits, seizures, or altered mental status and were more likely to have complications affecting outcome.
3) Neurosurgical evacuation of large empyemas causing significant midline shift was associated with a more favorable outcome in
Transverse myelitis is a pathology, whose etiology is associated with autoimmune or infectious diseases, which directly affects the spinal cord, coursing with motor, sensory and acute or subacute dysfunction9. We report a case of a 32-year-old multiparous woman who, after the first postpartum day, reported pain and paresthesia in the lumbar and lower limbs with progressive worsening. Patient started clinical investigation, with orthopedic causes ruled out, together with the neurology and neurosurgery team. She underwent magnetic resonance imaging of the thoracic and lumbar spine where infectious neuropathy was evidenced at L4-L5. Patient was transferred to a referral hospital where Mycobacterium tuberculosis was evidenced as the cause and, when performing a rapid test for SARS-CoV-2, it was positive.
Diagnostic Approaches to Chronic Fungal and Tuberculous Meningitisinventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This document provides information on meningitis, including:
- Meningitis is an inflammation of the meninges (membranes covering the brain and spinal cord) that can be caused by bacteria, viruses, fungi, or other causes.
- Common symptoms include fever, headache, and neck stiffness.
- Bacterial meningitis requires immediate treatment with antibiotics to prevent disability or death. Viral meningitis is generally less severe but still requires supportive care.
- Complications can include hearing loss, seizures, learning difficulties, and even death if not properly treated.
Case presentation, meningitis and treatment, Moh'd SharshirMoh'd sharshir
Meningitis is an inflammation of the meninges, the membranes surrounding the brain and spinal cord. It is caused by bacterial, viral, or fungal infections. The classic symptoms are fever, headache, and neck stiffness. Diagnosis involves examination of cerebrospinal fluid which shows increased white blood cells and decreased glucose levels in bacterial meningitis. Treatment depends on the identified pathogen but generally involves antibiotics. Adjunctive steroids may reduce complications for some types of bacterial meningitis. Outcomes vary depending on the cause, but bacterial meningitis can have mortality rates around 20% even with treatment.
Management of infections in immunocompromised patientsSujay Iyer
This document provides an overview of managing infections in immunocompromised patients. It discusses various conditions that can cause immunosuppression like cancer, HIV, malnutrition, and immunosuppressive drugs. It focuses on febrile neutropenia, describing the definition, etiology, risk stratification, diagnosis, and management depending on if the patient is high-risk or low-risk. It also covers catheter-related infections, pneumonia, gastrointestinal infections, and prevention of infections. The management of febrile neutropenia involves broad-spectrum antibiotics, monitoring response, and modifying treatment based on culture results and patient risk factors.
This document summarizes guidelines for the management of febrile neutropenia. It describes definitions of fever and neutropenia and risk factors. Initial evaluation involves blood cultures, site-specific cultures as indicated, and monitoring. Risk is stratified using tools like the MASCC index. Prophylaxis includes hand hygiene, oral care, and sometimes antibiotics or antifungals. Empiric antibiotic therapy is recommended, with modifications based on risk and response. Therapy typically continues until resolution of fever and recovery of neutrophils. Empiric antifungals may be considered for persistent fever.
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
32-year-oldprimigravida, CATB2, Covid positive patient with acute onset of facial palsy, fever, sore throat and productive cough referred from a peripheral hospital came for caesarian section. Past history revealed occurrence of juvenile dermatomyositis for which she took steroids for one and a half year which was slowly weaned off. Prevalence of dermatomyositis is 1to 8 in 100,000. She was started on steroids which was to be continued for a week after caesarian section. She was on paracetamol and cefuroxime on admission. Basic investigations were normal. Caesarian section was done in covid theater following covid protocols under subarachnoid anesthesia Baby had an APGAR score of 9 and was covid negative. Mothers’ recovery was slow. Facial deviation got corrected in 4to 5 months. Ptosis persisted even after 9months and is on treatment. Dermatomyositis is an uncommon inflammatory disease that affects mainly proximal muscle limiting day to day activities. But it can affect respiratory, cardiac and gastrointestinal systems, eyes and joints. Diagnosis is by muscle biopsy and an increase in muscle enzymes. Pregnancy during remission period is safe. But pregnancy can provoke the disease. Skin changes usually precedes muscle symptoms, though we could not notify any lesions. Lung involvement is prominent, and covid also carries the same amount of risk with respiratory system. Systemic glucocorticoids are the first line of treatment. Immunosuppressant drugs Azathioprine and methotrexate are added as second line of therapy, though these drugs are unsafe during pregnancy. Intravenous immunoglobulin, give good outcome during pregnancy. Plasmapheresis is also beneficial. Most of the pregnant patients end up in caesariansection. Regionalanesthesia is the choice of anesthesia. Covid patients with respiratory infections, maintaining saturation above90%, choice of anesthesia is usually regional anesthesia.
Key Words: Juvenile Dermatomyositis, COVID, Cesarian Section
This document discusses antibiotics and their use in the intensive care unit (ICU). It begins by defining key terms like infection, SIRS, sepsis, severe sepsis, and septic shock. It then discusses the most common causes of infections in the ICU, including devices, nursing care, and antibiotic overuse. The most frequent infectious organisms in the ICU are noted as gram-positive bacteria like coagulase-negative staphylococci and Candida species. Factors predisposing patients to infection and approaches for diagnosis and empiric antibiotic therapy are also summarized.
The document discusses neonatal intensive care units (NICUs), providing a history of their development and describing common diseases, challenges, and infections treated in NICUs. It notes that prematurity, respiratory issues, and sepsis are leading problems and that nosocomial infections from organisms like Klebsiella, E. coli, coagulase-negative Staphylococcus, and Candida are a major challenge requiring prevention efforts like judicious antibiotic use, sterile equipment and procedures, and contact precautions.
This case report describes a 43-year-old man who presented with a painful right scrotal swelling and fever that had been evolving over a year. Ultrasound revealed a poorly limited scrotal swelling with thick echogenic content and swelling of the right spermatic cord. Surgical exploration showed a hydrocele with fibrous tissue involving the right testicle. Biopsies were positive for tuberculosis. The patient was treated with anti-tuberculosis drugs and surgery for the hydrocele. His condition improved with medical treatment, demonstrating that tuberculous orchi-epididymitis can initially present as a painful hydrocele.
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and usually affects the lungs. It remains a major global health problem, with around 10 million new cases and 1.5 million deaths per year worldwide according to the WHO. Tuberculosis flourishes in conditions of poverty, crowding and immunosuppression. Clinical manifestations vary depending on whether the infection is primary or secondary, and can include cough, fever, weight loss, or disseminated disease. Diagnosis involves smear, culture and radiography. Standard treatment is 6 months of multiple antitubercular drugs. Effectiveness of treatment is assessed by repeat smears and cultures after 2 and 5 months.
Repeated Hemoptysis With Progressive Bronchiectasis: A Case Report of Lady Wi...semualkaira
Bronchiectasis is a type of incurable structural lung disease with
clinical manifestations of chronic cough, expectoration or recurrent hemoptysis, which is often given anti-infection and symptomatic treatment. In this study, a patient suffering from bronchiectasis
with repeated hemoptysis caused by nontuberculous mycobacterium (NTM) was discussed. A 54-year-old female immunocompetent patient was admitted to our hospital due to repeated hemoptysis for 5 years. Computed tomography (CT) scan revealed progressive bronchiectasis in the upper and middle lobes of her right lung.
She subsequently underwent thoracoscopic lobectomy of the right
middle lobe plus segmentectomy of the anterior segment of the
right upper lobe. Postoperative pathological diagnosis was confirmed to be intracellular mycobacterium. In view of her results,
the patient was concluded to have “Lady Windermere syndrome”
and was clinically cured following 15 months of anti-NTM treatment.
Repeated Hemoptysis with Progressive Bronchiectasis: a case report of Lady Wi...komalicarol
Bronchiectasis is a type of incurable structural lung disease with
clinical manifestations of chronic cough, expectoration or recurrent hemoptysis, which is often given anti-infection and symptomatic treatment. In this study, a patient suffering from bronchiectasis
with repeated hemoptysis caused by nontuberculous mycobacterium (NTM) was discussed. A 54-year-old female immunocompetent patient was admitted to our hospital due to repeated hemoptysis for 5 years. Computed tomography (CT) scan revealed progressive bronchiectasis in the upper and middle lobes of her right lung.
She subsequently underwent thoracoscopic lobectomy of the right
middle lobe plus segmentectomy of the anterior segment of the
right upper lobe. Postoperative pathological diagnosis was confirmed to be intracellular mycobacterium. In view of her results,
the patient was concluded to have “Lady Windermere syndrome”
and was clinically cured following 15 months of anti-NTM treatment.
1. The IDSA guidelines provide recommendations for managing neutropenic patients with cancer who develop fever, focusing on antimicrobial treatment.
2. It distinguishes between high-risk and low-risk patients based on factors like anticipated duration of neutropenia, severity of neutropenia, and comorbidities. High-risk patients require initial IV antibiotics in the hospital, while low-risk patients may be candidates for oral or outpatient treatment.
3. The guidelines make recommendations on appropriate empiric antibiotic therapy, modifying treatment, treatment duration, and use of prophylaxis for both high-risk and low-risk neutropenic fever patients. It also provides guidance on use of empirical and preempt
Antibiotics revolutionized medicine by curing infections that routinely killed patients. However, overuse and misuse of antibiotics has led to increased bacterial resistance. This document discusses the principles of antibiotic prophylaxis for dermatological surgery. It finds that antibiotics should only be used when there is significant risk of infection, be targeted against likely pathogens, and use the narrowest effective spectrum. Indiscriminate or prolonged use contributes to growing antibiotic resistance. Topical decolonization of nasal carriers of Staphylococcus aureus before surgery may reduce surgical site infections more effectively than systemic antibiotics.
This document discusses infectious and non-infectious complications of pediatric peritoneal dialysis. It covers topics such as peritonitis (the most common complication), peritoneal catheter exit-site and tunnel infections, gastroesophageal reflux disease, delayed gastric emptying, back pain, and pleural effusions. For each complication, it discusses causes, risk factors, clinical presentation, microbiology, diagnosis, treatment recommendations, and management strategies.
1) Discitis is a bacterial infection of the intervertebral disc that is commonly caused by direct inoculation from surgery or hematogenous spread from another infection site.
2) MRI is the preferred imaging modality for diagnosing discitis, which shows inflammation and enhancement involving the vertebral bodies and discs.
3) While discitis is usually treated with long-term antibiotics, surgery may be needed for debridement and fusion if the infection fails to improve or causes neurological impairment.
Ulcerative Colitis with Aseptic Abscesses Controlled by Vedolizumab: A Case R...clinicsoncology
Aseptic abscesses (AAs) are neutrophilic infiltrative lesions that often coincide with systemic inflammatory disorders such as inflammatory bowel diseases (IBD). According to recent literature, medical therapies in IBD with AAs include corticosteroid, immunosuppressants and anti-TNFα biologics.
Prevalence and Determinants of Distress Among Residents During COVID Crisisclinicsoncology
This study assessed the prevalence of distress, burnout, and depression among residents in France during the COVID-19 pandemic. 34 residents completed an online survey assessing sociodemographic factors, workload, work environment, impact of the pandemic, and mental wellbeing. Over 20% of residents reported high distress, 56% reported moderate to severe burnout, and 27% reported moderate to severe depressive symptoms. Being single and having a high workload increased the risk of distress and burnout. While COVID-19 did not affect prevalence, it increased stress intensity. Residents were concerned about impacts on training and careers. Higher wellbeing was associated with poorer quality of life, more regrets, and lower satisfaction. The pandemic disrupted training and increased
A Road from Coronary to Pulmonary: A Rare Imaging Presentationclinicsoncology
This case report describes a rare presentation in a 21-year-old female patient with pentalogy of Fallot. Cardiac CT imaging revealed multiple sources of blood flow to the lungs, including a dilated coronary artery-to-pulmonary artery collateral from the left main coronary artery to the right pulmonary artery, as well as a patent ductus arteriosus connecting the aorta to the left pulmonary artery. Additionally, there were several major aortopulmonary collateral arteries arising from the descending aorta. This represents an extremely rare finding, as coronary-to-pulmonary connections are unusual. Identifying all sources of pulmonary blood flow is important for surgical planning in patients with conditions like pentalogy of Fallot and
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it was associated with thrombotic incidents like acute limb ischemia and pulmonary embolism.
Loop –Mediated Isothermal Amplification (LAMP) Based POINT-OF-CARE for Rapid ...clinicsoncology
Abstract Infectious diseases, including foodborne diseases, to this day remain a major health threat worldwide. Molecular diagnostics, based on nucleic acid (NA) amplification technologies, are in the forefront for the detection of pathogens. Polymerase chain reaction (PCR) is one of the most widely used methods for nucleic acid amplification in pathogen diagnostic.
More Related Content
Similar to Postpartum Meningitis by Enterococcus Faecalis Secondary to Neuraxial Anesthesia
Management of infections in immunocompromised patientsSujay Iyer
This document provides an overview of managing infections in immunocompromised patients. It discusses various conditions that can cause immunosuppression like cancer, HIV, malnutrition, and immunosuppressive drugs. It focuses on febrile neutropenia, describing the definition, etiology, risk stratification, diagnosis, and management depending on if the patient is high-risk or low-risk. It also covers catheter-related infections, pneumonia, gastrointestinal infections, and prevention of infections. The management of febrile neutropenia involves broad-spectrum antibiotics, monitoring response, and modifying treatment based on culture results and patient risk factors.
This document summarizes guidelines for the management of febrile neutropenia. It describes definitions of fever and neutropenia and risk factors. Initial evaluation involves blood cultures, site-specific cultures as indicated, and monitoring. Risk is stratified using tools like the MASCC index. Prophylaxis includes hand hygiene, oral care, and sometimes antibiotics or antifungals. Empiric antibiotic therapy is recommended, with modifications based on risk and response. Therapy typically continues until resolution of fever and recovery of neutrophils. Empiric antifungals may be considered for persistent fever.
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
32-year-oldprimigravida, CATB2, Covid positive patient with acute onset of facial palsy, fever, sore throat and productive cough referred from a peripheral hospital came for caesarian section. Past history revealed occurrence of juvenile dermatomyositis for which she took steroids for one and a half year which was slowly weaned off. Prevalence of dermatomyositis is 1to 8 in 100,000. She was started on steroids which was to be continued for a week after caesarian section. She was on paracetamol and cefuroxime on admission. Basic investigations were normal. Caesarian section was done in covid theater following covid protocols under subarachnoid anesthesia Baby had an APGAR score of 9 and was covid negative. Mothers’ recovery was slow. Facial deviation got corrected in 4to 5 months. Ptosis persisted even after 9months and is on treatment. Dermatomyositis is an uncommon inflammatory disease that affects mainly proximal muscle limiting day to day activities. But it can affect respiratory, cardiac and gastrointestinal systems, eyes and joints. Diagnosis is by muscle biopsy and an increase in muscle enzymes. Pregnancy during remission period is safe. But pregnancy can provoke the disease. Skin changes usually precedes muscle symptoms, though we could not notify any lesions. Lung involvement is prominent, and covid also carries the same amount of risk with respiratory system. Systemic glucocorticoids are the first line of treatment. Immunosuppressant drugs Azathioprine and methotrexate are added as second line of therapy, though these drugs are unsafe during pregnancy. Intravenous immunoglobulin, give good outcome during pregnancy. Plasmapheresis is also beneficial. Most of the pregnant patients end up in caesariansection. Regionalanesthesia is the choice of anesthesia. Covid patients with respiratory infections, maintaining saturation above90%, choice of anesthesia is usually regional anesthesia.
Key Words: Juvenile Dermatomyositis, COVID, Cesarian Section
This document discusses antibiotics and their use in the intensive care unit (ICU). It begins by defining key terms like infection, SIRS, sepsis, severe sepsis, and septic shock. It then discusses the most common causes of infections in the ICU, including devices, nursing care, and antibiotic overuse. The most frequent infectious organisms in the ICU are noted as gram-positive bacteria like coagulase-negative staphylococci and Candida species. Factors predisposing patients to infection and approaches for diagnosis and empiric antibiotic therapy are also summarized.
The document discusses neonatal intensive care units (NICUs), providing a history of their development and describing common diseases, challenges, and infections treated in NICUs. It notes that prematurity, respiratory issues, and sepsis are leading problems and that nosocomial infections from organisms like Klebsiella, E. coli, coagulase-negative Staphylococcus, and Candida are a major challenge requiring prevention efforts like judicious antibiotic use, sterile equipment and procedures, and contact precautions.
This case report describes a 43-year-old man who presented with a painful right scrotal swelling and fever that had been evolving over a year. Ultrasound revealed a poorly limited scrotal swelling with thick echogenic content and swelling of the right spermatic cord. Surgical exploration showed a hydrocele with fibrous tissue involving the right testicle. Biopsies were positive for tuberculosis. The patient was treated with anti-tuberculosis drugs and surgery for the hydrocele. His condition improved with medical treatment, demonstrating that tuberculous orchi-epididymitis can initially present as a painful hydrocele.
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and usually affects the lungs. It remains a major global health problem, with around 10 million new cases and 1.5 million deaths per year worldwide according to the WHO. Tuberculosis flourishes in conditions of poverty, crowding and immunosuppression. Clinical manifestations vary depending on whether the infection is primary or secondary, and can include cough, fever, weight loss, or disseminated disease. Diagnosis involves smear, culture and radiography. Standard treatment is 6 months of multiple antitubercular drugs. Effectiveness of treatment is assessed by repeat smears and cultures after 2 and 5 months.
Repeated Hemoptysis With Progressive Bronchiectasis: A Case Report of Lady Wi...semualkaira
Bronchiectasis is a type of incurable structural lung disease with
clinical manifestations of chronic cough, expectoration or recurrent hemoptysis, which is often given anti-infection and symptomatic treatment. In this study, a patient suffering from bronchiectasis
with repeated hemoptysis caused by nontuberculous mycobacterium (NTM) was discussed. A 54-year-old female immunocompetent patient was admitted to our hospital due to repeated hemoptysis for 5 years. Computed tomography (CT) scan revealed progressive bronchiectasis in the upper and middle lobes of her right lung.
She subsequently underwent thoracoscopic lobectomy of the right
middle lobe plus segmentectomy of the anterior segment of the
right upper lobe. Postoperative pathological diagnosis was confirmed to be intracellular mycobacterium. In view of her results,
the patient was concluded to have “Lady Windermere syndrome”
and was clinically cured following 15 months of anti-NTM treatment.
Repeated Hemoptysis with Progressive Bronchiectasis: a case report of Lady Wi...komalicarol
Bronchiectasis is a type of incurable structural lung disease with
clinical manifestations of chronic cough, expectoration or recurrent hemoptysis, which is often given anti-infection and symptomatic treatment. In this study, a patient suffering from bronchiectasis
with repeated hemoptysis caused by nontuberculous mycobacterium (NTM) was discussed. A 54-year-old female immunocompetent patient was admitted to our hospital due to repeated hemoptysis for 5 years. Computed tomography (CT) scan revealed progressive bronchiectasis in the upper and middle lobes of her right lung.
She subsequently underwent thoracoscopic lobectomy of the right
middle lobe plus segmentectomy of the anterior segment of the
right upper lobe. Postoperative pathological diagnosis was confirmed to be intracellular mycobacterium. In view of her results,
the patient was concluded to have “Lady Windermere syndrome”
and was clinically cured following 15 months of anti-NTM treatment.
1. The IDSA guidelines provide recommendations for managing neutropenic patients with cancer who develop fever, focusing on antimicrobial treatment.
2. It distinguishes between high-risk and low-risk patients based on factors like anticipated duration of neutropenia, severity of neutropenia, and comorbidities. High-risk patients require initial IV antibiotics in the hospital, while low-risk patients may be candidates for oral or outpatient treatment.
3. The guidelines make recommendations on appropriate empiric antibiotic therapy, modifying treatment, treatment duration, and use of prophylaxis for both high-risk and low-risk neutropenic fever patients. It also provides guidance on use of empirical and preempt
Antibiotics revolutionized medicine by curing infections that routinely killed patients. However, overuse and misuse of antibiotics has led to increased bacterial resistance. This document discusses the principles of antibiotic prophylaxis for dermatological surgery. It finds that antibiotics should only be used when there is significant risk of infection, be targeted against likely pathogens, and use the narrowest effective spectrum. Indiscriminate or prolonged use contributes to growing antibiotic resistance. Topical decolonization of nasal carriers of Staphylococcus aureus before surgery may reduce surgical site infections more effectively than systemic antibiotics.
This document discusses infectious and non-infectious complications of pediatric peritoneal dialysis. It covers topics such as peritonitis (the most common complication), peritoneal catheter exit-site and tunnel infections, gastroesophageal reflux disease, delayed gastric emptying, back pain, and pleural effusions. For each complication, it discusses causes, risk factors, clinical presentation, microbiology, diagnosis, treatment recommendations, and management strategies.
1) Discitis is a bacterial infection of the intervertebral disc that is commonly caused by direct inoculation from surgery or hematogenous spread from another infection site.
2) MRI is the preferred imaging modality for diagnosing discitis, which shows inflammation and enhancement involving the vertebral bodies and discs.
3) While discitis is usually treated with long-term antibiotics, surgery may be needed for debridement and fusion if the infection fails to improve or causes neurological impairment.
Similar to Postpartum Meningitis by Enterococcus Faecalis Secondary to Neuraxial Anesthesia (17)
Ulcerative Colitis with Aseptic Abscesses Controlled by Vedolizumab: A Case R...clinicsoncology
Aseptic abscesses (AAs) are neutrophilic infiltrative lesions that often coincide with systemic inflammatory disorders such as inflammatory bowel diseases (IBD). According to recent literature, medical therapies in IBD with AAs include corticosteroid, immunosuppressants and anti-TNFα biologics.
Prevalence and Determinants of Distress Among Residents During COVID Crisisclinicsoncology
This study assessed the prevalence of distress, burnout, and depression among residents in France during the COVID-19 pandemic. 34 residents completed an online survey assessing sociodemographic factors, workload, work environment, impact of the pandemic, and mental wellbeing. Over 20% of residents reported high distress, 56% reported moderate to severe burnout, and 27% reported moderate to severe depressive symptoms. Being single and having a high workload increased the risk of distress and burnout. While COVID-19 did not affect prevalence, it increased stress intensity. Residents were concerned about impacts on training and careers. Higher wellbeing was associated with poorer quality of life, more regrets, and lower satisfaction. The pandemic disrupted training and increased
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O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
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Postpartum Meningitis by Enterococcus Faecalis Secondary to Neuraxial Anesthesia
1. Annals of Clinical and Medical
Case Reports
ISSN 2639-8109
Case Report
Postpartum Meningitis by Enterococcus Faecalis Secondary to Neuraxial
Anesthesia
Coll S1*
, Murillo E1
, Raynard M2
, Serra B1
and Prats P1
1
Department of Obstetrical, Gynecologic and Reproductive Unit, Hospital Universitari Dexeus, Barcelona, Spain
2
Department of Anesthesiology, Resuscitation and Pain, Hospital Universitari Dexeus, Barcelona, Spain
Volume 4 Issue 1- 2020
Received Date: 14 Apr 2020
Accepted Date: 14 May2020
Published Date: 21 May 2020
1. Abstract
Meningitis is an infrequent and serious cause of postpartum fever that requires early diagnosis and
treatment to prevent serious complications and to reduce the high mortality rate. Neuraxial anesthesia
is a frequently used technique in obstetrics. Meningitis is a very rare complication of neuraxial an-
esthesia and enterococcus is only involved in exceptional cases. We report the case of a 32-year-old
female patient who developed meningitis during the immediate postpartum by Enterococcus faecalis,
probably caused by contamination of the anesthesia puncture site and we reviewed available litera-
ture. Only five cases of enterococcal meningitis after neuraxial anesthesia have been reported so far.
Median age was 36 years, 2 cases were males and 3 females. Only in our case there were risk factors
for the development of meningitis such as obesity and the difficulty at the catheter insertion. Only one
additional case was reported in the obstetrics setting. All patients recovered completely without any
sequel.
2. Background
Endometritis is the most common infection during the postpar-
tum. However, we should also consider mastitis, postsurgical
wounds or episiotomy infections, urinary tract infections and
septic pelvic thrombophlebitis. Meningitis is a rare cause of post-
partum fever1
. Risk factors for infection are advanced age, preexis-
tent comorbidities (diabetes mellitus (DM), immunosuppression,
obesity, etc), intrapartum maneuvers (premature rupture of mem-
branes, frequent cervical examination, internal fetal monitoring,
instrumental delivery, manual examination of the uterine cavity)
and postpartum complications (anemia, hematoma or seroma of
the postsurgical wounds) [1].
Enterococci are significant human pathogens that are frequently
involved in nosocomial infections [2]. Enterococcal Meningitis
(EM) is an uncommon disease, accounting for only 0.3-4% of cases
of bacterial meningitis [3] and E. faecalis is the bacteria involved
in the majority of cases4
. The clinical presentation of meningitis is
similar to other causes of acute purulentmeningitis.
3. Case Report andReview
A 32-year-old secundigravida with a single pregnancy after an in
vitro fertilization attended our center to control her pregnancy. She
presented a non-complicated pregnancy with normal ultrasound
scans. In her medical record, her obesity (BMI: 37 kg/m2
) and hy-
pothyroidism were points that were noted.
The patient was admitted at the Delivery Ward for labor induction
at 38+2 gestational weeks. Combined spinal and epiduralanesthe-
sia were offered and it wasperformed following antiseptic measures
(the anesthesiologist used heat, gloves and mask and the patient’s
skin was prepared with iodopovidone). The procedure was difficult
due to the patient’s obesity and it was necessary to perform two
attempts. Six hours later, she delivered vaginally with a first-degree
perineal tear sutured successfully. Epidural catheter was removed
immediately after delivery.
Almost 24 hours after delivery, the patient had an acute holocranial
headache which irradiated to the neck and which was not alleviat-
ed by painkillers or/and postural measures. She was afebrile and
hemodynamically stable. Two hours later, she had a fever (38.1ºC).
Clinical examination was unremarkable. Intravenous (iv) ampicil-
lin 1g qid hours and gentamicin 80mg tid were administrated as
empirical treatment for a possible postpartum infection. Blood test
showed leukocytosis (15400/ml) and mild neutrophilia. Reactive
C Protein was 106.2 mg/dl (nr <1). No other abnormalities were
found. Cranial and abdominopelvic CT scanning came out with
no pathological findings. Two hours later, the patient presented an
altered mental status and meningeal signs and postpartum menin-
gitis was suspected (Figure 1). A lumbar puncture was performed
showing the following results: purulent cerebrospinal fluid (CSF),
pleocytosis (12160cel/mL, nr <5cel/mL) elevated protein level
(320.7mg/dL, nr <45 mg/dL) and hypoglycorrhachia (1mg/dL, nr
> 50% of the glycemia). Antimicrobial regimen was modified to iv
*Corresponding Author (s): Dra Sandra Coll, Obstetrical, Gynecologic and Reproductive
Unit, Hospital Universitari Dexeus, Barcelona, Spain, E-mail: sancol@dexeus.com
http://www.acmcasereport.com/
Citation: Coll S, Postpartum Meningitis by Enterococcus Faecalis Secondary to Neuraxial Anesthe-
sia. Annals of Clinical and Medical Case Reports. 2020; 4(1): 1-3.
3. Volume 4 Issue 1-2020 Case Report
Table 1: Reported cases of enterococcal meningitis secondary to neuraxial anesthesia
Patient
Reference
List
Gender +
Age
Anesthesia
indication +
type Symptoms CSF analysis
CSF
culture or
PCR Treatment Evolution
1 5 F/80
Vertebral
fracture/
Epidural
Fever, headache,
altered mental
status and
meningeal signs
L: 3360cel/ml
P: 211mg/dl
G: 68ml/dl
E faecalis
Ceftriaxone +
Vancomycin Complete recover
2 6 M/20
Inguinal hernia/
Spinal
Fever, headache,
stiff neck, and
meningeal signs
L: 9550cel/ml
P: 1239mg/dl
G: 19ml/dl
E faecalis
Ampicillin +
Gentamicin
Complete
recover
3 7 M/22
Left knee
ligamento-
plasty/
Rachidian
Fever, headache,
vomiting,
meningeal signs
L: 1500cel/ml
P: 89mg/dl
G: 58ml/dl
E faecalis
Linezolid (R to
vancomycin) +
Imipenem/cilastatin +
Rifampicin
Complete
recover
4 8 F/28
C-section/
Epidural
Fever, cellulitis,
headache,
stiff neck and
photophobia
L: 3000cel/ml
P: 308mg/dl
G: 27mg/dl
E faecalis
Penicillin G
+ Vancomycin
Complete
recover
5 Reported here F/32
Labor/ CSE
Fever, headache,
altered mental
stratus,
meningeal signs
L: 12160cel/
ml
P: 321mg/dl
G: 1mg/dl
E faecalis
Ampicillin
+
Gentamicin
Complete recover
CSF,cerebrospinal fluid; PCR, polymerase chain reaction; F,female; M, male; L, leukocytes count; P,protein concentration; G, glucose concentration; R: resistance; CSE:
combined spinal and epidural anesthesia.
5. Conclusion
To the best of our knowledge, this is the second case of postpartum
meningitis by Enterococcus faecalis published so far. Although in-
frequent in the obstetric setting, acute meningitis is an infectious
emergency that requires early diagnosis and treatment to prevent
fatal complications and reduce the associated morbidity. It must
be suspected in all cases of postpartum fever, particularly when
headache is also present and it was not solved by painkillers or/
and postural measures. In obstetrical patients without a patholog-
ical medical history, NA during the delivery could be a risk factor
for bacterial meningitis when it is technically difficult. To prevent
EM, optimized antiseptic measures during the administration of
the NA must beapplied.
Reference
1. WHO recommendations for prevention and treatment of maternal
peripartum infections. Geneve. 2015.
2. Giridhara PM, Ravikumar KL and Umapathy BL. Review of viru-
lence factors of enterococcus: an emerging nosocomial pathogen.
Indian Journal of Medical Microbiology. 2009; 27(4):301-5.
3. Pintado V, Cabellos C, moreno S, Meseguer MA, Ayats J, Viladrich
PF. Enterococcal Meningitis: A clinical study of 39 cases and review
of the literature. Medicine. 2003;82:346-64.
4. Traurig E. Post-Dural Puncture Bacterial Meningitis. Anesthesiolo-
gy. 2006; 105:381-93.
5. Donnelly T., Koper M. and Mallaiah S. Meningitis following spinal
anaesthesia – a coincidental infection? International Journal of Ob-
stetric Anesthesia. 1998; 7:170-172.
6.
Laguna P, Castañeda A, López-Cano M, García P. Bacterial meningitis
secondary to spinal analgesia. Neurología. 2010; 25(9): 552-556.
7. Tortosa J.A. and Hernández P.Enterococcus faecalis Meningitis after
Spinal Anesthesia. Anesthesiology. 2000; 92: 909.
8. Cournac J.-M., Landais C., Gaillard T., Bordes J. and Carli P.Ménin-
gite à Enterococcus faecalis après rachianesthésie traitée avec succès
par linézolide. Médecine et Maladies Infectieuses. 2012; 42(7): 327-
8.
9. Ready B. and Helfer D. Bacterial Meningitis in Parturients after Epi-
dural Anesthesia. Anesthesiology. 1989; 71: 988-990.
10. Maki DG, Agger VA.Enterococcal bacteremia: Clinical features, the
risk of endocarditis, and management. Medicine (Baltimore). 1988;
67: 248-269.
11. van de Beek D, Cabellos C, Dzupova O, Esposito S, Klein M, Kloek
AT, et al. ESCMID guideline: diagnosis and treatment of acute bac-
terial meningitis. 2016.
12. Tunkel A, Hartman B, Kaplan S, Kaufman B, Roos K, Scheld M. et
al. Practice Guidelines for the Management of Bacterial Meningitis.
Clinical Infectious Disease. 2004;39:1267-1284.
13. Murray BE. Vancomycin-resistant enterococcal infections. New En-
gland Journal of Medicine. 2000; 342:710-721.
14. García-Solache M and Rice L.B. The Enterococcus: a Model of
Adaptability to Its Environment. Clinical Microbiology Reviews.
2019; 32(2).
15. Sparo M., Delpech G and García Allende N. Impact on Public
Health of the Spread of High-Level Resistance to Gentamicin and
Vancomycin in Enterococci. Frontiers in Microbiology. 2018.
http://www.acmcasereport.com/ 3