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INTRODUCTION: Leptospirosis and melioidosis are common in tropical and temperate climates and can be acquired by exposure to contaminated water and soil. However, concomitant leptospirosis and melioidosis infection is rarely described in the literature. We report a case of leptospirosis-melioidosis coinfection and systematically review the literature. CASE PRESENTATION: A 42-year-old male presented with fever associated with chills and rigor, dull aching pain in the right thigh, myalgia, progressive breathlessness, and dry cough for 10 days. At presentation, he was tachypneic and had tachycardia, and oxygen saturation was 46% in room air. Chest radiography and computed tomography scan showed interstitial involvement. Magnetic resonance imaging for thigh pain revealed right femur osteomyelitis. Leptospira serology was positive, and blood culture grew Burkholderia pseudomallei, confirming the diagnosis of melioidosis. Thus, a diagnosis of presumptive leptospirosis based on modified Faine's criteria and systemic melioidosis was made. He received doxycycline and intravenous meropenem and improved. RESULTS: We performed a systematic review to understand the spectrum of leptospirosis-melioidosis coinfection. We identified only nine cases of coinfection described in literature. Only one patient had septic arthritis, and our case is the only one presenting with osteomyelitis. Serology diagnosed leptospirosis, whereas melioidosis was confirmed by blood culture in most patients. The majority of coinfected patients developed some complications, and six died. CONCLUSIONS: Leptospirosis-melioidosis coinfection is rarely reported in the literature. Physicians should maintain a high index suspicion of leptospirosis-melioidosis coinfection in patients presenting with acute febrile illness following exposure to soil or freshwater, particularly in tropical and endemic regions.
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Antibacterianos , Burkholderia pseudomallei , Coinfección , Leptospirosis , Melioidosis , Osteomielitis , Síndrome de Dificultad Respiratoria , Humanos , Melioidosis/complicaciones , Melioidosis/diagnóstico , Melioidosis/tratamiento farmacológico , Melioidosis/microbiología , Masculino , Adulto , Leptospirosis/complicaciones , Leptospirosis/diagnóstico , Osteomielitis/microbiología , Osteomielitis/diagnóstico , Osteomielitis/tratamiento farmacológico , Coinfección/microbiología , Coinfección/diagnóstico , Antibacterianos/uso terapéutico , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/microbiología , Burkholderia pseudomallei/aislamiento & purificación , Doxiciclina/uso terapéutico , Meropenem/uso terapéutico , Meropenem/administración & dosificaciónRESUMEN
A non-smoker man in his second decade presented to a medical centre with intermittent haemoptysis over 2 years. The haemoptysis was infrequent initially to be ignored, but later, the episodes increased in amount and frequency. Routine blood tests including coagulation profile showed normal results. The chest radiography and echocardiography were normal. The contrast-enhanced CT scan of the chest showed a cystic lesion with intracystic abnormality and surrounding ground-glass opacity in the left upper lobe. The CT pulmonary angiography and invasive pulmonary angiography showed the abnormality to be a dilated pulmonary vessel draining into the left atrium, thereby confirming the diagnosis of congenital pulmonary varix contained within a lung cyst. The patient underwent a successful lobectomy following which he experienced no further haemoptysis.
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Quistes , Enfermedades Pulmonares , Várices , Masculino , Humanos , Hemoptisis/etiología , Pulmón/diagnóstico por imagen , Pulmón/cirugía , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/cirugía , Quistes/complicaciones , Quistes/diagnóstico por imagen , Quistes/cirugía , Várices/congénitoRESUMEN
BACKGROUND AND OBJECTIVE: Cough is invariably encountered during flexible bronchoscopy despite sedation and topical anaesthetics. The ideal cough suppressant during flexible bronchoscopy is not known. We assessed the role of dextromethorphan premedication in relieving the cough during flexible bronchoscopy in adults. METHODS: In this single-centre study, we randomized patients aged ≥18 years to receive dextromethorphan syrup 30 ml (90 mg) or an equal volume of placebo 1 h before the procedure. Patients rated their cough severity and discomfort on a visual analogue scale at the end of the procedure. Bronchoscopists also rated cough severity at the end of the procedure. RESULTS: Out of 112 patients screened, 94 patients (median (interquartile range [IQR]) age 51 (36.25-60.75) years, male: female 2.13:1) were randomized to either the dextromethorphan (n = 47) or placebo (n = 47) groups. The patients-rated median (IQR) cough scores at the end of the procedure were 15 (10-23) mm in dextromethorphan versus 20 (12-45.5) mm in placebo groups (p = 0.03). Patients-rated median cough scores at 1 h (5 mm vs. 6 mm, p = 0.21), discomfort scores (12.5 mm vs. 12.5 mm, p = 0.49), and midazolam and lignocaine usage were similar between the two groups. The bronchoscopist-rated median cough score was non-significantly lower in the intervention compared to the placebo (26 mm vs. 35 mm, p = 0.09) groups. CONCLUSION: Dextromethorphan premedication 1 h before flexible bronchoscopy may have an additive effect on cough suppression under conscious sedation and topical lignocaine. Further trials are needed to reiterate our findings with certainty.
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Tos , Dextrometorfano , Humanos , Masculino , Adulto , Femenino , Adolescente , Persona de Mediana Edad , Tos/tratamiento farmacológico , Dextrometorfano/uso terapéutico , Broncoscopía/efectos adversos , Broncoscopía/métodos , Lidocaína/uso terapéutico , Premedicación/métodos , Método Doble CiegoRESUMEN
In this retrospective observational study, we have performed a comparative analysis of the demographic, clinical and epidemiological characteristics of the HCWs affected with SARS-CoV-2 infection during first two waves in India. The overall prevalence of SARS-CoV-2 infection among HCWs was found to be 15.24% (14.20-16.33) and 23.38% (22.14-25.65) during first and second waves respectively. The second wave showed an adjusted odds ratio of 0.04(0.02-0.07) and 2.09(1.49-2.93) for hospitalization and being symptomatic, respectively. We detected significantly higher level of C-reactive protein (CRP) among admitted HCWs during the second wave (5.10 -14.60 mg/dl) as compared to the first wave (2.00 - 2.80 mg/dl). Our study found the relative risk of SARS-CoV-2 reinfection among HCWs during the second wave to be 0.68 [0.57-0.82, p < 0.001)]. Although, the prevalence of SARS CoV-2 infection and risk of being symptomatic was higher during second wave, the risk of hospitalization was less when compared with the first wave.
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OBJECTIVE: This study intends to compare the clinical characteristics and the prevalence and spectrum of bacterial pathogens in COVID-19 patients admitted to ICU during the first and second waves at a tertiary care, teaching and referral hospital of eastern India. METHOD: This is a hospital-based retrospective study which analysed demographic details, clinical profile and bacterial culture results of severe and critically ill COVID-19 patients admitted in intensive care units (ICU) during April -Oct 2020 (1st wave) and April -July 2021 (2nd wave). RESULT: The patients admitted during the 2nd wave were comparatively older and had multiple comorbidities compared to the 1st wave. (23.8%) (45/189) and 50% (173/346) of the COVID-19 patients admitted to ICU developed bacterial infection during the 1st and 2nd wave respectively. Overall, there was predominance of multidrug resistant Gram negative bacilli in both the waves. There was increased isolation of intrinsic colistin resistant microorganisms. CONCLUSION: Multidrug resistant Gram negative bacterial infections, remain a dreaded complication in severe and critically ill hospitalised COVID-19 patients requiring ICU care and high usage of colistin spirals the emergence and spread of pathogens intrinsically resistant to colistin.
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COVID-19 , Colistina , Antibacterianos/uso terapéutico , Bacterias , Enfermedad Crítica , Humanos , Unidades de Cuidados Intensivos , Pandemias , Estudios Retrospectivos , Centros de Atención TerciariaRESUMEN
BACKGROUND: Ivermectin is one among several potential drugs explored for its therapeutic and preventive role in SARS-CoV-2 infection. The study was aimed to explore the association between ivermectin prophylaxis and the development of SARS-CoV-2 infection among healthcare workers. METHODS: A hospital-based matched case-control study was conducted among healthcare workers of AIIMS Bhubaneswar, India, from September to October 2020. Profession, gender, age and date of diagnosis were matched for 186 case-control pairs. Cases and controls were healthcare workers who tested positive and negative, respectively, for COVID-19 by RT-PCR. Exposure was defined as the intake of ivermectin and/or hydroxychloroquine and/or vitamin-C and/or other prophylaxis for COVID-19. Data collection and entry was done in Epicollect5, and analysis was performed using STATA version 13. Conditional logistic regression models were used to describe the associated factors for SARS-CoV-2 infection. RESULTS: Ivermectin prophylaxis was taken by 76 controls and 41 cases. Two-dose ivermectin prophylaxis (AOR 0.27, 95% CI, 0.15-0.51) was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month. Those involved in physical activity (AOR 3.06 95% CI, 1.18-7.93) for more than an hour/day were more likely to contract SARS-CoV-2 infection. Type of household, COVID duty, single-dose ivermectin prophylaxis, vitamin-C prophylaxis and hydroxychloroquine prophylaxis were not associated with SARS-CoV-2 infection. CONCLUSION: Two-dose ivermectin prophylaxis at a dose of 300 µg/kg with a gap of 72 hours was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month. Chemoprophylaxis has relevance in the containment of pandemic.
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COVID-19/prevención & control , Personal de Salud/estadística & datos numéricos , Ivermectina/uso terapéutico , Adulto , Ácido Ascórbico/administración & dosificación , Ácido Ascórbico/uso terapéutico , COVID-19/epidemiología , Estudios de Casos y Controles , Quimioprevención/métodos , Combinación de Medicamentos , Femenino , Humanos , India , Ivermectina/administración & dosificación , Masculino , Persona de Mediana EdadRESUMEN
Etiologic diagnosis of an eosinophilic pleural effusion (EPE) presents a diagnostic challenge when intrapleural air and blood have been ruled out as its proximate causes. Among the causes of EPE, those that require immunosuppression for the underlying disease include connective tissue diseases, sarcoidosis, vasculitis, and eosinophilic pneumonia. We present a case of clinically suspected Behcet's syndrome based on a 10-year history of recurrent multiple oral ulcers and human leukocyte antigen-B51 positivity who presented with only an EPE. Computed tomography pulmonary angiogram ruled out central thoracic vein thrombosis but was inconclusive in ruling out a subsegmental pulmonary embolism. The patient declined immunosuppressants and while on follow-up developed bilateral extensive acute lower limb deep venous thrombosis and pulmonary embolism. Upper infrarenal inferior vena cava demonstrated chronic thrombosis suggestive of its antecedent role in pulmonary embolism-related EPE during the first instance. Behcet's syndrome-related EPE can be associated with venous thromboembolism, and immunosuppressive therapy prevents the subsequent thrombotic episodes.
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High minute ventilation is required to lower intracranial pressures in patients with intracranial bleed. Respiratory acidemia consequent to ventilatory difficulty is dangerous in such patients as it further raises intracranial tension. We describe such a case. A 24-year-old man had to be intubated and mechanically ventilated after he met with a road traffic accident and sustained extensive maxillofacial injuries and intracranial bleed. A tooth was accidentally aspirated in this injury and progressively resulted in left lower lobe collapse, pneumomediastinum, and consequent difficult ventilation. Under video bronchoscope guidance, the tooth was removed with grasping forceps. Pneumomediastinum temporarily increased after the tooth removal, but by 12 h postextraction, resolution of both the pneumomediastinum and left lower lobe collapse was observed. There was a 17 h delay postadmission before the cause of ventilatory failure was realized. Aspiration of foreign bodies, in general, and teeth, in particular, should be actively looked for in patients with ventilatory difficulties in the post-trauma setting.