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Malaria Journal Jun 2024Neonatal malaria is defined as the detection of asexual stages of Plasmodium species in the cord blood within the first 28 days of life. It can be congenital or...
BACKGROUND
Neonatal malaria is defined as the detection of asexual stages of Plasmodium species in the cord blood within the first 28 days of life. It can be congenital or acquired through mosquito bites or blood transfusions. Neonates are generally considered to be relatively protected due to the multiple innate and acquired physiological protective effects present in neonates. However, in areas where malaria is endemic, the prevalence of malaria in neonates is high. The predominant clinical feature of malaria in neonates is fever. Other clinical manifestations of neonatal malaria include respiratory distress, pallor and anaemia, hepatomegaly, refusal to feed, jaundice and diarrhoea. Atypical presentations without fever can lead to inaccurate diagnosis and contribute to neonatal morbidity and mortality. Neonates from endemic areas with any of the above symptoms should be screened for malaria.
CASE PRESENTATION
We present a series of three cases of neonatal Plasmodium falciparum malaria that presented atypically without febrile episodes and were diagnosed and managed at Mizan-Tepi University Teaching Hospital between July and September 2023. The first patient presented with vomiting, refusal to feed, pallor, severe anaemia, and splenomegaly. The second patient presented with an inconsolable cry, failure to pass feces, abdominal distention, and anaemia. The third patient presented with vomiting and anaemia. All patients received a 7-day course of intravenous artesunate; the first patient also received a blood transfusion. All patients recovered and were discharged.
CONCLUSIONS
Partial immunity resulting from repeated malaria infections in endemic regions may result in the transfer of high levels of maternal Immunoglobulin G (IgG) antibodies through the placenta and can produce different atypical clinical presentations. In malaria-endemic areas, neonates presenting with any of the presenting signs and symptoms of malaria, including afebrile presentation, require malaria screening to avoid delays in diagnosis.
Topics: Humans; Infant, Newborn; Malaria, Falciparum; Female; Male; Ethiopia; Plasmodium falciparum; Antimalarials; Artesunate
PubMed: 38840266
DOI: 10.1186/s12936-024-04987-y -
Cureus May 2024A 47-year-old male, a known case of alcoholic chronic liver disease with portal hypertension, presented with complaints of abdominal distension and shortness of breath....
Iatrogenically Acquired Mycobacterium abscessus Infection in an Indwelling Intercostal Drainage In Situ in a Patient With Alcoholic Liver Disease and Bilateral Hepatic Hydrothorax: A Report of a Rare Case.
A 47-year-old male, a known case of alcoholic chronic liver disease with portal hypertension, presented with complaints of abdominal distension and shortness of breath. A provisional diagnosis of ethanol-related compensated chronic liver disease (CLD) with portal hypertension and splenomegaly, gross ascites with bilateral hepatic hydrothorax was made. The left-sided pleural effusion subsided after three pleural taps, but the right-sided effusion kept refilling even after four to five days of repeated therapeutic taps, so a pigtail catheter was left in situ. The pleural fluid was sent for culture which did not grow any pathogenic organisms. Cartridge-based nucleic acid amplification tests where complex (MTBC) was not detected, Ziehl-Neelsen staining was done in which acid-fast bacilli were not seen, and cytology was done where no malignant cells were seen. The patient was discharged with the pigtail in situ on the right side and, after 20 days, the patient again presented with shortness of breath, and imaging revealed moderate right-side pleural effusion. Draining of pleural fluid was done and sent for investigation which again revealed no infective etiology. The patient was admitted to the hospital for one month as the right-sided effusion did not resolve. Suddenly, the patient developed shortness of breath, and a chest X-ray was done, which showed pigtail blockage; pigtail flushing was done, and the bag was drained. The patient was empirically started on IV meropenem 500 mg TID, IV teicoplanin 400 mg BD, and inj polymyxin B 500,000 IU IV BD. The pleural fluid was sent continuously for investigation for the first two months which again did not reveal any infective etiology. After two months of pigtail in situ, the pleural fluid was sent for CBNAAT where MTBC was not detected, and ZN stain showed smooth acid-fast bacilli. The sample was cultured, and it grew acid-fast bacilli in 72 hours on blood agar, MacConkey agar, and Lowenstein-Jensen media. A line probe assay done from the isolate revealed it to be subsp. abscessus which was resistant to macrolides and sensitive to aminoglycosides. subsp. abscessus was isolated from repeated cultures of pleural fluid, and the patient was advised on a combination treatment of amikacin, tigecycline, and imipenem. The patient was discharged with the indwelling pigtail with the advised treatment; unfortunately, we lost patient follow-up as the patient never returned to us.
PubMed: 38832176
DOI: 10.7759/cureus.59626 -
Clinical Case Reports Jun 2024It is essential to consider non-tuberculosis mycobacterium in HIV-positive patients with fever, abdominal pain, weight loss, and splenomegaly.
KEY CLINICAL MESSAGE
It is essential to consider non-tuberculosis mycobacterium in HIV-positive patients with fever, abdominal pain, weight loss, and splenomegaly.
ABSTRACT
is an opportunistic slow-growing nontuberculous mycobacterium in patients with immunocompromised backgrounds, especially HIV-positive patients. In this study, we present two cases of infection in HIV-positive patients with a good clinical response to accurate treatment.
PubMed: 38831981
DOI: 10.1002/ccr3.8993 -
Journal of Cancer 2024Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are primary liver cancers with different therapeutic methods and prognoses. This study aims to...
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are primary liver cancers with different therapeutic methods and prognoses. This study aims to investigate the ultrasonography and enhanced computed tomography (CT) features of these cancers and improve the early diagnosis rate. We retrospectively analyzed the clinical and imaging data of 319 patients diagnosed with HCC and 124 patients diagnosed with ICC, confirmed by pathology. A total of 443 patients were eligible in this study. From the perspective of clinical data, between HCC and ICC patients existed significant differences in age, gender, hepatic background, serum tumor markers of AFP and CA19.9, chronic hepatitis B/C and lymph node infiltration (p<0.05), but not in tumor size, microvascular invasion, serum tumor markers of CEA and CA125 (P>0.05). With respect to ultrasonography features, HCC patients had a higher proportion than ICC patients in splenomegaly (p=0.001), while ICC patients had a higher proportion than HCC patients in absence/not rich vascularity and intrahepatic bile duct dilatation (p<0.05). With respect to CT features, HCC patients were significantly different from ICC patients in the three-phase enhanced CT value mean, enhanced intensity and homogeneity of nodules (P<0.05). A multivariate logistic regression analysis was performed to further clarify the correlation of these indices. However, only age≤60 years (OR=1.861, P=0.045), male (OR=3.850, P<0.001), AFP>7ng/ml (OR=0.119, P<0.001), lymph node infiltration (OR=5.968, P<0.001), intrahepatic bile duct dilatation (OR=2.414, P=0.04), splenomegaly (OR=0.081, P<0.001), rim APHE (OR=3.109, P=0.002), and iso- or hyper enhancement (OR=0.188, P<0.001) were independent risk factors. While there are overlapping ultrasonography and CT features between HCC and ICC, the integration of tumor markers and specific imaging characteristics can be beneficial in distinguishing between the two.
PubMed: 38817871
DOI: 10.7150/jca.94550 -
SAGE Open Medical Case Reports 2024Enteric fever is a systemic bacterial infection caused by enteroinvasive, gram-negative bacilli, named and . It presents with hectic fever, headache, malaise, bowel...
Enteric fever is a systemic bacterial infection caused by enteroinvasive, gram-negative bacilli, named and . It presents with hectic fever, headache, malaise, bowel habit changes, and abdominal pain. Diagnosis is usually confirmed by blood culture. Gastrointestinal complications of enteric fever include intestinal bleeding, bowel perforation, pancreatitis, and cholecystitis. We encountered a case of lower gastrointestinal bleeding (hematochezia) as a complication of enteric fever. A 35-year-old male patient presented to Aster CMI hospital, India, with an intermittent fever of 2-week duration associated with dry cough, loss of appetite, abdominal pain, and generalized body weakness. Four days after admission, he experienced three episodes of lower gastrointestinal bleeding. Upon physical examination, he was hemodynamically stable and had a high-grade fever, mild hepatomegaly, tipped splenomegaly, and lower abdominal tenderness. Blood culture grew . Abdominal ultrasound showed ileocolonic thickening with enlarged mesenteric lymph nodes. Abdominal computed tomography scan displayed enlarged mesenteric lymph nodes with surrounding fat strands. A colonoscopy revealed multiple shallow, punched-out, and punctate ileocolonic ulcerative lesions, with stigmata of active bleeding at caecal ulcers. Colonoscopy-guided biopsy suggested multifocal active colitis favoring infective etiology. Diagnosis of blood culture-confirmed enteric ulcer was made. He was treated with ceftriaxone 1 g iv twice daily for 10 days and rehydrated with intravenous fluids. Adrenaline injection was done at the site of bleeding ulcers, and hemostasis was secured. Other additional medications were antipyretics, anti-emetics, multivitamins, and proton pump inhibitors. He was fever-free on the third day of admission and discharged after 10 days of hospital stay. He was appointed to follow-up clinic after a week. He was completely healthy on the day of the first follow-up clinic visit and planned to resume his duties. Enteric fever remains a common public health problem in most developing countries. Early suspicion and prompt institution of appropriate antibiotics are crucial in the reduction of systemic and local complications of enteric fever. Since gastrointestinal complications of enteric fever are less often encountered in the antibiotic era, clinicians should be cognizant of an enteric ulcer as a cause of lower gastrointestinal bleeding.
PubMed: 38817408
DOI: 10.1177/2050313X241255506 -
Frontiers in Veterinary Science 2024Contrast-enhanced computed tomography (CT) of the spleen in dogs and cats often displays a heterogeneous enhancement pattern. This study aimed to describe the CT...
INTRODUCTION
Contrast-enhanced computed tomography (CT) of the spleen in dogs and cats often displays a heterogeneous enhancement pattern. This study aimed to describe the CT appearances and duration of heterogeneous splenic enhancement in clinically healthy cats and to compare those enhancements with diffuse infiltrative splenic lesions (DISL).
METHODS
Spleens of 14 healthy cats were imaged using contrast-enhanced CT protocols which were obtained at 10, 25, and 45 s, and then every 40 s thereafter until 245 s had past from the initiation of contrast medium injection. The presence of transient splenic heterogeneity was evaluated. In addition, the relationships of certain variables including age, weight, systolic blood pressure, and splenic volume to the duration and the degree of splenic enhancement were determined. Also, medical records and CT images of five cats with DISL were retrospectively evaluated.
RESULT
Transient heterogeneous enhancement of the spleen was observed in all 14 healthy cats, and the maximum heterogeneity was observed 25 s after the injection. Splenic heterogeneity lasted more than 5 min in nine of 14 cats (64.3%). No statistically significant relationships were seen between the duration and degree of splenic heterogeneity in the images taken 25 s after the injection and variables including weight, age, systolic blood pressure, and splenic volume.
DISCUSSION
Compared to the healthy group, early homogeneous splenic enhancement along with generalized splenomegaly was observed in all cats with DISL. Transient splenic heterogeneity is highly common in cats undergoing contrast-enhanced CT even in the generally scanned delayed phases, which can help with the interpretation of CT images of feline spleens. In addition, our results suggest that homogeneous splenic enhancement in post-contrast CT scans along with splenomegaly on CT images could be useful as a diagnostic indicator of DISL in cats.
PubMed: 38812561
DOI: 10.3389/fvets.2024.1276984 -
Infectious Disease Reports Apr 2024(1) Background: Since the advent of zidovudine in 1987, antiretroviral therapy has undergone significant evolution, marked by the introduction of 34 antiretroviral drugs...
(1) Background: Since the advent of zidovudine in 1987, antiretroviral therapy has undergone significant evolution, marked by the introduction of 34 antiretroviral drugs and 24 fixed-dose combinations. Despite these advances, hepatotoxicity remains a formidable challenge, influencing morbidity, mortality, and treatment adherence in HIV-infected patients. This study aims to compare the hepatotoxic effects of latest-generation antiretroviral medications with those of older-generation therapies, assessing their long-term impact on liver health in HIV patients. (2) Methods: This retrospective study analyzed data from 304 HIV patients treated with either latest-generation or older-generation antiretroviral drugs over four years. Patients were monitored for hepatotoxicity through liver function tests at diagnosis, six months, and one-year post-treatment initiation. (3) Results: Initial and six-month liver function tests showed no significant differences between the two groups. However, at one-year post-treatment, patients on latest-generation antiretrovirals exhibited significant improvements in ALT, AST, and ALP levels, suggesting a better safety profile regarding hepatotoxicity. Additionally, a significantly lower incidence of splenomegaly was observed in patients treated with newer medications. (4) Conclusions: The findings suggest that the latest-generation antiretroviral medications may offer a safer profile in terms of hepatotoxicity compared to older therapies, with potential benefits for long-term liver health. This study underscores the importance of continuous monitoring and further research to optimize ART strategies, ensuring improved patient outcomes and quality of life for individuals living with HIV.
PubMed: 38804441
DOI: 10.3390/idr16030031 -
Heliyon May 2024Hepatitis Delta represents a greater risk in the progression of advanced liver disease and HCC compared with HBV. The exact mechanism that determines the spontaneous...
BACKGROUND
Hepatitis Delta represents a greater risk in the progression of advanced liver disease and HCC compared with HBV. The exact mechanism that determines the spontaneous clearance of delta virus or its progression to cirrhosis remains unknown. Therefore, this study aimed to analyze the clinical profile of HBV and HBV/HDV individuals in the Western Amazon.
METHODS
The study was carried out at the Specialized Outpatient Clinic for Viral Hepatitis belonging to the Centro de Pesquisa em Medicina Tropical de Rondônia/CEPEM. 100 individuals were included, stratified into two groups: 50 with hepatitis B virus and 50 with hepatitis Delta virus.
RESULTS
The overall mean age was 48 years. For the HBV and HDV groups, 66 % (33/50) and 54 % (27/50) were men and 56 % (28/50) and 58 % (29/50) were on antiviral treatment, respectively. Patients with detectable HDV-RNA demonstrated high levels of ALT and AST compared to individuals with undetectable HDV-RNA. Comparative analysis between HBV carriers and infected with HDV shows significant differences in terms of age, HBV-DNA levels, albumin, hepatomegaly and splenomegaly.
CONCLUSION
Several markers were important for differentiating HBV and HDV infections. HDV-RNA detectable showed significant changes in biomarkers compared to undetectable patients, suggesting a possible worse prognostic effect in this group.
PubMed: 38803893
DOI: 10.1016/j.heliyon.2024.e31065 -
Cureus Apr 2024Common variable immunodeficiency (CVID) is a primary immunodeficiency with the involvement of B cells, T cells, and antigen-presenting cells. Patients with CVID are more...
Common variable immunodeficiency (CVID) is a primary immunodeficiency with the involvement of B cells, T cells, and antigen-presenting cells. Patients with CVID are more susceptible to malignancies and bacterial infections in the gastrointestinal and respiratory tracts. We discuss a case of a 50-year-old male who presented to the emergency department with a history of intermittent abdominal pain, diarrhea, night sweats, fever, nausea, and weight loss of 40 pounds over six months. A CT of the abdomen revealed splenomegaly with several infiltrated solid nodules as well as enlarged mediastinal, hilar, periesophageal, cervical, and left supraclavicular lymph nodes, findings suggestive of lymphoma. The diagnosis of nodular lymphocyte-predominant Hodgkin lymphoma was confirmed by immunohistology, which revealed that CD20 and CD3 were both positive in small lymphocytes. Immunoglobulin (Ig) levels were low for IgG and IgM, findings highly suggestive of CVID. We want to shed light on the importance of performing the clinical workup for CVID when Hodgkin lymphoma and recurrent infections are present, as the immunodeficiency remains underdiagnosed and underreported.
PubMed: 38800171
DOI: 10.7759/cureus.58989 -
Medical Mycology Case Reports Jun 2024Spontaneous mycosis caused by is documented in roach in a cyprinid-prevalent water reservoir in Czechia. Gross pathological lesions included pale gills and...
Spontaneous mycosis caused by is documented in roach in a cyprinid-prevalent water reservoir in Czechia. Gross pathological lesions included pale gills and splenomegaly, as revealed during necropsy examination. Histological examination showed extensive foci with fungal elements in the kidney. The isolated fungus was identified through phenotypic and molecular characterization, including phylogeny. This report represents the first case of infection in fish and cold-blooded vertebrates, to the best of our knowledge.
PubMed: 38799503
DOI: 10.1016/j.mmcr.2024.100652