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European Journal of Case Reports in... 2023Infectious mononucleosis (IM), the most common presentation of acute Epstein Barr virus (EBV) infection, typically presents with fever, pharyngitis and lymphadenopathy....
UNLABELLED
Infectious mononucleosis (IM), the most common presentation of acute Epstein Barr virus (EBV) infection, typically presents with fever, pharyngitis and lymphadenopathy. We describe an unusual case of IM presenting as acute sinusitis. A 25 year-old male presented to the emergency department with worsening right frontal sinus pain along with fever, chills, and greenish nasal discharge for 3 weeks. Laboratory workup showed leukocytosis with high lymphocyte counts as well as transaminitis. Facial computerized tomography (CT) showed extensive right frontal, ethmoidal and maxillary sinusitis and antrochoanal polyp. The patient underwent endoscopy with drainage of purulent material and polyp removal. Unfortunately, cultures of the sample were not sent and bacterial infection could not be ruled out. Broad spectrum antibiotics were continued. Pathology of redundant tissue revealed large atypical lymphocytes with positive EBV-encoded RNA and lack of evidence of extranodal natural killer/T-cell (NK/T-cell) type lymphoma (ENKTCL). Tests for serum EBV IgM antibodies and EBV early Antigen antibodies were positive, indicating acute EBV infection. Lymphocytosis resolved along with significant clinical improvement at the 10-day follow up visit. Even though patient did receive antibiotics, multiple factors including isolated lymphocytosis, pathology positive for EBV with no neutrophilia were more suggestive of sinusitis caused by viral infection, EBV in this case. Lymphocytosis with fever and sore throat should prompt physicians to consider IM. There are no known reports in the literature of EBV as a causal organism for acute viral sinusitis. There are some studies relating EBV with ENKTCL. It is unknown whether this particular patient with a history of EBV sinusitis will be at high risk for nasal type lymphoma in the future. Further studies should be conducted to understand the pathogenesis and relationship between EBV and ENKTCL.
LEARNING POINTS
Infectious mononucleosis (IM) can present with various atypical presentations. Consideration of IM should not be limited to people presenting with a triad of fever, lymphadenopathy and sore throat. Lymphocytosis with atypical symptoms should raise suspicion of infectious mononucleosis.No case has been reported of EBV as a causal organism for acute sinusitis. Association with EBV infection and chronic sinusitis or nasal polyp or extranodal NK/T cell lymphoma has been demonstrated but pathogenesis is poorly understood.Studies should be done on whether acute sinusitis secondary to EBV poses a risk for nasal type lymphoma.
PubMed: 37789985
DOI: 10.12890/2023_004039 -
Journal of Dairy Science Dec 2010The objective of this observational study was to investigate the risk factors for metritis, purulent vaginal discharge, and cytological endometritis. The hypothesis was...
The objective of this observational study was to investigate the risk factors for metritis, purulent vaginal discharge, and cytological endometritis. The hypothesis was that purulent vaginal discharge and cytological endometritis would have different risk factors because they represent distinct manifestations of uterine disease. Data generated from 1,363 Holstein cows (3 herds) enrolled in a randomized clinical trial were used. Calving history, periparturient disease incidence, and body condition score at calving and at 63 d in milk (DIM) were recorded. Serum nonesterified fatty acid concentration was measured once during the week before expected calving. Serum nonesterified fatty acid, β-hydroxybutyric acid, and haptoglobin (Hapto) concentrations were measured at 4 ± 3, 11 ± 3, and 18 ± 3 DIM. Serum progesterone concentration was measured at 21 ± 3, 35 ± 3, 49 ± 3, and 63 ± 3 DIM. Metritis was diagnosed by farm managers within the first 20 DIM using a standardized definition. Cows were examined at 35 ± 3 DIM by a veterinarian for purulent vaginal discharge (mucopurulent or worse vaginal discharge; Metricheck device) and cytological endometritis (≥ 6% polymorphonuclear cells on endometrial cytology; cytobrush device). Statistical analyses were performed using multivariable logistic regression models for each disease, accounting for the random effect of herd. Risk factors for metritis included increased nonesterified fatty acid prepartum (≥ 0.6 mmol/L), dystocia, retained placenta, and increased Hapto in the first week postpartum (≥ 0.8 g/L). Risk factors for purulent vaginal discharge included twinning, dystocia, metritis, and increased Hapto (≥ 0.8 g/L) in the first week postpartum. Risk factors for cytological endometritis included low body condition score at parturition (≤ 2.75), hyperketonemia (≥ 1,100 μmol/L), and increased Hapto (≥ 0.8 g/L) in the first week postpartum. These results support the hypothesis that some of the risk factors for purulent vaginal discharge and cytological endometritis are different, which supports that they are distinct manifestations of uterine disease.
Topics: Animals; Body Constitution; Cattle; Cattle Diseases; Dystocia; Endometritis; Female; Lactation; Parity; Placenta, Retained; Pregnancy; Prospective Studies; Puerperal Disorders; Randomized Controlled Trials as Topic; Risk Factors; Seasons; Twins; Vaginal Discharge
PubMed: 21094748
DOI: 10.3168/jds.2010-3429 -
Ear, Nose, & Throat Journal Jul 2023The clinical diagnosis and treatment, including information such as age, history, clinical symptoms, signs, audiology, imaging examination, mode of operation, and...
The clinical diagnosis and treatment, including information such as age, history, clinical symptoms, signs, audiology, imaging examination, mode of operation, and postoperative follow-up, of a patient with suppurative temporomandibular arthritis caused by chronic suppurative otitis media were analyzed. As conservative drug treatment and drainage surgery were ineffective, the patient was treated with microscopic open radical mastoidectomy, tympanoplasty, the plasty of the cavity of auricular concha, facial nerve decompression, coarctation of the mastoid cavity combined with otoendoscpic resection of the lower temporomandibular lesions, and standard anti-inflammatory treatment after surgery. The patient appeared to be cured at the 3-month follow-up. The ear canal was dry, without any preauricular swelling, purulent ear discharge, otalgia, limitation of mouth opening, or other symptoms. A clear diagnosis by defining the scope of the lesions, analysis of the transmission route of the lesions, and standard conservative treatment, local drainage, and surgical resection, if necessary, are recommended for patients with suppurative temporomandibular arthritis.
PubMed: 37491883
DOI: 10.1177/01455613231185020 -
European Heart Journal. Case Reports Feb 2021Purulent pericarditis, a rare disease with a high associated mortality rate in patients without adequate treatment, can cause serious complications, such as perforation...
BACKGROUND
Purulent pericarditis, a rare disease with a high associated mortality rate in patients without adequate treatment, can cause serious complications, such as perforation of the surrounding tissue and organs. is a very rare cause of purulent pericarditis.
CASE SUMMARY
A 70-year-old male patient presented to our emergency room with chest pain of 10 days' duration. An electrocardiogram showed ST-segment elevation and PR-segment depression on multiple leads. A transthoracic echocardiogram showed normal left ventricular function and a large amount of pericardial effusion. Acute pericarditis was diagnosed, and anti-inflammatory drug therapy was initiated. Due to the lack of improvement in the symptoms, pericardiocentesis was performed on Day 8 and revealed about 800 cc of the bloody fluid. was detected in a culture of the pericardial effusion and blood. Although intravenous antibiotic therapy was initiated for purulent pericarditis, his fever persisted. Computed tomography of the chest performed on Day 14 showed an abscess cavity in the pericardial space around the right atrium (RA). Furthermore, transoesophageal echocardiography revealed vegetation in the RA. Emergency surgery confirmed the presence of vegetation and minor perforation of the RA with communication to the abscess cavity. After surgical therapy, the patient clinically improved and was discharged on Day 51.
DISCUSSION
In cases of acute pericarditis, purulent pericarditis should be considered if clinical improvement is not observed after initial treatment with anti-inflammatory drugs. Once the diagnosis of purulent pericarditis is made, aggressive source control is necessary for improved clinical outcomes.
PubMed: 33598614
DOI: 10.1093/ehjcr/ytaa528 -
Journal of Dental Sciences Jan 2022Recently, many reports have recommended surgical treatment for medication-related osteonecrosis of the jaw (MRONJ). However, MRONJ is more likely to occur in older...
BACKGROUND/PURPOSE
Recently, many reports have recommended surgical treatment for medication-related osteonecrosis of the jaw (MRONJ). However, MRONJ is more likely to occur in older patients with poor general condition and often necessitates extensive surgery, such as segmental mandibulectomy. The purpose of this study was to investigate treatment outcome of patients with MRONJ undergoing segmental mandibulectomy.
MATERIALS AND METHODS
This retrospective study included 137 patients with medication-related osteonecrosis of the lower jaw who underwent surgical treatment at our hospital between 2011 and 2019. A total of 168 surgeries (155 marginal mandibulectomies and 13 segmental mandibulectomies) were performed. The relationship between clinical and imaging factors and the treatment outcome was investigated in the segmental mandibulectomy cases.
RESULTS
Preoperative computed tomography (CT) showed osteolytic lesions in 13/13, periosteal reaction (PR) in 12/13, and osteosclerosis in 12/13 cases of segmental mandibulectomy. On postoperative CT, no residual osteolytic lesion and PR were noted, and 9 cases showed osteosclerosis. Twelve patients (92.3%) undergoing segmental mandibulectomy had complete healing, whereas the cure rate of those undergoing marginal mandibulectomy was 104/155 (67.1%). One patient with relapse after segmental mandibulectomy showed healing after an additional resection. In the patients who underwent segmental mandibulectomy, clinical symptoms, such as pain and purulent discharge, disappeared, and oral intake was possible.
CONCLUSION
Segmental mandibulectomy is a treatment option for end-of-life care of refractory MRONJ, because it can eliminate clinical symptoms early. When performing segmental mandibulectomy, the area of the osteolytic lesion and periosteal reaction needs to be included.
PubMed: 35028069
DOI: 10.1016/j.jds.2021.07.029 -
Critical Care (London, England) Dec 2020Little is known on the association between local signs and intravascular catheter infections. This study aimed to evaluate the association between local signs at removal...
BACKGROUND
Little is known on the association between local signs and intravascular catheter infections. This study aimed to evaluate the association between local signs at removal and catheter-related bloodstream infections (CRBSI), and which clinical conditions may predict CRBSIs if inflammation at insertion site is present.
METHODS
We used individual data from four multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies for arterial and central venous catheters. We used multivariate logistic regressions in order to evaluate the association between ≥ 1 local sign, redness, pain, non-purulent discharge and purulent discharge, and CRBSI. Moreover, we assessed the probability for each local sign to observe CRBSI in subgroups of clinically relevant conditions.
RESULTS
A total of 6976 patients and 14,590 catheters (101,182 catheter-days) and 114 CRBSI from 25 ICUs with described local signs were included. More than one local sign, redness, pain, non-purulent discharge, and purulent discharge at removal were observed in 1938 (13.3%), 1633 (11.2%), 59 (0.4%), 251 (1.7%), and 102 (0.7%) episodes, respectively. After adjusting on confounders, ≥ 1 local sign, redness, non-purulent discharge, and purulent discharge were associated with CRBSI. The presence of ≥ 1 local sign increased the probability to observe CRBSI in the first 7 days of catheter maintenance (OR 6.30 vs. 2.61 [> 7 catheter-days], p = 0.02).
CONCLUSIONS
Local signs were significantly associated with CRBSI in the ICU. In the first 7 days of catheter maintenance, local signs increased the probability to observe CRBSI.
Topics: Adult; Aged; Catheter-Related Infections; Catheterization, Central Venous; Central Venous Catheters; Female; France; Humans; Incidence; Logistic Models; Male; Middle Aged; Odds Ratio; Qualitative Research; Randomized Controlled Trials as Topic; Sepsis
PubMed: 33317594
DOI: 10.1186/s13054-020-03425-0 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Oct 2023Fournier's gangrene (FG) is a rapidly progressing and life-threatening necrotizing fasciitis of the genital and perineal regions. To estimate the mortality rate...
BACKGROUND
Fournier's gangrene (FG) is a rapidly progressing and life-threatening necrotizing fasciitis of the genital and perineal regions. To estimate the mortality rate associated with FG, Laor et al. developed the FG severity index (FGSI), an index with proven prognostic significance. On the other hand, the C-reactive protein (CRP)/albumin (CAR) ratio is a proven objective marker of inflam-matory response. In light of the foregoing, the objective of this study is to assess the prognostic value of the CAR ratio in predicting mortality in patients with FG in comparison with FGSI.
METHODS
This retrospective study consisted of 58 patients who were operated on for FG between 2019 and 2022. Research data were obtained from electronic and paper patient files, surgery notes, clinical follow-up forms, anamnesis, intensive care forms, and laboratory test results obtained from the hospital automation system. The clinical course of each patient was reviewed based on these records. The relationships between patients' CAR ratios and their demographic and clinical characteristics, including age, gender, and comorbidities, whether ostomy was performed, length of hospital stay, growth in wound culture, isolated bacterial species, FGSI scores, and laboratory test results (hemoglobin, sodium, potassium, bicarbonate, glucose, blood urea nitrogen (BUN), creatinine, albumin, and CRP levels, white blood cell counts, hematocrit values, glucose-to-potassium, neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-CRP ratios) and the prognostic power of CAR ratio in predicting the mortality associated with FG were investigated.
RESULTS
The mean age of the study group, 45 male and 13 female, was 57 (min. 17, max. 85) years. The most common predisposing factor was diabetes mellitus (DM), which was present in 32 (55.1%) patients. The most common symptoms at admission were erythema (89.6%), swelling/hardening (82.7%), pain (41.3%), fever (31%), and purulent discharge (37.9%). Of the 58 patients included in the study, six had died. The most common comorbidity, second to DM (55.1%), was cardiovascular disease (39.6%). The median ages of patients who had died and survived were 60 (min. 56, max. 85) and 56 (min. 18, max. 80) years, respectively. CAR ratio effectively differentiated FG patients who had survived from those who had died (area under the curve [AUC]: 0.907 [0.824-0.984]). The CAR ratio cutoff value of 2.8 effectively differentiated FG patients and FSGI scores who had survived from those who had died (AUC: 0.904 [0.823-0.992]).
CONCLUSION
The study findings demonstrated that the CAR ratio might serve as an effective biomarker in predicting the mortal-ity associated with FG.
Topics: Humans; Male; Female; Fournier Gangrene; C-Reactive Protein; Retrospective Studies; Diabetes Mellitus; Albumins; Severity of Illness Index; Glucose; Potassium
PubMed: 37889021
DOI: 10.14744/tjtes.2023.08903 -
Medical Journal of the Islamic Republic... 2021Diabetic foot syndrome (DFS) causes damage to the peripheral arteries in 50% of patients with diabetes mellitus (DM). The purpose of this study was to evaluate the...
Diabetic foot syndrome (DFS) causes damage to the peripheral arteries in 50% of patients with diabetes mellitus (DM). The purpose of this study was to evaluate the efficacy of endovascular interventions, stenting, and balloon angioplasty for the treatment of patients with purulent and necrotic lesions in DFS. This was a retrospective study. During 2019-2020, stenting and balloon angioplasty were performed in 51 patients (study group) with purulent and necrotic complications of diabetic foot with limb ischemia. There were 32 women (62.7%) and 19 men (37.3%). The age of the patients varied from 45 to 81 years. Endovascular interventions were performed in combination with conservative therapy and topical treatment on 2 to 3 days after the debridement of the purulent lesions. To assess the outcomes of endovascular interventions, we studied the nature of changes in arterial circulation in the lower extremities. The mean blood flow velocity was calculated using the Doppler ultrasonography. The study was performed on the popliteal artery (PA), the posterior tibial artery (PTA), and on the dorsalis pedis artery. In this study, patients were divided into 2 groups: the study group- those who received endovascular intervention- and the control group- those who received only conservative therapy, which included local treatment without surgery. The weightbearing function of the foot at discharge from the hospital was preserved in 94.2% (48 patients) of the study group and in 73.4% (22 patients) of the control group. During the next 6 months, repeated small foot surgeries were required in 7.3% (3 patients) of patients from the study group and in 20% (4 patients) of patients from the control group. Six months after discharge, the weightbearing function of the foot was preserved in all the patients from the study group available for follow-up and in 85% of the patients from the control group. The results of the study demonstrate the positive corrective effects of endovascular interventions, stenting, and balloon angioplasty on the clinical course of ischemic and neuroischemic forms of DFS.
PubMed: 34956952
DOI: 10.47176/mjiri.35.106 -
Australian Veterinary Journal May 2022This study aimed to determine the bacterial isolates associated with postpartum endometritis among dairy cows in Western Australia and their antimicrobial susceptibility...
This study aimed to determine the bacterial isolates associated with postpartum endometritis among dairy cows in Western Australia and their antimicrobial susceptibility profiles. A cross-sectional study was conducted between June-October 2020. Endometritis was defined as evidence of mucopurulent to purulent vaginal discharge 60-100 days postpartum. Vaginal discharge samples were obtained, cultured, identified and tested for antimicrobial susceptibility. A total of 118 bacterial isolates were grown from 46 animals, representing 36 species. The bacteria isolated from both aerobic and anaerobic cultures included Bacillus (60.2%), Streptococcus (12.7%), Trueperella (10.1%), Escherichia (6.7%) and Staphylococcus (5.9%). The remaining genera <5% were Histophilus, Aeroccocus, Enterococcus and Moraxella. Resistance was variable between isolates, but the highest resistance levels were observed in Streptococcal and Bacillus isolates to enrofloxacin, clindamycin and erythromycin, respectively. All Streptococcal isolates exhibited 100% resistance to enrofloxacin, and the greatest resistance levels were found in Streptococcus luteinises to trimethoprim-sulfamethoxazole 83%, clindamycin 66% and 33% quinupristin-dalfopristin. There was 84.5% resistance to clindamycin and 35.2% to erythromycin in the Bacillus isolates, with the highest resistance found in Bacillus licheniformis and Bacillus subtilis. Escherichia coli exhibited 12.5% resistance to gentamycin, ceftiofur, whereas amoxicillin-clavulanic acid exhibited 37.5%. Within the Staphylococcal isolates, 28.5%, 28.5%, 42.8% and 14.2% resistance to ceftiofur, erythromycin, cefoxitin, penicillin and tetracycline were observed, respectively. The presence of resistance to important antimicrobials for human use, such as cephalosporins, macrolides and fluoroquinolones, highlights the need for judicious use of antimicrobials in dairy cattle.
Topics: Animals; Anti-Bacterial Agents; Cattle; Clindamycin; Cross-Sectional Studies; Drug Resistance, Bacterial; Endometritis; Enrofloxacin; Erythromycin; Escherichia coli; Female; Humans; Microbial Sensitivity Tests; Pilot Projects; Staphylococcus; Streptococcus; Vaginal Discharge; Western Australia
PubMed: 35243613
DOI: 10.1111/avj.13152 -
International Journal of Surgery Case... Nov 2023The paranasal sinuses are a group of four paired air-filled spaces located within the bony skull; maxillary, frontal, sphenoid, and ethmoid sinuses. Paranasal sinuses...
INTRODUCTION AND IMPORTANCE
The paranasal sinuses are a group of four paired air-filled spaces located within the bony skull; maxillary, frontal, sphenoid, and ethmoid sinuses. Paranasal sinuses aplasia is a rare condition that is mainly confined to the frontal sinus unilaterally. Combined aplasia of multiple sinuses along with hypoplasia of other sinuses is extremely rare. This rare case should be considered in mind before scheduling any endoscopic sinus surgery to prevent complications during these surgeries.
CASE PRESENTATION
A 13-year-old male patient presented to our ENT clinic complaining of a prolonged history of persistent headache, nasal obstruction, and nasal discharge. He also complained of bilateral ears fullness and facial pain. On physical examination, bilateral purulent nasal discharge with congested inflamed nasal mucosa and both inferior turbinate. The patient was diagnosed to have sinusitis and was started on treatment. The patient returns to our clinic after several weeks with minimal improvement. Computed tomography (CT was obtained and showed completely absent pneumatization of bilateral frontal and sphenoid sinuses.
CLINICAL DISCUSSION
The development of the paranasal sinuses appears prenatally which can lead to a variety of PNS anomalies. However, the aplasia or hypoplasia of the PNS is found to be rare. Aplasia is mainly found in frontal and maxillary sinuses with a prevalence of 12 % and 6 %, respectively. While the prevalence of sphenoid sinus aplasia is extremely rare and found to be less than 0.7 %. Moreover, aplasia of multiple sinuses "combined aplasia" is an incredibly unusual finding.
CONCLUSION
this patient is one of the extremely rare cases of the combined aplasia of frontal and sphenoid sinuses who was diagnosed and confirmed at an early age without any skeletal, systemic, or hematological abnormalities. Despite that, this rare case should be considered in mind before scheduling any endoscopic sinus surgery to prevent complications during these surgeries.
PubMed: 37852096
DOI: 10.1016/j.ijscr.2023.108927