Assocıatıon of serum urıc acıd level wıth dısease severıty and clınıcal outcomes ın COVID-19

Abstract. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is likely to cause uric acid dysregulation, resulting in abnormal serum uric acid concentrations. In this study, we aimed to evaluate the associations between admission serum uric acid levels and demographic, clinical and laboratory features of patients hospitalized with Coronavirus disease 2019 (Covid-19) and to explore the effect of admission serum uric acid values on clinical outcomes. Methods. In this retrospective study, the demographic, clinical and laboratory data of patients with confirmed Covid-19 were collected from the electronic health records of the hospital. The study population was stratified according to the quartiles of serum uric acid; Quartile 1: ≤ 3.5 mg/dl, Quartile 2: 3.6 mg/dl to 6 mg/dl for women and 3.5 mg/dl to 7 mg/dl for men, Quartile 3: ≥ 6 mg/dl for women and ≥ 7 mg/dl for men. The outcomes were the development of acute kidney injury (AKI) and in-hospital mortality. Results. 146 patients were included in the analysis. The median age of patients was 57 (IQR, 49-65) years and 70.5% were male. The overall median serum uric acid level on admission was 4.4 (IQR, 3.5-5.9) mg/dl.  Participants in the highest serum uric acid quartile were significantly more hypertensive, and diabetics and showed significantly higher estimated glomerular filtration rate (eGFR) and troponin T levels compared to patients in the lowest serum uric acid quartile. On the other hand; patients in the lowest serum uric acid quartile were admitted with more severe disease than patients with Quartile 2. During follow-up, 19 (13.1%) participants experienced AKI and 15 (10.3%) died. There were significantly positive correlations between AKI and age, hypertension, serum creatinine (SCr), hyperuricemia, C-reactive protein (CRP) and Troponin T (r=0.263, P=0.001; r=0.192, P=0.02; r=0.182, P=0.028; r=0.235, P = 0.004; r=0.219, P=0.008; r=0.236, P=0.004, respectively). A significantly negative correlation was noted between AKI and eGFR (r=-0.189, P=0.023). According to multivariate logistic regression analysis, AKI development was independently associated with CRP and hyperuricemia (OR, 1.009; 95% CI, 1.0082-1.016, P=0.009 and OR, 4.314; 95% CI, 1.190-15.633, P=0.026). The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of the concentration of serum admission uric acid was 0.693 (95% CI 0.537–0.849, P=0.006) and the cutoff value was 5.45 mg/dl (sensitivity: 68.4%; specificity: 75.6%). Conclusions. Hyperuricemia and increased CRP were independent risk factors for the development of AKI. Although patients with lower uric acid values developed more severe symptoms, mechanical ventilation and mortality rates were not found to be significantly different among patients with Covid-19 grouped based on admission serum uric values. Following the patients admitted with high uric acid levels closely in terms of renal functions would be helpful for early detection of AKI

Prediction of Mortality in Patients with Sepsis Due to Gram-negative Bacteremia: Pitt Bacteremia Score, qSOFA, SIRS

Introduction: Sepsis is a syndrome of physiologic, biochemical and pathologic abnormalities induced by infection and has been associated with high mortality and morbidity. This study aimed to compare Systemic Inflammatory Response Syndrome (SIRS) criteria, Pitt bacteremia score and quick Sequential Organ Failure Assessment (qSOFA) for the prediction of mortality in patients with sepsis due to Gram-negative bacteremia

Cytomegalovirus (CMV)-related cutaneous necrotizing vasculitis: case report and literature review

Cytomegalovirus (CMV) infection is usually asymptomatic in immunocompetent patients. A mononucleosis-like syndrome may develop in some patients. Various organ involvements (eg: encephalitis, meningitis, retinitis, myocarditis, pneumonia, hepatitis, enterocolitis, neuritis), which rarely occur inimmunocompetent patients, have also been reported. Cutaneous necrotizing vasculitis caused by CMV infection has been reported very rarely in the literature. Here, a case with a very rare clinical form of CMV infection, presenting with persistent fever and livedo reticularis on the extremities and cutaneous necrotizing vasculitis of the toes, is described, and the relevant literature is reviewed. This case report aims to highlight the possibility of CMV infection to be a cause of cutaneous necrotizing vasculitis. (C) 2012 Elsevier Editora Ltda. All rights reserved

Cytomegalovirus (CMV)-related cutaneous necrotizing vasculitis: case report and literature review

Cytomegalovirus (CMV) infection is usually asymptomatic in immunocompetent patients. A mononucleosis-like syndrome may develop in some patients. Various organ involvements (eg: encephalitis, meningitis, retinitis, myocarditis, pneumonia, hepatitis, enterocolitis, neuritis), which rarely occur in immunocompetent patients, have also been reported. Cutaneous necrotizing vasculitis caused by CMV infection has been reported very rarely in the literature. Here, a case with a very rare clinical form of CMV infection, presenting with persistent fever and livedo reticularis on the extremities and cutaneous necrotizing vasculitis of the toes, is described, and the relevant literature is reviewed. This case report aims to highlight the possibility of CMV infection to be a cause of cutaneous necrotizing vasculitis

Splenic abscess caused by MRSA developing in an infarcted area: case report and literature review

We report a case of a 41-year-old man with a splenic abscess caused by methicillin-resistant Staphylococcus aureus (MRSA). He had been treated with antimicrobials and corticosteroids for interstitial pneumonia caused by Mycoplasma pneumoniae and hemolytic anemia. He developed catheter-related (MRSA) bacteremia during his stay in the ICU and was treated with teicoplanin for 2 weeks. After 4 weeks of outpatient follow-up, he was readmitted to the hospital with fever and pain in the left upper quadrant. A thoracoabdominal CT scan showed subcapsular collection in areas of splenic infarction that had been detected on his first admission. CT-guided percutaneous aspiration resulted in the isolation of MRSA. The patient was treated successfully with teicoplanin for 6 weeks. Our aim in presenting this quite rare case is to highlight the tendency of infarcts that develop as a result of hemolytic attacks during systemic infections to be a focus of infection for nosocomial bacteremia

Cytomegalovirus (CMV)-related cutaneous necrotizing vasculitis: case report and literature review

Cytomegalovirus (CMV) infection is usually asymptomatic in immunocompetent patients. A mononucleosis-like syndrome may develop in some patients. Various organ involvements (eg: encephalitis, meningitis, retinitis, myocarditis, pneumonia, hepatitis, enterocolitis, neuritis), which rarely occur in immunocompetent patients, have also been reported. Cutaneous necrotizing vasculitis caused by CMV infection has been reported very rarely in the literature. Here, a case with a very rare clinical form of CMV infection, presenting with persistent fever and livedo reticularis on the extremities and cutaneous necrotizing vasculitis of the toes, is described, and the relevant literature is reviewed. This case report aims to highlight the possibility of CMV infection to be a cause of cutaneous necrotizing vasculitis

Angio-oedema as an unusual tolerable side effect of voriconazole therapy.

Voriconazole (VRC) has not previously been reported to cause angio-oedema. Here, we report a case of angio-oedema associated with VRC therapy. A 37-year-old woman with relapsing invasive vertebral aspergillosis received intravenous VRC and developed angio-oedema 10 days after starting therapy. This condition rapidly diminished after administration of intravenous antihistaminics and did not necessitate cessation of VRC treatment. The treatment was continued for 6 months without recurrence of the symptoms. After 18 months, the patient was in good health. To our knowledge, this is the first report of an angio-oedema associated with VRC

Macrophage activation syndrome triggered by primary disseminated toxoplasmosis

We report the case of a patient with disseminated toxoplasmosis who presented with cervical lymphadenopathies and pneumonia. Although the infection was successfully treated with co-trimoxazole, the patient developed reactive macrophage activation syndrome (rMAS). To our knowledge, this is the first reported case of rMAS triggered by toxoplasmosis in the medical literature