9 research outputs found
Massive haemorrhagic pericardial effusion as the cardiac manifestation of Salmonella enteritidis infection in a severely immunocompromised patient
A 41-years-old gentleman was admitted for reduced effort
tolerance with non-specific symptoms of weight loss and
generalised body weakness. Chest X-ray (CXR) showed
cardiomegaly. Echocardiography showed a large pericardial
effusion with septation. Emergency pericardiocentesis was
performed and pericardial fluid culture grew Salmonella
enteritidis (S. enteritidis). He tested positive for the retroviral
disease, with a CD4 count of 10 cells/µL. Intravenous (IV)
ceftriaxone was administered. A pericardial drain was
inserted due to the rapid re-accumulation of pericardial fluid
after the initial pericardiocentesis. He also had drainage of
his left pleural effusion. He had a guidewire exchange of
pericardial drain around 2 weeks after admission, with
flushing performed whenever the flow was poor. A repeat
echocardiogram showed early signs of constrictive
pericarditis with residual pericardial effusion in which intrapericardial fibrinolysis was considered. He was started on
antiretroviral therapy (ART) and his condition remained
stable. The pericardial drain was kept throughout his
admission. Unfortunately, he developed severe sepsis and
succumbed to it about a month post-admission
Pulmonary tuberculosis and COVID-19 coinfection: Hickam’s Dictum revisited
COVID-19 and pulmonary tuberculosis (PTB) coinfection is associated with increased mortality
and presents a unique diagnostic challenge to the clinician. We describe three cases of newly
diagnosed PTB in COVID-19 patients treated at our centre and their clinical and radiological
features. The challenges associated with diagnosis and management are also explored. Patient 1
was a case of smear positive, endobronchial tuberculosis incidentally diagnosed due to CT
changes, and eventually made good recovery. Patient 2 was a case of COVID-19 who succumbed
but was diagnosed posthumously due to a positive sputum culture for tuberculosis. Patient 3
showed radiographic features of PTB and was treated empirically for TB. In conclusion, COVID-19
and PTB coinfection should be suspected in the presence of constitutional symptoms, prior
immunocompromised states, prolonged respiratory symptoms or fever, or unresolved radiological
abnormalities, more so in regions where TB is endemic.
List of abbreviations
TB tuberculosis
PTB pulmonary tuberculosis
CT computed tomography
WHO World Health Organization
NPOP nasopharyngeal and oropharyngeal
CTPA computed tomography pulmonary angiogram
HRCT high resolution computed tomography
GGO ground glass opacities
ATT anti-tuberculous therapy
IGRA interferon-gamma release assay
* Corresponding author. Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
E-mail addresses: [email protected] (L.E. Nyanti), [email protected] (Z.H. Wong), [email protected] (B. Sachdev Manjit Singh),
[email protected] (A.K.W. Chang), [email protected] (A.T. Jobli), [email protected] (H.H. Chua).
Contents lists available at ScienceDirect
Respiratory Medicine Case Reports
journal homepage: www.elsevier.com/locate/rmcr
https://doi.org/10.1016/j.rmcr.2022.101653
Received 5 February 2022; Received in revised form 12 March 2022; Accepted 13 April 202
Pulmonary tuberculosis and COVID-19 coinfection: Hickam’s Dictum revisited
COVID-19 and pulmonary tuberculosis (PTB) coinfection is associated with increased mortality and presents a unique diagnostic challenge to the clinician. We describe three cases of newly diagnosed PTB in COVID-19 patients treated at our centre and their clinical and radiological features. The challenges associated with diagnosis and management are also explored. Patient 1 was a case of smear positive, endobronchial tuberculosis incidentally diagnosed due to CT changes, and eventually made good recovery. Patient 2 was a case of COVID-19 who succumbed but was diagnosed posthumously due to a positive sputum culture for tuberculosis. Patient 3 showed radiographic features of PTB and was treated empirically for TB. In conclusion, COVID-19 and PTB coinfection should be suspected in the presence of constitutional symptoms, prior immunocompromised states, prolonged respiratory symptoms or fever, or unresolved radiological abnormalities, more so in regions where TB is endemic
Pulmonary tuberculosis and COVID-19 coinfection : Hickam's Dictum revisited
COVID-19 and pulmonary tuberculosis (PTB) coinfection is associated with increased mortality and presents a unique diagnostic challenge to the clinician. We describe three cases of newly diagnosed PTB in COVID-19 patients treated at our centre and their clinical and radiological features. The challenges associated with diagnosis and management are also explored. Patient 1 was a case of smear positive, endobronchial tuberculosis incidentally diagnosed due to CT changes, and eventually made good recovery. Patient 2 was a case of COVID-19 who succumbed but was diagnosed posthumously due to a positive sputum culture for tuberculosis. Patient 3 showed radiographic features of PTB and was treated empirically for TB. In conclusion, COVID-19 and PTB coinfection should be suspected in the presence of constitutional symptoms, prior immunocompromised states, prolonged respiratory symptoms or fever, or unresolved radiological abnormalities, more so in regions where TB is endemic
ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance
Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest
Acute Anuric Renal Failure Following Jering Bean Ingestion
Djenkol beans or jering (Pithecellobium jeringa) is a traditional delicacy consumed by the local population in Malaysia. Jering poisoning or djenkolism is characterized by spasmodic pain, urinary obstruction and acute renal failure. The underlying pathology is an obstructive nephropathy, which is usually responsive to aggressive hydration and diuretic therapy. We present a case of djenkolism following ingestion of jering. The patient required urgent bilateral ureteric stenting following the failure of conservative therapy. Healthcare providers need to recognize djenkolism as a cause of acute renal failure and the public educated on this potential health hazard
Hand hygiene promotion delivered by change agents-Two attitudes, similar outcome
To assess the effect of peer-identified change agents (PICAs) compared to management-selected change agents (MSCAs) on hand hygiene behavior in acute care
Hand hygiene - social network analysis of peer-identified and management-selected change agents
Hand hygiene compliance can be improved by strategies fostering collaborative efforts among healthcare workers (HCWs) through change agents. However, there is limited information about how change agents shape the social networks of work teams, and how this relates to organisational culture. The objectives of this study were to describe the influence of peer-identified change agents (PICAs) and management-selected change agents (MSCAs) on hand hygiene, perception of their leadership style by peers, and the role of the organisational culture in the process of hand hygiene promotion
Causative organisms and outcomes of peritoneal dialysis-related peritonitis in Sarawak General Hospital, Kuching, Malaysia: a 3-year analysis
Abstract Background Peritoneal dialysis peritonitis remains a significant cause of morbidity for peritoneal dialysis patients and the main reason for conversion from peritoneal dialysis to hemodialysis. As the characteristics of patients and microbial susceptibility vary from center to center, the aim of this study is to evaluate the microbiology and the clinical outcomes among continuous ambulatory peritoneal dialysis patients in Kuching, Malaysia. Methods This is a retrospective record review of 82 continuous ambulatory peritoneal dialysis patients who developed peritonitis during 2013 to 2015. Data examined included patients’ demographic data, causative organisms, and outcomes. Results A total of 124 episodes of peritonitis were recorded, and the overall peritonitis rate was 0.40 episodes per patient-year. There was an increasing incidence in continuous ambulatory peritoneal dialysis peritonitis over the 3-year study period (0.35 to 0.47 episodes per patient-year). The gram-negative peritonitis rate increased over the period until towards the end of the study period, when gram-positive and gram-negative organisms accounted for almost equal proportions of peritonitis. Streptococcus sp. was the most common organism among the gram-positive peritonitis while Pseudomonas sp. was the most common organism in gram-negative peritonitis. The culture-negative peritonitis rate was 25.8%. The peritoneal dialysis catheter was removed in 32 episodes (26.6%). The catheter loss rate was significantly higher in gram-negative peritonitis, as compared to gram-positive peritonitis (38.9 vs 16.7%, p = 0.027). Conclusions The increasing trend of peritonitis and high rates of culture negativity and peritoneal dialysis catheter removal are areas that need further evaluation and improvement in the future. Study on risk factors of continuous ambulatory peritoneal dialysis peritonitis, detailed microbiology, and antimicrobial treatment and response are warranted to further improve the outcomes of continuous ambulatory peritoneal dialysis patients