Legionnaires Disease in Immunocompromised Host

Legionella bacteria are aerobic, pleomorphic, gram negative bacilli found in fresh water environments and are usually transmitted through inhalation aerosols from contaminated water or soil. Legionnaire’s disease is a severe form of pneumonia caused by legionella species and can be community acquired or hospital acquired. The reported incidence of Legionnaires’ disease is approximately 1.4–1.8 cases per 100,000 persons and immunocompromised state is a very important risk factor. Some of the other important risk factors include old age, impaired cellular immunity, hematologic malignancies, solid organ transplantation, splenectomy, tumor necrosis factor-alpha inhibitors, chronic respiratory disease, diabetes and end stage renal disease. Legionella pneumophila serotype 1 is the most commonly reported cause of human Legionella infections. The pathogenesis of legionnaire’s disease involves invasion of alveolar macrophages and cell mediated immunity is the primary means of immune control. The prevalence of Legionnaires disease has risen possibly from increased awareness and reporting. The symptoms of the disease are nonspecific requiring a high index of suspicion in vulnerable hosts, as effective treatment could be life-saving. Sensitivity of urinary antigen testing is lower in immunocompromised patients because of higher likelihood of infections caused non L. pneumophila species. Extrapulmonary manifestations and higher mortality are particularly more common in immunocompromised patients than in immunocompetent hosts

Sleep and Diabetes

Sleep apnea is clinically recognized as a heterogeneous group of disorders characterized by recurrent apnea and/or hypopnea. Its prevalence ranges from 4% to 24%. It has been implicated as an independent risk factor for several conditions such as hypertension, stroke, arrhythmia, and myocardial infarction. Recently data has been emerging which suggests an independent association of obstructive sleep apnea with several components of the metabolic syndrome, particularly insulin resistance and abnormalities in lipid metabolism. We hereby review the salient features of the association between sleep and diabetes

Multidrug-Resistant Gram-Negative Pneumonia and Infection in Intensive Care Unit

Multidrug-resistant (MDR) pneumonia can be problematic and challenging to treat in an era of increasing resistance and limited treatment armamentarium. Multidrug-resistant pathogens are associated with increased morbidity and mortality, thus early empiric appropriate antibiotics are critical for survival. Many factors play a role in the selection, optimization, and duration of therapy that should be made on an individual basis. New technologies such as “rapid diagnostics” may provide the clinician with early phenotypic or genotypic result, thus improving early appropriate therapy. The increasing antibiotic resistance is a global threat to patients worldwide and is an economic burden. In the United States, drug-resistant bacteria cause approximately 2 million cases of illnesses and contribute to 23,000 deaths each year. The inappropriate use of antibiotics has contributed to the healthcare burden that ranges from $27 to$42 billion annually. As a result, several governmental agencies have placed forth regulatory mandates to enforce antimicrobial stewardship programs in acute care hospitals. Education will be vital across all healthcare disciplines to ultimately ensure optimal prescribing and reduce the emergence of resistance

Pseudomyxoma pleurii and peritonei secondary to sigmoid colon adenocarcinoma: a rare clinico-pathologico-radiological presentation

Pseudomyxoma peritonei (PMP) is a rare condition resulting from mucin-producing tumors that have disseminated intointraperitoneal implants and mucinous ascites. The extra-abdominal spread of PMP is exceptionally rare, with few reportedcases in the medical literature. Pseudomyxoma pleurii is an infrequently encountered clinical syndrome characterized bytransdiaphragmatic pleural extension and spread of PMP. The disease is highly fatal. We hereby report a case of 58 years oldwoman who presented with an abdominal distension and shortness of breath of 2 months duration. Histopathology confirmedthe diagnosis of large mucin-producing rectosigmoid adenomatous polypoid lesion with malignant transformation and PMPthat had spread to the right pleural space. PMP from colon tumor is uncommon and its transdiaphragmatic pleural extensionis very unusual complicated by management challenge and high mortality rate

Plastic Bronchitis

Plastic bronchitis is not yet well understood. There have been less than 500 reported cases in adults worldwide. This patient presented with a one month history of productive sputum consisting of bronchial casts resulting in a diagnosis of plastic bronchitis. [West J Emerg Med. 2011;12(1):118-119.

Pylephlebitis: An Uncommon Complication of Intra-Abdominal Infection

<p>We herein present a case of pylephlebitis, which is an infective suppurative thrombosis of the portal vein. Pylephlebitis is an uncommon complication of intra-abdominal infections and carries with it significant morbidity and mortality. [West J Emerg Med. 2011;12(4):575–576.]</p

Cystic fibrosis-related diabetes: The unmet need

Cystic fibrosis (CF) is a common autosomal recessive disease. Life expectancy of patients with CF continues to improve mainly driven by the evolving therapies for CF-related organ dysfunction. The prevalence of CF-related diabetes (CFRD) increases exponentially as patients’ age. Clinical care guidelines for CFRD from 2010, recommend insulin as the mainstay of treatment. Many patients with CFRD may not require exogenous insulin due to the heterogeneity of this clinical entity. Maintenance of euglycemia by enhancing endogenous insulin production, secretion and degradation with novel pharmacological therapies like glucagonlike peptide-1 agonist is an option that remains to be fully explored. As such, the scope of this article will focus on our perspective of glucagon-like peptide-1 receptor agonist in the context of CFRD. Other potential options such as sodiumglucose cotransporter-2 and dipeptidyl peptidase 4 inhibitors and their impact on this patient population is limited and further studies are required