Spontaneous Massive Streptococcus constellatus Empyema Thoracis in a healthy individual: a case report

Empyema thoracis is a well-known condition that is characterised by a collection of pus in the pleural space and has historically been related to high mortality rate. The cause of high mortality rate is unknown, but it may have higer risk in pneumonia cases or immunocompromised patients. This case study presented a 50-year-old man with no chronic co-morbidities, admitted with the diagnosis of sepsis secondary to community-acquired pneumonia, which was covered with ceftriaxone. Subsequently, he developed massive spontaneous right lung empyema, necessitating an urgent thoracotomy and comprehensive right decortication. Broad-spectrum antibiotics, meropenem, was then given to him. Streptococcus constellatus was discovered in the pleural fluid’s culture and sensitivity test. On his tenth day of stay, the patient had a right thoracotomy and decortication. The patient was extubated on day two post-operative and recovered on subsequent days. He was then discharged at 30 days post-operatively. We reported a case of adult spontaneous empyema thoracis from a patient with few risk factors: he was not immunocompromised, had no chronic illnesses and had no interaction with tuberculosis patients

Parkinsonism complicating acute organophosphate insecticide poisoning

Organophosphate insecticides have a triphasic effect on the central nervous system, namely acute cholinergic crisis, intermediate syndrome and delayed polyneuropathy. Although acute organophosphate poisoning is relatively common, case reports describing parkinsonism as a neurological complication following an acute intoxication are limited. 1 We report a case of parkinsonism noted on day 24 of admission following an acute severe organophosphate poisoning which was successfully treated with benzhexol and levodopa. Previously, response to levodopa was reported to be poor in 3 patients studied by Bhatt et al 1whereas amantidine, dopamine agonist and bipiriden have been shown to be helpful. 2To the best of our knowledge, this is the fi rst case of parkinsonism complicating organophosphate poisoning which responded to levodopa and benzhexol therapy

Sera of patients with systemic lupus erythematosus cross-neutralizes dengue viruses

Dengue is the most prevalent mosquito-borne disease in Southeast Asia, where the incidence of systemic lupus erythematosus (SLE) is approximately 30 to 53 per 100,000. Severe dengue, however, is rarely reported among individuals with SLE. Here, whether sera of patients with SLE cross-neutralize dengue virus (DENV) was investigated. Serum samples were obtained from individuals with SLE who were dengue IgG and IgM serology negative. Neutralization assays were performed against the three major DENV serotypes. Of the dengue serology negative sera of individuals with SLE, 60%, 61% and 52% of the sera at 1/320 dilution showed more than 50% inhibition against dengue type-1 virus (DENV-1), DENV-2 and DENV-3, respectively. The neutralizing capacity of the sera was significantly greater against DENV-1 (P < 0.001) and DENV-3 (P < 0.01) than against DENV-2 (P < 0.05). Neutralization against the DENV correlated with dengue-specific IgG serum titers below the cut-off point for dengue positivity. Depletion of total IgG from the sera of patients with SLE resulted in significant decreases of up to 80% in DENV inhibition, suggesting that IgG plays an important role. However, some of the SLE sera was still able to neutralize DENV, even with IgG titers <0.1 OD absorbance. Our findings suggest that sera of patients with SLE contain IgG, and possibly other type of antibodies, that can cross-neutralize DENV, which may explain the rarity of severe dengue in individuals with SLE. Further studies, are needed to further substantiate this finding and to elucidate the specific neutralizing epitopes recognized by the sera of individuals with SLE