Clinical Characteristics and Predictors Affecting the Probability of Complications and Negative Outcome in Hospitalized Patients with Influenza

Cilj: Istraživanju je glavni cilj ispitati kliničke karakteristike u odnosu na dob i komplikacije te pronaći prediktore koji utječu na vjerojatnost pojave komplikacija i negativnog ishoda u hospitaliziranih bolesnika s influencom. Ispitanici i metode: Istraživanjem su obuhvaćeni svi hospitalizirani bolesnici s klinički i/ili laboratorijski dokazanom gripom u Klinici za infektologiju Kliničkog bolničkog centra Osijek u razdoblju od prosinca 2018. do travnja 2019. godine. Istraživanje je provedeno nad 128 ispitanika. Iz povijesti bolesti prikupljeni su i analizirani klinički, demografski, mikrobiološki, radiološki, biokemijski i hematološki podatci. Rezultati: Istraživanjem koje je provedeno, pokazano je kako je starija životna dob povezana s težim oblikom kliničke slike gripe i kompliciranim tijekom bolesti. Kao prediktor negativnog ishoda korisnom se pokazala urea s vrijednosti većom od 9,2 mmol/L te dob veća od 78 godina, a kao prediktori prisutnosti pneumonije ženski spol i CRP uz točku razlučivanja veću od 128,9 mg/L. Komplikacije su općenito češće u bolesnika s duljim kliničkim tijekom bolesti i višim vrijednostima upalnih pokazatelja pri prijamu na bolničko liječenje. Zaključak: Rezultati provedenog istraživanja upućuju na nedvojbenu težinu kliničke slike, razinu laboratorijskih poremećaja, pojavu komplikacija te utjecaj dobi i komorbiditeta u bolesnika s gripom. Za konačno definiranje specifičnih ranih prediktora težine kliničke slike, u svrhu pravovremenog i učinkovitog liječenja te povoljnijeg ishoda bolesti, potrebno je daljnje sustavno praćenje bolesnika i prospektivne studije.Aim: The main objective of the study is to examine clinical characteristics in relation to age and complications, and to find predictors that affect the likelihood of complications and the negative outcome in hospitalized patients with influenza. Respondents and methods: The study included all hospitalized patients with clinically and/or laboratory-proven influenza at the Clinic for Infectious Diseases of the Clinical Hospital Center Osijek in the period from December 2018 to April 2019. The survey was conducted on 128 respondents. Clinical, demographic, microbiological, radiological, biochemical, and hematological data were collected and analyzed from the History of the disease. Results: Research has shown that higher age is associated with a more severe form of the clinical picture of influenza and a complicated course of the disease. Urea with a value of more than 9.2 mmol / L and an age higher than 78 years proved to be useful as predictors of the negative outcome, and female sex and CRP with a resolution point of more than 128.9 mg / L as predictors of the presence of pneumonia. Complications are generally more common in patients with a longer clinical course of the disease and higher values of inflammatory parameters when admitted to the hospital. Conclusion: The results of the study indicate the undisputed severity of the clinical picture, the level of laboratory disorders, the occurrence of complications, and the impact of age and comorbidity in patients with influenza. Further systematic monitoring of patients and prospective studies are needed to finally define specific early predictors of the severity of the clinical picture, for the purpose of timely and effective treatment and a more favorable disease outcome

Syndrome of inappropriate antidiuretic hormone secretion as an adverse reaction of ciprofloxacin: a case report and literature review

Highlights Euvolemic patient with mild hyponatremia during ciprofloxacin treatment was evaluated No diuretic use; hypothyroidism and hypocortisolism were excluded as causes Our findings highlight ciprofloxacin\u27s potential role in inducing Syndrome of inappropriate antidiuretic hormone secretion Antidiuretic hormone (ADH) is secreted by the posterior pituitary gland. Unsuppressed release of ADH leads to hyponatremia. This condition is referred to as syndrome of inappropriate antidiuretic hormone secretion (SIADH). Hereby, a case report is presented on ciprofloxacin-induced SIADH. A 67-year-old male patient was examined in the emergency room with symptoms of lethargy, headache, lack of attention, and a generally depressed mood lasting for three days. One week prior, empirical antimicrobial therapy involving ciprofloxacin for prostatitis was initiated. Laboratory analysis showed no relevant abnormalities except for hyponatremia (Na = 129 mmol/L). Chronic hyponatremia, thyroid dysfunction, and adrenal dysfunction were ruled out. Serum osmolality was 263 mOsmol/kg, urine osmolality was 206 mOsmol/kg, and urine sodium was 39 mmol/L. Given that all criteria for SIADH were met, ciprofloxacin was discontinued, and fluid restriction was advised. Four days later, the patient’s serum sodium concentrations nearly normalized (Na = 135 mmol/L), and all symptoms resolved. The Naranjo Scale yielded a score of 8, supporting the likelihood of a probable adverse reaction to ciprofloxacin. This case is presented to raise awareness among clinicians about the potential of ciprofloxacin to cause even mild hyponatremia

Encephalitis or Encephalopathy During an Influenza-A Epidemic

Six female patients with encephalitis, mean age 36.5 (17–60) years, were admitted to the hospital during the 2000–2001 influenza A (H1N1) epidemic in the Osijek – Baranja County. In three (50.0%) patients, the manifestation of encephalitis occurred on day 4 or 5, and in two (33.3%) patients within 24–48 hours of the onset of influenza symptoms. The disease manifestations included headache, elevated body temperature, generalized fatigue, and consciousness disturbance through coma. Three (50.0%) patients had grand mal seizures. Pathologic electroencephalography findings were recorded in all six (100%) patients, whereas computed tomography showed cerebral edema in three (50.0%) patients. Elevated levels of hepatic enzymes and peripheral blood leukopenia were found in two (33.3%) patients in whom encephalitis developed early upon the onset of influenza. One (16.6%) of these patients died, whereas permanent sequels remained in the other two (33.3%) patients

Krpeljni encefalitis kod profesionalno izložene osobe nakon uredno provedenog primarnog cijepljenja

In this paper we present a case report of tick-borne encephalitis (TBE) in a professionally exposed person (forestry worker) who acquired this infection three years after he had received a complete primary vaccination. The patient reported multiple tick bites, the last one eighteen days prior to disease onset. The TBE diagnosis was confirmed according to the European Center for Disease Prevention and Control case definition of TBE by clinical criteria (meningitis), epidemiological link (exposure to tick bites in an endemic area) and laboratory criteria (detection of TBEV specific IgM and IgG antibodies in CSF and serum samples). The case presented indicates the need of awareness of possible TBE even in persons who have received complete vaccination, especially in the professionally exposed ones or those exposed to multiple tick bites.U radu prikazujemo slučaj krpeljnog encefalitisa (KE) kod profesionalno izložene osobe (šumar) koja je oboljela tri godine nakon uredno provedenog primarnog cijepljenja. Pacijent je naveo višestruke ugrize krpelja, od kojih je posljednji bio osamnaest dana prije početka bolesti. Dijagnoza KE potvrđena je prema kriterijima Europskog centra za kontrolu bolesti (ECDC) na temelju kliničkih (meningitis), epidemioloških (izloženost krpeljima u endemskom području) te laboratorijskih kriterija (dokaz specifičnih IgM i IgG protutijela za KE u uzorcima seruma i cerebrospinalnog likvora). Prikazani slučaj naglašava potrebu za promišljanjem o mogućoj pojavi KE i kod osoba kod kojih je provedeno kompletno cijepljenje, osobito profesionalno izloženih osoba te onih izloženih čestim ugrizima krpelja

Krpeljni encefalitis kod profesionalno izložene osobe nakon uredno provedenog primarnog cijepljenja

In this paper we present a case report of tick-borne encephalitis (TBE) in a professionally exposed person (forestry worker) who acquired this infection three years after he had received a complete primary vaccination. The patient reported multiple tick bites, the last one eighteen days prior to disease onset. The TBE diagnosis was confirmed according to the European Center for Disease Prevention and Control case definition of TBE by clinical criteria (meningitis), epidemiological link (exposure to tick bites in an endemic area) and laboratory criteria (detection of TBEV specific IgM and IgG antibodies in CSF and serum samples). The case presented indicates the need of awareness of possible TBE even in persons who have received complete vaccination, especially in the professionally exposed ones or those exposed to multiple tick bites.U radu prikazujemo slučaj krpeljnog encefalitisa (KE) kod profesionalno izložene osobe (šumar) koja je oboljela tri godine nakon uredno provedenog primarnog cijepljenja. Pacijent je naveo višestruke ugrize krpelja, od kojih je posljednji bio osamnaest dana prije početka bolesti. Dijagnoza KE potvrđena je prema kriterijima Europskog centra za kontrolu bolesti (ECDC) na temelju kliničkih (meningitis), epidemioloških (izloženost krpeljima u endemskom području) te laboratorijskih kriterija (dokaz specifičnih IgM i IgG protutijela za KE u uzorcima seruma i cerebrospinalnog likvora). Prikazani slučaj naglašava potrebu za promišljanjem o mogućoj pojavi KE i kod osoba kod kojih je provedeno kompletno cijepljenje, osobito profesionalno izloženih osoba te onih izloženih čestim ugrizima krpelja

Encefalitis ili encefalopatija tijekom epidemije influence-a

Six female patients with encephalitis, mean age 36.5 (17–60) years, were admitted to the hospital during the 2000–2001 influenza A (H1N1) epidemic in the Osijek – Baranja County. In three (50.0%) patients, the manifestation of encephalitis occurred on day 4 or 5, and in two (33.3%) patients within 24–48 hours of the onset of influenza symptoms. The disease manifestations included headache, elevated body temperature, generalized fatigue, and consciousness disturbance through coma. Three (50.0%) patients had grand mal seizures. Pathologic electroencephalography findings were recorded in all six (100%) patients, whereas computed tomography showed cerebral edema in three (50.0%) patients. Elevated levels of hepatic enzymes and peripheral blood leukopenia were found in two (33.3%) patients in whom encephalitis developed early upon the onset of influenza. One (16.6%) of these patients died, whereas permanent sequels remained in the other two (33.3%) patients.Tijekom epidemije influence A (H1N1) u Osječko-baranjskoj županiji od 2000. do 2001. godine liječeno je 6 bolesnica s encefalitisom. Najmla|a bolesnica imala je 17, a najstarija 60 godina. Srednja životna dob je 36.5 godina. Tri (50%) su bolesnice dobile encefalitis 4-tog i 5-tog dana od pojave simptoma influence, a dvije (33.3%) tijekom prvih 24–48 sati od početka bolesti. Bolest se očitovala glavoboljom, visokom temperaturom, općom slabošću i poremećajem svijesti do kome. Tri (50%) su bolesnice imale epi napad tipa grand mal. U svih je bolesnica (100%) na|en patolo{ki EEG, u tri (50%) je na CT-u nađen jači edem mozga. U dvije (33.3%) bolesnice u kojih se encefalitis javio prvih dana influence na|ene su povišene vrijednosti jetrenih enzima i leukopenija u perifernoj krvi. Jedna (16.6%) je bolesnica umrla, a u dvije (33.3%) ostale su trajne sekvele