ro13-9904 and Respiratory-Insufficiency

Seven species of coronavirus cause acute respiratory illness in humans. Coronavirus HKU 1 (CoV HKU 1) was first described in 2005 in an adult patient with pneumonia in Hong Kong. Although it is a well-known respiratory tract pathogen, there is not much information about its role in hospitalized adults, especially in southern Europe. Here, we describe a case of radiologically demonstrated CoV HKU 1-related bronchiolitis with acute respiratory failure in an adult female without significant comorbidities except obesity.

Topics: Anti-Bacterial Agents; Bronchiolitis; Bronchodilator Agents; Ceftriaxone; Coronavirus; Coronavirus Infections; Female; Humans; Methylprednisolone; Middle Aged; Obesity, Morbid; Oxygen; Pericardial Effusion; Respiratory Insufficiency

Infective endocarditis is associated with a variety of clinical signs, but its association with multisystem vasculitis is rarely reported. A high index of suspicion is necessary to differentiate a primary autoimmune vasculitis from an infectious cause as the wrong treatment can lead to significant morbidity and mortality. We present a 71-year-old female patient with negative blood cultures, on antibiotics for recent bacteraemia, who presented with cutaneous and renal leucocytoclastic vasculitis. Workup revealed a vegetation adjacent to her right atrial pacemaker lead consistent with infective endocarditis and her vasculitis completely resolved with appropriate antibiotics.

Topics: Acute Kidney Injury; Aged; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Bacteremia; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Pulmonary Edema; Renal Dialysis; Respiratory Insufficiency; Rifampin; Skin Diseases, Vascular; Staphylococcal Infections; Vasculitis

The evolving pandemic of Coronavirus Disease 2019 has posed a substantial health risk worldwide. However, there is a paucity of data regarding the clinical course and the therapeutic management of patients with chronic kidney disease and COVID-19 infection. To date, most evidence has come from renal transplantation, with about 45 patients reported thus far, and the current data from the ERA-EDTA (ERACODA) registry for transplanted patients and patients on Renal Replacement Therapy (RRT); as for those with glomerular diseases, data are lacking. Herein, we report the case of a 62-year-old patient with severe membranoproliferative glomerulonephritis who had been receiving a high burden of immunosuppression until four months before the COVID-19 infection. He developed severe disease with acute respiratory failure requiring mechanical ventilation. After treatment with hydroxychloroquine and azithromycin, despite his low chances, he gradually recovered and survived. To the best of our knowledge, this is one of the few reported patients with glomerulonephritis who had COVID-19 Besides our single case with glomerulonephritis early during the disease outbreak, the very low prevalence of COVID-19 infection in the country's transplant recipients (0.038%) and dialysis patients (0.24%) reflects the impact of the rapid implementation of social distancing rules as well as of preventive measures for disease control in the hospitals and dialysis units in our country.

Topics: Anti-Bacterial Agents; Azithromycin; Betacoronavirus; Ceftriaxone; Coronavirus Infections; COVID-19; Creatinine; Cryoglobulinemia; Cyclophosphamide; Enzyme Inhibitors; Glomerulonephritis, Membranoproliferative; Glucocorticoids; Greece; Humans; Hydroxychloroquine; Immunocompromised Host; Immunologic Factors; Kidney Failure, Chronic; Kidney Transplantation; Leukemia, Lymphocytic, Chronic, B-Cell; Lung; Male; Methylprednisolone; Middle Aged; Pandemics; Pneumonia, Viral; Renal Dialysis; Respiration, Artificial; Respiratory Insufficiency; Reverse Transcriptase Polymerase Chain Reaction; Rituximab; SARS-CoV-2; Tomography, X-Ray Computed

Neuroborreliosis can cause multiple cranial and peripheral neuropathies; however, involvement of both recurrent laryngeal nerves is rare. We report the case of a 90-year-old man who presented with dysphonia and right upper and lower extremity weakness. His course was complicated by bilateral vocal cord paralysis and respiratory failure requiring tracheostomy. The diagnosis of borreliosis was made by detection of IgM and IgG antibodies against Borrelia burgdorferi on enzyme immunoassay and Western blot. The patient received IV ceftriaxone for 2 weeks, followed by complete recovery of motor and vocal function over 2 months. Our case is the third report of bilateral vocal cord paralysis in the literature, and the first one, to our knowledge, presenting with respiratory failure requiring an artificial airway. Physicians should be aware of this unusual complication of neuroborreliosis.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Antibodies, Bacterial; Borrelia; Borrelia burgdorferi; Ceftriaxone; Follow-Up Studies; Humans; Injections, Intravenous; Laryngoscopy; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Male; Recovery of Function; Respiratory Insufficiency; Tracheostomy; Vocal Cord Paralysis

We report a case of a 5-year-old boy with acute disseminated encephalomyelitis as the initial presentation of neuroborreliosis. Parents report an upper-airway infection a few days before the development of acute encephalopathy, mild facial palsy, and seizures. The patient needed mechanical ventilation for 10 days, and after extubation, he presented hypotonia, ataxia, dysarthria, as well as weak gag and cough reflexes. Brain magnetic resonance imaging showed hyperintense lesions on T2- and fluid-attenuated inversion recovery sequences on the right subcortical occipital and parietal region, left posterior arm of the internal capsule, and in the medulla oblongata. Borrelia burgdorferi was identified in the plasma and cerebrospinal fluid by polymerase chain reaction and in the plasma by Western blotting. He was treated with ceftriaxone, methylprednisolone, and human immunoglobulin. Recovery was partial.

Topics: Brain Damage, Chronic; Cefotaxime; Ceftriaxone; Child, Preschool; Coma; Diazepam; Encephalomyelitis, Acute Disseminated; Facial Paralysis; Humans; Immunoglobulins, Intravenous; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Male; Mastoiditis; Methylprednisolone; Portugal; Respiration, Artificial; Respiratory Insufficiency; Respiratory Tract Infections; Seizures; Sinusitis; Vancomycin

Here we describe a case of viral sepsis beyond the neonatal period caused by human parechovirus subtype 3 (HPeV-3), which manifested as cardio-respiratory failure, hepatitis, and necrotizing enterocolitis (NEC). HPeV-1 and 2 were originally classified as enteroviruses but the advent of sequence analysis led to them being recognized as a new genus in the picornavirus family. Subsequently, nine additional HPeV strains have been reported including HPeV-3 in 1999.(1) The spectrum of disease that these viruses may cause is still unknown, and they are rarely screened for in clinical practice.

Topics: Anti-Bacterial Agents; Blood Coagulation Disorders; Ceftriaxone; Enterocolitis, Necrotizing; Enzyme Inhibitors; Fever; Heart Failure; Hepatitis; Humans; Infant; Male; Parechovirus; Penicillanic Acid; Picornaviridae Infections; Piperacillin; Respiratory Insufficiency; Reverse Transcriptase Polymerase Chain Reaction; RNA, Viral; Sepsis; Sequence Analysis, RNA; Tazobactam

Intravesical bacillus Calmette-Guerin (BCG) therapy, recommended for superficial bladder tumors, triggers side effects in fewer than 5% of patients. The most severe side effects, however, are septic shock and acute respiratory failure.. A 70-year-old man was hospitalized for septic shock with acute respiratory and renal failure after intravesical instillation of BCG, which was identified in the gastric aspiration sample. Treatment with rifampicin, ethambutol, isoniazid, and corticosteroid therapy, as well as standard reanimation measures, led to the patient's recovery.. This case shows the potentially severe side effects of intravesical BCG instillation. Although this treatment is well tolerated in more than 95% of patients and its systemic complications can be effectively treated, these side effects can be life-threatening.

Topics: Acute Disease; Administration, Intravesical; Aged; Anti-Bacterial Agents; BCG Vaccine; Ceftriaxone; Humans; Male; Mycobacterium bovis; Ofloxacin; Respiratory Insufficiency; Shock, Septic; Urinary Bladder Neoplasms

An immune complex mechanism for ceftriaxone sodium- induced severe autoimmune hemolytic anemia has previously been demonstrated using routine blood bank techniques. We describe herein a patient with severe hemolysis that subsided once the drug was discontinued. Serologic techniques demonstrated immune complex-mediated ceftriaxone-dependent red cell antibodies. These findings were further supported by the results of flow cytometry, in which a change in basal red cell autofluorescence was seen in the presence of the antibody and the drug. Our case illustrates the adjunctive value of flow cytometry in the diagnosis of ceftriaxone-dependent red cell antibody.

Topics: Anemia, Hemolytic, Autoimmune; Anemia, Sickle Cell; Antigen-Antibody Complex; Blood Transfusion; Ceftriaxone; Child; Drug Hypersensitivity; Epilepsy, Generalized; Erythrocytes; Flow Cytometry; Fluorescence; Humans; Male; Oxidative Stress; Pneumonia, Bacterial; Respiratory Insufficiency

Central venous catheterization is commonly performed in the critically ill. The femoral vein is widely accepted as an insertion site with complications thought to be comparable to other central access sites. We used serial ultrasound examinations with Doppler to examine the evolution of a heretofore undescribed complication of femoral vein catheterization, phlegmasia cerulea dolens with compartment syndrome.. Serial ultrasounds were performed in patients before the insertion of femoral venous catheters and sequentially every 48 hrs while the catheters were in place. The noncatheterized leg served as a control.. A trauma and life support center of a tertiary multidisciplinary critical care unit.. A 32-yr-old man with respiratory failure as a consequence of a severe community-acquired pneumonia that required central venous access for antibiotics because no peripheral sites could be obtained.. None.. The initial ultrasound examination of both legs before femoral catheter insertion revealed no sign of venous thrombosis. Ultrasound of the catheterized leg at 48 hrs revealed a small nonocclusive thrombosis, whereas the opposite leg remained normal. At 72 hrs, the catheterized leg had clinical and ultrasonographic evidence of a massive thrombosis. A compartment syndrome defined by pressure measurements soon ensued and required emergent surgical release.. This case report and a review of the available literature suggest that thrombosis associated with femoral vein catheterization should be considered when clinicians decide where to obtain central venous access when multiple sites are available. This report also suggests the utility of serial ultrasound examinations to define clinically nonapparent thrombosis as an early indicator of a potentially catastrophic complication.

Topics: Adult; Catheterization, Central Venous; Ceftriaxone; Compartment Syndromes; Critical Care; Drug Therapy, Combination; Erythromycin; Femoral Vein; Humans; Male; Pneumonia, Bacterial; Respiratory Insufficiency; Thrombophlebitis; Ultrasonography