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Agi N, Zarbin MA, Bhagat N. Klebsiella Endogenous Endophthalmitis During the COVID-19 Pandemic. JOURNAL OF VITREORETINAL DISEASES 2023; 7:316-321. [PMID: 37920850 PMCID: PMC10170248 DOI: 10.1177/24741264231170462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Purpose: To describe the characteristics of Klebsiella pneumoniae endogenous endophthalmitis (KEE) encountered during the COVID-19 pandemic. Methods: This retrospective consecutive case series evaluated eyes that presented with KEE between March 2020 and July 2022. Results: Seven eyes of 5 patients developed KEE. Between January 2020 and July 2022, KEE was observed in 42% of consecutive EE cases compared with 7.8% during the preceding 13 years. COVID-19 was positive in 4 of 5 patients before they developed KEE. Only 1 patient presented with a VA better than hand motions (20/400). All eyes were treated with urgent vitrectomy and intravitreal and systemic antibiotics. No improvement in vision occurred in any patient; VA remained light perception to no light perception in 60% of eyes. Conclusions: The visual prognosis in KEE is extremely poor. The presence of a preceding COVID-19 infection in 80% of patients may signal a new risk factor for KEE. Patients with a hypervirulent Klebsiella syndrome should be routinely screened for EE.
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Affiliation(s)
- Nathan Agi
- Institute of Ophthalmology and Visual Sciences, Rutgers University–New Jersey Medical School, Newark, NJ, USA
| | - Marco A. Zarbin
- Institute of Ophthalmology and Visual Sciences, Rutgers University–New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Sciences, Rutgers University–New Jersey Medical School, Newark, NJ, USA
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2
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Hasan MJ, Rabbani R. Extensive Pneumocephalus Caused by Multidrug-Resistant Klebsiella pneumoniae. World Neurosurg 2020; 137:29-30. [PMID: 32032797 DOI: 10.1016/j.wneu.2020.01.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 11/17/2022]
Abstract
Pneumocephalus is a life-threatening event associated with different infectious diseases and trauma. Klebsiella pneumoniae is a gas-forming organism that can cause pneumocephalus. A woman aged 56 years presented with a history of septic shock and community-acquired pneumonia. She was supported by mechanical ventilation in intensive care unit. Multidrug-resistant K. pneumoniae was detected in her blood and tracheal aspirate. Her level of consciousness reduced, and clinical condition was deteriorating. The computed tomography scan of the brain revealed abundant pneumocephalus entities. Multidrug-resistant K. pneumoniae was found in her cerebrospinal fluid while on appropriate antibiotic therapy. She died from acute stroke during her treatment.
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Affiliation(s)
- Md Jahidul Hasan
- Clinical Pharmacy Services, Department of Clinical Pharmacy, Square Hospitals Ltd., Dhaka, Bangladesh.
| | - Raihan Rabbani
- Internal Medicine and Intensive Care Unit, Medical Services, Square Hospitals Ltd., Dhaka, Bangladesh
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3
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Bianucci R, Abenavoli L, Charlier P, Lippi D, Appenzeller O, Perciaccante A. A great legal scholar of the 18th century with liver cirrhosis and septicemia. Med Hypotheses 2019; 127:88-89. [PMID: 31088655 DOI: 10.1016/j.mehy.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/28/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022]
Affiliation(s)
- R Bianucci
- Legal Medicine Section, Department of Public Health and Paediatric Sciences, University of Turin, Italy; Warwick Medical School, Microbiology and Infection Division, University of Warwick, United Kingdom; UMR 7268, Laboratoire d'Anthropologie bio-culturelle, Droit, Etique & Santé (Adés), Faculté de Médecine de Marseille, France.
| | - L Abenavoli
- Department of Health Sciences, University Magna Graecia of Catanzaro, Italy
| | - P Charlier
- Section of Medical and Forensic Anthropology (UVSQ DANTE Laboratory EA 4498), Montigny-Le-Bretonneux, France; Direction Département de la Recherche et de l'Enseignement Musée du Quai Branly - Jacques Chirac, Paris, France
| | - D Lippi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - O Appenzeller
- New Mexico Health Enhancement and Marathon Clinics Research Foundation, 361 Big Horn Ridge Dr. NE, Albuquerque, NM, USA; New Mexico Museum of Natural History and Science, 1801 Mountain Road NW. Albuquerque, NM, USA
| | - A Perciaccante
- Department of Medicine, San Giovanni di Dio Hospital, Gorizia, Italy
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4
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Mohapatra DP, Singh SK, Sahoo M, Patole S, Mishra M, Debata NK, Mohapatra H. Retrospective study on clonal relationship of multidrug-resistant Klebsiella spp. indicates closed circulation and initiation of clonal divergence. J Med Microbiol 2018. [PMID: 29521617 DOI: 10.1099/jmm.0.000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Antibiotic resistance patterns often exhibit geographical variations. Periodic analyses of resistance spectra and phylogenetic trends are important guides for facilitating judicious use of therapeutic interventions. The present study retrospectively analysed the infection trends, resistance patterns, and clonal relationships between isolates of Klebsiella spp. from a tertiary care hospital. METHODOLOGY Bacterial isolates were collected from January 2013 to June 2014 and their resistance profiles were identified using an automated bacterial identification system. A phylogenetic tree was constructed using housekeeping genes with Molecular Evolutionary Genetic Analysis software. The dN/dS ratio was determined by the Synonymous Non-synonymous Analysis Program while polymorphic sites, and the difference per site was calculated using DNA Sequence Polymorphism software. Statistical Package for Social Science software was used to perform all statistical analyses. KEY FINDINGS The results of this study indicated the prevalence of community-acquired urinary tract and lower respiratory tract infections caused by Klebsiella spp. among geriatric patients. The occurrence of new allelic profiles, a low dN/dS ratio and the lack of strong evolutionary descent between isolates indicated that mutations play a major role in the evolution of the organism. CONCLUSION The findings of this study highlight the consequences of antimicrobial agents exerting a silent and strong selective force on the evolution of Klebsiella spp. The expansion of such analyses is of great importance for addressing rapidly emerging antibiotic-resistant opportunistic pathogens.
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Affiliation(s)
- Debi Prasad Mohapatra
- Department of Microbiology, Institute of Medical Sciences, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Santosh Kumar Singh
- School of Biological Sciences, National Institute of Science Education and Research, HBNI, Bhubaneswar, Jatni, Odisha, India
| | - Minu Sahoo
- School of Biological Sciences, National Institute of Science Education and Research, HBNI, Bhubaneswar, Jatni, Odisha, India
| | - Shashank Patole
- School of Biological Sciences, National Institute of Science Education and Research, HBNI, Bhubaneswar, Jatni, Odisha, India
| | - Mitali Mishra
- School of Biological Sciences, National Institute of Science Education and Research, HBNI, Bhubaneswar, Jatni, Odisha, India
| | - Nagen Kumar Debata
- Department of Microbiology, Institute of Medical Sciences, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Harapriya Mohapatra
- School of Biological Sciences, National Institute of Science Education and Research, HBNI, Bhubaneswar, Jatni, Odisha, India
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5
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Reddy BVR, Kuruba KK, Yalamanchili S, Mupparapu M. Granulomatous Diseases Affecting Jaws. Dent Clin North Am 2017; 60:195-234. [PMID: 26614955 DOI: 10.1016/j.cden.2015.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The common aspect of all granulomatous diseases is the typical form of chronic inflammatory response with distinct microscopic granulomas that are formed secondary to either definitive etiologic agents, like bacteria, fungal, or parasitic, or due to an unknown etiologic agent, such as trauma, autoimmune, or even neoplastic process. Although they can be histologically distinct, granulomatous diseases demonstrate a variety of clinical features that may not seem to be inflammatory. Two types of granulomas are typically encountered: foreign body granulomas and immune granulomas. The differences between the two types of granulomas lie in the pathogenesis.
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Affiliation(s)
- Baddam Venkat Ramana Reddy
- Department of Oral & Maxillofacial Pathology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, 522601, India
| | - Kiran K Kuruba
- Department of Oral & Maxillofacial Pathology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, 522601, India
| | - Samatha Yalamanchili
- Department of Oral Medicine & Radiology, Sibar Institute of Dental Sciences, Guntur, India
| | - Mel Mupparapu
- Department of Oral Medicine, Robert Schattner Center, University of Pennsylvania School of Dental Medicine, #214, 240 South 40th Street, Suite 214, Philadelphia, PA 19104, USA.
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Tewari SO, Wolfe AR, Seguritan R, Faroqui R, Meshreki M. Esophageal pneumatosis in the setting of small bowel ileus with acute resolution after nasogastric tube decompression. Radiol Case Rep 2017; 12:479-482. [PMID: 28828106 PMCID: PMC5551920 DOI: 10.1016/j.radcr.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 02/20/2017] [Accepted: 03/06/2017] [Indexed: 02/07/2023] Open
Abstract
Esophageal pneumatosis is a rare condition with diverse potential etiologies including traumatic, mechanical, ischemic, obstructive respiratory, autoimmune, immunodeficient, and infectious causes. Here, we present a case of esophageal pneumatosis in the setting of upper gastrointestinal and small bowel ileus, diagnosed on computed tomography (CT), with acute resolution after nasogastric tube decompression. A patient presented to the emergency department with epigastric discomfort. CT of the abdomen/pelvis demonstrated intramural air in the mid-to-distal esophagus, consistent with esophageal pneumatosis, and diffuse dilatation of the visualized esophagus, stomach, and small bowel, consistent with an ileus. Patient was managed with nasogastric tube decompression and bowel rest. Subsequent esophagram did not demonstrate any evidence of perforation and a repeat CT of the abdomen/pelvis, performed 11 hours after initial diagnostic CT, demonstrated interval resolution of patient's esophageal pneumatosis, and improvement of patient's ileus.
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Affiliation(s)
- Sanjit O Tewari
- Department of Radiology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - Allen R Wolfe
- Department of Radiology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - Richard Seguritan
- Department of Radiology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - Raihan Faroqui
- Department of Radiology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - Michael Meshreki
- Department of Radiology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, USA
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Bang JH, Cho KT. Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess. KOREAN JOURNAL OF SPINE 2015; 12:139-42. [PMID: 26512268 PMCID: PMC4623168 DOI: 10.14245/kjs.2015.12.3.139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/28/2015] [Accepted: 07/31/2015] [Indexed: 12/31/2022]
Abstract
Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus.
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Affiliation(s)
- Jin Hyuk Bang
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea and Dongguk University, Seoul, Korea
| | - Keun-Tae Cho
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea and Dongguk University, Seoul, Korea
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Su TM, Lan CM, Lee TH, Hsu SW. Gas-containing brain abscess: etiology, clinical characteristics, and outcome. Kaohsiung J Med Sci 2014; 30:619-24. [PMID: 25476100 DOI: 10.1016/j.kjms.2014.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/21/2014] [Accepted: 10/08/2014] [Indexed: 11/26/2022] Open
Abstract
Gas-containing brain abscess remains a life-threatening disease that requires immediate diagnostic and therapeutic intervention. The aim of this study is to report on a series of gas-containing brain abscess and discuss its pathological mechanism and therapeutic consideration. This study included 11 patients with gas-containing brain abscess at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan during a 27-year period. The predisposing factors to infection included hematogenous spread in five patients, contiguous infection in one patient, and abnormal fistulous communication due to head injury in four patients. In one patient, the predisposing factor might be contiguous infection from frontal sinusitis or abnormal fistulous communication due to previous sinus surgery. Klebsiella pneumoniae was the most common causative pathogen that was isolated from the gas-containing abscess not related to skull base defect. Among these 11 patients, six underwent excision and five accepted aspiration for the surgical treatment of abscess. In the five patients who underwent aspiration, two required repeated craniotomy to excise the recurrent abscess and repair the abnormal fistulous communication through the skull base. When encountered with a gas-containing abscess in patients with an impaired host defense mechanism, K. pneumoniae infection should be suspected, and further attention should be paid to discovering if other metastatic septic abscesses exist. For patients with a history of basilar skull fracture or surgery involving the skull base, craniotomy is indicated to excise the abscess and repair the potential fistulous communication through the cranium. Aspiration may be a reasonable alternative to treat deep-seated lesions, lesions in an eloquent area, patients with severe concomitant medical disease, or patients without a history of basilar skull fracture or surgery involving the skull base. Prompt diagnosis, appropriate antibiotic use, and meticulous surgical treatment are the only way to obtain a favorable outcome.
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Affiliation(s)
- Tsung-Ming Su
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Chu-Mei Lan
- Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan
| | - Tsung-Han Lee
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Wei Hsu
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Sarkiss CA, Soleymani T, Caplan JM, Dorsi MJ, Huang J. Intracerebral abscess with dissecting pneumocephalus caused by a gas-producing gram-positive rod following craniotomy for glioblastoma multiforme resection. J Clin Neurosci 2013; 20:1625-7. [DOI: 10.1016/j.jocn.2012.09.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 09/14/2012] [Indexed: 11/28/2022]
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10
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Luey C, Tooley D, Briggs S. Emphysematous osteomyelitis: a case report and review of the literature. Int J Infect Dis 2012; 16:e216-20. [PMID: 22230028 DOI: 10.1016/j.ijid.2011.11.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 11/20/2011] [Indexed: 12/01/2022] Open
Abstract
We report the case of a 15-year-old girl with pelvic and sacral emphysematous osteomyelitis caused by Fusobacterium necrophorum. This infection was cured following four surgical procedures and 4 weeks of intravenous then 4 weeks of oral antibiotics. We review our case alongside the 24 previously reported cases of emphysematous osteomyelitis in the literature. The 25 cases include 15 monomicrobial and 10 polymicrobial infections. The causative organism(s) in all but three cases included an anaerobe or a member of the Enterobacteriaceae family. A significant underlying comorbidity was reported in 18 cases. At least 15 cases required one or more surgical procedures. There was a significant associated mortality with eight (32%) patients dying in hospital at 7 to 56 days after the diagnosis of emphysematous osteomyelitis.
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Affiliation(s)
- Christopher Luey
- Department of Infectious Diseases, Auckland City Hospital, Auckland, 1010, New Zealand.
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