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Khan MA, Almas T, Ullah M, Alkhattab M, Shaikh F, Shaikh S, Bagwe I, Antony M, Khedro T, Nagarajan VR, Ramjohn J, Alsufyani R, Almubarak D, Al-Awaid AH, Alsufyani M, Nagarajan DR, Khan MO, Huang H, Oruk M, Samy A, Alqallaf N, Shafi A, Adeel A, Khan MK. Candida glabrata infection of a pancreatic pseudocyst in a COVID-19 patient: A case report and review of the literature. Ann Med Surg (Lond) 2022; 77:103648. [PMID: 35638027 PMCID: PMC9142617 DOI: 10.1016/j.amsu.2022.103648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Pancreatic pseudocysts remain a feared complication of acute or chronic pancreatitis and are often characterized by collections of fluids due to underlying damage to the pancreatic ducts, culminating in a walled-off region bereft of an epithelial layer but surrounded by granulation tissue. While fungal infections of pancreatic pseudocysts are rarely encountered, candida albicans remains the most frequently implicated organism. Case presentation A 55-year-old male presented with pain in the left-hypochondriac region, accompanied by non-bilious emesis and nausea. Interestingly, the patient also tested positive for a COVID-19 infection. Investigative workup divulged enhancing pancreatic walls with a radiologic impression consistent with a pancreatic pseudocyst. An ultrasound-guided external drainage was performed; the drainage was conducted unremarkably, with the resultant fluid collection revealing the presence of Candida Glabrata. The patient was commenced on antifungal therapy and continues to do well to date. Discussion Infectious ailments of pancreatic pseudocysts remain a widely known complication of acute pancreatitis. While it is rare, fungal infection is a crucial consideration for patients with pancreatic pseudocysts, especially in the context of a lack of an adequate response to antibiotics, deterioration, comorbidities, and immunocompromised states. Conclusion Rapid identification of the microbe responsible for pancreatic pseudocyst infection is vital for time-sensitive treatment and a more rapid recovery, curbing associated morbidity and mortality. Fungal infections of pancreatic pseudocysts remain a rare but well-characterized complication, culminating in significant morbidity and mortality. Telltale signs include unresponsiveness to antibiotics and worsening clinical symptoms. Rapid identification of the responsible microbe is vital for time-sensitive treatment and a more rapid recovery.
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Affiliation(s)
| | - Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Muneeb Ullah
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | - Maha Alkhattab
- Department of Surgery, Galway University Hospital, Galway, Ireland
| | | | | | - Isha Bagwe
- Mercy University Hospital, Cork, Ireland
| | | | - Tarek Khedro
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Reema Alsufyani
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Dana Almubarak
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Majid Alsufyani
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Helen Huang
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Mert Oruk
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Arjun Samy
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Nagi Alqallaf
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Adil Shafi
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | - Aqsa Adeel
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
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Shanahan W, Bagwe I, Brassill MJ, O'Regan P. Reduced and more appropriate referrals of patients with type 2 diabetes using liver stiffness measurement compared to FIB-4. Ir J Med Sci 2022; 192:649-654. [PMID: 35486350 DOI: 10.1007/s11845-022-03019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fatty liver disease and fibrosis are common in patients with type 2 diabetes mellitus (T2DM). Recently published European Association for the Study of the Liver guidelines have suggested screening such patients using liver stiffness measurement (LSM) or fibrosis-4 index (FIB-4) to exclude advanced fibrosis. AIMS We initiated a screening programme at the diabetes out-patient clinic to assess the reliability of the suggested approaches and resulting referrals. METHODS In this prospective study, consecutive patients attending for T2DM review at an Irish level 3 (district general) hospital between September and November 2021 were screened for liver fibrosis using LSM and had their FIB-4 calculated. The first 100 patients with valid LSM measurements were included in the analysis. RESULTS Referral rates to the hepatology clinic varied by modality used. If FIB-4 ≥ 1.3 criterion was used, the referral rate to the hepatology clinic was 45%; using LSM < 8 kPa to rule out advanced fibrosis resulted in 34% referral rate; using LSM ≥ 10 kPa to suggest probable compensated advanced chronic liver disease reduced referral rates to 15%. Combining FIB-4 with LSM in a two-step algorithm led to missed potentially significant liver disease in large numbers. 47% patients with LSM ≥ 8 kPa and 33% with LSM ≥ 10 kPa had FIB-4 < 1.3. CONCLUSIONS Screening of patients with T2DM using LSM alone rather than FIB-4 leads to reduced numbers of, and more appropriate, referrals to the hepatology clinic. Shifting from an exclusion (LSM < 8 kPa) to an inclusion based (LSM ≥ 10 kPa) approach may lessen the potential of screening to overwhelm hepatology services.
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Affiliation(s)
- William Shanahan
- Department of Gastroenterology, Tipperary University Hospital, Clonmel, Co Tipperary, Ireland.
| | - Isha Bagwe
- Department of Endocrinology, Tipperary University Hospital, Clonmel, Co Tipperary, Ireland
| | - Mary Jane Brassill
- Department of Endocrinology, Tipperary University Hospital, Clonmel, Co Tipperary, Ireland
| | - Paud O'Regan
- Department of Gastroenterology, Tipperary University Hospital, Clonmel, Co Tipperary, Ireland
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Affiliation(s)
- Oliver J McElvaney
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Cedric Gunaratnam
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Oisin Fiachra McElvaney
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Isha Bagwe
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Emer P Reeves
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Noel G McElvaney
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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