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Usman RM, Yahya O, Marella HK, Jain AL, Peravali R, Premkumar R, Bradsher R. Renal Cell Carcinoma Presenting With Combined Cervical Lymphadenopathy and Cardiac Metastasis Without Inferior Vena Cava Involvement. WMJ 2021; 120:142-144. [PMID: 34255955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Renal cell cancer is the third most common urological malignancy following prostate and bladder malignancies. Cardiac metastases to the right side of the heart without inferior vena cava (IVC) involvement are exceedingly rare, with only a handful of cases described in the literature. Metastasis to the head and neck region is also rare, occurring in an estimated 1% of cases. Here we present a case of a patient with recurrent syncopal events secondary to renal cell carcinoma without IVC involvement, with metastases both to the right ventricle and cervical lymph nodes. To our knowledge, this is the first case that presents with both of these rare findings together and that highlights cancer screening in patients with high risk factors and new exam findings in patients with syncopal events having negative initial workup.
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Affiliation(s)
- Rana M Usman
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee,
| | - Owais Yahya
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hemnishil K Marella
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Amit L Jain
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rahul Peravali
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Reshma Premkumar
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Robert Bradsher
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
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Labuda SM, Garner K, Cima M, Moulton-Meissner H, Laufer Halpin A, Charles-Toney N, Yu P, Bolton E, Pierce R, Crist MB, Gomes D, Gable P, McAllister G, Lawsin A, Houston H, Patil N, Wheeler JG, Bradsher R, Vyas K, Haselow D. Bloodstream Infections With a Novel Nontuberculous Mycobacterium Involving 52 Outpatient Oncology Clinic Patients-Arkansas, 2018. Clin Infect Dis 2020; 71:e178-e185. [PMID: 31872853 PMCID: PMC7938859 DOI: 10.1093/cid/ciz1120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In July 2018, the Arkansas Department of Health (ADH) was notified by hospital A of 3 patients with bloodstream infections (BSIs) with a rapidly growing nontuberculous Mycobacterium (NTM) species; on 5 September 2018, 6 additional BSIs were reported. All were among oncology patients at clinic A. We investigated to identify sources and to prevent further infections. METHODS ADH performed an onsite investigation at clinic A on 7 September 2018 and reviewed patient charts, obtained environmental samples, and cultured isolates. The isolates were sequenced (whole genome, 16S, rpoB) by the Centers for Disease Control and Prevention to determine species identity and relatedness. RESULTS By 31 December 2018, 52 of 151 (34%) oncology patients with chemotherapy ports accessed at clinic A during 22 March-12 September 2018 had NTM BSIs. Infected patients received significantly more saline flushes than uninfected patients (P < .001) during the risk period. NTM grew from 6 unused saline flushes compounded by clinic A. The identified species was novel and designated Mycobacterium FVL 201832. Isolates from patients and saline flushes were highly related by whole-genome sequencing, indicating a common source. Clinic A changed to prefilled saline flushes on 12 September as recommended. CONCLUSIONS Mycobacterium FVL 201832 caused BSIs in oncology clinic patients. Laboratory data allowed investigators to rapidly link infections to contaminated saline flushes; cooperation between multiple institutions resulted in timely outbreak resolution. New state policies being considered because of this outbreak include adding extrapulmonary NTM to ADH's reportable disease list and providing more oversight to outpatient oncology clinics.
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Affiliation(s)
- Sarah M Labuda
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Michael Cima
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Heather Moulton-Meissner
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- US Public Health Service, Rockville, Maryland, USA
| | - Nadege Charles-Toney
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Peter Yu
- Jefferson Regional Medical Center, Pine Bluff, Arkansas, USA
| | - Erin Bolton
- Jefferson Regional Medical Center, Pine Bluff, Arkansas, USA
| | - Reid Pierce
- Jefferson Regional Medical Center, Pine Bluff, Arkansas, USA
| | - Matthew B Crist
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Danica Gomes
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gillian McAllister
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adrian Lawsin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hollis Houston
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - J Gary Wheeler
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Robert Bradsher
- University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Keyur Vyas
- University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Dirk Haselow
- Arkansas Department of Health, Little Rock, Arkansas, USA
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Agarwal M, Patel B, Shah R, Ibebuogu U, Thenappan T, Shah M, Bradsher R, Dagogo-Jack S. IMPACT OF HEART FAILURE ON OUTCOMES OF SEPSIS RELATED HOSPITALIZATIONS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Alzghoul B, Geppert S, Innabi A, Kovelamudi S, Johnsrud J, Kothari A, Meena N, Bradsher R. 700: SUCCESSFULLY TREATED LISTERIA RHOMBOENECEPHALITIS WITH HYDROCEPHALUS IN AN IMMUNOCOMPETENT PATIENT. Crit Care Med 2018. [DOI: 10.1097/01.ccm.0000528715.64809.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Apewokin S, Vyas K, Lester LK, Grazzuitti M, Haselow DT, Wolfe F, Roberts M, Bellamy W, Kumar NS, Hunter D, Lee J, Laudadio J, Wheeler JG, Bradsher R. Influenza a outbreak in an ambulatory stem cell transplant center. Open Forum Infect Dis 2014; 1:ofu050. [PMID: 25734122 PMCID: PMC4281787 DOI: 10.1093/ofid/ofu050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/04/2014] [Indexed: 01/04/2023] Open
Abstract
Background In the era of cost-consciousness regarding healthcare , provision of medical services in an outpatient setting has become increasingly attractive. We report an influenza outbreak in an ambulatory stem cell transplant center in 2013 that highlights unique identification and infection control challenges in this setting. Methods Nasopharyngeal swabs were performed on patients with suspected influenza-like illnesses (ILI), defined by subjective fever or measured temperature of ≥37.7°C (≥100°F) with cough or sore throat during July 25, 2013 through August 7, 2013. In addition, testing was triggered by an elevated C-reactive protein (CRP). Specimens were analyzed by using eSensor Respiratory Viral Panel. Clinical and epidemiologic information was collected in real time, and frequencies were calculated on demographics, baseline clinical parameters, treatment methods, comorbidities, and symptoms of affected persons. Results Thirty-one patients had influenza A (H3N2) infection during July 25, 2013 through August 7, 2013. Only 7 patients (23%) met the Centers for Disease Control and Prevention and Council of State and Territorial Epidemiologists ILI case definition. Twenty-five patients (81%) had received ≥1 transplant, with 13 (42%) having occurred within 1 year before the outbreak. Twenty-five patients (81%) had received B-cell active chemotherapy <60 days before influenza diagnosis, 6 (19%) were neutropenic, and 25 (81%) lymphopenic. Among clinical and laboratory markers analyzed, abnormal CRP was the most sensitive screening tool for influenza. Twelve (39%) patients were hospitalized (median stay, 10 days; range, 2–20). No deaths occurred. Conclusions Immunocompromised hosts with influenza have atypical presentations. Existing surveillance case definitions might be insufficient to reliably identify influenza outbreaks in such patients.
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Affiliation(s)
| | | | - Laura K Lester
- Epidemic Intelligence Service , Centers for Disease Control and Prevention , Atlanta, Georgia ; Arkansas Department of Health, Little Rock
| | | | | | | | | | | | | | | | - Jeannette Lee
- Biostatistics , University of Arkansas for Medical Sciences , Little Rock
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Haselow D, Saccente M, Vyas K, Bariola R, Safi H, Bradsher R, Smith N, Phillips J. Geographic distribution of endemic fungal infections among older persons, United States. Emerg Infect Dis 2012; 18:360-1; author reply 361. [PMID: 22305518 PMCID: PMC3311154 DOI: 10.3201/eid1802.111537] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Wheat J, Sarosi G, McKinsey D, Hamill R, Bradsher R, Johnson P, Loyd J, Kauffman C. Practice guidelines for the management of patients with histoplasmosis. Infectious Diseases Society of America. Clin Infect Dis 2000; 30:688-95. [PMID: 10770731 DOI: 10.1086/313752] [Citation(s) in RCA: 292] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/1999] [Revised: 07/09/1999] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The objective of this guideline is to provide recommendations for treating patients with the more common forms of histoplasmosis. PARTICIPANTS AND CONSENSUS PROCESS: A working group of 8 experts in this field was convened to develop this guideline. The working group developed and refined the guideline through a series of conference calls. OUTCOMES The goal of treatment is to eradicate the infection when possible, although chronic suppression may be adequate for patients with AIDS and other serious immunosuppressive disorders. Other important outcomes are resolution of clinical abnormalities and prevention of relapse. EVIDENCE The published literature on the management of histoplasmosis was reviewed. Controlled trials have been conducted that address the treatment of chronic pulmonary and disseminated histoplasmosis, but clinical experience and descriptive studies provide the basis for recommendations for other forms of histoplasmosis. VALUE: Value was assigned on the basis of the strength of the evidence supporting treatment recommendations, with the highest value assigned to controlled trials, according to conventions established for developing practice guidelines. BENEFITS AND COSTS: Certain forms of histoplasmosis cause life-threatening illnesses and result in considerable morbidity, whereas other manifestations cause no symptoms or minor self-limited illnesses. The nonprogressive forms of histoplasmosis, however, may reduce functional capacity, affecting work capacity and quality of life for several months. Treatment is clearly beneficial and cost-effective for patients with progressive forms of histoplasmosis, such as chronic pulmonary or disseminated infection. It remains unknown whether treatment improves the outcome for patients with the self-limited manifestations, since this patient population has not been studied. Other chronic progressive forms of histoplasmosis are not responsive to pharmacologic treatment. TREATMENT OPTIONS Options for therapy for histoplasmosis include ketoconazole, itraconazole, fluconazole, amphotericin B (Fungizone; Bristol-Meyer Squibb, Princeton, NJ), liposomal amphotericin B (AmBisome; Fujisawa, Deerfield, IL), amphotericin B colloidal suspension (ABCD, or Amphotec; Seques, Menlo Park, CA), and amphotericin B lipid complex (ABLC, or Abelcet; Liposome, Princeton, NJ).
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Affiliation(s)
- J Wheat
- Department of Medicine and Pathology, Indiana University School of Medicine, Indianapolis 46202, USA.
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Wheat J, Wheat H, Connolly P, Kleiman M, Supparatpinyo K, Nelson K, Bradsher R, Restrepo A. Cross-reactivity in Histoplasma capsulatum variety capsulatum antigen assays of urine samples from patients with endemic mycoses. Clin Infect Dis 1997; 24:1169-71. [PMID: 9195077 DOI: 10.1086/513647] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We evaluated cross-reactivity in the antigen assay used for the diagnosis of histoplasmosis by testing urine samples from patients with disseminated fungal infections. The mycoses chosen for this study were selected on the basis of the observation that during clinical testing, cross-reactions may occur between Histoplasma capsulatum var. capsulatum, Paracoccidioides brasiliensis, Blastomyces dermatitidis, Coccidioides immitis, and Penicillium marneffei. We detected antigen in 12 of 19 patients with blastomycosis, 8 of 9 with paracoccidioidomycois, in 17 of 18 with P. marneffei infection, and in one with disseminated H. capsulatum var. duboisii infection. Cross-reactions were not observed in the assays for six patients with disseminated coccidioidomycosis. Cross-reactivity between the agents of other endemic mycoses should be considered in interpreting a positive H. capsulatum var. capsulatum antigen assay. Antigen detection may provide a rapid, provisional diagnosis for patients with serious infections caused by one of these organisms.
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Affiliation(s)
- J Wheat
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
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Abstract
Fungal infections of the breast are unusual and may clinically mimic carcinoma. When studied by fine-needle aspiration (FNA), such masses may yield necrosis, granulomatous inflammation, reactive histiocytes, and atypical epithelial cells. Cohesive groups of atypical epithelial cells featured nuclear enlargement and overlapping, as well as prominent nucleoli. The organisms may be widely scattered, so that careful evaluation was required for their identification. In concert with provocative clinical findings, these features may lead to an erroneous diagnosis of malignancy. We describe three women with mycotic masses of the breast initially studied by FNA. The first patient presented at age 31 with a large, firm breast mass, chest wall extension, and radiographic evidence of vertebral bone involvement. FNA was requested to confirm the clinical diagnosis of advanced breast carcinoma. In addition to the atypia described above, the smears showed yeast forms indicative of blastomycosis surrounded by neutrophils. She remains well, following antifungal treatment. The second case of Blastomycosis was diagnosed by FNA of a breast mass in a 64-yr-old woman, who also responded to treatment. The third patient's preoperative needle aspiration showed granulomas, but no organisms were identified, even with special stains; silver stains of surgically excised tissue showed histoplasmosis.
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Affiliation(s)
- C Farmer
- Department of Pathology, Medicine, University of Arkansas for Medical Sciences, Little Rock 72205, USA
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Vannier A, Dodson S, Jagannath S, Bradsher R. Histoplasma capsulatumFrom a Bone Marrow Harvest. Lab Med 1992. [DOI: 10.1093/labmed/23.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
The management of infections requiring surgical drainage or debridement is a significant component of surgical education and practice. Standard Gram's stain and culture techniques usually allow ready identification and adjunctive therapy of the offending organism; however, the surgical patient population is changing. More patients who require surgery are elderly, critically ill, have been exposed to broad-spectrum antibiotics, or are otherwise immunosuppressed. We identified 33 infections in this group of 32 patients. The majority of the etiologic agents were not identified using traditional microbiologic techniques, often leading to a delay in diagnosis. In this high-risk group of patients, we recommend histologic study of tissue with special stains such as methenamine silver. When the patient's condition warrants, frozen sections can be used. Optimal outcome requires early recognition of the specific etiologic agent.
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Affiliation(s)
- J B Cone
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock 72205
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Narain JP, Bradsher R, Sanders CR, Lofgren JP. Unilocular hydatid disease in Arkansas. South Med J 1986; 79:781-2. [PMID: 3715549 DOI: 10.1097/00007611-198606000-00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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