Fatal Superimposed Bacterial Sepsis in a Healthy Coronavirus (COVID-19) Patient

Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by the newly discovered coronavirus, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). The novel coronavirus first emerged in Wuhan, China, in December 2019 and has led to a global pandemic. The virus mainly spreads through respiratory droplets from an infected person, but environmental contamination can also act as a source of infection, making social distancing an important key in containing the spread of infection. Those with underlying health conditions are more susceptible to complications such as acute respiratory distress syndrome, which can be fatal. However, healthy individuals experience a mild flu-like illness or may be asymptomatic, recuperating from the infection even without any particular intervention. We present a case of a healthy COVID positive individual, with no underlying comorbidities, who rapidly deteriorated overnight on readmission to the hospital after initial discharge and succumbed to this disease due to a superimposed bacterial infection with COVID pneumonia. This case report highlights the importance of educating COVID-19 positive patients about the precautions, as well as signs and symptoms of a superimposed bacterial infection, when their plan of care is in a home setting. It also emphasizes the potential role of checking procalcitonin levels as a part of routine laboratory investigation at initial presentation in all suspected as well as confirmed COVID-19 cases to rule out an on-going bacterial infection that can prove fatal in the course of the disease.

Bronchoscopy and molecular diagnostic techniques to identify superimposed infections in COVID-19-associated ARDS: a case series from Ecuador during the second wave

Introduction

COVID-19-associated acute respiratory distress syndrome (CARDS) poses significant challenges in resource-limited settings. This case series explores the role of bronchoscopy and molecular techniques in identifying superimposed infections in CARDS patients during the second wave of the pandemic in Ecuador.

Methods

Nine critically ill CARDS patients underwent bronchoscopy and molecular testing to detect co-infections and superinfections. Clinical presentations, diagnostic findings, and outcomes were analyzed.

Results

Bronchoscopy and molecular techniques identified a range of secondary infections, including multidrug-resistant pathogens such as Acinetobacter baumannii and Klebsiella pneumoniae. The case series highlights the complexities of managing severe COVID-19 cases in resource-constrained environments.

Discussion

Early identification of microorganisms using PCR methods allows for rapid and accurate diagnosis, facilitating targeted management of critically ill CARDS patients. The study underscores the importance of advanced diagnostic tools and adaptable strategies in pandemic situations, particularly in low-resource settings.

Dengue Fever Complicated by Pneumonia in Pregnancy: A Case Report

Dengue fever, a mosquito-borne viral disease, was the most prevalent arthropod-borne illness globally and posed a significant public health challenge due to its increasing incidence and potential complications. While most patients recovered within one to two weeks, some cases progressed to severe dengue, requiring hospitalization. This case report described a 39-year-old pregnant woman at 27 weeks gestation who developed severe dengue fever complicated by bacterial pneumonia, leading to ICU admission. She initially presented with fever, tachycardia, and vomiting, and her diagnosis was confirmed by polymerase chain reaction (PCR). Due to worsening respiratory symptoms, she was treated with oxygen and antibiotics, which stabilized her condition for discharge. This case underscored the need for vigilance in managing dengue during pregnancy, as secondary bacterial infections, though uncommon, could complicate treatment. Prompt recognition and early antibiotic intervention in high-risk patients were crucial for improving outcomes.

Right-to-Left Intra-cardiac Shunt in a COVID-19 Patient Leading to Stroke and Poor Prognosis: A Case Report and Review of the Literature

Coronavirus disease 2019 (COVID-19) often presents with a wide range of complications, including respiratory distress, acute respiratory distress syndrome (ARDS), and hypercoagulable states with resultant cerebrovascular incidents. Intra- and extra-pulmonological shunts can further complicate patient courses, leading to persistent hypoxemia and paradoxical emboli, resulting in potentially life-threatening consequences, necessitating a comprehensive, multidisciplinary approach to patient care. Here we present the case of a 73-year-old male who experienced severe persistent hypoxemic respiratory failure, superimposed methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, and stroke with a previously undiagnosed patent foramen ovale (PFO) contributing to his clinical presentation.

Hepatitis C Cirrhosis, Hepatitis B Superimposed Infection, and the Emergence of an Acute Portal Vein Thrombosis: A Case Report

Acute portal vein thrombosis (PVT) is a complication of liver cirrhosis. The presence of viral infections such as hepatitis B (HBV) and hepatitis C (HCV) can further increase cirrhotic patients' risk of developing PVT, especially in the rare case when there is superinfection with both HBV and HCV. We present a patient with HCV cirrhosis whose clinical condition was decompensated secondary to the development of superimposed HBV infection, who developed acute PVT during hospitalization. This case offers a unique presentation of acute PVT that developed within several days of hospitalization for decompensated liver disease, as proven by the interval absence of portal venous flow on repeat imaging. Despite the workup on the initial presentation being negative for PVT, reconsideration of differentials after the change in our patient's clinical status led to the diagnosis. Active HBV infection was likely the initial trigger for the patient's cirrhosis decompensation and presentation; the subsequent coagulopathy and alteration in the portal blood flow triggered the development of an acute PVT. The risk for both prothrombotic and antithrombotic complications remains high in patients with cirrhosis, a risk that is vastly increased by the presence of superimposedinfections. The diagnosis of thrombotic complications such as PVT can be challenging, thus stressing the importance of repeat imaging in instances where clinical suspicion remains high despite negative imaging. Anticoagulation should be considered for cirrhotic patients with PVT on an individual basis for both prevention and treatment. Prompt diagnosis, early intervention, and close monitoring of patients with PVT are crucial for improving clinical outcomes. The goal of this report is to illustrate diagnostic challenges that accompany the diagnosis of acute PVT in cirrhosis, as well as discuss therapeutic options for optimal management of this condition.