DOCSLIB.ORG

Case 16-2019: a 53-Year-Old Man with Cough and Eosinophilia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Case 16-2019: a 53-Year-Old Man with Cough and Eosinophilia The new england journal of medicine Case Records of the Massachusetts General Hospital Founded by Richard C. Cabot Eric S. Rosenberg, M.D., Editor Virginia M. Pierce, M.D., David M. Dudzinski, M.D., Meridale V. Baggett, M.D., Dennis C. Sgroi, M.D., Jo-Anne O. Shepard, M.D., Associate Editors Alyssa Y. Castillo, M.D., Case Records Editorial Fellow Emily K. McDonald, Sally H. Ebeling, Production Editors Case 16-2019: A 53-Year-Old Man with Cough and Eosinophilia Rachel P. Simmons, M.D., David M. Dudzinski, M.D., Jo-Anne O. Shepard, M.D., Rocio M. Hurtado, M.D., and K.C. Coffey, M.D.​​ Presentation of Case From the Department of Medicine, Bos- Dr. David M. Dudzinski: A 53-year-old man was evaluated in an urgent care clinic of ton Medical Center (R.P.S.), the Depart- this hospital for 3 months of cough. ment of Medicine, Boston University School of Medicine (R.P.S.), the Depart- Five years before the current evaluation, the patient began to have exertional ments of Medicine (D.M.D., R.M.H.), dyspnea and received a diagnosis of hypertrophic obstructive cardiomyopathy, with Radiology (J.-A.O.S.), and Pathology a resting left ventricular outflow gradient of 110 mm Hg on echocardiography. (K.C.C.), Massachusetts General Hos- pital, and the Departments of Medicine Although he received medical therapy, symptoms persisted, and percutaneous (D.M.D., R.M.H.), Radiology (J.-A.O.S.), alcohol septal ablation was performed 1 year before the current evaluation, with and Pathology (K.C.C.), Harvard Medical resolution of the exertional dyspnea. School — all in Boston. Nine months later, the patient began to have cough that was intermittently N Engl J Med 2019;380:2052-9. productive of yellow sputum. The cough developed shortly after he had returned DOI: 10.1056/NEJMcpc1900595 Copyright © 2019 Massachusetts Medical Society. from travel to Southeast Asia and the Middle East. Antitussive medications did not provide symptom relief. Three years before this cough developed, three discrete episodes of upper respiratory tract infection and sinusitis had occurred, for which courses of amoxicillin–clavulanic acid, trimethoprim–sulfamethoxazole, and azithro- mycin had been prescribed. During the current episode, the cough waxed and waned in intensity, with no clear relation to other symptoms or the time of day. Ten days before the current evaluation, the patient traveled to the Middle East; the weather was colder than he had expected and he felt chills. During the trip, the cough worsened — with more frequent and copious production of yellow- green sputum and associated coryza, pharyngitis, frontal sinus “heaviness,” malaise, and fatigue — such that he had to miss work after he returned home. He called his cardiologist and was advised to present to an urgent care clinic of this hospital for evaluation. A review of systems was negative for fever, anorexia, unintentional weight loss, night sweats, dyspnea, hemoptysis, chest pressure or discomfort, pleuritic pain, wheezing, light-headedness, palpitations, syncope, nausea, vomiting, diarrhea, myalgia, arthralgia, lymphadenopathy, and pruritus. The patient had had multiple contacts with nonspecific illnesses while he had been traveling both 3 months and 10 days before the current evaluation. The most recent tuberculin skin test had 2052 n engl j med 380;21 nejm.org May 23, 2019 The New England Journal of Medicine Downloaded from nejm.org by GIUSEPPE GIOCOLI on June 2, 2019. For personal use only. No other uses without permission. Copyright © 2019 Massachusetts Medical Society. All rights reserved. Case Records of the Massachusetts General Hospital been performed 10 years earlier and had been On examination, the patient appeared to be negative. He had not undergone seasonal influ- comfortable. The temperature was 37.2°C, the enza vaccination. pulse 66 beats per minute, the blood pressure The patient’s medical history was also notable 122/89 mm Hg, the respiratory rate 14 breaths for placement of an implantable cardioverter– per minute, and the oxygen saturation 98% while defibrillator (ICD) for ventricular tachycardia that he was breathing ambient air. During the evalu- had been induced during an electrophysiological ation, the patient coughed twice, and the second study. He had allergic rhinitis, obstructive sleep cough produced light-green sputum with a bloody apnea, gonococcal urethritis, and dyslipidemia. streak. The oropharynx had no erythema or exu- Medications included metoprolol succinate and dates, but there was a slight yellow discoloration atorvastatin. He had had no known adverse reac- on the tongue. There was no tenderness on per- tions to medications, except prolongation of the cussion of the sinuses or conjunctival hyperemia. corrected QT interval with disopyramide. There was no cervical, submandibular, supracla- The patient was born in South Asia, raised in vicular, or axillary lymphadenopathy. Ausculta- the Middle East, and educated in the United tion revealed a clear chest, without rales, wheez- States, where he had lived for the past 25 years. ing, or egophony. The jugular venous pulse was He was an executive and traveled frequently for 6 cm of water. There was a crescendo–decrescendo work, generally to urban areas and only rarely to systolic murmur (grade 3/6) along the left ster- rural areas, although he had walked barefoot nal border that increased during a Valsalva ma- near beaches in various locations in Southeast neuver. There was no edema or calf tenderness. Asia. He was divorced and had a child. He smoked The remainder of the examination was normal. cigars occasionally and drank 1 to 2 glasses of Dr. Jo-Anne O. Shepard: A posteroanterior chest wine nightly but did not use illicit substances. radiograph (Fig. 1) showed clear lungs and a He had been sexually active while traveling but slightly enlarged heart, findings that had not had used condoms. Several first-degree relatives changed from a study obtained 1 year earlier. had hypertrophic cardiomyopathy. His mother had There was a dual-lead ICD that terminated in the died 3 years earlier from pulmonary tuberculosis, right atrium and right ventricle. but he had not been in contact with her during Dr. Dudzinski: An electrocardiogram (Fig. 2) her illness. was notable for sinus rhythm, left ventricular A B Figure 1. Chest Radiograph. Posteroanterior and lateral images (Panels A and B, respectively) show clear lungs and a slightly enlarged heart, as well as implantable cardioverter–defibrillator leads in the right atrium and right ventricle. n engl j med 380;21 nejm.org May 23, 2019 2053 The New England Journal of Medicine Downloaded from nejm.org by GIUSEPPE GIOCOLI on June 2, 2019. For personal use only. No other uses without permission. Copyright © 2019 Massachusetts Medical Society. All rights reserved. The new england journal of medicine I V1 V4 aVR II V2 V5 aVL III aVF V3 V6 V1 Figure 2. Electrocardiogram. An electrocardiogram shows sinus rhythm, left ventricular hypertrophy, and T-wave inversions in leads I, aVL, V4, V5, and V6; these findings had not changed from three tracings obtained in the previous year. hypertrophy, and T-wave inversions in leads I, tests for galactomannan, 1,3-β-D-glucan, and aVL, V4, V5, and V6, findings that had not antibodies to human immunodeficiency virus changed from previous tracings. A 5-day course types 1 and 2. Testing for antibodies to para- of azithromycin was prescribed, along with acet- gonimus was negative, but testing for antibodies aminophen, oxymetazoline nasal spray, and a to strongyloides was positive. phenol-based topical throat spray. A tuberculin Additional diagnostic tests were performed. skin test was negative for induration. Results of liver-function tests were normal; other labora- Differential Diagnosis tory test results are shown in Table 1. A trans- thoracic echocardiogram was notable for a left Dr. Rachel P. Simmons: This 53-year-old man with a ventricular ejection fraction of 60%, a maximum history of hypertrophic obstructive cardiomyop- left ventricular wall thickness of 16 mm, systolic athy and allergic rhinitis presented to this hos- anterior motion of the mitral-valve chordae with pital with a chronic illness of 3 months’ dura- trace mitral regurgitation, and a resting left ven- tion that was characterized by intermittently tricular outflow gradient of 16 mm Hg; these productive cough, marked peripheral eosinophilia findings had not changed from a study obtained (with an absolute eosinophil count of 3800 to 9 months earlier. 4550 per cubic millimeter), an elevated IgE level, Azithromycin therapy resulted in decreased and normal results on pulmonary examination fatigue and malaise and reduced the frequency and chest radiography. His history is also nota- of the cough but did not eliminate it. A few epi- ble for extensive travel and habitation in Asia sodes of hemoptysis with scant blood occurred, and the Middle East. and bloody streaks were present in nasal mucus. Although several features of this patient’s pre- After the patient completed the course of azithro- sentation could point us toward the diagnosis, mycin, additional laboratory tests were performed I will focus my differential diagnosis on the (Table 1). Cultures of the stool and sputum were development of marked peripheral eosinophilia negative, as was examination of the stool and and symptoms that were localized to the respi- sputum for ova and parasites. A hypersensitivity ratory system. His travel history warrants a pneumonitis panel (including a test for antibod- thorough workup for tissue-invasive parasites, ies to aspergillus) was also negative, as were particularly helminths; however, a multitude of 2054 n engl j med 380;21 nejm.org May 23, 2019 The New England Journal of Medicine Downloaded from nejm.org by GIUSEPPE GIOCOLI on June 2, 2019. For personal use only. No other uses without permission. Copyright © 2019 Massachusetts Medical Society. All rights reserved. Case Records of the Massachusetts General Hospital Table 1.
Load more

Recommended publications
  • Care Process Models Streptococcal Pharyngitis
    Care Process Model MONTH MARCH 20152019 DEVELOPMENTDIAGNOSIS AND AND MANAGEMENT DESIGN OF OF CareStreptococcal Process Models Pharyngitis 20192015 Update This care process model (CPM) was developed by Intermountain Healthcare’s Antibiotic Stewardship team, Medical Speciality Clinical Program,Community-Based Care, and Intermountain Pediatrics. Based on expert opinion and the Infectious Disease Society of America (IDSA) Clinical Practice Guidelines, it provides best-practice recommendations for diagnosis and management of group A streptococcal pharyngitis (strep) including the appropriate use of antibiotics. WHAT’S INSIDE? KEY POINTS ALGORITHM 1: DIAGNOSIS AND TREATMENT OF PEDIATRIC • Accurate diagnosis and appropriate treatment can prevent serious STREPTOCOCCAL PHARYNGITIS complications . When strep is present, appropriate antibiotics can prevent AGES 3 – 18 . 2 SHU acute rheumatic fever, peritonsillar abscess, and other invasive infections. ALGORITHM 2: DIAGNOSIS Treatment also decreases spread of infection and improves clinical AND TREATMENT OF ADULT symptoms and signs for the patient. STREPTOCOCCAL PHARYNGITIS . 4 • Differentiating between a patient with an active strep infection PHARYNGEAL CARRIERS . 6 and a patient who is a strep carrier with an active viral pharyngitis RESOURCES AND REFERENCES . 7 is challenging . Treating patients for active strep infection when they are only carriers can result in overuse of antibiotics. Approximately 20% of asymptomatic school-aged children may be strep carriers, and a throat culture during a viral illness may yield positive results, but not require antibiotic treatment. SHU Prescribing repeat antibiotics will not help these patients and can MEASUREMENT & GOALS contribute to antibiotic resistance. • Ensure appropriate use of throat • For adult patients, routine overnight cultures after a negative rapid culture for adult patients who meet high risk criteria strep test are unnecessary in usual circumstances because the risk for acute rheumatic fever is exceptionally low.
    [Show full text]
  • Diagnosis and Treatment of Acute Pharyngitis/Tonsillitis: a Preliminary Observational Study in General Medicine
    Eur opean Rev iew for Med ical and Pharmacol ogical Sci ences 2016; 20: 4950-4954 Diagnosis and treatment of acute pharyngitis/tonsillitis: a preliminary observational study in General Medicine F. DI MUZIO, M. BARUCCO, F. GUERRIERO Azienda Sanitaria Locale Roma 4, Rome, Italy Abstract. – OBJECTIVE : According to re - pharmaceutical expenditure, without neglecting cent observations, the insufficiently targeted the more important and correct application of use of antibiotics is creating increasingly resis - the Guidelines with performing of a clinically val - tant bacterial strains. In this context, it seems idated test that carries advantages for reducing increasingly clear the need to resort to extreme the use of unnecessary and potentially harmful and prudent rationalization of antibiotic thera - antibiotics and the consequent lower prevalence py, especially by the physicians working in pri - and incidence of antibiotic-resistant bacterial mary care units. In clinical practice, actually the strains. general practitioner often treats multiple dis - eases without having the proper equipment. In Key Words: particular, the use of a dedicated, easy to use Acute pharyngitis, Tonsillitis, Strep throat, Beta-he - diagnostic test would be one more weapon for molytic streptococcus Group A (GABHS), Rapid anti - the correct diagnosis and treatment of acute gen detection test, Appropriateness use of antibiotics, pharyngo-tonsillitis. The disease is a condition Cost savings in pharmaceutical spending. frequently encountered in clinical practice but
    [Show full text]
  • Common Questions About Streptococcal Pharyngitis MONICA G
    Common Questions About Streptococcal Pharyngitis MONICA G. KALRA, DO, Memorial Family Medicine Residency, Sugar Land, Texas KIM E. HIGGINS, DO, Envoy Hospice and Brookdale Hospice, Fort Worth, Texas EVAN D. PEREZ, MD, Memorial Family Medicine Residency, Sugar Land, Texas Group A beta-hemolytic streptococcal (GABHS) infection causes 15% to 30% of sore throats in children and 5% to 15% in adults, and is more common in the late winter and early spring. The strongest independent predictors of GABHS pharyngitis are patient age of five to 15 years, absence of cough, tender anterior cervical adenopa- thy, tonsillar exudates, and fever. To diagnose GABHS pharyngitis, a rapid antigen detection test should be ordered in patients with a modified Centor or FeverPAIN score of 2 or 3. First-line treatment for GABHS pharyngitis includes a 10-day course of penicillin or amoxicillin. Patients allergic to penicillin can be treated with first- generation cephalosporins, clindamycin, or macrolide antibiotics. Nonsteroidal anti-inflammatory drugs are more effective than acet- aminophen and placebo for treatment of fever and pain associated with GABHS pharyngitis; medicated throat lozenges used every two hours are also effective. Corticosteroids provide only a small reduc- tion in the duration of symptoms and should not be used routinely. (Am Fam Physician. 2016;94(1):24-31. Copyright © 2016 American Academy of Family Physicians.) ILLUSTRATION JOHN BY KARAPELOU CME This clinical content haryngitis is diagnosed in 11 mil- EVIDENCE SUMMARY conforms to AAFP criteria lion persons in the outpatient set- Several risk factors should increase the index for continuing medical 1 education (CME). See ting each year in the United States.
    [Show full text]
  • Learning Objectives
    Restrictive Lung Diseases & Pulmonary Vascular Disease Pulmonary 2018 RESTRICTIVE LUNG DISEASES AND PULMONARY VASCULAR DISEASE Joel Thibodeaux, MD, Phone: 469-419-4535 Email: [email protected] INTRODUCTION This lecture will discuss basic concepts, etiologic factors, pathologic features, pathogenesis, and clinicopathologic findings in the different types of interstitial lung diseases. It also will touch briefly on pulmonary vascular diseases. LEARNING OBJECTIVES: • Acute respiratory distress syndrome (ARDS) (BP, pp. 460-461) o Define ARDS and list common causes o Illustrate the mechanism of lung injury in ARDS and the role of proinflammatory and anti-inflammatory mediators o Describe the morphologic features of ARDS. Understand how they evolve, and know what happens if the patient survives. • Diffuse interstitial lung disease (BP, pp. 472-474, 480-482) o List the major forms of diffuse interstitial lung diseases discussed o Be able to identify classic morphologic features of common interstitial lung diseases. o Recognize the major causes of pneumoconioses (BP, pp. 474-478) o Delineate the gross and microscopic features resulting from exposure to coal dust, silica, organic/animal dust, and asbestos. o Sarcoidosis (BP, pp. 478-480) . Define sarcoidosis . List the most common organs involved, and describe the characteristic histologic lesion . Describe the radiographic, gross, and histologic appearance of lesions in the hilar lymph nodes and lungs • Define primary pulmonary hypertension. Recognize the characteristic histologic
    [Show full text]
  • Pediatric Ambulatory Community Acquired Pneumonia (CAP)
    ANMC Pediatric (≥3mo) Ambulatory Community Acquired Pneumonia (CAP) Treatment Guideline Criteria for Respiratory Distress Criteria For Outpatient Management Testing/Imaging for Outpatient Management Tachypnea, in breaths/min: Mild CAP: no signs of respiratory distress Vital Signs: Standard VS and Pulse Oximetry Age 0-2mo: >60 Able to tolerate PO Labs: No routine labs indicated Age 2-12mo: >50 No concerns for pathogen with increased virulence Influenza PCR during influenza season Age 1-5yo: >40 (ex. CA-MRSA) Blood cultures if not fully immunized OR fails to Age >5yo: >20 Family able to carefully observe child at home, comply improve/worsens after initiation of antibiotics Dyspnea with therapy plan, and attend follow up appointments Urinary antigen detection testing is not Retractions recommended in children; false-positive tests are common. Grunting If patient does not meet outpatient management criteria Radiography: No routine CXR indicated Nasal flaring refer to inpatient pneumonia guideline for initial workup Apnea and testing. AP and lateral CXR if fails initial antibiotic therapy Altered mental status AP and lateral CXR 4-6 weeks after diagnosis if Pulse oximetry <90% on room air recurrent pneumonia involving the same lobe Treatment Selection Suspected Viral Pneumonia Most Common Pathogens: Influenza A & B, Adenovirus, Respiratory Syncytial Virus, Parainfluenza No antimicrobial therapy is necessary. Most common in <5yo If influenza positive, see influenza guidelines for treatment algorithm. Suspected Bacterial
    [Show full text]
  • Nebulised N-Acetylcysteine for Unresponsive Bronchial Obstruction in Allergic Brochopulmonary Aspergillosis: a Case Series and Review of the Literature
    Journal of Fungi Review Nebulised N-Acetylcysteine for Unresponsive Bronchial Obstruction in Allergic Brochopulmonary Aspergillosis: A Case Series and Review of the Literature Akaninyene Otu 1,2,*, Philip Langridge 2 and David W. Denning 2,3 1 Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State P.M.B. 1115, Nigeria 2 The National Aspergillosis Centre, 2nd Floor Education and Research Centre, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK; [email protected] (P.L.); [email protected] (D.W.D.) 3 Faculty of Biology, Medicine and Health, The University of Manchester, and Manchester Academic Health Science Centre, Oxford Rd, Manchester M13 9PL, UK * Correspondence: [email protected] Received: 5 September 2018; Accepted: 8 October 2018; Published: 15 October 2018 Abstract: Many chronic lung diseases are characterized by the hypersecretion of mucus. In these conditions, the administration of mucoactive agents is often indicated as adjuvant therapy. N-acetylcysteine (NAC) is a typical example of a mucolytic agent. A retrospective review of patients with pulmonary aspergillosis treated at the National Aspergillosis Centre in Manchester, United Kingdom, with NAC between November 2015 and November 2017 was carried out. Six Caucasians with Aspergillus lung disease received NAC to facilitate clearance of their viscid bronchial mucus secretions. One patient developed immediate bronchospasm on the first dose and could not be treated. Of the remainder, two (33%) derived benefit, with increased expectoration and reduced symptoms. Continued response was sustained over 6–7 months, without any apparent toxicity. In addition, a systematic review of the literature is provided to analyze the utility of NAC in the management of respiratory conditions which have unresponsive bronchial obstruction as a feature.
    [Show full text]
  • Original Article Incidence of Eosinophilia in Rural Population In
    Original Article DOI: 10.21276/APALM.2017.1044 Incidence of Eosinophilia in Rural Population in North India: A Study at Tertiary Care Hospital Rimpi Bansal, Anureet Kaur, Anil K Suri, Puneet Kaur, Monika Bansal and Rupinderjeet Kaur Dept. of Pathology, Gian Sagar Medical College and Hospital, Banur, Dist Patiala, Punjab. India ABSTRACT Background: Eosinophilia is abnormally high number of eosinophils in the blood. Normally, eosinophils constitute 1 to 6% of the peripheral blood leukocytes, at a count of 350 to 650 per cubic millimeter. Eosinophilia can be categorized as mild (less than 1500 eosinophils per cubic millimeter), moderate (1500 to 5000 per cubic millimeter), or severe (more than 5000 per cubic millimeter). Eosinophilia may be primary or secondary. The aim of the study was to determine the incidence of eosinophilia and evaluate the patients thoroughly for the cause of eosinophilia. Method: The study was conducted in the Pathology department in the medical college and hospital in rural are of Punjab. Complete blood count and peripheral blood film study was done in almost all the patients visiting the hospital. The patients with eosinophilia were segregated and were made to fill the detailed proforma. The information included family history, chief complaints, food habits, disease history and drug history. A thorough general examination and diagnostic work up followed. Result: In all 3442 (10.7%) patients visiting the hospital had eosinophilia; out of this 2136 (62%) patients had mild eosinophilia, 1297 (37.7%) had moderate and 9 (0.3%) had severe eosinophilia. 2451(71.2%) patients were males and 991 (28.8%) were females.
    [Show full text]
  • Rise in Children Presenting with Periodic Fever, Aphthous Stomatitis, Pharyngitis and Adenitis Syndrome During the COVID-19 Pandemic
    Letter Arch Dis Child: first published as 10.1136/archdischild-2021-322792 on 22 July 2021. Downloaded from Rise in children presenting with periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome during the COVID-19 pandemic Periodic fever, aphthous stomatitis, phar- yngitis and adenitis (PFAPA) syndrome is characterised by episodes of fever lasting a few days that classically exhibit clockwork periodicity. Since the initial description of PFAPA syndrome by Gary Marshall in 1987, it has been recognised that stomatitis, pharyngitis and adenitis Figure 1 Rise in children presenting with PFAPA syndrome during the COVID-19 pandemic. are variably present.1 Its phenotype is Children with a new diagnosis of PFAPA syndrome as absolute number (black circles) and consistent with an autoinflammatory as proportion of overall referrals (grey circles) to the tertiary paediatric immunology and condition of unknown genetic aetiology rheumatology outpatient clinics at Bristol Royal Hospital for Children (2015–2020). possibly involving an infectious/environ- mental trigger, given that a family history is present in approximately 27% of cases.2 their characteristics were similar to chil- condition was already increasing. Third, The natural history is onset before 6 years dren diagnosed in the pre-pandemic era many of our cohort underwent multiple old, followed by spontaneous resolution (figure 1 and table 1). In comparison, SARS- CoV-2 tests, and the disruption by 15 years. Treatment with colchicine there was a modest overall increase in associated with repeated periods of house- can reduce the frequency of episodes and referrals to the service (incidence rate hold self- isolation may have contributed tonsillectomy is usually curative.3 ratio 1.71; 95% CI 1.46 to 2.00).
    [Show full text]
  • JMSCR Vol||05||Issue||03||Page 18694-18697||March 2017
    JMSCR Vol||05||Issue||03||Page 18694-18697||March 2017 www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i3.69 Microfilariae in Lymph Node Aspirate- A Case Report Authors Dr Jyoti Sharma, Dr Nitin Chaudhary, Dr Sandhya Bordia R.N.T. Medical College Abstract Lymphatic filariasis is a major public health problem in India. It is routinely examined in night peripheral blood smears. Fine-needle aspiration cytology (FNAC) is not routinely used for its identification. It has always been detected incidentally, while doing FNACs for evaluation of other lesions. It is unusual to find microfilariae in fine needle aspiration cytology (FNAC) smears of lymph nodes in spite of very high incidence in India. In the absence of clinical features of filariasis, FNAC may help in the diagnosis of lymphatic filariasis. We present this case because of unusual occurrence of isolated lymph node filariasis (occult filariasis) without microfilaremia. Keywords- Axillary lymph node, Microfilaria, FNAC. Introduction swellings. There was no history of fever or Filariasis is a global problem.It is largely confined generalized lymphadenopathy. On examination, to tropics and subtropicsof Africa, Asia, Western the lymph nodes were firm and matted. There Pacific and parts of the Americas, affecting over were four groups of lymph nodes and each was 3 83 countries1.The disease is endemic all over India x 3cms. There was no local rise of temperature and is caused by two closely related nematode and skin over swelling was normal.
    [Show full text]
  • Approaching Otolaryngology Patients During the COVID-19 Pandemic
    Complete ManuscriptClick here to access/download;Complete Manuscript;Otolaryngology Diseases in COVID-19 Patients-V17-final.docx This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. Approaching Otolaryngology Patients during the COVID-19 Pandemic Chong Cui1,2#, Qi Yao3#, Di Zhang4#, Yu Zhao1,2#, Kun Zhang1,2, Eric Nisenbaum5, Pengyu Cao1,2,6, Keqing Zhao1,2,6, Xiaolong Huang3, Dewen Leng3, Chunhan Liu4, Ning Li7, Yan Luo8, Bing Chen1,2, Roy Casiano5, Donald Weed5, Zoukaa Sargi5, Fred Telischi5, Hongzhou Lu6, James C. Denneny III9, Yilai Shu1,2 Xuezhong Liu 5 1. ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Institutes of Biomedical Sciences Fudan University, Shanghai, 200031, China. 2. NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, China. 3. Department of Otorhinolaryngology, Chinese and Western Medicine Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. 4. Department of Otolaryngology, The Third People’s Hospital of Shenzhen, 29 Bulan Road, Longgang District, Shenzhen, 518112, China. 5. Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA. 6. Department of Infectious Diseases, Shanghai Public Health Clinical Center, 2901 Caolang Road, Shanghai 201508, China 7. Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai, 200040, China. This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. 8. Department of Hospital-Acquired Infection Control, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China. 9. American Academy of Otolaryngology – Head and Neck Surgery, Alexandria, VA 22314, USA # contributed equally Corresponding Authors: Dr.
    [Show full text]
  • Invasive Pseudomembranous Upper Airway and Tracheal Aspergillosis
    Khan et al. BMC Infectious Diseases (2020) 20:13 https://doi.org/10.1186/s12879-019-4744-2 CASE REPORT Open Access Invasive pseudomembranous upper airway and tracheal Aspergillosis refractory to systemic antifungal therapy and serial surgical debridement in an Immunocompetent patient Shihan N. Khan1, Rashmi Manur2, John S. Brooks2, Michael A. Husson2, Kevin Leahy3 and Matthew Grant1* Abstract Background: The development of respiratory infections secondary to Aspergillus spp. spores found ubiquitously in the ambient environment is uncommon in immunocompetent patients. Previous reports of invasive upper airway aspergillosis in immunocompetent patients have generally demonstrated the efficacy of treatment regimens utilizing antifungal agents in combination with periodic endoscopic debridement, with symptoms typically resolving within months of initiating therapy. Case presentation: A 43-year-old previously healthy female presented with worsening respiratory symptoms after failing to respond to long-term antibiotic treatment of bacterial sinusitis. Biopsy of her nasopharynx and trachea revealed extensive fungal infiltration and Aspergillus fumigatus was isolated on tissue culture. Several months of oral voriconazole monotherapy failed to resolve her symptoms and she underwent mechanical debridement for symptom control. Following transient improvement, her symptoms subsequently returned and failed to fully resolve in spite of increased voriconazole dosing and multiple additional tissue debridements over the course of many years. Conclusions: Invasive upper airway aspergillosis is exceedingly uncommon in immunocompetent patients. In the rare instances that such infections do occur, combinatorial voriconazole and endoscopic debridement is typically an efficacious treatment approach. However, some patients may continue to experience refractory symptoms. In such cases, continued aggressive treatment may potentially slow disease progression even if complete disease resolution cannot be achieved.
    [Show full text]
  • Multi-Tiered Screening and Diagnosis Strategy for COVID-19: a Model for Sustainable Testing Capacity in Response to Pandemic
    ANNALS OF MEDICINE 2020, VOL. 52, NO. 5, 207–214 https://doi.org/10.1080/07853890.2020.1763449 ORIGINAL ARTICLE Multi-tiered screening and diagnosis strategy for COVID-19: a model for sustainable testing capacity in response to pandemic Michael S. Puliaa, Terrence P. O’Brienb, Peter C. Houc, Andrew Schumand and Robert Samburskye aBerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; bCharlotte Breyer Rodgers Distinguished Chair Ocular Microbiology Laboratory, Infection Control Unit, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, U.S.A; cDivision of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; dDepartment of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; eLumos Diagnostics, Inc., Sarasota, FL, USA ABSTRACT ARTICLE HISTORY Coronavirus disease 2019 (COVID-19), caused by novel enveloped single stranded RNA corona- Received 8 April 2020 virus (SARS-CoV-2), is responsible for an ongoing global pandemic. While other countries Revised 27 April 2020 deployed widespread testing as an early mitigation strategy, the U.S. experienced delays in Accepted 28 April 2020 development and deployment of organism identification assays. As such, there is uncertainty KEYWORDS surrounding disease burden and community spread, severely hampering containment efforts. COVID-19; Coronavirus; COVID-19 illuminates the need for a tiered diagnostic approach to rapidly identify clinically sig- SARS-CoV-2; myxovirus nificant infections and reduce disease spread. Without the ability to efficiently screen patients, resistance protein A (MxA); hospitals are overwhelmed, potentially delaying treatment for other emergencies.
    [Show full text]