Pub Date : 2023-12-11DOI: 10.1097/ipc.0000000000001331
Osejie Oriaifo, Melisa Pasli, Supriya Sivadanam, Brandon Tedder, Nim Chan, Olanrewaju K Adabale, Arthur Dilibe, Paul Cook
Cunninghamella spp are a group of filamentous fungi commonly found in soil and decaying matter and can cause infections in immunocompromised individuals, especially those undergoing chemotherapy or with hematologic malignancies. These infections can lead to a rapidly progressive and fatal outcome. Despite accounting for less than 10% of documented mucormycosis cases, disseminated Cunninghamella infections have a higher mortality rate when compared with other mucormycosis. We present the case of a patient with chronic myelogenous leukemia and myelodysplastic syndromes/myeloproliferative neoplasms overlap, receiving azacitidine, who initially presented with a diabetic foot ulcer infested with maggots. The patient rapidly developed respiratory distress and encephalopathy, with imaging revealing consolidation in the right upper lung lobe infected with Cunninghamella spp. Treatment with amphotericin B did not improve the patient's condition. Brain imaging also indicated a 24.4 × 16.9-mm lesion, and given the patient's comorbidities and disease progression, surgical intervention was not feasible. The patient was subsequently transitioned to comfort care.
{"title":"Rapid Progression of Cunninghamella Species Leading to Respiratory Compromise","authors":"Osejie Oriaifo, Melisa Pasli, Supriya Sivadanam, Brandon Tedder, Nim Chan, Olanrewaju K Adabale, Arthur Dilibe, Paul Cook","doi":"10.1097/ipc.0000000000001331","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001331","url":null,"abstract":"\u0000 \u0000 Cunninghamella spp are a group of filamentous fungi commonly found in soil and decaying matter and can cause infections in immunocompromised individuals, especially those undergoing chemotherapy or with hematologic malignancies. These infections can lead to a rapidly progressive and fatal outcome. Despite accounting for less than 10% of documented mucormycosis cases, disseminated Cunninghamella infections have a higher mortality rate when compared with other mucormycosis.\u0000 We present the case of a patient with chronic myelogenous leukemia and myelodysplastic syndromes/myeloproliferative neoplasms overlap, receiving azacitidine, who initially presented with a diabetic foot ulcer infested with maggots. The patient rapidly developed respiratory distress and encephalopathy, with imaging revealing consolidation in the right upper lung lobe infected with Cunninghamella spp. Treatment with amphotericin B did not improve the patient's condition. Brain imaging also indicated a 24.4 × 16.9-mm lesion, and given the patient's comorbidities and disease progression, surgical intervention was not feasible. The patient was subsequently transitioned to comfort care.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138981066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-11DOI: 10.1097/ipc.0000000000001314
Faisal Khan, Drew W Engers, Joshua A. Lieberman, Varsha Moudgal
Cat bite wound infections are common, and much is known about their bacteriology, pathogenesis, and management. We report a case of a rare Mycoplasma species from a cat bite causing tenosynovitis and septic arthritis of the hand, as well as distant prosthetic joint infection of the knee. The patient demonstrated poor clinical response to standard and expanded antibiotic regimens. Repeated surgical interventions were necessary until nucleic acid amplification revealed a previously undescribed Mycoplasma species that was effectively treated with the addition of doxycycline.
{"title":"Disseminated Infection With a Previously Undescribed Mycoplasma Species From a Cat Bite","authors":"Faisal Khan, Drew W Engers, Joshua A. Lieberman, Varsha Moudgal","doi":"10.1097/ipc.0000000000001314","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001314","url":null,"abstract":"\u0000 Cat bite wound infections are common, and much is known about their bacteriology, pathogenesis, and management. We report a case of a rare Mycoplasma species from a cat bite causing tenosynovitis and septic arthritis of the hand, as well as distant prosthetic joint infection of the knee. The patient demonstrated poor clinical response to standard and expanded antibiotic regimens. Repeated surgical interventions were necessary until nucleic acid amplification revealed a previously undescribed Mycoplasma species that was effectively treated with the addition of doxycycline.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138979597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Unilateral parotitis is due to ductal obstruction. Bilateral parotitis occurs due to viral infections such as mumps, bacterial infections, Sjögren syndrome, and ductal obstruction. Drug-induced parotitis is a relatively uncommon adverse reaction, and it can be unilateral and bilateral. Unilateral causes of drug-induced parotitis can be due to clozapine, chlorpromazine, l-asparaginase, and α-methyldopa, whereas bilateral causes can be due to thioridazine, sulfadiazine, phenylbutazone, oxyphenylbutazone, nitrofurantoin, and valproic acid. Adverse reactions to sulfonamide are rare and manifest as rashes or urticaria. Herein, we report a case of acute unilateral parotitis occurring as a result of cotrimoxazole that resolved within 48 hours after discontinuation of therapy, which highlights that sulfonamide therapy can cause parotitis. Early clinical suspicion and discontinuation of therapy help in the prompt resolution of the allergic reaction to cotrimoxazole.
{"title":"Drug-Induced Parotitis—A Rarity?","authors":"Sweatha Kumar, Vidya Devarajan, Ramya Sivaramakrishnan, Srinivasan Kalyanasundaram, Purushothaman P.K, Rufus Vasanth Raj","doi":"10.1097/ipc.0000000000001333","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001333","url":null,"abstract":"Unilateral parotitis is due to ductal obstruction. Bilateral parotitis occurs due to viral infections such as mumps, bacterial infections, Sjögren syndrome, and ductal obstruction. Drug-induced parotitis is a relatively uncommon adverse reaction, and it can be unilateral and bilateral. Unilateral causes of drug-induced parotitis can be due to clozapine, chlorpromazine, l-asparaginase, and α-methyldopa, whereas bilateral causes can be due to thioridazine, sulfadiazine, phenylbutazone, oxyphenylbutazone, nitrofurantoin, and valproic acid. Adverse reactions to sulfonamide are rare and manifest as rashes or urticaria. Herein, we report a case of acute unilateral parotitis occurring as a result of cotrimoxazole that resolved within 48 hours after discontinuation of therapy, which highlights that sulfonamide therapy can cause parotitis. Early clinical suspicion and discontinuation of therapy help in the prompt resolution of the allergic reaction to cotrimoxazole.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139210402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-29DOI: 10.1097/ipc.0000000000001328
Arunava Saha, Erin E O'SHEA PAUDEL
The negative predictive value (NPV) of nasal methicillin-resistant Staphylococcus aureus (MRSA) screens has been compromised by universal decolonization practices. We aimed to determine the reliability of the nasal MRSA culture screen to deescalate antibiotic therapy in the setting of decolonization with ethyl alcohol. A retrospective observational cohort study was conducted using 62% ethanol solution intranasally per protocol. Patients were divided into 2 groups based on whether they received decolonization. Data were analyzed to determine NPV of the nasal MRSA culture screen with and without decolonization. A total of 505 cases were screened, and 128 subjects were included. One hundred two received decolonization, whereas 26 did not. Baseline characteristics were well balanced. Overall MRSA infection prevalence was 31.25%. The NPV was 73% in the decolonized group compared with 80% in the group without. Positive predictive value was 63% in the group receiving decolonization compared with 100% in the group without. There was also a higher specificity but lower sensitivity of the nasal MRSA culture screen in the decolonization group. Nine patients in the decolonization group required reescalation of antibiotics compared with nil in the other group. Culture-based nasal MRSA screens are less accurate than PCR tests, as ethyl alcohol leads to false-negative results. A lower NPV in the decolonization group predisposes to increased false negative results, leading to inappropriate antibiotic deescalation and often requiring reinitiation. Nasal MRSA culture screen is less reliable if alcohol has already been administered for decolonization and cannot be used as an appropriate tool to guide antibiotic deescalation.
{"title":"Nasal Methicillin-Resistant Staphylococcus aureus Culture Screens in the Setting of Universal Decolonization","authors":"Arunava Saha, Erin E O'SHEA PAUDEL","doi":"10.1097/ipc.0000000000001328","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001328","url":null,"abstract":"The negative predictive value (NPV) of nasal methicillin-resistant Staphylococcus aureus (MRSA) screens has been compromised by universal decolonization practices. We aimed to determine the reliability of the nasal MRSA culture screen to deescalate antibiotic therapy in the setting of decolonization with ethyl alcohol. A retrospective observational cohort study was conducted using 62% ethanol solution intranasally per protocol. Patients were divided into 2 groups based on whether they received decolonization. Data were analyzed to determine NPV of the nasal MRSA culture screen with and without decolonization. A total of 505 cases were screened, and 128 subjects were included. One hundred two received decolonization, whereas 26 did not. Baseline characteristics were well balanced. Overall MRSA infection prevalence was 31.25%. The NPV was 73% in the decolonized group compared with 80% in the group without. Positive predictive value was 63% in the group receiving decolonization compared with 100% in the group without. There was also a higher specificity but lower sensitivity of the nasal MRSA culture screen in the decolonization group. Nine patients in the decolonization group required reescalation of antibiotics compared with nil in the other group. Culture-based nasal MRSA screens are less accurate than PCR tests, as ethyl alcohol leads to false-negative results. A lower NPV in the decolonization group predisposes to increased false negative results, leading to inappropriate antibiotic deescalation and often requiring reinitiation. Nasal MRSA culture screen is less reliable if alcohol has already been administered for decolonization and cannot be used as an appropriate tool to guide antibiotic deescalation.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139209475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-20DOI: 10.1097/ipc.0000000000001325
Shivakumar Narayanan, Edward C. Traver, Aaron David Greenblatt
We present a case of pseudocellulitis in a patient with chronic wounds from active injection drug use and edema and edema from secondary amyloidosis and highlight diagnostic challenges and approaches to differentiate infection from vascular and other noninfectious causes as well as the opportunity to intervene at a reachable moment to try to mitigate risk related to injection drug use.
{"title":"A Red Swollen Leg","authors":"Shivakumar Narayanan, Edward C. Traver, Aaron David Greenblatt","doi":"10.1097/ipc.0000000000001325","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001325","url":null,"abstract":"We present a case of pseudocellulitis in a patient with chronic wounds from active injection drug use and edema and edema from secondary amyloidosis and highlight diagnostic challenges and approaches to differentiate infection from vascular and other noninfectious causes as well as the opportunity to intervene at a reachable moment to try to mitigate risk related to injection drug use.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139258683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-20DOI: 10.1097/ipc.0000000000001329
Moamen Al Zoubi, Huma M. Khan, Sona Najafi
This report presents a case of a 14-year-old female patient diagnosed with lumbar (L2–L3) epidural abscess and vertebral osteomyelitis caused by Cardiobacterium hominis. The diagnosis was made using universal 16S rRNA polymerase chain reaction. To the best of our knowledge, this is the first reported case of C. hominis lumbar epidural abscess and vertebral osteomyelitis in pediatric population. This case serves to illustrate the potential value of polymerase chain reaction and DNA sequencing in diagnosing culture-negative vertebral osteomyelitis and the potential role of C. hominis in causing this infection.
本报告介绍了一例 14 岁女性患者的病例，她被诊断为腰椎（L2-L3）硬膜外脓肿和脊椎骨髓炎，病因是人类心脏杆菌（Cardiobacterium hominis）。诊断是通过通用 16S rRNA 聚合酶链反应做出的。据我们所知，这是首例报道的儿童腰椎硬膜外脓肿和椎体骨髓炎病例。该病例说明了聚合酶链式反应和 DNA 测序在诊断培养阴性的脊椎骨髓炎中的潜在价值，以及人尾蚴在导致这种感染中的潜在作用。
{"title":"Lumbar Osteomyelitis and Epidural Abscess Caused by Cardiobacterium hominis—First Reported Case in the Pediatric Population: The Role of Universal 16S rRNA Gene PCR and Sequencing","authors":"Moamen Al Zoubi, Huma M. Khan, Sona Najafi","doi":"10.1097/ipc.0000000000001329","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001329","url":null,"abstract":"This report presents a case of a 14-year-old female patient diagnosed with lumbar (L2–L3) epidural abscess and vertebral osteomyelitis caused by Cardiobacterium hominis. The diagnosis was made using universal 16S rRNA polymerase chain reaction. To the best of our knowledge, this is the first reported case of C. hominis lumbar epidural abscess and vertebral osteomyelitis in pediatric population. This case serves to illustrate the potential value of polymerase chain reaction and DNA sequencing in diagnosing culture-negative vertebral osteomyelitis and the potential role of C. hominis in causing this infection.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139256500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-20DOI: 10.1097/ipc.0000000000001320
A. Njoroge, Morgan Froehlich, G. Psevdos
{"title":"Treatment Experience With Oral Antivirals for US Veterans With COVID-19 Infection","authors":"A. Njoroge, Morgan Froehlich, G. Psevdos","doi":"10.1097/ipc.0000000000001320","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001320","url":null,"abstract":"","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139257259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-20DOI: 10.1097/ipc.0000000000001323
Derrick Ferguson, Javier Antonio Aguilar-Aragon, Imad Obeid
We present the case of a 61-year-old woman with a medical history of rheumatoid arthritis on immunosuppressive therapy who presented with generalized weakness, progressive dry cough, and dyspnea. She rapidly progressed to profound acute hypoxemic respiratory failure prompting initiation of mechanical ventilatory support. She was subsequently discovered to have diffuse vesicular rash about her abdomen without respect for dermatome borders that disseminated to her back and neck. Diagnostic testing confirmed varicella zoster virus with concomitant varicella pneumonia. Disseminated varicella infection is not uncommon and most frequently affects those with immunosuppression, but cases have been documented somewhat regularly in those without overt immunosuppression. Of the complications associated with disseminated varicella infection, varicella pneumonia is the most deadly. Mortality rate for disseminated varicella infection with varicella pneumonia ranges from 10% to 30%. However, for those with extreme respiratory failure requiring mechanical ventilation, mortality can reach as high as 50%. The most common presentation is a patient with cutaneous eruption that does not follow dermatomal distribution; this is followed by the onset of pulmonary symptoms within 2 to 5 days of rash. However, our case contributes another example of a rare presentation of varicella pneumonia, that being a case wherein the viral exanthem was preceded by the onset of respiratory failure. Recognizing the possibility of respiratory symptoms preceding the classic cutaneous manifestations of disseminated varicella infection is an important lesson, as it will allow for earlier detection and initiation of therapy. The profound mortality associated with varicella pneumonia is justification for further dedicated research into improved prevention and treatment, and increasing physician awareness of this clinical entity will be beneficial to that end.
{"title":"An Atypical Presentation of Disseminated Varicella Infection","authors":"Derrick Ferguson, Javier Antonio Aguilar-Aragon, Imad Obeid","doi":"10.1097/ipc.0000000000001323","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001323","url":null,"abstract":"We present the case of a 61-year-old woman with a medical history of rheumatoid arthritis on immunosuppressive therapy who presented with generalized weakness, progressive dry cough, and dyspnea. She rapidly progressed to profound acute hypoxemic respiratory failure prompting initiation of mechanical ventilatory support. She was subsequently discovered to have diffuse vesicular rash about her abdomen without respect for dermatome borders that disseminated to her back and neck. Diagnostic testing confirmed varicella zoster virus with concomitant varicella pneumonia. Disseminated varicella infection is not uncommon and most frequently affects those with immunosuppression, but cases have been documented somewhat regularly in those without overt immunosuppression. Of the complications associated with disseminated varicella infection, varicella pneumonia is the most deadly. Mortality rate for disseminated varicella infection with varicella pneumonia ranges from 10% to 30%. However, for those with extreme respiratory failure requiring mechanical ventilation, mortality can reach as high as 50%. The most common presentation is a patient with cutaneous eruption that does not follow dermatomal distribution; this is followed by the onset of pulmonary symptoms within 2 to 5 days of rash. However, our case contributes another example of a rare presentation of varicella pneumonia, that being a case wherein the viral exanthem was preceded by the onset of respiratory failure. Recognizing the possibility of respiratory symptoms preceding the classic cutaneous manifestations of disseminated varicella infection is an important lesson, as it will allow for earlier detection and initiation of therapy. The profound mortality associated with varicella pneumonia is justification for further dedicated research into improved prevention and treatment, and increasing physician awareness of this clinical entity will be beneficial to that end.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139258036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-20DOI: 10.1097/ipc.0000000000001332
M. Harirchian, M. Ghabaee, P. Sarraf, Sakineh Ranji-Burachaloo, Elmira Agah, Seyed Vahid Mousavi, Aminreza Abkhoo, Kiana Amani, Nina Javadian, Ghasem Farahmand, Hanna Magrouni, Fatemeh Alizadeh Boroujeni, Fatemeh Nazari, S. Ghafouri, Maryam Hosseinzadeh, Sonya Enayati, Samaneh Kabiri, Yeganeh Pasebani, A. Rafati, Mehdi Azizmohammad Looha, Abbas Tafakhori, M. Jameie
COVID-19 patients with neurological manifestations have poorer outcomes. We investigated the association between clinicodemographic and laboratory findings with poorer outcomes among COVID-19 inpatients with neurological manifestations. This was a retrospective study of consecutive medical records (March–April 2020). Neurological manifestations (altered level of consciousness, acute cerebrovascular disease, ataxia, seizure, headaches, dizziness/vertigo, muscle weakness, and peripheral neuropathies) were categorized into serious and nonserious. Of 119 COVID-19 inpatients, 38 with neurological manifestations were included (age, 63.7 ± 13.4 years; male, 65.8%), of whom 27 (71.1%) had serious manifestations. Muscle weakness (57.9%), impaired consciousness (47.4%), and acute cerebrovascular disease (23.7%) were the most frequent manifestations. The in-hospital mortality rate was 28.9%. Patients with serious manifestations were significantly older (66.9 vs 55.7, P = 0.018), with significantly higher white blood cell count (6.8 vs 5.1 × 103/μL, P = 0.023), direct bilirubin (0.3 vs 0.2 mg/dL, P = 0.030), prothrombin time (PT) (15.4 vs 14.4 seconds, P = 0.006), international normalized ratio (1.2 vs 1.1, P = 0.005), and model for end-stage liver disease (MELD) scores (10 vs 7, P = 0.011), compared with those with nonserious manifestations. In addition, the nonsurvivors had higher potassium (4.5 vs 4.0 mEq/L, P = 0.021), total bilirubin (1.1 vs 0.6 mg/dL, P = 0.008), and MELD scores (12 vs 8, P = 0.025) compared with the survivors. After adjustment, we found significant impacts of age (adjusted odds ratio [aOR], 1.11; P = 0.032), PT (aOR, 5.04; P = 0.019), and MELD score (aOR, 1.27, P = 0.047) on poorer outcomes. Older age, higher white blood cell count, bilirubin, PT, international normalized ratio, potassium, and MELD scores were associated with poorer outcomes in COVID-19 inpatients with neurological manifestations.
{"title":"Nervous System Involvement in Hospitalized Patients With COVID-19","authors":"M. Harirchian, M. Ghabaee, P. Sarraf, Sakineh Ranji-Burachaloo, Elmira Agah, Seyed Vahid Mousavi, Aminreza Abkhoo, Kiana Amani, Nina Javadian, Ghasem Farahmand, Hanna Magrouni, Fatemeh Alizadeh Boroujeni, Fatemeh Nazari, S. Ghafouri, Maryam Hosseinzadeh, Sonya Enayati, Samaneh Kabiri, Yeganeh Pasebani, A. Rafati, Mehdi Azizmohammad Looha, Abbas Tafakhori, M. Jameie","doi":"10.1097/ipc.0000000000001332","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001332","url":null,"abstract":"COVID-19 patients with neurological manifestations have poorer outcomes. We investigated the association between clinicodemographic and laboratory findings with poorer outcomes among COVID-19 inpatients with neurological manifestations. This was a retrospective study of consecutive medical records (March–April 2020). Neurological manifestations (altered level of consciousness, acute cerebrovascular disease, ataxia, seizure, headaches, dizziness/vertigo, muscle weakness, and peripheral neuropathies) were categorized into serious and nonserious. Of 119 COVID-19 inpatients, 38 with neurological manifestations were included (age, 63.7 ± 13.4 years; male, 65.8%), of whom 27 (71.1%) had serious manifestations. Muscle weakness (57.9%), impaired consciousness (47.4%), and acute cerebrovascular disease (23.7%) were the most frequent manifestations. The in-hospital mortality rate was 28.9%. Patients with serious manifestations were significantly older (66.9 vs 55.7, P = 0.018), with significantly higher white blood cell count (6.8 vs 5.1 × 103/μL, P = 0.023), direct bilirubin (0.3 vs 0.2 mg/dL, P = 0.030), prothrombin time (PT) (15.4 vs 14.4 seconds, P = 0.006), international normalized ratio (1.2 vs 1.1, P = 0.005), and model for end-stage liver disease (MELD) scores (10 vs 7, P = 0.011), compared with those with nonserious manifestations. In addition, the nonsurvivors had higher potassium (4.5 vs 4.0 mEq/L, P = 0.021), total bilirubin (1.1 vs 0.6 mg/dL, P = 0.008), and MELD scores (12 vs 8, P = 0.025) compared with the survivors. After adjustment, we found significant impacts of age (adjusted odds ratio [aOR], 1.11; P = 0.032), PT (aOR, 5.04; P = 0.019), and MELD score (aOR, 1.27, P = 0.047) on poorer outcomes. Older age, higher white blood cell count, bilirubin, PT, international normalized ratio, potassium, and MELD scores were associated with poorer outcomes in COVID-19 inpatients with neurological manifestations.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139259565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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