Pub Date : 2019-01-01DOI: 10.18297/JRI/VOL3/ISS1/8
V. Nagarajan, Srinivas R Dontineni, V. Corcino, F. Arnold
Dr.Viswanathan Nagarajan (Infectious Diseases fellow): A 39-year-old previously healthy male presented to the emergency room for sudden onset left sided chest pain, cough with blood tinged sputum and shortness of breath, which started abruptly six hours prior to the presentation. He had been to another emergency room three days prior with myalgia, fever, headache, nausea, vomiting and diarrhea. Rapid influenza screen had been negative at that hospital. Nevertheless, he was discharged on oseltamivir. Now, shortness of breath was at rest and the chest pain was associated with cough and deep breathing. He also continued to have diarrhea and vomiting. Apart from having a 27 pack-year history of smoking, marijuana use and consuming a pint of alcohol every day, he had no history of intravenous drug use. He lived with his girlfriend, and denied promiscuous sexual activity or sex with males. He denied any travel outside of the US, or having pets at home. He had no known drug allergies. His temperature was 38.8° Celsius, heart rate 130 beats/min, respiratory rate 33 breaths/min, blood pressure 151/83 mm Hg, and oxygen saturation 93% on room air (FiO2 21%). The patient was in moderate respiratory distress and was seen using accessory muscles of respiration. He was alert, but unable to speak up as his voice was feeble. He had no signs of clubbing or generalized lymphadenopathy. No needle tracks were observed. Lung auscultation revealed equal air entry on both sides with no changes in his inspiration to expiration ratio. Bilateral crackles and wheezing were noted on the entire left side. On percussion, no dullness or resonance was noted.
{"title":"A Man with Acute Severe Pneumonia: Case Discussion from the University of Louisville Hospital","authors":"V. Nagarajan, Srinivas R Dontineni, V. Corcino, F. Arnold","doi":"10.18297/JRI/VOL3/ISS1/8","DOIUrl":"https://doi.org/10.18297/JRI/VOL3/ISS1/8","url":null,"abstract":"Dr.Viswanathan Nagarajan (Infectious Diseases fellow): A 39-year-old previously healthy male presented to the emergency room for sudden onset left sided chest pain, cough with blood tinged sputum and shortness of breath, which started abruptly six hours prior to the presentation. He had been to another emergency room three days prior with myalgia, fever, headache, nausea, vomiting and diarrhea. Rapid influenza screen had been negative at that hospital. Nevertheless, he was discharged on oseltamivir. Now, shortness of breath was at rest and the chest pain was associated with cough and deep breathing. He also continued to have diarrhea and vomiting. Apart from having a 27 pack-year history of smoking, marijuana use and consuming a pint of alcohol every day, he had no history of intravenous drug use. He lived with his girlfriend, and denied promiscuous sexual activity or sex with males. He denied any travel outside of the US, or having pets at home. He had no known drug allergies. His temperature was 38.8° Celsius, heart rate 130 beats/min, respiratory rate 33 breaths/min, blood pressure 151/83 mm Hg, and oxygen saturation 93% on room air (FiO2 21%). The patient was in moderate respiratory distress and was seen using accessory muscles of respiration. He was alert, but unable to speak up as his voice was feeble. He had no signs of clubbing or generalized lymphadenopathy. No needle tracks were observed. Lung auscultation revealed equal air entry on both sides with no changes in his inspiration to expiration ratio. Bilateral crackles and wheezing were noted on the entire left side. On percussion, no dullness or resonance was noted.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80963407","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 : 2019-01-01DOI: 10.18297/JRI/VOL3/ISS1/4
J. Harting
In 2013, the Centers for Disease Control (CDC) issued antimicrobial resistance guidance ranking carbapenemresistant Enterobacteriaceae (CRE), Neisseria gonorrhea, and Clostridium difficile as the three most urgent resistance threats in the United States [1]. CRE are defined as pathogens testing resistant to the following carbapenem antimicrobials (imipenem, meropenem, doripenem, or ertapenem) or are documented to produce a carbapenemase [2]. In the 2013 CDC report, an estimated 9,300 inpatient cases were predicted annually, and as of December 2017, CRE isolates have now been reported in all 50 states [3]. Enterobacteriaceae cause roughly 27.2% of healthcare-associated infections (HAIs) in acute care settings, with Klebsiella pneumoniae and E. coli as the predominant species [4]. Carbapenems are useful last line treatment options in multidrug-resistant gram-negative infections. Therefore, CRE are truly a healthcare threat.
{"title":"Carbapenem-resistant Enterobacteriaceae Infections: A Review of Epidemiology and Treatment Options","authors":"J. Harting","doi":"10.18297/JRI/VOL3/ISS1/4","DOIUrl":"https://doi.org/10.18297/JRI/VOL3/ISS1/4","url":null,"abstract":"In 2013, the Centers for Disease Control (CDC) issued antimicrobial resistance guidance ranking carbapenemresistant Enterobacteriaceae (CRE), Neisseria gonorrhea, and Clostridium difficile as the three most urgent resistance threats in the United States [1]. CRE are defined as pathogens testing resistant to the following carbapenem antimicrobials (imipenem, meropenem, doripenem, or ertapenem) or are documented to produce a carbapenemase [2]. In the 2013 CDC report, an estimated 9,300 inpatient cases were predicted annually, and as of December 2017, CRE isolates have now been reported in all 50 states [3]. Enterobacteriaceae cause roughly 27.2% of healthcare-associated infections (HAIs) in acute care settings, with Klebsiella pneumoniae and E. coli as the predominant species [4]. Carbapenems are useful last line treatment options in multidrug-resistant gram-negative infections. Therefore, CRE are truly a healthcare threat.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87456713","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 : 2018-04-06DOI: 10.18297/JRI/VOL2/ISS1/1
J. Ramirez, T. File, D. Musher
In a recent review article of the causes of community-acquired pneumonia (CAP) in adults, Musher et al. reported that S. aureus is now the third most common bacterial pathogen causing CAP [1]. Physicians treating patients with CAP will be confronted with the question of how best to treat a hospitalized patient with bacteremic S. aureus CAP. In this opinion piece, we will review current controversies on the topic and offer our point of view regarding management and treatment.
{"title":"Duration of antibiotic therapy for patients with bacteremic Staphylococcus aureus\u0000 community-acquired pneumonia","authors":"J. Ramirez, T. File, D. Musher","doi":"10.18297/JRI/VOL2/ISS1/1","DOIUrl":"https://doi.org/10.18297/JRI/VOL2/ISS1/1","url":null,"abstract":"In a recent review article of the causes of community-acquired pneumonia (CAP) in adults, Musher et al. reported that S. aureus is now the third most common bacterial pathogen causing CAP [1]. Physicians treating patients with CAP will be confronted with the question of how best to treat a hospitalized patient with bacteremic S. aureus CAP. In this opinion piece, we will review current controversies on the topic and offer our point of view regarding management and treatment.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91257828","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 : 2018-04-06DOI: 10.18297/jri/vol2/iss1/11
B. Puskur, V. Corcino, Srikanth Ramachandruni, V. Nagarajan, F. Arnold
Dr Bhavani Puskur (Infectious Diseases (ID) fellow): A 54-year-old male active smoker with a history of chronic obstructive lung disease (COPD) on 2 L/min of home oxygen and human immunodeficiency virus-1 (HIV) on antiretroviral therapy with a recent CD4 count of 482 (26%) cells/cc and a suppressed viral load, presented to the Emergency Room (ER) of University of Louisville Hospital with a cough productive of thick, yellow phlegm, dyspnea for 4 days and chest tightness for one day. He complained of having a sore throat, rhinorrhea and nasal congestion during the previous week. He had been using his inhalers at home without significant relief. He denied fever or chills. He had been to the ER multiple times with worsening dyspnea and nonproductive cough, which improved with prednisone and bronchodilators. He declined frequent admission, but this was his third visit to the ER in the last two days; each via emergency medical services transportation. In the ER, his temperature was 36.6°C, blood pressure was 210/141 mmHg, heart rate was 120 beats/min, and respiratory rate 16/min. His oxygen saturation was 98% while wearing a non-rebreather mask. On physical examination, there was no pharyngeal erythema or exudate and sinuses were nontender. He had pursed lip breathing with significant inspiratory wheezing. After administration of a breathing treatment and steroids, there was improved aeration throughout all lung fields with decreased, but still diffuse, expiratory wheezing. A chest X-ray was obtained. (Figure 1) His electrocardiography was unchanged, and troponins were negative. He was admitted to the Intensive Care Unit (ICU) for use of non-invasive ventilation.
博士Bhavani Puskur(传染病(ID)研究员):一名54岁男性主动吸烟史的慢性阻塞性肺疾病(COPD)在2 L / min的氧气和人类免疫缺陷virus-1 (HIV)在482年最近的CD4细胞计数的抗逆转录病毒治疗(26%)细胞/ cc和抑制病毒载量,呈现在路易斯维尔大学医院的急诊室(ER)与咳嗽生产厚,4天黄痰、呼吸困难,胸闷了一天。他说上个星期喉咙痛、流鼻涕、鼻塞。他一直在家里使用吸入器，但没有明显缓解。他否认发烧或发冷。他曾多次因呼吸困难加重和无生产性咳嗽就诊，经强的松和支气管扩张剂治疗后好转。他拒绝频繁入院，但这是他在过去两天内第三次去急诊室;每个都通过紧急医疗服务运输。在急诊室，患者体温36.6℃，血压210/141 mmHg，心率120次/分，呼吸频率16次/分。他戴着非呼吸面罩时血氧饱和度为98%。体格检查未见咽部红斑或渗出，鼻窦无压痛。他撅起嘴唇呼吸，伴有明显的吸气式喘息。在给予呼吸治疗和类固醇治疗后，所有肺区通气改善，呼吸性喘息减少，但仍然弥漫性喘息。胸部x光片。(图1)心电图无变化，肌钙蛋白阴性。他被送入重症监护室(ICU)使用无创通气。
{"title":"Case 2-2017: An HIV-Positive Patient with COPD Admitted to the ICU with Respiratory\u0000 Failure","authors":"B. Puskur, V. Corcino, Srikanth Ramachandruni, V. Nagarajan, F. Arnold","doi":"10.18297/jri/vol2/iss1/11","DOIUrl":"https://doi.org/10.18297/jri/vol2/iss1/11","url":null,"abstract":"Dr Bhavani Puskur (Infectious Diseases (ID) fellow): A 54-year-old male active smoker with a history of chronic obstructive lung disease (COPD) on 2 L/min of home oxygen and human immunodeficiency virus-1 (HIV) on antiretroviral therapy with a recent CD4 count of 482 (26%) cells/cc and a suppressed viral load, presented to the Emergency Room (ER) of University of Louisville Hospital with a cough productive of thick, yellow phlegm, dyspnea for 4 days and chest tightness for one day. He complained of having a sore throat, rhinorrhea and nasal congestion during the previous week. He had been using his inhalers at home without significant relief. He denied fever or chills. He had been to the ER multiple times with worsening dyspnea and nonproductive cough, which improved with prednisone and bronchodilators. He declined frequent admission, but this was his third visit to the ER in the last two days; each via emergency medical services transportation. In the ER, his temperature was 36.6°C, blood pressure was 210/141 mmHg, heart rate was 120 beats/min, and respiratory rate 16/min. His oxygen saturation was 98% while wearing a non-rebreather mask. On physical examination, there was no pharyngeal erythema or exudate and sinuses were nontender. He had pursed lip breathing with significant inspiratory wheezing. After administration of a breathing treatment and steroids, there was improved aeration throughout all lung fields with decreased, but still diffuse, expiratory wheezing. A chest X-ray was obtained. (Figure 1) His electrocardiography was unchanged, and troponins were negative. He was admitted to the Intensive Care Unit (ICU) for use of non-invasive ventilation.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87562731","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 : 2018-04-06DOI: 10.18297/jri/vol2/iss1/12
J. Ramirez
56 ULJRI Vol 2, (1) 2018 Affiliations: 1Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY 40202 DOI: 10.18297/jri/vol2/iss1/12 Abstract Julio A. Ramirez, M.D., FACP, Professor of Medicine/Associate Professor of Microbiology and Immunology; Chief, Division of Infectious Diseases; Director, Infectious Diseases Fellowship Training Program and Founding Director, Global Health Initiative at The University of Louisville, presented “Clinical Research: From Idea to Publication” at University of Louisville Department of Medicine Grand Rounds on February 15, 2018. The talk focused on performing an overview of clinical study designs, describing the planning and performing of a clinical study, reviewing the process for statistical and clinical analysis, and presenting the structure of a Clinical Research Coordinating Center.
{"title":"Clinical Research: From Idea to Publication","authors":"J. Ramirez","doi":"10.18297/jri/vol2/iss1/12","DOIUrl":"https://doi.org/10.18297/jri/vol2/iss1/12","url":null,"abstract":"56 ULJRI Vol 2, (1) 2018 Affiliations: 1Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY 40202 DOI: 10.18297/jri/vol2/iss1/12 Abstract Julio A. Ramirez, M.D., FACP, Professor of Medicine/Associate Professor of Microbiology and Immunology; Chief, Division of Infectious Diseases; Director, Infectious Diseases Fellowship Training Program and Founding Director, Global Health Initiative at The University of Louisville, presented “Clinical Research: From Idea to Publication” at University of Louisville Department of Medicine Grand Rounds on February 15, 2018. The talk focused on performing an overview of clinical study designs, describing the planning and performing of a clinical study, reviewing the process for statistical and clinical analysis, and presenting the structure of a Clinical Research Coordinating Center.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83861712","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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