Lemierre's syndrome is also known as postangina septicemia, which is commonly caused by Fusobacterium necrophorum also known as Necrobacillus and also by other microorganisms like Staphylococcus, Streptococcus, Peptostreptococcus, and Bacteroides. Though the disease starts as an upper respiratory tract infection, it may spread and cause thrombophlebitis of the internal jugular vein. It may present itself through cranial nerve palsy or sepsis involving distant organs like the lungs or bones. It is also known as forgotten disease because of its rarity. Fusobacterium necrophorum usually causes infection in animals and rarely affects humans. We hereby present a case of Necrobacillus infection which did not cause any thrombophlebitis but resulted in severe pneumonia and acute kidney injury, leading to respiratory failure and requiring mechanical ventilation.
Thrombotic storm (TS) is a rare, acute, hypercoagulable state characterized by multiple thromboembolic events affecting at least two different areas of the vascular system/organs over a short period of time. Typical triggers include inflammation, infections, minor trauma, surgery, pregnancy, and the puerperium. A single thrombotic event can set off a number of thromboembolic events, often including unusual locations like hepatic, portal, or renal veins, skin (purpura fulminans), adrenal glands, and cerebral sinus venous thrombosis. Usually, younger female patients are affected; in some patients, there is an association with an autoimmune disorder like lupus erythematosus, and they show evidence of antiphospholipid antibodies or other phenotypic expressions of anticoagulation disorders. The majority of patients have no previous history of thromboembolism. As the diagnosis of thrombotic storm relies solely on clinical symptoms with a lack of specific diagnostic tests, this can result in a delay of diagnosis. The treatment consists of uninterrupted lifelong anticoagulation. Sometimes immunomodulatory therapies have been used. The distinction between extensive thrombotic events like Heparin Induced Thrombosis (HIT), Thrombotic Thrombocytopenic Purpura (TTP), Antiphospholipids Syndrome (APS), and TS can sometimes be difficult, and the etiology of TS remains uncertain.
Objective: As patients refusal has been a major issue in diagnosing the disease, we carried out this study to determine the magnitude of the refusal or denial of suspected COVID 19 cases. Methods: All patients seen with COVID 19 symptoms in medical out doors and emergency in Bahria International Hospital, Lahore in two weeks period from April 15, 2020 to April 30, 2020 were included in study. COVID 19 symptoms were ascertained on WHO guidelines labelling patients as COVID 19 suspected through laboratory tests. Depending upon results individual consultation with each patient was arranged to convince them to carry out nasopharyngeal swab for SARS Co-V-2 PCR. Some patients refused despite counselling for follow up regarding symptoms and advised tests. The public fear was the main barrier for the suspected cases to get tested. Each patient who refused PCR test was labelled as in denial. Results: Of the 40 cases diagnosed as suspected COVID 19. 21 refused to get tested. Majority (15) were male. Fever with chills was common among all with majority presented with shortness of breath (43%) followed by diarrhea (33%) and chest pain (9%). Conclusion: Patients who remain in denial pose a great threat to society as by spreading the virus or deteriorating themselves. An effective campaign on government level should be run to overcome the fear which has made this infection a social stigma to help contain this pandemic in a resource scarce country like Pakistan. Keywords: Coronavirus denial, COVID-19 denial, COVID in Pakistan, Public reaction to COVID 19 How to cite: Pervaiz R., Rana A.M., Qayyum A.M., Munawar A., Tariq S., Lashari A.A. Patient denialism for COVID19 pose difficulty for treating Physicians. Esculapio 2021;17(02):183-186.
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