Photobacterium damsela (formerly Vibrio damsela) is a pathogen found in both immunocompromised and healthy hosts. It can cause rapid, fulminate infections, such as septicemia, and is associated with a high death rate. Infections generally result from the exposure of subcutaneous tissue to contaminated seawater or from fish-fin puncture wounds [1]. The pathogen can also be transmitted through water or food [2,3]. Here, we discuss the case of a patient with liver cirrhosis who, following his consumption of raw seafood, developed P. damsela septicemia that subsequently resulted in fatal hepatic dysfunction.A 46-year-old man was admitted to our hospital with a 1-day history of fever, abdominal pain, and dyspnea. He had been diagnosed with Child-Pugh Class B alcoholic cirrhosis 2 years prior to presentation and had not consumed alcohol for the last year. The patient had eaten marinated raw fish the day before the symptoms started. On physical examination, his blood pressure was 110/60 mmHg, the pulse rate was 135 beats/min, the respiratory rate was 38/min, and his body temperature was 38.8°C. Abdominal examination revealed diffuse tenderness over the whole abdomen, diminished bowel sounds, and distension. The results of the laboratory tests were: hemoglobin concentration, 9.1 g/dl; leukocyte count, 7,090/l (21% band, 71% poly, 7% lymph); platelet count, 68,000/l; serum creatinine level, 2.0 mg/dl; serum bilirubin level, 8.4 mg/dl; serum albumin level, 2.0 g/dl; prothrombin time, 27.7 s. The arterial blood gas analysis showed metabolic acidosis (pH 7.05, pCO 2 17.6 mmHg, pO 2 83.3 mmHg, HCO 3 10 mmol/l). The ascitic fluid analysis revealed an albumin level of 0.3 g/dl and a leukocyte count of 12,050/l (100% poly). Early esophageal varices were observed during an upper gastrointestinal endoscopy. Coarse hepatic parenchymal echogenicity, ascites, and splenomegaly were evident on the abdominal ultrasonograph. Blood cultures were taken within 1 h of admission to hospital. The ascitic fluid was inoculated in aerobic and anaerobic blood culture bottles simultaneously [4].Three days after admission, analysis of the blood cultures using the BACTEC 9240 blood culture system (Becton Dickinson, Sparks, MD, USA) revealed Gramnegative bacilli that were subsequently identified as P. damsela using a VITEK GN card (bioMé rieux, Marcyl'Etoile, France). The phenotypes of this strain were analyzed biochemically using the API 20E test (bio-Mé rieux), as per the manufacturer's instructions. In this test, 20 conventional substrates are inoculated with a 0.85% saline suspension of the organism being tested. O'Hara et al. [5] found that the identification of P. damsela using the API and VITEK GN system was 100% accurate. The strain tested positive for glucose fermentation and the oxidase, urease, and arginine dihydrolase activity tests. The indole test was negative. The MIC of various antimicrobial agents for this isolate was determined by the microbroth dilution method using graded concentrations of antimicrobial agents [6]. This strain was ...
BackgroundRheumatoid arthritis is a systemic disease with various extra-articular symptoms. Anemia is common comorbidity of RA.ObjectivesThe purpose of this study is to compare the effect of tocilizumab and TNF-α inhibitors on hemoglobin changes and disease activity changes in RA patients. This study aims to determine whether tocilizumab is more effective in controlling hemoglobin elevation and disease activity in patients with anemia.MethodsThe data in this study derived from the Korean College of Rheumatology Biologics (KOBIO) registry. OF the patients registered in KOBIO registry, patients using tocilizumab and TNF-α inhibitors were enrolled in this study. To exclude the effects of previously used biologic DMARDs, patients who started the first biologic DMARDs and have been using one biologic DMARD for more than 1 year were included in this study. Anemia was defined as Hb levels <12.0 g/dL in women and <13.0 g/dL in men according to the World Health Organization (WHO) criteria at index date.ResultsAmong rheumatoid arthritis patients with anemia, there were 126 patients in the tocilizumab group and 248 patients in the TNF-α inhibitor group. Initial and follow-up data collected after 1 year of biologic use were analyzed. After initiation of treatment, Hb and Hct were significantly elevated in tocilizumab group. Mean increases in Hb and Hct were 1.56 and 3.53 in tocilizumab group, 1.02 and 2.64 in TNF-α inhibitor group. DAS28-ESR and RAPID3 decreased significantly in tocilizumab group after using biologics. In tocilizumab group, DAS28-ESR decreased by 3.35 and RAPID3 decreased by 8.31. The changes in SJC, PGA, PhGA, SDAI and CDAI were not different between the two groups. Multivariate analysis was performed using the TNF-α inhibitor group as a control. Tocilizumab was more effective than TNF-α inhibitors in increasing Hb.ConclusionIn RA patients with anemia, although tocilizumab was more effective than TNF inhibitors in increasing Hb, there was no difference between the two drugs in controlling disease activity. During the course of this research, the results of the DAS28-ESR and other outcome measures did not match. In patients treated tocilizumab, assessment of disease activity using the DAS28-ESR may be overestimated due to its effect on acute phase reactant values.Table 1.Comparison of hemoglobin and disease activity between initial and 1 year follow up in anemia patientsTocilizumab (n=126)TNFi (n=248)Between-Group Difference in Changep-valueaMeasurementBaseline1 year changeBaseline1 year changeHB10.95 (10.77, 11.13)1.56 (1.33, 1.80)11.04 (10.93, 11.15)1.02 (0.86, 1.18)0.55 (-2.00, 3.09)<.001HCT34.05 (33.60, 34.51)3.53 (2.90, 4.17)34.07 (33.76, 34.38)2.64 (2.20, 3.09)0.89 (-6.05, 7.84).013TJC7.63 (6.68, 8.58)-5.97 (-6.92, -5.02)9.40 (8.46, 10.35)-7.43 (-8.32, -6.54)1.46 (-10.79, 13.72).023PTGA7.14 (6.79, 7.48)-3.76 (-4.20, -3.31)6.88 (6.64, 7.13)-3.51 (-3.86, -3.16)-0.25 (-5.48, 4.98).370PhGA6.25 (5.93, 6.57)-3.39 (-3.80, -2.98)6.59 (6.35, 6.82)-3.67 (-4.01, -3.32)0.28 (-4.69, 5.24).288ESR53.84 (48.78, 58.90)-43.31 (-48.37, -38.24)55.7 (52.12, 59.28)-26.85 (-30.59, -23.10)-16.46 (-73.46, 40.54)<.001CRP3.08 (2.47, 3.68)-2.75 (-3.39, -2.12)2.69 (2.33, 3.06)-1.87 (-2.28, -1.47)-0.88 (-7.56, 5.80).015SDAI29.8 (27.87, 31.73)-20.68 (-22.74, -18.62)30.27 (28.89, 31.65)-20.64 (-22.18, -19.10)-0.04 (-23.38, 23.30).914CDAI26.73 (24.94, 28.52)-17.93 (-19.86, -16.00)27.58 (26.29, 28.87)-18.75 (-20.17, -17.33)0.83 (-20.86, 22.51).377SJC6.62 (5.76, 7.48)-5.57 (-6.45, -4.69)7.53 (6.79, 8.26)-6.37 (-7.07, -5.67)0.80 (-9.52, 11.11).144DAS28-ESR5.68 (5.49, 5.87)-3.35 (-3.58, -3.12)5.77 (5.65, 5.89)-2.59 (-2.77, -2.41)-0.76 (-3.39, 1.87)<.001RAPID316.66 (15.63, 17.69)-8.31 (-9.42, -7.19)15.23 (14.5, 15.97)-6.82 (-7.65, -5.99)-1.49 (-14.09, 11.12).034REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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