Nocardiosis is a rare opportunistic infection, especially seen in immunocompromised patients, including renal allograft recipients. Primary pulmonary infection is the most common clinical pattern and can easily result in disseminated Nocardia infection if treatment therapy is not adequate at the beginning. We report a case of pulmonary nocardiosis associated with cytomegalovirus retinitis in a renal transplant recipient, followed by chronic allograft dysfunction. Our patient was a 50-year-old male renal allograft recipient, with diabetes mellitus and hypertension, who was diagnosed with pneumonia and cytomegalovirus retinitis. High-resolution computed tomography scan of the thorax and bronchoscopy revealed nocardial pneumonia. The patient responded well to ceftriaxone and was later switched to oral minocycline. To our knowledge, this is the first report of a successful treatment of co-infection with Nocardia pneumonia and cytomegalovirus retinitis in a renal transplant patient, with early diagnosis and prompt treatment.
Purpose
The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis in these patients is very much concerning. COVID-19-associated mucormycosis was detected in huge numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucormycosis (CAM).
Methods
A multicenter retrospective study across three tertiary health care centers in Southern part of India was conducted during April-June 2021.
Results
Among the 217 cases of CAM, mucormycosis affecting the nasal sinuses was the commonest, affecting 95 (44%) of the patients, orbital extension seen in 84 (38%), pulmonary (
n
= 25, 12%), gastrointestinal (
n
= 6, 3%), isolated cerebral (
n
= 2) and disseminated mucormycosis (
n
= 2). Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAM patients. The mucormycosis-associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucormycosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucormycosis patients.
Conclusion
Judicious and appropriate management of the predisposing factor and factors affecting mortality associated with CAM with multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.
Serum uric acid levels are an ideal marker in sepsis cases to assess oxidative stress and to predict disease prognosis. Elevated serum uric acid levels are associated with chronic disease conditions such as chronic kidney disease (CKD), cardiovascular disease (CVD). The present study was designed to assess the correlation between Hyperuricemia and mortality and morbidity in cases with clinically diagnosed sepsis. A total of 94 cases with a working diagnosis of sepsis above 18 years of age were recruited. The duration of hospital stay, mechanical ventilation, acute respiratory syndrome and acute kidney injury was noted. Patient discharge or death was considered an outcome of the sepsis. The most prevalent comorbidity was type 2 diabetes (44.68%), followed by type 1 diabetes (8.5%), type 2 diabetes with systemic hypertension (4.25%), chronic kidney disease (3.19%), cerebrovascular accident (3.19%), severe pulmonary disease (2.12%) and malignancy (2.12%). 59% cases had uric acid levels <7mg/dl and 41% had uric acid levels >7mg/dl. The comparison of uric acid levels with comorbidities (p=0.022), duration of hospital stay (p=0.003) and associated complications (p=0.003) was statistically significant. Hyperuricemia on patient arrival to the MICU with sepsis was associated with poor clinical outcome. High mortality rate was associated in cases with elevated uric acid levels.
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