Encephalitis is an inflammatory process of the brain that is most commonly related to infectious etiology; nonetheless, autoimmune encephalitis has been an increasingly identified entity that can cause it as well and should be considered. N-methyl-D-aspartate (NMDA) receptor encephalitis is a recently identified process but remains less recognized than autoimmune encephalitis. We report a case of an 18-year old female who initially presented with seizures and later developed behavioral symptoms of agitation, crying, screaming, and emotional lability. Ultimately, she was found to have NMDA receptor encephalitis related to ovarian paraneoplastic teratoma. The patient was treated with anti-epileptics and intravenous immunoglobulin and underwent oophorectomy that lead to her recovery. This case highlights the importance of early recognition of NMDA receptor encephalitis to facilitate appropriate investigations and management.
Rosacea granulomatosis is a common, chronic skin disorder that primarily affects the central face, namely the cheek, nose, chin, and central forehead. Although rosacea is mainly a disorder of innate and adaptive immunity, a variety of endogenous and exogenous triggers such as Demodex may stimulate it. Often found as commensal organisms in human skin, Demodex can be parasitic if there is a change in the host's cutaneous environment. This is especially relevant for immunosuppressed patients, who need prompt treatment to prevent further complications. We review the literature regarding rosacea granulomatosis in immunosuppression and present an acute myelogenous leukemia patient with severe neutropenia, which may have promoted the development of rosacea due to Demodex mite proliferation. This local proliferation of the ectoparasite on the face can cause an atypical skin rash that mimics severe infections in the setting of neutropenia.
BackgroundImproving efficiency of documentation and sign outs during transitions of care were identified as areas of interest by the University of South Florida Infectious Disease (ID) Division. Our aim is by May 2018, we will achieve >50% improvement in our ID EMR note efficiency score for any adult patient at Tampa General Hospital. Note efficiency score involves listing all of the following key elements with 1 point awarded for each: active problem in the subjective section, updated hospital course under assessment, active problem prioritized first under assessment and non-relevant problems removed from assessment.MethodsInstitute of Healthcare Improvement’s model with Plan-Do-Study-Act (PDSA) cycles was used for project implementation from March 2018 to May 2018 (Figure 1). Cycle 1: Conducting a needs assessment survey and education. Cycle 2: Changing the existing template and implementing a new standardized template that includes the key elements, along with removal of auto populated non relevant information. Audits of notes with a 4-point system scoring was done. A pre and post implementation physician survey was conducted.ResultsID fellow and faculty completed the baseline survey (N = 25). Less than half (46%) felt that they could interpret patient assessments with ease and even fewer respondents (36%) felt there was adequate weekend sign out. More than one-third (36%) reported writing majority of notes after 5 pm (Figure 1). Pilot project involved nine ID faculty and fellows. We had 95% compliance with use of the standardized EMR template. Notes were evaluated at baseline (n = 190), cycle 1 (n = 85), and cycle 2 (n = 56). An increase in average note efficiency score from baseline, cycle 1 and cycle 2 occurred as follows (Mean ± SD): 2.0 ± 0.84 vs. 2.8 ± 0.95 vs. 3.6 ± 0.5 (Figure 2). Compared with baseline, cycle 2 achieved 42% improvement in the ease of interpretation of patient assessments and 41% improvement in adequate sign out. No increase in note writing after 5pm (36% vs. 30% baseline and cycle 2, respectively) reported.ConclusionTargeted education and changing the EMR note template can achieve improved efficiency of ID note. These efforts to improve documentation enhance physician’s ease of interpretation of patient assessments and sign out during transition of care. Disclosures All authors: No reported disclosures.
BackgroundUrinary tract infection (UTI) is one of the most common infectious diagnoses and in 2007 accounted for 10.5 million primary care visits in the US Advancing age and comorbidities, such as chronic kidney disease (CKD) and diabetes, affect antimicrobial prescribing habits. Sulfamethoxazole/trimethoprim (SMX-TMP), nitrofurantoin, and fosfomycin are first-line recommendations for uncomplicated cystitis. In an aging male population with potential allergies or contraindications to the above, fosfomycin is a potential option for treatment.MethodsA retrospective chart review of fosfomycin prescribing habits at a large VA academic medical center. Patients were selected based on fosfomycin prescription in both inpatient and outpatient settings from January 1, 2004 to December 5, 2017. Data reviewed included indication, organism(s), susceptibility, duration of treatment, CKD, and clinical success. Treatment success was defined as no representation with UTI symptoms for 30 days.Results117 cases of UTI in which fosfomycin was used were identified with a median patient age of 70 years old and 90% male. Twenty-five were uncomplicated cystitis, 49 complicated cystitis, and 34 catheter associated infections. Treatment success was obtained in 92% of the uncomplicated cystitis cases, 76% in complicated cystitis cases, and 67% in catheter associated UTIs. In half of all the cases an ESBL bacterium was isolated and 79% were successfully treated with fosfomycin. The most common pathogen identified was E. coli 58/118 (49%), followed by Klebsiella 25/118 (21%).ConclusionFosfomycin is an antibiotic recommended for simple cystitis due to its safety profile, less collateral damage (gut flora disturbance), and low resistance as currently known. This review displays the largest ESBL cohort identified in the literature and uniquely used in a predominant male population. These findings suggest that ESBL producing bacteria can be treated successfully with fosfomycin in a male population as well as uncomplicated cystitis. However, caution should be used with catheterized patients as treatment was less effective regardless of isolated bacteria.Disclosures All authors: No reported disclosures.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.