Background: Leptospirosis is an emerging spirochetal zoonosis worldwide. It is underreported and under diagnosed in India. The clinical manifestations of Leptospirosis range from an asymptomatic illness, self-limiting systemic infection to severe and potentially fatal disease. Approximately 1 million severe cases occur per year. Aims and Objectives: To study the clinical profile of acute onset fever (less than 7 days) that are IgM positive for leptospira and to study their in hospital outcome. Methods: This observational study was conducted in Dr. Hedgewar Hospital, Aurangabad, Maharashtra. The IgM positive leptospirosis patients admitted during January 2014 to December 2018 were included in the study. The information on demographic and clinical profile of these patients was recorded and analyzed based on modified Faine's criteria. Their in hospital outcome was assessed. Result: The study included 62 leptospirosis IgM positive patients. The mean age was 38.14±15.84 years. All patients presented with fever. Acute Respiratory Distress Syndrome (ARDS) was the most common complication seen in 48.38%. Case Fatality Rate (CFR) was found to be 16.12% (10 out of 62) patients. Conclusion • High proportion of cases indirectly reflects the endemic nature of the disease. • The clinical presentation of leptospirosis is highly protean and may vary from sub-clinical to mild illness to life-threatening complications and death.
Introduction: Cryptogenic Organizing Pneumonia (COP) earlier known as 'Bronchiolitis Obliterans with Organizing Pneumonia' (BOOP), is a rare lung condition in which the bronchioles, alveoli and the walls of small bronchi become inflamed and plugged with connective tissue. The condition is called "cryptogenic" because the cause is unknown. Aim: To study clinical and radiological spectrum of cases reported as COP. Materials and Methods: This is an observational study including secondary data analysis. The medical records, clinical and radiological profiles of COP patients, visiting Dr. Hedgewar Hospital, Aurangabad (2016-2019) were analyzed. Result: The Study included 25 cases. The urban: rural ratio was 14:11. Male: Female ratio was 14:11. The presenting symptoms were mainly Progressive dyspnoea (72%) and Dry cough (68%). Co-morbidities were observed in 72% patients and 28% patients required assisted ventilation. The radiological features were bilateral patchy opacities in 36%, unilateral consolidation in 24%, reticulo-nodular opacities in 8% patients. 32% of Chest Xray were reported as normal. HRCT Lung showed Ground Glass Opacities in 44%, Sub pleural And Interstitial Thickening in 23%, Multiple Nodular Enhancements in 14%, Cystic Changes and Traction Bronchiectasis in 15% and Others (Crazy paving, cavitory changes) in 4% patients. Steroids were administered in 48% patients. The mortality was 20%. The survivors (80% patients) showed clinical improvement. Elderly population, co-morbidities, smoking and ventilator support were the high risk factors for the outcome. Conclusion: COP has varied clinico-radiological spectrum. A high index of suspicion will lead to proper diagnosis and management resulting in better outcome. The steroid therapy resulted in better outcome.
Cefuroxime auxetil is a second-generation cephalosporin antibiotic that can cause immediate hypersensitivity reactions, ranging from mild urticaria to severe anaphylactic shock. Anaphylactic reactions typically involve multiple systems, notably the skin, the respiratory and cardiovascular systems. Here, we report an unusual case presented with anaphylaxis secondary to IV cefuroxime administration with no history of any allergic reaction to date. There was no family history of allergic reactions. A 54 years old male was diagnosed witha left knee meniscal injury and so was posted for arthroscopy. He was given IV cefuroxime (ZOCEF) 1.5 gm intravenously preoperatively and the patient collapsed immediately. The patient developed chills with rigor, change in voice, profuse sweating, itching and rash all over the body, severe chest pain, difficulty in breathing, abdominal pain, vomiting, and drowsiness. The patient had hypotension with cold peripheral extremities. He was severely drowsy, and arousable only after deep stimuli. The patient was resuscitated successfully with IV fluids and steroids. This case shows that clinicians must be cautious while giving a drug in any form to apatient in OPD or IPD.
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