ABSTRACT
AIM: To assess the prevalence and patterns of ocular involvement in disseminated candidiasis in intensive care setting. MATERIALS AND METHODS: Institutional review board approved case review of intensive care admissions. These were patients of septicemia who had undergone ocular examination as part of their initial assessment. The records of patients in whom Candida spp. was detected in two sites or had a clinical diagnosis of candidemia were analyzed. RESULTS: Twelve patients (nine male, three female) were diagnosed with candida-induced sepsis during this period. Their ages ranged from 26 to 97 years (mean 52.7 years). Six patients (50%) had ocular lesions. The commonest lesion was chorioretinitis, seen in seven eyes of six patients followed by Roth spots seen in one eye. There was no evidence of vitritis or endophthalmitis in any eye. Systemic immunosuppression was present in three of six (50%) patients with ocular changes. Incidental findings included two eyes with non-proliferative diabetic retinopathy. CONCLUSIONS: Any suspicion of disseminated candidiasis should prompt an ocular evaluation which may help in the early diagnosis and in the institution of early antifungal therapy. This may reduce ocular morbidity and patient morbidity.
Subject(s)
Adult , Aged , Aged, 80 and over , Antifungal Agents/therapeutic use , Candida/isolation & purification , Candidiasis/complications , Chorioretinitis/diagnosis , Diabetes Complications , Female , Fluconazole/therapeutic use , Humans , Immunocompromised Host , India/epidemiology , Intensive Care Units , Male , Middle Aged , Prevalence , Sepsis/microbiologyABSTRACT
A three year prospective study of a total of 62 critically ill HIV patients in MICU showed a rising percentage from 0.86 in 1992 to 3.17 in 1994. Four major presentations were observed, neurological-20 patients (32.5%), sepsis syndrome-18 (29%), poisoning-10 (16.1%) and miscellaneous-14 (22.6%). Acute poisoning emerged as the most important preventable indication for MICU admissions. Interventions like CVP and haemodynamic monitoring-25 patients, endotracheal intubation-18, mechanical ventilation-14, tracheostomy-3, haemodialysis-3 were done when indicated. The mortality of the 14 ventilated patients was high at 92.9% compared to the overall HIV mortality of 46.8%. This study shows that critically ill HIV patients do deserve intensive care management with optimum infection control precautions. Survival of 53.2% is noteworthy in a resource stretched set up.
Subject(s)
Adult , Aged , Child , Disease Transmission, Infectious/statistics & numerical data , Female , HIV Antibodies/analysis , HIV Infections/epidemiology , HIV-1/immunology , HIV-2/immunology , Hospital Mortality , Humans , India/epidemiology , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Prospective Studies , Survival Rate/trendsSubject(s)
Anti-Bacterial Agents/therapeutic use , Digitalis/therapeutic use , Endocarditis, Bacterial/diagnosis , Female , Humans , Middle Aged , Phytotherapy , Plants, Medicinal , Plants, Toxic , Pseudomonas/isolation & purification , Pseudomonas Infections/diagnosis , Ventricular Dysfunction, Right/diagnosisABSTRACT
One hundred patients with Multiple System Organ Failure (MSOF) were studied. The precipitating factors were infections, poisoning, metabolic disorders, surgical disorders and cardiac arrest resulting in an overall mortality of 65%. Mean inpatient stay was 3.86 days, being significantly longer in patients who survived (6.25 days). Age, sex, addictions and premorbid health did not affect outcome. GIT (89%), CNS (81%) and Liver failure (62%) were seen most commonly. Highest mortalities were observed with RS (81.2%), CVS (80.37%) and CNS (76.5%). The mortality with 2,3,4,5,6 and 7 OSF was 8.3%, 18.7%, 70%, 92%, 100% and 100% respectively. The mortality was highest (50.76%) on the first day of MSOF and during the initial 48 hours of the total duration of disease. The method proposes an easily reproducible way to evaluate severity of illness and predicting outcome in acute MSOF.