Dengue hemorrhagic fever/ dengue shock syndrome in a patient with hereditary spherocytosis

BACKGROUND: Dengue Hemorrhagic Fever/Dengue Shock Syndrome (DHF/DSS) occurs only in a small number of dengue fever (DF).This condition,when coupled with a form of congenital hemolytic nemia called Hereditary Spherocytosis (HS), will turn a relatively manageable case of DF into a complicated condition with very poor prognosis. CASE PRESENTATION: Here we report a case of a 19-year-old male student from Manila who came in with fever,jaundice, and dengue warning signs. He was also diagnosed with HS. This compounding infection initiated a hemolytic crisis of his HS, causing severe bleeding and multiple organ failure on top of DHF/DSS. The progression of the disease started with bleeding, and later on with altered sensorium (encephalopathy), respiratory failure, and ultimately, demise. CONCLUSION: DHF/DSS together with HS may cause a hemolytic crisis. High RBC turnover and heightened erythroid marrow activity in HS makes a patient vulnerable to develop aplastic crisis due to dengue virus infection. Erythroid marrow failure may result in profound anemia, heart failure, hypoxia, cardiovascular collapse, and death.

Clinical profile and outcome of Stenotrophomonas maltophilia infections among adult patients admitted at the University of Santo Tomas Hospital: A seven-year retrospective study

INTRODUCTION: Stenotrophomonas maltophilia is an aerobic gram-negative rod of low virulence. However, it is becoming an important cause of nosocomial infections usually among susceptible patients. More data in the local setting is needed to help clinicians recognize this emerging cause of infection. OBJECTIVE: Determine the clinical profile and outcome of S. maltophilia infections among adult patients admitted at the University of Santo Tomas Hospital over a period of seven years. METHODOLOGY: This is a retrospective descriptive study. Medical records of all patients > 18 years old admitted and assessed to have S. maltophilia infection from January 1, 2006 to December 31, 2012 were available for review. RESULTS: Medical charts of 66 patients with S. maltophilia infection were reviewed. Seventy-two percent of these were hospital-acquired, whereas 28% were from the community. Most patients were male (57.6%), with a mean age of 68.97 ± 15.5 years. The lungs were the most common foci of infection (75.6%). Most common co-morbid illnesses were hypertension (54.5%) and diabetes mellitus (39.4%). Forty eight percent were on mechanical ventilatory support. Ninety five percent had invasive devices most notably indwelling urinary catheter (43%) and internal jugular catheter (13.6%). Fifty six percent (56.1%) received antibiotics prior to onset of S. maltophilia infection. Thirty six percent (36%) had polymicrobial infections associated with S. maltophilia. The organisms most frequently isolated were Klebsiella pneumonia (29.2%), Pseudomonas aeruginosa (25%), and Staphylococcus aureus (16.7%). Sixty percent of the isolates were fully susceptible to the recommended antibiotics. Only 1.5% were found to be multi-drug resistant. Majority (57.6%) of the patients were discharged improved, while 4.5% died due to S. maltophilia infection and 25.8% died from other causes mostly myocardial infarction. CONCLUSION: Stenotrophomonas maltophilia infections were mostly hospital acquired. Most of the organisms were isolated from the respiratory tract. Most commonly associated co-morbid illnesses included hypertension and diabetes mellitus. Other associated factors included mechanical ventilatory support, prior antibiotics use, and presence of indwelling catheters. Most of the isolates remained susceptible to the recommended antibiotics, however, a fraction were resistant, most notably to Cotrimoxazole. Majority of the patients were discharged improved. Mortality attributable to S. maltophilia was only 4.5%.

Clinical profile and outcome of infections among adult leukemia patients with febrile neutropenia admitted at the University of Santo Tomas Hospital

INTRODUCTION: Ferbile neutropenia is considered a medical emergency and remains a major cause of morbidity and mortality among cancer patients. In this population, infections are often characterized by the lack of significant clinical findings during physical examination and a clear focus of infection, perhaps because of the inability to mount an adequate inflammatory response. It has long been recognized that any delay in treatment may result in a higher risk of mortality especially when caused by highly virulent pathogens such as Pseudomonas aeruginosa.OBJECTIVE: To determine the clinical profile and disease outcome of the various infections an adult patient with leukemia who developed febrile neutropenia admitted at the University of Santo Tomas Hospital from January 1,2010 to July 31,2013.METHODOLOGY: This is a three and a half year retrospective descriptive study. Medical records of all patients >18 old with leukemia, who were admitted and assessed to have infection which developed at the time of the neutropenia were included.RESULTS: A total of 44 cases of leukemia with febrile neutropenia were reviewed. There was equal distribution between genders. Mean age was 39.64 years. Majority of patients had acute myelogenous leukemia (AML) [72.7%, (32/44)]. All patients had sepsis, where two, (4.5%) manifested with shock. Co-morbidities included hyperthyroidism (9.15%), diabetes milletus (DM) (6.8%), and hypertension (6.8%). Cefepime [40.9% (18/44)] and meropenem [31.8%, (14/44)] were the most coon antimicrobial agents used to treat neutropenic patients.All of the patients had blood cultures, however, only 12, (27.3%) yielded positive results. Among those with negative culture results, 18.8% received antibiotics prior to collection of blood. Other specimens tested sputum and urine. Among those with positive results, the most common organisms isolated were E. coli [33.3%, (4/12)] followed by Enterobacter cloacae [16.7%, (2/12)]. Other organisms isolated include Aeromonas hydrophilia , Pseudomonas aeruginosa , Stenotrophomonas maltophilia , coagulase-negative straphylococci (CoNS), and viridans streptococci.Nineteen (43.2%) patients had pneumonia, while five (11.4%) patients had urinary tract infection. Seventeen (38.6%) patients had no known focus of infection despite aggressive search. Culture positivity was observed more frequently among those with profound neutropenia [91.7% (11/12)] and those with Multinational Association for Supportive Care in Cancer (MASCC) score of less than 21 [100%, (6/6)].Thirty seven (84%) of patients were discharged improved, (six 14%) died due to infection and one patients was discharged against medical advice. Mortality was high among those with profound neutropenia, (6/6, 100%) and those with MASCC score of less than 21 [100%, (6/6)].CONCLUSION: Acute myelogenous leukemia cases comprised majority of febrile neutropenic patients. All patients had sepsis commonly involving the lungs. Co-morbidities included hyperthyroidism, DM and hypertension and few patients had prior use of antibiotics. Blood culture was positive in more than one fourth of the population. The most common organisms isolated were E. coli followed by Enterobacter cloacae. Mortality was high among patients with profound neutropenia and MASCC score of less than 21.