ABSTRACT
SESSION TITLE: Rare Pulmonary Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Aspergillus is a group of opportunistic endemic fungal species that causes pathology within the respiratory tract and sinuses of individuals with predisposing factors, such as immunosuppression. While less frequently discussed, aspergillosis thyroiditis represents the most common fungal thyroiditis. We present a case of this condition that was misdiagnosed as amiodarone induced thyrotoxicosis. CASE PRESENTATION: A 54-year-old male was evaluated in outpatient pulmonary clinic after a chest CT revealed new upper lobe mass-like pleural based infiltrates with accompanying symptoms of dyspnea on exertion and fevers. His medical history was significant for orthotopic heart transplant 6 months ago due to a combination of non-ischemic cardiomyopathy with further decompensation from COVID-19 infection. After transplant, he was diagnosed with thyrotoxicosis secondary to amiodarone that was being treated with prednisone and methimazole. Given the concern for infection on imaging, he was admitted to the hospital and underwent urgent bronchoscopic evaluation. During the procedure, he was noted to have severe extrinsic tracheal compression. His neck imaging was consistent with a nodular goiter. The BAL revealed Aspergillosis fumigatus and he was subsequently treated with isavuconazium. Given the compression on the trachea and persistent dyspnea, the decision was to pursue total thyroidectomy. Surgery occurred 2 months after treatment was initiated for the Aspergillosis and with improvement on serial chest CTs. Pathologic examination of the thyroid tissue revealed extensive invasive aspergillus with abscesses involving both lobes. DISCUSSION: Aspergillus infection leading to disseminated disease typically occurs in individuals that have a compromised immune system such as seen in malignancy, solid organ transplant, chronic steroid use, and poorly controlled diabetes mellitus. Recently, it has been cited that up to 15% of hospitalized COVID-19 patients requiring intensive care develop aspergillus infection. After initial aspergillosis infection has been established, the thyroid gland is a site for dissemination due to its rich vascular supply. In addition, due to the angioinvasive properties of the pathogen, the fungus can breakdown tissue planes and easily travel from its site of origin. Thereby a primary infection in the respiratory tract can lead to dissemination to the neck structures due to its proximity. When thyroid invasion occurs, the common complaints are neck pain and swelling. Thyroid laboratory findings encompass the full spectrum including hyperthyroidism, hypothyroidism, and euthyroid. Given these non-specific findings, clinicians need to be conscious of this disease entity. CONCLUSIONS: In patients with immunocompromising conditions, findings of neck pain, swelling, and abnormal thyroid laboratory values should broaden the differential for clinicians to include aspergillosis thyroiditis. Reference #1: Alvi, Madiha M et al. "Aspergillus thyroiditis: a complication of respiratory tract infection in an immunocompromised patient.” Case reports in endocrinology vol. 2013 (2013): 741041. doi:10.1155/2013/741041 Reference #2: Marui, Suemi, et al. "Suppurative thyroiditis due to aspergillosis: a case report.” Journal of Medical Case Reports 8.1 (2014): 1-3. Reference #3: Kuehn, Bridget M. "Aspergillosis Is Common Among COVID-19 Patients in the ICU.” JAMA 326.16 (2021): 1573-1573. DISCLOSURES: No relevant relationships by A. Whitney Brown, value=Honoraria Removed 04/03/2022 by A. Whitney Brown No relevant relationships by A. Whitney Brown, value=Honoraria Removed 04/03/2022 by A. Whitney Brown No relevant relationships by A. Whitney Brown, value=Consulting fee Removed 04/03/2022 by A. Whitney Brown No relevant relationships by Kristen Bussa Advisory Committee Member relationship with Boehringer Ingelheim Please note: 2019-2021 Added 04/03/2022 by Christopher King, value=Consulting f e Advisory Committee Member relationship with Actelion Please note: 2019-2022 Added 04/03/2022 by Christopher King, value=Consulting fee Advisory Committee Member relationship with United Therapeutics Please note: 2019-2022 Added 04/03/2022 by Christopher King, value=Consulting fee Speaker/Speaker's Bureau relationship with Actelion Please note: 2019-2022 Added 04/03/2022 by Christopher King, value=Consulting fee Speaker/Speaker's Bureau relationship with United Therapeutics Please note: 2020-22 Added 04/03/2022 by Christopher King, value=Consulting fee No relevant relationships by Haresh Mani No relevant relationships by Mary Beth Maydosz No relevant relationships by Alan Nyquist No relevant relationships by Anju Singhal No relevant relationships by Amy Thatcher
ABSTRACT
Currently humans are employed for temperature screening and mask identification in public places to prevent the spread of COVID-19. We have temperature testing systems for all scanning entrances, but manual temperature scanning has numerous drawbacks. The staff isn't well-versed in the use of temperature scanners. When reading values, there is space for human error. People are often allowed entry despite higher temperature readings or the lack of masks. For large crowds, a manual scanning device is ineffective. Hence there arises a need to have an automatic system that checks for temperature and mask. We propose a fully automated temperature scanner and entry provider system to solve this issue. The system uses a contactless temperature scanner and a camera to capture image. If a high temperature or the absence of a mask is observed, the scanner is connected to a gate like structure that prevents entry. To monitor the entire process, the device uses a temperature sensor and camera connected to a Raspberry Pi system. The main theme of this paper is to automate the entire covid scanning process for reducing risk of spread COVID-19 in highly crowded places such as malls, schools and colleges. © 2021 Author(s).
ABSTRACT
Background: There is increasing evidence that particulate matter (PM) in air (air pollution) is associated with ill health, hospital admission and all-cause mortality. The main source of PM in Western countries is road transport. The aim of this study was to examine the potential carbon footprint of clinics at a district general hospital. Method: A 2-week period at the start of September 2019 was evaluated to calculate the distance patients travelled to clinic compared with the distance to their GP. Distance was calculated using the fastest direct car route between the postcode of the GP and the postcode of the patient's home address. Due to the local geography and transport links, train travel was not considered feasible. Results: 202 patients travelled a combined distance of 1,625 miles to be seen in clinic. The mean distance between the clinic and the patient's home was 8.0 miles, compared with 2.2 miles between patients' homes and their GP. 163 patients were seen in clinic in Kettering General Hospital and 39 in peripheral clinics. Conclusions: Coming to hospital for an appointment has led to 404 more road journeys. Including the return journey, the 3,250 miles travelled is more than driving from Kettering to Baghdad. The study was limited as it was assumed that all patients would be traveling from their home address. While for some patients and some conditions this journey is unavoidable, wider options like increasing the number of virtual clinics and care offered closer to home would help further reduce the carbon footprint. Since the start of the COVID-19 pandemic in March 2020, all clinics have been converted to virtual clinics where possible. The change in practice has demonstrated that, for many patients, virtual consultations can be appropriate. There is a plan to maintain as many virtual clinics as possible in post-COVID practice.