Clinical Outcome of COVID-19 Patients Presenting With Gastrointestinal Symptoms.

Background Patients with coronavirus disease 2019 (COVID-19) usually have fever and respiratory tract complaints; however, many report gastrointestinal (GI) symptoms. The frequency of GI symptoms ranges from 16% to 61%. Although COVID-19 morbidity and mortality are related to pulmonary disease, poor outcomes have been linked to GI symptoms. Therefore, this study aimed to determine the outcomes of COVID-19 patients who presented with GI symptoms. Methods We conducted a retrospective cohort study at Isra University Hospital in Hyderabad, Pakistan, from April 2020 to October 2020. Results In total, 395 polymerase chain reaction-positive individuals were included. No differences in age or comorbidities were found. Of the 84 patients who needed intensive care unit admission, 17 had GI symptoms (P= 0.357). Moreover, GI symptoms were reported in 9/42 patients who required mechanical ventilation (P = 0.674) and 35/184 patients who required non-invasive ventilation (P = 0.029). GI symptoms were reported in 47/206 patients discharged on room air (without supplemental oxygen) (P= 0.549), 11/77 who died (P = 0.025), 2/11 who were referred elsewhere due to financial issues (P = 0.999), 7/32 who left against medical advice (P = 0.764), and 28/69 who were discharged requiring oxygen at home (P = 0.001).  Conclusions Patients with GI symptoms had reduced odds of mortality, and increased odds of discharge requiring supplemental oxygen.

A Rare Case of Brain Abscesses Caused by Acremonium Species.

Acremonium species are saprophytic fungi that are rarely pathogenic in humans. According to several reports, Acremonium species can cause various diseases, ranging from superficial infections after traumatic inoculation in immunocompetent individuals to invasive infections in the immunocompromised. To the best of our knowledge, this is the first case report of brain abscess in an 18-year-old male caused by Acremonium species in Pakistan. A combination of intravenous amphotericin B and oral voriconazole was administered to the patient, which resulted in marked clinical improvement. However, the recurrence of fungiwas observed after three months of completion of the antifungal course. The purpose of this report is to alert clinicians regarding this pathogen and its ability to cause systemic disease.

A Case Report on Dengue Encephalitis With Optic Neuropathy.

The dengue virus is a type of Flavivirus, responsible for causing dengue fever. It mostly prevails in tropical and subtropical countries, with Southeast Asia reporting the greatest disease burden. The virus can affect a multitude of organ systems and the disease spectrum varies from a mild flu-like illness to severe dengue hemorrhagic fever or dengue shock syndrome. Two serotypes, DENV-2 and DENV-3, have been most frequently associated with neurological complications. We report a case of a 19-year-old male presented with signs and symptoms of encephalitis and optic neuropathy, following a diagnosis of dengue fever. Our diagnosis was supported by findings from brain MRI, electroencephalogram, fundoscopy, and a visual evoked potential test. A high-dose intravenous steroid therapy was given in pulses, which resulted in complete visual and neurological recovery. Dengue fever can present with atypical findings due to its propensity to affect multiple organ systems throughout the body. Neurological involvement is not uncommon and hence, clinicians should be aware of such systemic manifestations in order to diagnose promptly. Effective and timely treatment can reduce associated morbidity and result in complete recovery.

An Unusual Case of Extensively Drug Resistant Typhoid Fever.

Enteric fever is a potentially fatal multisystemic illness caused primarily by Salmonella typhi and, to a lesser extent, by Paratyphi A, B, and C. Emergence of resistance has depleted the antimicrobial arsenal overtime, making treatment challenging and costly. In 2016, a new extensively drug resistant (XDR) strain of Salmonella typhi emerged in Sindh, which only responds to two antibiotics--carbapenems and azithromycin. Its clinical spectrum is not yet clear but increased morbidity and mortality is being observed with it. We present a severe case of XDR Salmonella typhi where the clinical course was complicated by delayed defervescence, severe hepatitis, soft tissue infection, and profuse lower gastrointestinal bleeding, which responded to a combination of carbapenem and azithromycin and an invasive procedure to contain bleeding from the cecal artery. The purpose of this case report is to highlight the morbidity, cost, and therapeutic challenges associated with severe XDR Salmonella typhi infection.