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Warkentin TE. Limb Ischemic Necrosis Secondary to Microvascular Thrombosis: A Brief Historical Review. Semin Thromb Hemost 2024; 50:760-772. [PMID: 38688305 PMCID: PMC11167199 DOI: 10.1055/s-0044-1786356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Ischemic limb injury can be broadly classified into arterial (absent pulses) and venous/microvascular (detectable pulses); the latter can be divided into two overlapping disorders-venous limb gangrene (VLG) and symmetrical peripheral gangrene (SPG). Both VLG and SPG feature predominant acral (distal) extremity ischemic necrosis, although in some instances, concomitant nonacral ischemia/skin necrosis occurs. Historically, for coagulopathic disorders with prominent nonacral ischemic necrosis, clinician-scientists implicated depletion of natural anticoagulants, especially involving the protein C (PC) system. This historical review traces the recognition of natural anticoagulant depletion as a key feature of nonacral ischemic syndromes, such as classic warfarin-induced skin necrosis, neonatal purpura fulminans (PF), and meningococcemia-associated PF. However, only after several decades was it recognized that natural anticoagulant depletion is also a key feature of predominantly acral ischemic microthrombosis syndromes-VLG and SPG-even when accompanying nonacral thrombosis is not present. These acquired acral limb ischemic syndromes typically involve the triad of (a) disseminated intravascular coagulation, (b) natural anticoagulant depletion, and (c) a localizing explanation for microthrombosis occurring in one or more limbs, either deep vein thrombosis (helping to explain VLG) or circulatory shock (helping to explain SPG). In most cases of VLG or SPG there are one or more events that exacerbate natural anticoagulant depletion, such as warfarin therapy (e.g., warfarin-associated VLG complicating heparin-induced thrombocytopenia or cancer hypercoagulability) or acute ischemic hepatitis ("shock liver") as a proximate factor predisposing to severe depletion of hepatically synthesized natural anticoagulants (PC, antithrombin) in the setting of circulatory shock.
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Affiliation(s)
- Theodore E. Warkentin
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Service of Benign Hematology, Hamilton Health Sciences, Hamilton General Hospital, Hamilton, Ontario, Canada
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Ogawa T, Hirai N, Fujikura H, Imakita N, Kasahara K. Financial Burden as a Potential Barrier to Vaccine Completion in Post-hematopoietic Stem Cell Transplant Patients in Japan. Cureus 2024; 16:e56842. [PMID: 38528999 PMCID: PMC10961236 DOI: 10.7759/cureus.56842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction The administration of routine vaccinations to patients following hematopoietic stem cell transplantation (HSCT) is highly recommended. However, studies examining reasons for not completing vaccination in post-HSCT patients are lacking. Method We reviewed the medical records of patients who sought vaccination following HSCT from January 2012 to December 2018 at the Center for Infectious Diseases, Nara Medical University. Results Information regarding patients' backgrounds, administered vaccines, and reasons for not administering recommended vaccines was collected for the study. Thirty-five patients (22 men and 13 women) with a median time from HSCT to the first visit of 25 months were enrolled. Vaccine coverage was highest for diphtheria, tetanus, and acellular pertussis (DTaP) at 89% (31 patients), followed by 23-valent pneumococcal, measles/rubella/mumps, and Japanese encephalitis at 71% (25 patients), 71% (25 patients), and 63% (22 persons), respectively. However, vaccine coverage for hepatitis B, 13-valent pneumococcal, and Hib was low at 26% (three patients), 11% (four patients), and 40% (14 patients), respectively. The reason for not completing the recommended vaccination series was not provided for most cases; however, the economic barrier was cited for all vaccines. Discussion This study identified several cases in Japan where individuals stopped completing post-HSCT vaccinations due to financial constraints. Larger-scale studies may be necessary in Japan in the future for further investigation.
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Affiliation(s)
- Taku Ogawa
- Department of Microbiology and Infection Control, Osaka Medical and Pharmaceutical University, Osaka, JPN
- Department of Infectious Diseases, Nara Medical University, Nara, JPN
| | - Nobuyasu Hirai
- Department of Infectious Diseases, Nara Medical University, Nara, JPN
| | - Hiroyuki Fujikura
- Department of Infectious Diseases, Nara Medical University, Nara, JPN
- Department of Infectious Diseases, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
| | - Natsuko Imakita
- Department of Infectious Diseases, Nara Medical University, Nara, JPN
| | - Kei Kasahara
- Department of Infectious Diseases, Nara Medical University, Nara, JPN
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Bobde S, Sohn WY, Bekkat-Berkani R, Banzhoff A, Cavounidis A, Dinleyici EC, Rodriguez WC, Ninis N. The Diverse Spectrum of Invasive Meningococcal Disease in Pediatric and Adolescent Patients: Narrative Review of Cases and Case Series. Infect Dis Ther 2024; 13:251-271. [PMID: 38285269 PMCID: PMC10904702 DOI: 10.1007/s40121-023-00906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) is a potentially life-threatening disease caused by Neisseria meningitidis infection. We reviewed case reports of IMD from newborns, infants, children, and adolescents, and described the real-life clinical presentations, diagnoses, treatment paradigms, and clinical outcomes. METHODS PubMed and Embase were searched for IMD case reports on patients aged ≤ 19 years published from January 2011 to March 2023 (search terms "Neisseria meningitidis" or "invasive meningococcal disease", and "infant", "children", "paediatric", pediatric", or "adolescent"). RESULTS We identified 97 publications reporting 184 cases of IMD, including 25 cases with a fatal outcome. Most cases were in adolescents aged 13-19 years (34.2%), followed by children aged 1-5 years (27.6%), children aged 6-12 years (17.1%), infants aged 1-12 months (17.1%), and neonates (3.9%). The most common disease-causing serogroups were W (40.2%), B (31.7%), and C (10.4%). Serogroup W was the most common serogroup in adolescents (17.2%), and serogroup B was the most common in the other age groups, including children aged 1-5 years (11.5%). The most common clinical presentations were meningitis (46.6%) and sepsis (36.8%). CONCLUSIONS IMD continues to pose a threat to the health of children and adolescents. While this review was limited to case reports and is not reflective of global epidemiology, adolescents represented the largest group with IMD. Additionally, nearly half of the patients who died were adolescents, emphasizing the importance of monitoring and vaccination in this age group. Different infecting serogroups were predominant in different age groups, highlighting the usefulness of multivalent vaccines to provide the broadest possible protection against IMD. Overall, this review provides useful insights into real-life clinical presentations, treatment paradigms, diagnoses, and clinical outcomes to help clinicians diagnose, treat, and, ultimately, protect patients from this devastating disease.
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Affiliation(s)
| | - Woo-Yun Sohn
- GSK, 14200 Shady Grove Rd, Rockville, MD, 20850, USA
| | | | | | | | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Wilfrido Coronell Rodriguez
- Pediatric Infectious Diseases, University of Cartagena, Cartagena, Colombia
- Serena del Mar Hospital, Cartagena, Colombia
| | - Nelly Ninis
- Imperial College Healthcare NHS Trust, London, UK
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Wang X, Huang Q, Huang R. Quantitative risk assessment of Bacillus cereus in wet rice noodles from raw material to marketing phase. Heliyon 2023; 9:e14354. [PMID: 36942229 PMCID: PMC10023962 DOI: 10.1016/j.heliyon.2023.e14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
From 2018, several foodborne diseases caused by the consumption of wet rice noodles contaminated with microorganisms have attracted the attention of consumers and surveillance departments. We explored the crucial risk factors for the contamination of Bacillus cereus during the various steps of the wet rice noodles production chain (from raw material to marketing phase). A total of 273 samples were collected in each corresponding production phase. The contamination level was quantitatively detected in the samples, and the corresponding temperature and time were recorded and analyzed using @Risk software. The quantitative detection results of raw material were determined as the initial contamination level in the model to predict the final contamination level and assess the key risk factors for B. cereus contamination in wet rice noodles. The model predicted that the final contamination level of B. cereus was in the range of -3.55 to 4.34 log CFU/g in 95% wet rice noodles at the marketing phase. The highest predicted contamination level was 6.28 log CFU/g, and the risk of exceeding the threshold was 0.80%. The model was verified to be valid for R2 > 0.96, and the predicted results could be used for reference. Moreover, the sensitivity analysis revealed that in addition to raw material, the key control factors were buffering temperature in the packaging delivery phase, transporting temperature and time from factory to marketing phase; their correlation coefficients (r) were 0.18, 0.16, and 0.15, respectively. Therefore, manufacturers need to adjust the current predelivery buffering and transporting mode. It is recommended to reduce the predelivery buffering temperature, and refrigerated trucks are preferred to control the proliferation of B. cereus in transported food, thus reducing the occurrence of foodborne diseases and improving the safety of food.
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Affiliation(s)
- Xinru Wang
- School of Public Health, Southern Medical University, Guangzhou, China
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Qiong Huang
- School of Public Health, Southern Medical University, Guangzhou, China
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Corresponding author. School of Public Health, Southern Medical University, Guangzhou, China.
| | - Rui Huang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Guangdong Provincial Institute of Public Health, Guangzhou, China
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Wenzel J. Infektiöse Exantheme. HAUTNAH DERMATOLOGIE 2023; 39. [PMCID: PMC9939249 DOI: 10.1007/s15012-023-7665-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
- Jörg Wenzel
- Klinik und Poliklinik f. Dermatologie u. Allergologie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Deutschland
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Hogge C, Holzman M, Khurana S, Brankovic M, Chang C, Fernandez G, Finkel D. Capnocytophaga sepsis causing purpura fulminans in a 50-year-old man with chronic opioid use. IDCases 2022; 29:e01505. [PMID: 35663605 PMCID: PMC9157452 DOI: 10.1016/j.idcr.2022.e01505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/18/2022] [Accepted: 05/16/2022] [Indexed: 11/19/2022] Open
Abstract
We present a case of polymicrobial sepsis with Capnocytophaga spp. complicated by purpura fulminans following a dog-bite in a 50-year-old-man with an extensive history of opioid use disorder. Generally, severe Capnocytophaga cases are thought to occur in patients with underlying immune deficiencies. However, this case highlights the importance of maintaining clinical suspicion for Capnocytophaga infection in immunocompetent patients, and we discuss the role of chronic opioid-use in severe infection.
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Affiliation(s)
- Christopher Hogge
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Miriam Holzman
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Sahiba Khurana
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Milos Brankovic
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Chrystal Chang
- Department of Urology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Gabriel Fernandez
- Department of Urology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Diana Finkel
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
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