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Zobair T, Sihlahla I, Arnolds DB, Raine RI, Calligaro G. A case of septic pulmonary embolism associated with hand sepsis in an immunocompetent host. Afr J Thorac Crit Care Med 2024; 30:e1014. [PMID: 39238568 PMCID: PMC11376348 DOI: 10.7196/ajtccm.2024.v30i2.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 03/25/2024] [Indexed: 09/07/2024] Open
Affiliation(s)
- T Zobair
- Division of Pulmonology, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - I Sihlahla
- Division of Radiology, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - D B Arnolds
- Division of Orthopaedic Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - R I Raine
- Division of Pulmonology, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - G Calligaro
- Division of Pulmonology, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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Yanagiya M, Kazama Y, Yang SM, Lal A, Russo D, Watanabe S, Wada A, Furuhata Y, Nakajima J. Intrapleural minocycline pleurodesis for bilateral pneumothorax due to septic pulmonary embolism: a case report. J Thorac Dis 2024; 16:3493-3502. [PMID: 38883652 PMCID: PMC11170380 DOI: 10.21037/jtd-23-1923] [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: 12/19/2023] [Accepted: 04/03/2024] [Indexed: 06/18/2024]
Abstract
Background Pneumothorax is a rare but serious complication of septic pulmonary embolism (SPE). SPE is a life-threatening disorder wherein infected thrombi bring infarction of the terminal and small caliber parts of the pulmonary vasculature and develop multiple nodular and cavitary lesions. Interventions other than conservative chest tube drainage for pneumothorax due to SPE have rarely been reported. Here, we present a case of bilateral pneumothorax due to SPE treated with intrapleural minocycline pleurodesis. Case Description A 72-year-old male patient previously diagnosed as esophageal carcinoma developed metachronous bilateral pneumothorax while treated for brain metastases. Based on blood cultures and chest computed tomography images, he was diagnosed with pneumothorax secondary to SPE due to methicillin-susceptible Staphylococcus aureus bacteremia. Bilateral chest tube drainage was instituted. Continuous air leakage was found bilaterally after chest tube placement. He was treated with broad-spectrum antibiotics based on the susceptibility profile and supportive treatment for sepsis. Approximately 3 weeks later, air leakage significantly reduced. We performed intrapleural minocycline pleurodesis bilaterally to prevent the recurrence of pneumothorax; the left side was firstly treated and the right side was treated 2 weeks later. Both chest tubes were successfully removed two days after procedures. Although the patient finally died of brain metastases 1 month after pleurodesis, he never recurred pneumothorax. Conclusions Intrapleural minocycline pleurodesis may be one of the useful and efficacious options in terms of treating intractable pneumothorax associated with SPE. Intrapleural minocycline pleurodesis could be a consideration for intractable pneumothorax related to SPE.
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Affiliation(s)
- Masahiro Yanagiya
- Department of Thoracic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yoshihiro Kazama
- Department of Gastroesophageal Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shun-Mao Yang
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Hsinchu County
| | - Amos Lal
- Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - Debora Russo
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, Carlo Poma Hospital, Mantova, Italy
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Chuouku, Niigata, Japan
| | - Ami Wada
- Department of Thoracic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yoshiaki Furuhata
- Department of Thoracic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
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Abstract
Septic pulmonary embolism (SPE) is a rare clinical entity that is distinct from the classic and more common non-septic thrombotic pulmonary embolism. SPE should be suspected in patients with a systemic acute inflammatory reaction or sepsis who develop signs and symptoms of pulmonary involvement. The diagnosis of SPE depends on the specific radiologic finding of multiple, peripheral, nodular, possibly cavitated lesions. SPE should prompt an immediate search for the primary source of infection; typically, right-sided infective endocarditis, cardiac implantable electronic devices, and septic thrombophlebitis as a complication of bone, skin, and soft tissue infection including Lemierre's syndrome, indwelling catheters, or direct inoculation via injection drug use. Invasive treatment of the infection source may be necessary; in thrombophlebitis, the efficacy and safety of anticoagulation remain undefined. Blood cultures may be negative, particularly among patients with recent antibiotic exposure, and broad-spectrum antimicrobial therapy should be considered. The in-hospital mortality of SPE ranges up to 20% in published case series. While trends in the incidence of SPE are unknown, the opioid epidemic, the growing use of cardiac implantable electronic devices worldwide, and the reported increase in cases of septic thrombophlebitis may be leading to an escalation in SPE cases. We provide a contemporary profile of SPE and propose a clinical management algorithm in patients with suspected or confirmed SPE.
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Affiliation(s)
- Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center at the Johannes Gutenberg University, Mainz, Germany
- Department of Cardiology, University Medical Center at the Johannes Gutenberg University, Mainz, Germany
| | - Larry M Baddour
- Departments of Medicine and Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Division of Public Health, Infectious Diseases and Occupational Health, Rochester, Minnesota
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Rowberry R, Mortimore G. Septic pulmonary emboli: a case discussion. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:832-838. [PMID: 37737857 DOI: 10.12968/bjon.2023.32.17.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
A septic pulmonary embolus occurs from the embolisation of an infected thrombus - typically from an infected source such as an abscess - that enters the venous circulation, implanting in the lungs, which in turn causes a parenchymal infection. This case discussion gives a candid reflection on the treatment and management of a patient who was a known intravenous drug user, with a past history of a deep vein thrombosis and new presentation of a groin abscess. He was initially reviewed by a trainee advanced clinical practitioner, working out of hours in a hospital setting. This article will reflect on the patient presentation, the clinical examinations and investigations undertaken, which finally led to the diagnosis of septic pulmonary emboli. Although this condition is rare, having a high index of suspicion in patients with known risk factors may lead to early diagnosis and successful treatment.
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Affiliation(s)
- Rowena Rowberry
- Lecturer, Department of Health, Psychology and Social Care, University of Derby
| | - Gerri Mortimore
- Lecturer, Department of Health, Psychology and Social Care, University of Derby
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Elmeazawy R, El Amrousy D. Baseline characteristics and analysis of predictors of the Outcome of septic pulmonary embolism in children: a retrospective observational study. BMC Pediatr 2023; 23:215. [PMID: 37147610 PMCID: PMC10161177 DOI: 10.1186/s12887-023-03998-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/07/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Septic pulmonary embolism is a rare disease in children. We aimed to assess the clinical, microbiological, and radiological characteristics and outcomes of pediatric septic pulmonary embolism (SPE) and to identify any predictive factors for in-hospital mortality in patients with this unusual disease to enhance prognosis and treatment. METHODS A retrospective study to search the electronic medical records of children admitted to the pediatric pulmonology unit, Tanta University hospital with the diagnosis of SPE between January 2015 and June 2022. RESULTS Seventeen pediatric patients were identified; ten males and seven females with a mean age of 9.4 ± 5.2 years. The most common presenting complaints were fever and shortness of breath (n = 17) followed by chest pain (n = 9), pallor (n = 5), limb swelling (n = 4), and back pain (n = 1). Methicillin-resistant Staphylococcus aureus (MRSA) was the most common causative pathogen in nine patients. The most common extra-pulmonary septic foci were septic arthritis in five patients (29.4%), septic thrombophlebitis in four patients (23.5%), and infective endocarditis in two patients (11.8%). All patients exhibited wedge-shaped peripheral lesions and feeding vessel sign in CT chest, whereas bilateral diffuse lesions, nodular lesions, and cavitation were present in 94.1% of patients, pleural effusion was identified in 58.8% of patients, and pneumothorax was detected in 41.2% of patients. Fifteen patients improved and survived (88.2%), while two patients died (11.8%). CONCLUSION Early diagnosis of SPE with vigorous early therapy is critical for a better outcome, including appropriate antibiotics and timely surgical interference to eradicate extra-pulmonary septic foci.
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Affiliation(s)
- Rehab Elmeazawy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Doaa El Amrousy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt.
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Sirbu O, Sorodoc V, Floria M, Statescu C, Sascau R, Lionte C, Petris OR, Haliga RE, Morariu PC, Tirnoveanu A, Burduloi VM, Ursulescu C, Sorodoc L. Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences. J Pers Med 2023; 13:jpm13020202. [PMID: 36836436 PMCID: PMC9963227 DOI: 10.3390/jpm13020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Nontrombotic pulmonary embolism represents the embolization of different types of materials (cells, organisms, gas, foreign material) into pulmonary circulation. The disease is uncommon, and clinical presentation together with laboratory findings are nonspecific. Its pathology is usually misdiagnosed based on imaging findings as pulmonary thromboembolism, but the correct diagnosis is essential because different therapeutic approaches are required. In this context, knowledge of the risk factors associated with nontrombotic pulmonary embolism and specific clinical symptoms is fundamental. Our objective was to discuss the specific features of the most common etiologies of nontrombotic pulmonary embolism, gas, fat, amniotic fluid, sepsis and tumors, to provide assistance for a rapid and correct diagnosis. Because the most common etiologies are iatrogenic, knowledge of the risk factors could be an important tool for prevention or rapid treatment if the disease develops during different procedures. The diagnosis of nontrombotic pulmonary embolisms represent a laborious challenge, and endeavors should be made to prevent development and increase awareness of this disease.
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Affiliation(s)
- Oana Sirbu
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Victorita Sorodoc
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Correspondence: (V.S.); (C.S.)
| | - Mariana Floria
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Cristian Statescu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases “Dr. George I.M. Georgescu”, 700503 Iasi, Romania
- Correspondence: (V.S.); (C.S.)
| | - Radu Sascau
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases “Dr. George I.M. Georgescu”, 700503 Iasi, Romania
| | - Catalina Lionte
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Ovidiu Rusalim Petris
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Raluca Ecaterina Haliga
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Paula Cristina Morariu
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Andreea Tirnoveanu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Vladut Mirel Burduloi
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Corina Ursulescu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Radiology, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
| | - Laurentiu Sorodoc
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
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Ikejiri K, Goto H, Usui M, Nakayama Y, Sugioka K, Ito A, Suzuki K, Hirokawa Y, Yamanaka K, Imai H. Septic pulmonary embolism and subsequent bilateral pneumothorax in patients undergoing chemoradiotherapy for head angiosarcoma: An autopsy case report and literature review. Medicine (Baltimore) 2022; 101:e31755. [PMID: 36397415 PMCID: PMC9666164 DOI: 10.1097/md.0000000000031755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
RATIONALE Septic pulmonary embolism (SPE) and subsequent pneumothorax are rare but serious conditions. We report a case of SPE and pneumothorax caused by central venous port (CV port) infection. PATIENT CONCERNS A 73-year-old woman, who underwent chemoradiotherapy for a head angiosarcoma and a CV port placement, presented with general malaise and myalgia. DIAGNOSIS A laboratory examination showed high levels of inflammatory markers. Chest computed tomography showed fluid collection around the CV port and multiple ground-glass opacities and nodular shadows in the bilateral lung field. She was admitted with a diagnosis of SPE due to CV port infection. The port was removed, and antibiotic administration was initiated; however, she was intubated because of refractory septic shock. Methicillin-susceptible Staphylococcus aureus was detected in the blood and pus around the port site. INTERVENTIONS Her respiratory status did not improve despite recovering from septic shock, and radiologic findings showed a left pneumothorax and exacerbation of SPE on day 9. Her condition was judged ineligible for surgery for pneumothorax, and chest tube thoracostomy was continued. OUTCOMES Air leaks persisted after chest tube thoracostomy, and her respiratory status did not improve despite ventilator management and recruitment maneuvers. Moreover, a right pneumothorax developed on day 19. Her respiratory status gradually worsened, and she died on day 21. Autopsy showed multiple cavitary lesions in the bilateral lungs and emboli containing organization and inflammatory cells that obstructed the pulmonary arterioles. LESSONS This case indicates that CV port-related infections are infrequent and difficult to diagnose; understanding the clinical features of SPE is important because of its high mortality rate; and pneumothorax secondary to SPE is a rare but serious condition and is difficult to treat during ventilator management.
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Affiliation(s)
- Kaoru Ikejiri
- Emergency and Critical Care Center, Mie University Hospital, Tsu City, Japan
- * Correspondence: Kaoru Ikejiri, Emergency and Critical Care Center, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan (e-mail: )
| | - Hiroyuki Goto
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Miki Usui
- Department of Diagnostic Pathology, Mie University Hospital, Tsu City, Japan
| | - Yuichi Nakayama
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Kyoko Sugioka
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Asami Ito
- Emergency and Critical Care Center, Mie University Hospital, Tsu City, Japan
| | - Kei Suzuki
- Emergency and Critical Care Center, Mie University Hospital, Tsu City, Japan
- Department of Infectious Diseases, Mie University Hospital, Tsu City, Japan
| | - Yoshifumi Hirokawa
- Department of Diagnostic Pathology, Mie University Hospital, Tsu City, Japan
| | - Keiichi Yamanaka
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University Hospital, Tsu City, Japan
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Kelson M, Chaudhry A, Nguyen A, Girgis S. Injection drug induced septic embolism—A growing concern. Radiol Case Rep 2022; 17:4345-4349. [PMID: 36188073 PMCID: PMC9520423 DOI: 10.1016/j.radcr.2022.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/22/2022] Open
Abstract
Septic pulmonary embolism is an obstruction of the pulmonary vasculature due to embolization of an infected thrombus. In many instances, the etiology is cardiac in origin, given the increased prevalence of intravenous drug users in the United States. This condition usually presents with fever, chest pain, dyspnea, and cough. In order to make the diagnosis, it is helpful to utilize tools like the modified Duke criteria when evaluating for infective endocarditis in the context of pulmonary emboli and septic shock. The gold standard method for establishing the diagnosis of this condition involves imaging modalities, including echocardiogram and computed tomography findings. This case report details a 36-year-old male with a history of drug abuse and hepatitis C, who was found to have an isolated vegetation on the pulmonic valve and septic pulmonary embolism. The patient experienced a rapidly deteriorating clinical course, however improved over the course of 2 weeks with supportive measures and appropriate antibiotic treatment. The purpose of this case report is to highlight the uncommon nature of pulmonary valve involvement in patients with infective endocarditis. Moreover, the goal of this report is to recognize the paralleled increase in septic pulmonary emboli with the rising incidence of patients using injectable opioids in the United States.
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Liu YC, Yao Y, Yu MM, Gao YL, Qi AL, Jiang TY, Chen ZS, Shou ST, Chai YF. Frequency and mortality of sepsis and septic shock in China: a systematic review and meta-analysis. BMC Infect Dis 2022; 22:564. [PMID: 35729526 PMCID: PMC9210671 DOI: 10.1186/s12879-022-07543-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/14/2022] [Indexed: 11/11/2022] Open
Abstract
Background Sepsis, a life-threatening organ dysfunction induced by infection, is a major public health problem. This study aimed to evaluate the frequency and mortality of sepsis, severe sepsis, and septic shock in China. Methods We Searched MEDLINE, Embase, PubMed, and Cochrane Library from 1 January 1992 to 1 June 2020 for studies that reported on the frequency and mortality of sepsis, severe sepsis, and septic shock conducted in China. Random effects models were performed to estimate the pooled frequency and mortality of sepsis, severe sepsis, and septic shock. Results Our search yielded 846 results, of which 29 studies were included in this review. The pooled frequency of sepsis was estimated at 33.6% (95% CI 25.9% to 41.3%, I2 = 99.2%; p < 0.001), and the pooled mortality of sepsis, severe sepsis and septic shock were 29.0% (95% CI 25.3%–32.8%, I2 = 92.1%; p = 0), 31.1% (95% CI 25.3% to 36.9%, I2 = 85.8%; p < 0.001) and 37.3% (95% CI 28.6%–46.0%, I2 = 93.5%; p < 0.001). There was significant heterogeneity between studies. With a small number of included studies and the changing definition of sepsis, trends in sepsis frequency and mortality were not sufficient for analysis. Epidemiological data on sepsis in the emergency department (ED) are severely lacking, and more research is urgently needed in this area is urgently needed. Conclusions Our findings indicated that the frequency and mortality of sepsis and septic shock in China were much higher than North America and Europe countries. Based on our results, an extremely high incidence and mortality of sepsis and septic shock in China's mainland requires more healthcare budget support. Epidemiological data on sepsis and septic shock in ED are severely lacking, and more research is urgently needed in this area. Trial registration This systematic review was conducted according to the statement of the preferred reporting items for systematic review (PROSPERO CRD42021243325) and the meta-analysis protocols (PRISMA-P). Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07543-8.
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Affiliation(s)
- Yan-Cun Liu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China.
| | - Ying Yao
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
| | - Mu-Ming Yu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
| | - Yu-Lei Gao
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
| | - An-Long Qi
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
| | - Tian-Yu Jiang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
| | - Zhen-Sen Chen
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
| | - Song-Tao Shou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
| | - Yan-Fen Chai
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China.
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Yusuf Mohamud MF, Mukhtar MS. Presenting Clinicoradiological Features, Microbiological Spectrum and Outcomes Among Patients with Septic Pulmonary Embolism: A Three-Year Retrospective Observational Study. Int J Gen Med 2022; 15:5223-5235. [PMID: 35651673 PMCID: PMC9148921 DOI: 10.2147/ijgm.s364522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/16/2022] [Indexed: 01/25/2023] Open
Abstract
Background Septic pulmonary embolism (SPE) is an unusual condition characterized by the implantation of infected thrombi into the pulmonary vasculature from a variety of infectious sources. This study aimed to illustrate the clinicoradiological features, microbiological spectrum, and clinical course of patients with SPE, as well as to promote the early identification, diagnosis, and prognosis of this unusual disease. Methods Nineteen patients with SPE collected from the electronic medical records of our hospital were retrospectively reviewed during three years. Results The study included twelve men and seven women with a mean age of 49 (15–78). The most common presenting features were fever (79%) and shortness of breath (73.7%). Chronic kidney disease (68.4%) and diabetes (36.8%) were the most common comorbidities. The most common source of infection was venous catheters (58%). Staphylococcus aureus was the most predominant pathogen in about 52.6% of the cases. According to the CT findings, bilateral opacities were detected in all cases, flowing by nodular in 73.9% and cavitations in 57.9%. Central distributions were the most patterns regarding the location of the lesion seen in 47.4% of the patients. All patients received antimicrobial treatment, while 13 cases administered systemic anticoagulant. Most of the patients (73.7%) recovered from their illness, while 26.3% died. The median duration of hospitalization was 11.5 days. Oxygen saturation level and altered mental status were significantly associated with the mortality rate of SPE patients. Conclusion The study’s findings presented that altered mental status and low oxygen saturation are associated with a high mortality rate in SPE patients, especially those requiring critical care. Early diagnosis of an embolic phenomenon to other organ systems like the central nervous system can greatly influence the patient’s outcome.
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Affiliation(s)
- Mohamed Farah Yusuf Mohamud
- Mogadishu Somali-Turkish Training and Research Hospital, Mogadishu, Somalia
- Correspondence: Mohamed Farah Yusuf Mohamud, Mogadishu Somali-Turkish Training and Research Hospital, 30 Street, Alikamin, Wartanabada District, Mogadishu, Somalia, Tel +252615591689, Email
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Huang CB, Hong CX, Xu TH, Zhao DY, Wu ZY, Chen L, Xie J, Jin C, Wang BZ, Yang L. Risk Factors for Pulmonary Embolism in ICU Patients: A Retrospective Cohort Study from the MIMIC-III Database. Clin Appl Thromb Hemost 2022; 28:10760296211073925. [PMID: 35043708 DOI: 10.1177/10760296211073925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Pulmonary embolism (PE) is a common and potentially lethal form of venous thromboembolic disease in ICU patients. A limited number of risk factors have been associated with PE in ICU patients. In this study, we aimed to screen the independent risk factors of PE in ICU patients that can be used to evaluate the patient's condition and provide targeted treatment. We performed a retrospective cohort study using a freely accessible critical care database Medical Information Mart for Intensive Care (MIMIC)-III. The ICU patients were divided into two groups based on the incidence of PE. Finally, 9871 ICU patients were included, among which 204 patients (2.1%) had pulmonary embolism. During the multivariate logistic regression analysis, sepsis, hospital_LOS (the length of stay in hospital), type of admission, tumor, APTT (activated partial thromboplastin time) and platelet were independent risk factors for patients for PE in ICU, with OR values of 1.471 (95%CI 1.001-2.162), 1.001 (95%CI 1.001-1.001), 3.745 (95%CI 2.187-6.414), 1.709 (95%CI 1.247-2.341), 1.014 (95%CI 1.010-1.017) and 1.002 (95%CI 1.001-1.003) (Ps < 0.05). ROC curve analysis showed that the composite indicator had a higher predictive value for ICU patients with PE, with a ROC area under the curve (AUC) of 0.743 (95%CI 0.710 -0.776, p < 0.001). Finally, sepsis, tumor, platelet count, length of stay in the hospital, emergency admission and APTT were independent predictors of PE in ICU patients.
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Affiliation(s)
- Cheng-Bin Huang
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Chen-Xuan Hong
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Tian-Hao Xu
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Ding-Yun Zhao
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zong-Yi Wu
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Chen
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Jun Xie
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Chen Jin
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Bing-Zhang Wang
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Lei Yang
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
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12
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Clinical and radiological variants of lung damage in the infection caused by staphylococcus aureus. КЛИНИЧЕСКАЯ ПРАКТИКА 2021. [DOI: 10.17816/clinpract71642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Despite the high level of modern technologies in the field of laboratory methods and imaging of the respiratory system, the problem of early and accurate differential diagnosis of inflammatory lung diseases remains important in practical medicine. It leads to improved treatment results and a reduction in the number of complications (pleural empyema, fistulas, mediastinitis, sepsis, etc.), and in some cases allows suspecting the presence of a primary purulent source in the body, such as that in the case of septic pulmonary embolism. The review covers the Staphylococcus aureus specifics as a pathogen of lung diseases, relevant epidemiology, pathogenesis, clinical features and imaging diagnostics of various types of inflammatory changes in the lungs with a focus on destruction.
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13
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Gatt D, Ben-Shimol S, Hazan G, Golan Tripto I, Goldbart A, Aviram M. Comparison of septic and nonseptic pulmonary embolism in children. Pediatr Pulmonol 2021; 56:3395-3401. [PMID: 34379881 DOI: 10.1002/ppul.25604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Septic pulmonary embolism (SPE) in children is a rare disease. Data are scarce regarding the clinical and laboratory manifestation of SPE compared with nonseptic pulmonary embolism (ns-PE). Furthermore, specific guidelines for the management of SPE in children are lacking. AIM We compared the clinical course and outcome of children with SPE and ns-PE. METHODS A retrospective, cohort study of hospitalized children, 2005-2020, with documented pulmonary embolism imaging. RESULTS Sixteen children (eight SPE, eight ns-PE) were identified. Episodes of SPE occurred secondary to endocarditis, musculoskeletal and soft tissue infections, with Staphylococcus aureus (n = 4) and streptococcus spp. (n = 2) as the most common pathogens. Radiographically, SPE presented as a microvascular disease with parenchymatic nodules/cavitations, whereas ns-PE presented as larger vessel disease with filling defects. Risk factors (including thrombophilia) were noted in 0% and 87.5% of SPE and ns-PE patients, respectively (p < .01). Pulmonary embolism diagnosis was delayed in SPE compared with ns-PE (median: 8.5 days vs. 1 day). The SPE group had higher rates of fever (100% vs. 12.5%, p < .01), C-reactive protein (CRP levels; 18.49 vs. 4.37 mg/dl, p = .02), and fibrinogen levels (880 vs. 467 mg/dl, p < .001). Antithrombotic treatment for >4 months was administrated to 14.3% and 87.5% of SPE and ns-PE patients, respectively (p < .01). One ns-PE patient had a second thromboembolic event compared to none in the SPE group. CONCLUSIONS SPE in children is a unique subgroup of PE with different clinical and laboratory findings that requires a different diagnostic approach and probably shorter duration of antithrombotic treatment.
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Affiliation(s)
- Dvir Gatt
- Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shalom Ben-Shimol
- Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Guy Hazan
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Inbal Golan Tripto
- Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Aviv Goldbart
- Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Micha Aviram
- Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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14
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Okuno D, Oshima K, Miyazaki T, Ashizawa N, Hirayama T, Takazono T, Saijo T, Yamamoto K, Imamura Y, Yamaguchi H, Sakamoto N, Obase Y, Izumikawa K, Yanagihara K, Mukae H. Duration of antifungal therapy for septic pulmonary embolism caused by Candida albicans from a central venous catheter: A case report. Clin Case Rep 2021; 9:707-710. [PMID: 33598229 PMCID: PMC7869368 DOI: 10.1002/ccr3.3628] [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: 08/23/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 11/06/2022] Open
Abstract
The treatment duration for candidemia with septic pulmonary embolism should be determined based on the clearance of fungus from the bloodstream and improvement of symptoms. The remaining lung nodules may not necessarily indicate persistent infection.
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Affiliation(s)
- Daisuke Okuno
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
| | - Kazuhiro Oshima
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
- Present address:
Department of Infection Control ScienceGraduate School of MedicineOsaka City UniversityOsakaJapan
| | - Taiga Miyazaki
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
- Department of Infectious DiseasesNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Nobuyuki Ashizawa
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
| | - Tatsuro Hirayama
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
| | - Takahiro Takazono
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
- Department of Infectious DiseasesNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Tomomi Saijo
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
| | - Kazuko Yamamoto
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
| | - Yoshifumi Imamura
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
| | - Hiroyuki Yamaguchi
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
| | - Noriho Sakamoto
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Yasushi Obase
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Koichi Izumikawa
- Department of Infectious DiseasesNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | | | - Hiroshi Mukae
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
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15
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Nishimura Y, Hagiya H, Obika M, Otsuka F. Comparison of the Clinico-Microbiological Characteristics of Culture-Positive and Culture-Negative Septic Pulmonary Embolism: A 10-Year Retrospective Study. Pathogens 2020; 9:pathogens9120995. [PMID: 33260940 PMCID: PMC7759841 DOI: 10.3390/pathogens9120995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022] Open
Abstract
Septic pulmonary embolism (SPE) is a rare yet serious infectious disorder with nonspecific clinical findings due to microorganism-containing emboli disseminating from extrapulmonary infectious foci. It is unknown whether a positive blood culture correlates with a worse clinical outcome. We compared the clinical and microbiologic characteristics of patients with SPE divided into the culture-positive group and the culture-negative one. This study was a retrospective observational study of the patients diagnosed with SPE and treated in an academic hospital from April 2010 to May 2020. We identified six culture-positive and four culture-negative patients with SPE during the study period. The culture-positive group had significantly longer periods of hospitalization (median: 75 days, range: 45-125 days) than the culture-negative group (median: 14.5 days, range: 3-43 days) (p < 0.05), as well as significantly elevated serum C-reactive protein and procalcitonin. Patients with culture-negative SPE more commonly had odontogenic infections as the primary infectious foci. Our study highlights the importance of giving extra attention to SPE patients who have a positive blood culture, as they may have worse clinical outcomes. Physicians need to collaborate with dentists when faced with patients with culture-negative SPE, since they may have primary odontogenic infections.
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16
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Wang Y, Cao Z, Zeng D, Wang X, Wang Q. Using deep learning to predict the hand-foot-and-mouth disease of enterovirus A71 subtype in Beijing from 2011 to 2018. Sci Rep 2020; 10:12201. [PMID: 32699245 PMCID: PMC7376109 DOI: 10.1038/s41598-020-68840-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023] Open
Abstract
Hand-foot-and-month disease (HFMD), especially the enterovirus A71 (EV-A71) subtype, is a major health problem in Beijing, China. Previous studies mainly used regressive models to forecast the prevalence of HFMD, ignoring its intrinsic age groups. This study aims to predict HFMD of EV-A71 subtype in three age groups (0–3, 3–6 and > 6 years old) from 2011 to 2018 using residual-convolutional-recurrent neural network (CNNRNN-Res), convolutional-recurrent neural network (CNNRNN) and recurrent neural network (RNN). They were compared with auto-regressio, global auto-regression and vector auto-regression on both short-term and long-term prediction. Results showed that CNNRNN-Res and RNN had higher accuracies on point forecast tasks, as well as robust performances in long-term prediction. Three deep learning models also had better skills in peak intensity forecast, and CNNRNN-Res achieved the best results in the peak month forecast. We also found that three age groups had consistent outbreak trends and similar patterns of prediction errors. These results highlight the superior performance of deep learning models in HFMD prediction and can assist the decision-makers to refine the HFMD control measures according to age groups.
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Affiliation(s)
- Yuejiao Wang
- The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Zhidong Cao
- The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
| | - Daniel Zeng
- The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Xiaoli Wang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
| | - Quanyi Wang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
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