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Mingjing NO, Casha R, Vella SM, Aquilina N, Fsadni C. Where you least expect it: paradoxical tuberculosis-immune reconstitution inflammatory syndrome and wrist joint tuberculosis as the initial manifestation in a patient who is HIV-seronegative. Br J Hosp Med (Lond) 2023; 84:1-4. [PMID: 38153015 DOI: 10.12968/hmed.2022.0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
| | - Ramon Casha
- Department of Infectious Diseases and General Medicine, Mater Dei Hospital, Msida, Malta
| | - Sarah M Vella
- Department of Infectious Diseases and General Medicine, Mater Dei Hospital, Msida, Malta
| | | | - Claudia Fsadni
- Department of Infectious Diseases and General Medicine, Mater Dei Hospital, Msida, Malta
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Xerri T, Borg J, Casha R, Fsadni C. Complexity of Mycobacterium avium complex immune reconstitution inflammatory syndrome (MAC-IRIS) in a patient with HIV. BMJ Case Rep 2021; 14:e241813. [PMID: 34479876 PMCID: PMC8420731 DOI: 10.1136/bcr-2021-241813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 01/08/2023] Open
Abstract
We report a case of Mycobacterium avium complex immune reconstitution inflammatory syndrome (MAC-IRIS) in a patient with HIV positive. Initial presentation was that of a purpuric purple macular rash in-keeping with Kaposi sarcoma as an AIDS defining illness. Three weeks following the initiation of antiretroviral treatment (ART) she developed chest pain, dry cough and fever. A diagnosis of MAC was made through imaging and sputum cultures and appropriate treatment was initiated. Despite adequate management with evidence of good immunological and virological response, the patient represented with persistent symptoms. Repeat CT of the chest confirmed worsening lymphadenopathy with necrosis. Given these findings, a diagnosis of MAC-IRIS was made with resolution of fever after corticosteroids were initiated. This case highlights the importance of considering MAC as a cause of IRIS in severely immunosuppressed patients with HIV.
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Affiliation(s)
- Thelma Xerri
- Infectious Diseases Unit, Mater Dei Hospital, Msida, Malta
| | - Janice Borg
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Ramon Casha
- Infectious Diseases Unit, Mater Dei Hospital, Msida, Malta
| | - Claudia Fsadni
- Infectious Diseases Unit, Mater Dei Hospital, Msida, Malta
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Abstract
A 47-year-old man, positive for SARS-CoV-2, was diagnosed with acute coronary syndrome (ACS) complicated by myocarditis on a background of COVID-19 pneumonia. He was medically treated for ACS; however, 3 days into his admission, the patient developed neurological complications confirmed on MRI of the brain. MRI showed established infarcts involving a large part of the left temporal lobe and right occipital lobe, with minor foci of micro-haemorrhagic transformation in the left temporal lobe. A left ventricular mural thrombus was then confirmed on echocardiogram, and this was attributed as the cause of his neurological infarct. Further infarctions in the kidneys and spleen, and thrombi in the superior mesenteric and left femoral artery were also identified on imaging of the abdomen. The left ventricular mural thrombus was removed surgically via a midline sternotomy incision under general anaesthesia. Surgery was successful and the patient was discharged to a rehabilitation centre.
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Affiliation(s)
| | - Ramon Casha
- Infectious Diseases and General Medicine, Mater Dei Hospital, Msida, Malta
| | - Thelma Xerri
- Infectious Diseases and General Medicine, Mater Dei Hospital, Msida, Malta
| | | | - Claudia Fsadni
- Infectious Diseases and General Medicine, Mater Dei Hospital, Msida, Malta
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Micallef S, Piscopo TV, Casha R, Borg D, Vella C, Zammit MA, Borg J, Mallia D, Farrugia J, Vella SM, Xerri T, Portelli A, Fenech M, Fsadni C, Mallia Azzopardi C. The first wave of COVID-19 in Malta; a national cross-sectional study. PLoS One 2020; 15:e0239389. [PMID: 33057434 PMCID: PMC7561161 DOI: 10.1371/journal.pone.0239389] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction The COVID-19 pandemic has posed major challenges to all aspects of healthcare. Malta’s population density, large proportion of elderly and high prevalence of diabetes and obesity put the country at risk of uncontrolled viral transmission and high mortality. Despite this, Malta achieved low mortality rates compared to figures overseas. The aim of this paper is to identify key factors that contributed to these favorable outcomes. Methods This is a retrospective, observational, nationwide study which evaluates outcomes of patients during the first wave of the pandemic in Malta, from the 7th of March to the 24th of April 2020. Data was collected on demographics and mode of transmission. Hospitalization rates to Malta’s main general hospital, Mater Dei Hospital, length of in-hospital stay, intensive care unit admissions and 30-day mortality were also analyzed. Results There were 447 confirmed cases in total; 19.5% imported, 74.2% related to community transmission and 6.3% nosocomially transmitted. Ninety-three patients (20.8%) were hospitalized, of which 4 were children. Patients with moderate-severe disease received hydroxychloroquine and azithromycin, in line with evidence available at the time. A total of 4 deaths were recorded, resulting in an all-cause mortality of 0.89%. Importantly, all admitted patients with moderate-severe disease survived to 30-day follow up. Conclusion Effective public health interventions, widespread testing, remote surveillance of patients in the community and a low threshold for admission are likely to have contributed to these favorable outcomes. Hospital infection control measures were key in preventing significant nosocomial spread. These concepts can potentially be applied to stem future outbreaks of viral diseases. Patients with moderate-severe disease had excellent outcomes with no deaths reported at 30-day follow up.
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Affiliation(s)
- Sarah Micallef
- Department of Medicine, Mater Dei Hospital, Msida, Malta
- * E-mail:
| | - Tonio V. Piscopo
- Department of Infectious Diseases, Mater Dei Hospital, Msida, Malta
| | - Ramon Casha
- Department of Infectious Diseases, Mater Dei Hospital, Msida, Malta
| | - Denise Borg
- Department of Infectious Diseases, Mater Dei Hospital, Msida, Malta
| | - Chantal Vella
- Department of Infectious Diseases, Mater Dei Hospital, Msida, Malta
| | | | - Janice Borg
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Daniela Mallia
- Department of Pharmacy, Mater Dei Hospital, Msida, Malta
| | - James Farrugia
- Department of Infectious Diseases, Mater Dei Hospital, Msida, Malta
| | | | - Thelma Xerri
- Department of Infectious Diseases, Mater Dei Hospital, Msida, Malta
| | - Anette Portelli
- Department of Infectious Diseases, Mater Dei Hospital, Msida, Malta
| | - Manuel Fenech
- Department of Infectious Diseases, Mater Dei Hospital, Msida, Malta
| | - Claudia Fsadni
- Department of Infectious Diseases, Mater Dei Hospital, Msida, Malta
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Abstract
Measles, which was once thought to be a disappearing viral infection due to effective vaccination, has been re-emerging globally, with increasing cases in adolescents and adults. This has been attributed to anti-vaccination campaigning in the early 21st century, which has resulted in a drop in overall herd immunity. In this case series we report three patients with complications secondary to measles who presented to a hospital in Malta in 2019. Through this series, we discuss the range of possible complications caused by the measles virus, ranging from mild viraemic symptoms to multiorgan involvement which could possibly lead to high-dependency care and may even be fatal. We also highlight recent global statistics which reflect the exponential increase in the incidence of measles, with a special focus on Europe. It is emphasised that vaccine education and compliance with the two-dose measles vaccine should be implemented worldwide.
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Affiliation(s)
- Thelma Xerri
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | | | | | - Claudia Fsadni
- Department of Infectious Disease, Mater Dei Hospital, Msida, Malta
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Mifsud S, Zammit MA, Casha R, Fsadni C. Influenza A: another cause of SIADH? BMJ Case Rep 2018; 2018:bcr-2018-226154. [PMID: 30337286 DOI: 10.1136/bcr-2018-226154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a frequent cause of hyponatraemia. It is a dilutional hyponatraemia secondary to impaired urinary dilution in the absence of renal disease or any identifiable non-osmotic stimulus known to induce antidiuretic hormone secretion. SIADH can arise secondary to various respiratory tract infections; however, the association between SIADH and influenza A infection is described in only a few cases in the literature. The authors present a case report of influenza A that may have caused a profound SIADH-related hyponatraemia.
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Affiliation(s)
- Simon Mifsud
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | | | - Ramon Casha
- Department of Medicine, Infectious Diseases Division, Mater Dei Hospital, Msida, Malta
| | - Claudia Fsadni
- Department of Medicine, Infectious Diseases Division, Mater Dei Hospital, Msida, Malta
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Abstract
Background The prevalence of allergic conditions is increasing in most countries. One possible explanation may be childhood nutrition. Objective The aim of the study was to investigate the relationship between consumption of pre-specified types of food in school-aged children and presence of respiratory and allergic symptoms. Methods A total of 191 students aged 9-11 years were recruited from 5 schools to geographically cover all of Malta. Data was collected between October 2011 and February 2012. This was part of a bigger study which included clinical and environmental tests besides standardized health questionnaires. For the purposes of this part of the study only the health questionnaires were used. These standardized health questionnaires based on the International Study of Asthma and Allergies in Childhood (ISAAC) were used to identify the presence of respiratory and allergic symptoms and to identify the types of foods and the frequency of consumption of various types of foods. Results We found that milk, meat, butter, olive oil, and yoghurt consumption had a negative association with allergic symptoms in children, whilst fish consumption had a detrimental effect. These relationships remained significant after correction for paternal level of education. Conclusion The study highlights the fact that nutrition in early childhood may have a significant effect on the risk of allergic conditions. Our results, taken together with data in the literature, suggest that different types of fish might have had different effects. This is probably related to their different fatty acid constitution thus warranting further studies.
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Affiliation(s)
- Claudia Fsadni
- Department of Medicine, Mater Dei Hospital, Msida, Malta.,University of Malta Medical School, Msida, Malta
| | - Peter Fsadni
- Department of Medicine, Mater Dei Hospital, Msida, Malta.,University of Malta Medical School, Msida, Malta
| | - Stephen Montefort
- Department of Medicine, Mater Dei Hospital, Msida, Malta.,University of Malta Medical School, Msida, Malta
| | - Stephen Fava
- Department of Medicine, Mater Dei Hospital, Msida, Malta.,University of Malta Medical School, Msida, Malta
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Sciriha A, Lungaro-Mifsud S, Scerri J, Bilocca D, Fsadni C, Fsadni P, Gerada E, Gouder C, Camilleri L, Montefort S. Pulmonary rehabilitation in chronic obstructive pulmonary disease: Outcomes in a 12 week programme. European Journal of Physiotherapy 2015. [DOI: 10.3109/21679169.2015.1078844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fsadni C, Fsadni P, Fava S, Montefort S. Association of prevalence of rhinitis, atopic eczema, rhinoconjunctivitis and wheezing with mortality from infectious diseases and with antibiotic susceptibility at a country level. Asia Pac Allergy 2015; 5:145-55. [PMID: 26240791 PMCID: PMC4521163 DOI: 10.5415/apallergy.2015.5.3.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/22/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND It was previously reported that there is a positive correlation between incidence of type 1 diabetes and prevalence of asthma and atopic eczema. A negative correlation between the prevalence of type 1 diabetes and mortality from infectious diseases as well as a positive correlation with antibiotic susceptibility at a country level have also been reported. OBJECTIVE The aim of this study was to investigate the association between country prevalence of rhinitis, atopic eczema, rhinoconjunctivitis, and wheezing with mortality from infectious diseases and also with antibiotic susceptibility at a country level. METHODS Data for prevalence of rhinitis, eczema, rhinoconjunctivitis, and wheezing was obtained from the International Study of Asthma and Allergies in Childhood study (ISAAC). ISAAC Phase one was a multicentre multicountry cross sectional study involving over 700,000 children in 2 age groups of school children, 13-14 years old (adolescents) and 6-7 years old (children) in 156 centres from 56 countries. Mortality from infectious diseases was taken from World Health Organisation data. The Alexander project was used to identify antibiotic susceptibilities to common bacteria. RESULTS There were significant positive correlations between atopic eczema and mortality from all infectious diseases studied, diarrhoeal illness, tropical infections, and childhood infections. A negative correlation exists between the prevalence of rhinitis and Streptococcus pneumoniae susceptibility to penicillin and to erythromycin, rhinitis and Haemophilus influenzae susceptibility to ampicillin and between rhinoconjunctivitis and H. influenzae susceptibility to ampicillin. CONCLUSION Th1/Th2 responses might influence the pathogenesis of infectious disease mortality, while antibiotic overprescription could explain the negative association between atopy and antibiotic susceptibility.
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Affiliation(s)
- Claudia Fsadni
- Department of Medicine, Mater Dei Hospital, Msida, MSD 2090, Malta. ; Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2090, Malta
| | - Peter Fsadni
- Department of Medicine, Mater Dei Hospital, Msida, MSD 2090, Malta. ; Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2090, Malta
| | - Stephen Fava
- Department of Medicine, Mater Dei Hospital, Msida, MSD 2090, Malta. ; Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2090, Malta
| | - Stephen Montefort
- Department of Medicine, Mater Dei Hospital, Msida, MSD 2090, Malta. ; Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2090, Malta
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Fsadni P, Fsadni C, Caruana Montaldo B. Primary laryngeal tuberculosis: An unusual cause of hoarseness. Ear Nose Throat J 2014; 93:E15-E17. [PMID: 25397382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Tuberculosis (TB) of the larynx is usually associated with concomitant pulmonary TB, but approximately 20% of cases represent primary disease. We report the case of an 85-year-old woman with asthma who presented with a 6-month history of persistent hoarseness. Bronchoscopy confirmed the presence of a lesion in the hemilarynx, and histology identified tuberculoid granulomas that were suggestive of TB. Treatment with a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol led to a complete resolution of symptoms. A high index of suspicion for laryngeal TB is required in patients who present with hoarseness.
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Affiliation(s)
- Peter Fsadni
- Department of Medicine, Mater Dei Hospital, Msida MSD 2090, Malta.
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Fsadni C, Fsadni P, Montaldo BC. Laryngeal Tuberculosis - an unusual case of hoarseness. J Infect 2011. [DOI: 10.1016/j.jinf.2011.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Fsadni P, Fsadni C, Fava S, Montefort S. Correlation of worldwide incidence of type 1 diabetes (DiaMond) with prevalence of asthma and atopic eczema (ISAAC). Clin Respir J 2011; 6:18-25. [PMID: 21501393 DOI: 10.1111/j.1752-699x.2011.00239.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Environmental factors play a role in pathogenesis of both type 1 diabetes and atopic disease but they remain incompletely understood. T cell-mediated responses primarily of the T helper type 1 (Th1) are involved in type 1 diabetes while T helper type 2 (Th2) responses favour allergic disease. This TH 1/TH 2 paradigm is currently the source of much controversy in various studies. OBJECTIVE The aim of the study was to compare the reported country incidence of type 1 diabetes with the prevalence of atopic disease. METHODS The prevalence of wheeze, rhinitis, rhinoconjunctivitis and atopic eczema in the preceding 12 months in the 13- to 14-year-old age group was taken from The International Study of Asthma and Allergies in Childhood phase 1 study. These were compared to the age specific incidence of type 1 diabetes in children per 100 000 per year obtained from the Diabetes Mondiale Project Group study from those countries participating in both studies. Data collected from these 31 countries together with latitude was analysed using a Pearson correlation and significance analysis. A multiple regression analysis determined the confounding effect of latitude. RESULTS The incidence of type 1 diabetes was found to have a positive correlation with both wheezing (P = 0.009) and atopic eczema (P < 0.01). There was a no correlation between the incidence of type 1 diabetes and the prevalance of rhinitis (r = 0.02, P = 0.88) or of rhinoconjunctivitis (r = 0.026, P = 0.88). Latitude correlated negatively with type 1 diabetes and positively with rhinitis and rhinoconjnctuvits; it was not significantly correlated with wheeze or eczema. Regression analysis showed that latitude is a significant confounding factor in the correlation of rhinitis (P value < 0.0008) and rhinoconjunctivitis (P value < 0.0003) with diabetes. CONCLUSIONS The study suggests that common environmental and/or genetic factors predispose to type 1 diabetes, wheezing and atopic eczema while factors predisposing to rhinitis and rhinoconjunctivitis appear to be distinct from those predisposing to type 1 diabetes.
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Affiliation(s)
- Peter Fsadni
- Department of Medicine, Mater Dei Hospital, Birkirkara, Malta.
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Abstract
The localization of Leishmania spp. in the larynx is rare especially when not associated with immunosuppression or with visceral or cutaneous leishmaniasis. We present a case of isolated laryngeal leishmaniasis, the first of its kind documented in Malta and infrequently reported from the Mediterranean basin.
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Affiliation(s)
- C Fsadni
- Infectious Diseases Unit (STZ), St. Luke's Hospital, Gwardamangia, Malta.
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