Chiara Casarsa

Disseminated tuberculosis in an immunocompetent patient

Miliary tuberculosis refers to the clinical disease resulting from the hematogenous dissemination of Mycobacterium tuberculosis. A tuberculous aneurysm of the aorta is exceedingly rare. Contiguous tuberculosis in the form of lymphadenitis is generally responsible for the aortic involvement. We report a case of tuberculous mycotic aneurysm in patient with miliary disease, not affected by a cellular immunodeficiency and with no other common risk factor for infection. He received anti-tubercular therapy and endovascular stenting before the identification of Mycobacterium tuberculosis in lung, lymph nodes, and gastric lavage. The clinician should be aware that a mycotic abdominal aortic aneurysm could be caused by M. tuberculosis, even if microbiological confirmation is lacking or is negative, especially if a contiguous focus of tubercular infection is detected.

Invasive filamentous fungus infection with secondary cerebral vasculitis in a patient with no obvious immune suppression.

Invasive mold infections represent an emerging and important diagnostic challenge, especially in immunocompetent patients when microscopy and cultures of the biological fluids remain negative. A central nervous system localization is not common and the clinical presentation is aspecific.

Septic Shock with Multi Organ Failure Due to Fluoroquinolones Resistant Campylobacter Jejuni

Patient: Male, 65 Final Diagnosis: Septic shock with MOF due to fluoroquinolones resistant Campylobacter jejuni Symptoms: Fever (37.4°C) • acute delirium Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Rare disease Background: Campylobacter jejuni infections are typically self-limited, and severe extra-intestinal complications are uncommon. Case Report: We report a case of a man with septic shock due to fluoroquinolones resistant Campylobacter jejuni. Conclusions: This manuscript emphasizes the potential lethality of fluorquinolones resistant Campylobacter jejuni bacteremia.

Role of Angiopoietin-2 in Medical-Ward Patients with SIRS/Sepsis

Background: SIRS/sepsis accounts for vast majority of deaths in ICU a medical ward department. More than 650,000 cases of sepsis are diagnosed in the United States annually, with 30-50% mortality and individually cost more than 22,000 dollars. Biomarkers could be useful tools for early risk stratification in these patients. Angiopioietin-2 (Ang-2) is a proinflamma- tory mediator of endothelial injury, which has received considerable attention over the past decade but little is known about its correlation with organ failure and mortality in SIRS/sepsis admitted to a medical ward. Methods: Ang-2 plasma levels, Charlson index, SOFA and routine laboratory test were carried out in 80 SIRS patients admitted to medical ward within 4 hours from diagnosis. Survival and organ dysfunction in the following week were recorded. Investigators were blinded from Ang-2 results. Results: Ang-2 plasma levels were higher in patients suffering from renal, pulmonary and hemostatic dysfunction (16, 6, 4% respectively) and patients who died within 1 week (11%). Ang-2 plasma levels higher than 15 ∝/mL account for 13 fold increased risk of death with 94% negative predictive value. Conclusions: Ang-2 plasma level at admission is predictive of early mortality and kidney, lung and hemostasis dysfunc- tion in SIRS/sepsis patients newly admitted in a medical ward.