Critical Care Obstetrics and Gynecology

Description                                          

Two years after receiving BCG injections for bladder cancer, we present a case of disseminated BCG infection. With an 18-month history of fevers, weight loss, and intermittent confusion, our 74-year-old male patient was referred. The patient had previously been admitted to multiple hospitals for evaluation of fatigue, confusion, and a fever of unknown cause prior to the referral. Despite receiving treatment for a number of acute infections, extensive investigations failed to pinpoint the primary cause of his persistent fever. Two aneurysms—iliac and aortic—were discovered and stented during this time. Both were thought to be mycotic, but neither had a positive microbiology. Consider disseminated BCG in patients who present with pyrexia of unknown origin following reported intravesical BCG treatment for bladder cancer in the years prior to presentation, as this case demonstrates. Mycotic aneurysms are a serious but uncommon but fatal side effect of disseminated BCG. A wide range of acute to chronic infections, chronic systemic diseases, and cancers are represented by cavitary lung lesions. Lung cavitation has increased during the COVID-19 pandemic, primarily as a result of bacterial infection; however, there have been few reports of lesions associated with mild COVID-19 disease. Secondary bacterial/fungal infections and cavitary lung lesions have been linked to severe COVID-19 infection. A 32-year-old man with well-controlled HIV who presented with cough and fever as a result of what appeared to be a cavitary lesion as a result of his recent COVID-19 infection is the first case that we have seen. During pregnancy, severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections are linked to poor outcomes for the mother, the fetus, and the newborn. The presence of SARS-CoV-2 in the placenta can cause a variety of complications during pregnancy, including various degrees of inflammation and malperfusion. Methods: Analyses were conducted on placental, fetal, and umbilical cord samples from three cases of fetal death that occurred when maternal SARS-CoV-2 infections were present.

Placental Physiopathology in Utero Transmission

The Colombian SARS-CoV-2 National Surveillance System was informed of cases. RT-PCR and immunohistochemistry (IHC) were used to look for signs of a viral infection in the tissue. The presence of viral antigens and genomes in placental and umbilical cord tissues was confirmed by RT-PCR and immunohistochemistry. Placental inflammation and malperfusion were confirmed by histopathological examination. During pregnancy, SARS-CoV-2 infection can damage the placenta and make it harder for the fetus to survive. There are still many unanswered questions regarding the dynamics of SARS-CoV-2 during pregnancy, including placental physiopathology and in utero transmission. Studies on pelvic inflammatory disease during pregnancy that described at least one case of pelvic inflammatory disease after conception, defined as infection in one or more of the following, were identified and considered eligible. The uterus, ovaries, and fallopian tubes; based on clinical findings, examination, and imaging, whether pelvic abscesses are present or not. The included studies evaluated perinatal outcomes only for pelvic inflammatory disease with or without tubo-ovarian abscesses during pregnancy. Risk factors, methods of delivery, and outcomes for the mother, fetus, and new-born were all taken into account. 34 manuscripts describing the occurrence of pelvic inflammatory disease in 49 pregnancies were analyzed after articles that did not meet the inclusion criteria were excluded. The primary focus was on cases that were reported after 1971. Patients had a mean age of 25 6.3 years, a mean gestational age of 19.0, 10.3 weeks at diagnosis, and 67.6% were multiparous. There were 27 exploratory laparotomies, 14 unilateral salpingo-oophorectomies, and 11 appendectomies among the included patients. There were 13 full-term pregnancies, 14 caesarean deliveries, 10 spontaneous vaginal deliveries, and 2 cesarean hysterectomies. There were 26 births that were viable and 17 births that were not viable. Sepsis was a complication in three (7.0%) cases, resulting in three deaths of newborns. A 64-year-old patient with right upper quadrant abdominal pain and nausea was referred to our surgical outpatient department by his physician for suspicion of liver hydatid cyst. The right upper quadrant of the abdomen displayed mild tenderness during the physical examination. A segment IV multivesicular cystic lesion with an exophytic component abutting the gallbladder was discovered during a computed tomography abdominal scan. The condition known as primary gallbladder hydatid cysts (PGHC) only occurs in less than 0.4% of echinococcosis locales. Only twenty-three such cases, including ours, have been reported in English literature after research of case reports. Radiologists rarely make a PHGB their first diagnosis due to its rarity. In only 50% of cases, a hydatid cyst could be diagnosed prior to surgery. As a result, careful attention is required to aid in the preoperative diagnosis and subsequent treatment. The commensal gram-negative bacterium Moraxella osloensis has also been reported to cause invasive infections, primarily in immunocompromised individuals.

Quadrant Abdominal Pain and Nausea

Due to its rarity and difficulty in identification, there is a lack of knowledge regarding the clinical significance of its isolation. This study was carried out at Hamad Medical Corporation facilities in the state of Qatar and aimed to describe the clinical characteristics and outcomes of patients with M. osloensis bacteremia. A retrospective data review was carried out on patients who had Moraxella osloensis detected in a blood culture. Over six years, nine patients were identified. Only two patients had a positive blood culture that was deemed clinically significant. Ampicillin and ceftriaxone were ineffective against the isolates in both instances. In the one-month follow-up, there were no recurrences and the outcomes were excellent. M. osloensis is a human commensal that typically only infects susceptible individuals. In the right clinical setting, positive culture results should be considered significant. A rare complication of empyema, empyema necessities involve the empyema spreading beyond the pleural space into the chest wall's subcutaneous tissues. A 74-year-old woman with periodontitis presented with a subcutaneous chest wall abscess as a case of empyema necessitans, which was brought on by an important anaerobic periodontal pathogen, Porphyromonas gingivalisthogen. The patient was admitted to our hospital with a tender soft tissue mass in the chest wall that was caused by an empyema-associated subpleural lung abscess. The chest wall mass was discovered to be infected with P. gingivalis after exploratory percutaneous puncture and aspiration revealed foul-smelling, chocolate-colored pus. A relapse of empyema necessitans after antibacterial treatment necessitated a second admission one month later. The subcutaneous abscess was successfully treated with a combination of surgical open drainage and decortication. Periodontitis is a potential source of infection, and physicians must be aware of emphysema necessitans as a cause of a chest wall mass.