Background Legionella species are important causative organisms of severe pneumonia. However, data are limited on predictors of progression to severe Legionella pneumonia (LP). Therefore, the risk factors for LP progression from non-severe to the severe form were investigated in the present study. Methods: This was a retrospective cohort study that included adult LP patients admitted to a 2,700-bed referral center between January 2005 and December 2019. Results: A total of 155 patients were identified during the study period; 58 patients (37.4%) initially presented with severe pneumonia and 97 (62.6%) patients with non-severe pneumonia. Among the 97 patients, 28 (28.9%) developed severe pneumonia during hospitalization and 69 patients (71.1%) recovered without progression to severe pneumonia. Multivariate logistic regression analysis showed platelet count ≤150,000/mm3 (odds ratio [OR], 2.923; 95% confidence interval [CI], 1.100–8.105; P=0.034) and delayed antibiotic treatment >1 day (OR, 3.092; 95% CI, 1.167–8.727; P=0.026) were significant independent factors associated with progression to severe pneumonia. Conclusions: A low platelet count and delayed antibiotic treatment were significantly associated with the progression of non-severe LP to severe LP.
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Severe fever with thrombocytopenia syndrome (SFTS) is a newly emerging infectious disease, caused by a novel species of Phlebovirus of Bunyaviridae family, in China, South Korea, and Japan. SFTS is primarily known as a tick-borne disease, and human-to-human transmission is also possible in contact with infectious blood. Common clinical manifestations include fever, thrombocytopenia, and leukopenia as initial symptoms, and multiple organ dysfunction and failure manifest with disease progression. Whereas disease mortality is reported to be 12% to 30% in China, a recent report of cumulative SFTS cases indicated 47% in Korea. Risk factors associated with SFTS were age, presence of neurologic disturbance, serum enzyme levels, and elevated concentrations of certain cytokines. Diagnosis of SFTS is based on viral isolation, viral identification by polymerase chain reaction, and serologic identification of specific immunoglobulin G. Therapeutic guideline has not been formulated, but conservative management is the mainstream of treatment to prevent disease progression and fatal complications.
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BACKGROUND Thrombocytopenia has been shown to be a useful predictor of mortality in adult intensive care units (ICUs).
The aim of this study is to assess whether the level of platelet count at ICU admission and the changes in platelet counts can predict mortality in the pediatric ICU (PICU). METHODS Platelet counts were checked daily for at least 4 days in a total of 303 children who were admitted to the ICU. We compared the initial platelet counts and changes in platelet counts between survivors and non-survivors. A multivariable logistic regression model, a receiver operating characteristic curve and a linear mixed model were used. RESULTS The initial platelet count was significantly lower in non-survivors when compared to survivors. Multivariate analysis demonstrated that platelet count <120 x 10(9)/L (Odds ratio, 4.913; 95% confidence interval 2.451-9.851; p < 0.0001) was an independent predictor of mortality. In the case of children with thrombocytopenia (<120 x 10(9)/L) at admission to the ICU, the platelet counts increased serially in survivors, whereas non-survivors maintained their decreased platelet counts. In the case of children without thrombocytopenia, the platelet counts decreased most on day 3 in non-survivors. CONCLUSIONS At admission to the ICU, thrombocytopenia defined as a platelet count <120 x 10(9)/L can be a useful predictor of mortality in children. In children who had initial thrombocytopenia, the serial increase of platelet counts can be related to increased survival, whereas in children who did not have initial thrombocytopenia, more than a 10% decrease of platelet counts on day 3 can be related to mortality.
Heparin-induced thrombocytopenia (HIT) is a prothrombotic, immune-mediated adverse reaction to heparin therapy. It is caused by antibodies binding to a complex of heparin and platelet factor 4, and this leads to platelet activation, excessive thrombin generation and often thrombosis. HIT with thrombosis (HITT) can lead to limb amputation, stroke, myocardial infarction and death. We report here on a case of a HITT patient who was successfully managed with argatroban therapy. Further knowledge is need about the ideal medical management for HITT.
Hemolytic uremic syndrome is an unusual and uncommon disease in adults but more common in children, which is defined by the triad of acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia. We report a 64-year-old man who developed hemolytic uremic syndrome after esophagectomy and esophagogastrostomy due to esophageal cancer. We treated him using continuous renal replacement therapy and plasmapheresis with large volume fresh frozen plasma transfusion for 9 days. We could not find the cause of hemolytic uremic syndrome, and so finally concluded that it is idiopathic. Bleeding continuously without a particular reason after an operation, it needs an early diagnosis and treatment with considering a possibility of the hemolytic uremic syndrome.