Interesting case. Second episode of Herpes Simplex encephalitis in an adult approximately 3 years after the first. Here is a case report and literature review on recurrent disease.
The main deteminant of outcome in HSV encephalitis is time to acyclovir. This article discusses factors associated with the delay of administration.
This article discusses the outcomes of HSV in population based study.
I discuss viral encephalitis in a previous blog.
Tuesday, March 16, 2010
Tuesday, March 9, 2010
Neutropenic Entercolysis
With thanks for the suggestion.
Today we saw a patient with lymphoma, status post bone marrow transplant, who developed fever, neutropenia, abdominal pain, diarrhea and colitis on CT scan with a presumed diagnosis of neutropenic enterocolitis.
This condition, loosely defined (but best defined as fever, abdominal pain and colonic thickening -- see here) is seen in about 5% of patients. The mortality approaches 50% in some studies.
Ultrasound may be useful in screening for this condition early on.
Usual pathogens are bacterial (gram negative bowel flora including pseudomonas, and gram positive bowel flora). Bacteremia is seen in 35-80% of cases. A reasonable coverage choice would be an anti-pseudomonal beta-lactam (i.e. piperacillin-tazobactam or meropenem) with anerobic activity, or something like ceftazadime with metronidazole.
Fungal infection is rare (~5%) and usually candidal, but caries a high mortality (~80% in some studies). Emperic antifungal coverage should be considered if still febrile and neutropenic at 5 days or in the severely ill.
Critically ill patients should be considered for colectomy as should patients with complications (megacolon, perforation).
Today we saw a patient with lymphoma, status post bone marrow transplant, who developed fever, neutropenia, abdominal pain, diarrhea and colitis on CT scan with a presumed diagnosis of neutropenic enterocolitis.
This condition, loosely defined (but best defined as fever, abdominal pain and colonic thickening -- see here) is seen in about 5% of patients. The mortality approaches 50% in some studies.
Ultrasound may be useful in screening for this condition early on.
Usual pathogens are bacterial (gram negative bowel flora including pseudomonas, and gram positive bowel flora). Bacteremia is seen in 35-80% of cases. A reasonable coverage choice would be an anti-pseudomonal beta-lactam (i.e. piperacillin-tazobactam or meropenem) with anerobic activity, or something like ceftazadime with metronidazole.
Fungal infection is rare (~5%) and usually candidal, but caries a high mortality (~80% in some studies). Emperic antifungal coverage should be considered if still febrile and neutropenic at 5 days or in the severely ill.
Critically ill patients should be considered for colectomy as should patients with complications (megacolon, perforation).
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