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Shamez N Ladhani - One of the best experts on this subject based on the ideXlab platform.

  • presentation with gastrointestinal symptoms and high case fatality associated with group w meningococcal disease menw in teenagers england july 2015 to january 2016
    Eurosurveillance, 2016
    Co-Authors: Helen Campbell, Sydel R Parikh, Ray Borrow, Ed Kaczmarski, Mary Ramsay, Shamez N Ladhani
    Abstract:

    Atypical clinical presentations associated with group W meningococcal disease (MenW) are well-described and include pneumonia, septic arthritis, endocarditis and epiglottitis/Supraglottitis. Following anecdotal reports of teenagers presenting with predominantly gastrointestinal symptoms, we undertook a case review of MenW cases in 15 to 19 year-olds diagnosed in England between July 2015 and January 2016. Of the 15 cases, seven presented with a short history of nausea, vomiting and diarrhoea; five of these seven cases died within 24 hours of presentation to hospital.

  • increase in endemic neisseria meningitidis capsular group w sequence type 11 complex associated with severe invasive disease in england and wales
    Clinical Infectious Diseases, 2015
    Co-Authors: Helen Campbell, Ed Kaczmarski, Mary Ramsay, Shamez N Ladhani, Kazim Beebeejaun, Jay Lucidarme, Steve Gray, Ray Borrow
    Abstract:

    Background. In England and Wales, the incidence of invasive meningococcal disease has been declining formore than a decade, but meningococcal group W (MenW) cases have been increasing since 2009.Methods. PublicHealthEnglandconductsenhancednationalsurveillanceofinvasivemeningococcaldiseaseinEn-glandandWales.Detailedclinicalinformationwasobtainedforalllaboratory-confirmedMenWcasesdiagnosedduring3 epidemiologic years (2010–2011 to 2012–2013), alongside whole-genome sequencing analysis of the clinical isolates.Results. Theyear-on-yearincreaseininvasiveMenWdiseaseacrossallagegroupssince2009 –2010wasduetorapidendemic expansion of a single clone belonging to the sequence type 11 complex (cc11). In 2013–2014, MenW wasresponsible for 15% of all invasive meningococcal disease. All but 1 of the recent MenW:cc11 isolates were very closelyrelated, consistent with recent clonal expansion. Clinical follow-up of all 129 MenW cases diagnosed during 2010 –2011to 2012–2013 revealed that most patients were previously healthy (n=105 [81%]), had not travelled abroad prior toillness and the majority presented with septicemia (n=63 [49%]), meningitis (n=16 [12%]) or both (n=21 [16%]);however, one-quarter had atypical presentations including pneumonia (n=15 [12%]), septic arthritis (n=9 [7%]),and epiglottitis/Supraglottitis (n=5 [4%]). Forty-eight (37%) required intensive care and 15 (12%) died. There wasno association between infecting strain, clinical disease, or outcome.Conclusions . The recent increase in invasive MenW disease in England and Wales is due to rapid endemic expan-sion of a single clone belonging to cc11 and is associated with severe disease with unusual clinical presentations. Thisincrease will require careful monitoring in the coming years.Keywords. meningococcal W disease; meningococcal pneumonia; ST-11 clonal complex; travel; epidemiology.Neisseria meningitidisis a major infectious cause ofmorbidity and mortality worldwide [1]. In the UnitedKingdom, routine vaccination against meningococcalcapsular group C (MenC) since 1999 has resulted incapsular group B (MenB) being responsible for >85%of invasive meningococcal disease (IMD) cases acrossall age groups [2]. The meningococcal quadrivalentconjugate vaccine (MenACWY) is only used for high-risk individuals and travelers to endemic regions andfor controlling outbreaks. Recently, much attentionhas been focused on MenB prevention following thelicensure of a novel, protein-based, multicomponentvaccineinEurope[3].Atpresent,however,EnglandandWales are experiencing an upsurge in invasive capsulargroupW(MenW)disease.Historically,MenWincidencehas been low, accounting for only 1%–2% of IMD casesannually. An increase during 2000–2002 was associatedwith travel to the Hajj [4], but following mandatorymeningococcal vaccination for pilgrims, MenW cases

Craig S Boutlis - One of the best experts on this subject based on the ideXlab platform.

Nabil Fuleihan - One of the best experts on this subject based on the ideXlab platform.

  • viral Supraglottitis in an adult a case presentation and literature update
    Journal of Infection, 1999
    Co-Authors: Umaya Musharrafieh, George F Araj, Nabil Fuleihan
    Abstract:

    Abstract Viral epiglottitis (Supraglottitis) is a rare entity but its presentation can mimic that of bacterial epiglottis. Regardless of the causative agent, Supraglottitis is a serious disease mostly affecting children and rarely seen in adults. Early suspicion and proper evaluation are mandatory to prevent a life-threatening crisis. In both children and adults the infectious aetiology in Supraglottitis is predominantly bacterial while viruses are rare, especially in adults. We describe a case of Supraglottitis in an adult in which the symptoms were insidious and blood indices suggested a bacterial aetiology. However, laryngoscopic examination revealed an ulcer over the left aryepiglottic fold and serology was positive for Herpes simplex virus (HSV) IgM Because Supraglottitis due to HSV is a rare entity with few reported cases in the literature, this case is presented to highlight the viral involvement in this disease and its management.

Balagangadhar Totapally - One of the best experts on this subject based on the ideXlab platform.

  • pediatric covid 19 presenting as Supraglottitis with vocal cord hypomobility
    SAGE open medical case reports, 2021
    Co-Authors: Balagangadhar Totapally, Meghana Nadiger, Manette Nesscochinwala, Carolina Sanchezvegas, Prithvi Sendi
    Abstract:

    In the United States, an estimated 7.3% of confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19) are among persons aged less than 18 years. Data regarding clinical manifestations in this age group are still evolving. An upper airway predilection has been reported in children. We describe the case of a 15-year-old female with Supraglottitis and unilateral hypomobility of vocal cord with concern for critical airway, associated with COVID-19. She was managed by a multidisciplinary team including critical care, infectious diseases, and otolaryngology. This report adds to the sparse but evolving body of literature on the clinical presentation of COVID-19 disease in children.

  • 66 epidemiology of Supraglottitis and epiglottitis in hospitalized children during 2012
    Pediatrics, 2018
    Co-Authors: Mukul Sehgal, Sruti Aiyaswamy, Mohammed Salameh, Balagangadhar Totapally
    Abstract:

    Title Epidemiology of Supraglottitis and Epiglottitis in Hospitalized Children during 2012 Mukul Sehgal, MD, Sruti Aiyaswamy, Mohammed Salameh, MD, Balagangadhar Totapally, MD Nicklaus Children's Hospital, Miami, FL. Background: The prevalence of Supraglottitis and epiglottitis has declined drastically in children compared to pre-vaccine era, with some studies reporting as much as 10 fold decrease (Ref: Faden H. Pediatric Emergency Care. 22(6):443-4, 2006). H inluenzae, which once was a predominant cause responsible for about 85% of cases, is not a leading cause anymore. Objective To evaluate the prevalence, demography, bacteriology, …

Robert A Gasser - One of the best experts on this subject based on the ideXlab platform.

  • fulminant Supraglottitis from neisseria meningitidis
    Emerging Infectious Diseases, 2007
    Co-Authors: Mark G Kortepeter, Brian L Adams, Wendell D Zollinger, Robert A Gasser
    Abstract:

    To the Editor: A 68-year-old Caucasian woman with non–insulin-dependent diabetes mellitus, hypertension, and peripheral vascular disease sought treatment at an emergency department after experiencing 2 days of pharyngitis and 1 day of fatigue and dysphagia for solid food. The morning of admission she noted dysphagia for solid food and liquids, dysphonia, severe anterior neck pain, swelling, and erythema, dyspnea, and a temperature of 102.3°F (39°C). A computed tomographic (CT) scan demonstrated substantial neck soft tissue edema and narrowing of the oropharynx and hypopharynx. She received single doses of intravenous ampicillin/sulbactam, clindamycin, dexamethasone (10 mg), and methylprednisolone (125 mg) before being evacuated by air to our intensive care unit (ICU) at Walter Reed Army Medical Center. Intravenous ampicillin/sulbactam, 3 g every 6 hours, and clindamycin, 900 mg every 8 hours, were continued after the transfer. Two doses of intravenous vancomycin, 1 g every 12 hours, were given before vancomycin was discontinued. Results of laboratory studies were the following: leukocyte count 13.3/mm3 (71% polymorphonuclear leukocytes, 18% bands) and normal hematocrit, platelet count, blood urea nitrogen and creatinine concentrations, and liver-associated enzymes. A marker pen was used to track the rapid advance of erythema overnight from her anterior, inferior chin to the top of her breasts (Figure). The infectious disease service was consulted the next morning. When she was examined, her condition had improved; she had normal vital signs, a slightly hoarse voice, and the ability to swallow some saliva. She had no headache or meningismus. The chest erythema was receding. Oral examination demonstrated erythema and an abrasion in the posterior pharynx. Her tongue was not elevated and her uvula was midline. Anterior firm edema without crepitus extended from her chin to the mid-neck. Results of her examination were otherwise unremarkable. The infectious disease consultant recommended restarting a course of vancomycin and discontinuing clindamycin. Figure Top, anterior and lateral views of patient on day 1 of receiving antimicrobial drugs, demonstrating neck erythema and edema. Bottom, anterior and lateral views of patient on day 8 of receiving antimicrobial drugs, demonstrating resolution of neck erythema ... A follow-up CT scan with contrast demonstrated anterior cervical soft tissue edema and patent airway with surrounding abnormal thickness and soft tissue density. No abscess or clot was seen. Endoscopic examination in the ICU showed diffuse erythema and generalized supraglottic edema affecting mostly the epiglottis and arytenoids. Dental examination demonstrated no acute pathologic features. Blood cultures at our hospital yielded no growth, and throat culture was negative for group A streptococci. The patient recovered without requiring intubation (Figure). On the day of discharge, a blood culture from the referring hospital’s emergency department was reported to be positive for Neisseria meningitidis, serogroup Y. Immediate family members and the otolaryngologists who conducted the endoscopic examination were given postexposure prophylaxis. The patient also received terminal prophylaxis. Results of a screening CH50 for terminal complement deficiency were normal. This patient’s condition is consistent with fulminant meningococcal Supraglottitis. Supraglottitis implies involvement of the epiglottis and surrounding structures and is more commonly used to describe adult infection than is epiglottitis (1). Epiglottitis has become more common in adults than in children since the introduction of the Haemophilus influenzae type b vaccine. Other organisms responsible for epiglottitis in adults include H. influenzae, H. parainfluenzae, pneumococci, Staphylococcus aureus, and group A streptococci (2). Despite its propensity to colonize the upper respiratory tract, N. meningitidis has rarely been identified as a cause of Supraglottitis or other deep neck infections. Only 6 cases have been reported, the first in 1995 (3–8). Previously reported cases were equally apportioned by sex, and patients were 44 to 95 years of age (3–8). Including our patient, 3 of 7 were diabetic (6,7). None showed evidence of meningitis or fulminant meningococcemia, but all had fever, pharyngitis, and airway compromise. Five required airway intervention: 3 intubations and 2 urgent tracheostomies. Two received steroids (3,4), a 54-year-old man required urgent tracheostomy before receiving steroids, and a 60-year-old man’s condition “deteriorated rapidly,” but the report does not indicate the interval between receipt of steroids and intubation. Although steroids have been used, their benefit is unproven, and no controlled clinical trials have been conducted (9). Blood cultures have been positive from all reported case-patients. Two isolates were typed as serogroup B, 4 as serogroup Y, and the serotype of 1 was unreported. Meningococcal strains causing Supraglottitis appear to be more locally aggressive but cause less disseminated disease, possibly due to decreased tropism for endothelial cells (8). To our knowledge, ours is the second case of meningococcal Supraglottitis reported with severe neck edema and cellulitis; a 44-year-old woman in a prior review had features similar to our patient (8). An 81-year-old woman with diabetes was noted to have “reddish swelling” on the right side of the neck (7), but little was described beyond that. All 3 had serogroup Y infection. We wondered whether serogroup Y might have a propensity to cause cellulitis; however, a review of 10 cases of meningococcal cellulitis included patients with multiple serogroups: C (4 cases), B (2 cases), Y (2 cases), and unknown (2 cases) (10). N. meningitidis may cause Supraglottitis more frequently than is recognized (3). Timely drawing of blood cultures in relation to administration of antimicrobial drugs is most likely to identify this pathogen in this setting. Because of its public health implications and potential for rapid progression to airway compromise, N. meningitidis should be considered among the differential diagnoses of Supraglottitis/epiglottitis.