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Mickey Koh - One of the best experts on this subject based on the ideXlab platform.
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An unusual presentation of neutropenic enterocolitis (Typhlitis)
The Lancet. Infectious diseases, 2016Co-Authors: Jonathan Youngs, Cristina Suarez, Mickey KohAbstract:A 40-year-old man who had refractory, very severe, aplastic anaemia 6 months after an unsuccessful allogenic stem-cell transplant, presented with neutropenic (0·1 × 109/L) septic shock. Examination showed a tender papule on his thigh. Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli grew from the skin biopsy. Blood, urine, and stool cultures were all negative (no oganisms grew). CT showed many liver abscesses. The patient recovered after 6 weeks of ertapenem (1 g once a day) with teicoplanin (initially 200 mg once a day), remaining neutropenic throughout, but 12 days after fi nishing therapy he re-presented with pyrexia and additional skin lesions (fi gure A). Blood cultures grew the same ESBL-E coli as was isolated from the skin biopsy. CT showed pulmonary nodules suggestive of septic emboli with a healthy colon and biliary tract. PET showed uptake in the terminal ileum and wall-thickened caecum, con sistent with neutropenic enterocolitis (fi gure B). Neutropenic enterocolitis is a potentially life-threatening condition of the lower gastrointestinal tract (typically the caecum, in which it is termed Typhlitis), where intestinal microbes invade the surrounding tissue of patients with neutropenia. Prevalence of this condition is rising because of liberal use of aggressive chemotherapy agents that damage the intestinal mucosa, and it is being increasingly recognised as a complication of stem-cell transplantation. Typhlitis usually produces a non-specifi c triad of fever, abdominal pain, and diarrhoea but can present as recrudescent fever or bacteraemia. Our patient’s presentation of skin (and probably liver and lung) septicemboli was unusual and emphasises the need for a high index of suspicion for this increasingly prevalent condition. Unexplained bacteraemia with enteric organisms in patients with neutropenia—especially if substantial and long lasting—should raise suspicion of Typhlitis and trigger the necessary investigations, if another source for these organisms cannot be identifi ed. CT is regarded as the diagnostic imaging modality of choice for Typhlitis, and usually shows bowel wall thickening of more than 4 mm. In our patient, CT did not show bowel wall thickening, but subsequent PET and ultrasonography both did. This diff erence shows that repeat imaging studies should be thought about for patients in whom the diagnosis of Typhlitis is suspected. Management of Typhlitis is predominantly conservative involving bowel rest, supportive measures, and correction of coagulopathies, thrombocytopenia, and neutropenia. Appropriate broad-spectrum antibiotics should be started promptly, but surgery is usually reserved for com plications such as perforation or if clinical deterioration continues despite conservative management. Our patient continued to receive ertapenem (1 g once a day) alongside teicoplanin (increased to 800 mg once a day) based on blood-culture sensitivities and allergy status. Unfortunately, he later died of complications arising from a second allogeneic transplant not connected with this episode of sepsis.
David E. Swayne - One of the best experts on this subject based on the ideXlab platform.
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Cases of Spirochete-associated Necrotizing Typhlitis in Captive Common Rheas (Rhea americana)
Avian Diseases, 1997Co-Authors: Kathryn A. Eaton, David E. SwayneAbstract:SUMMARY. Ceca from greater or common rheas (Rhea americana) with gastrointestinal disease were collected from diagnostic labs and avian pathologists across the United States. The ceca were evaluated for the presence of spirochetes and necrosis using hematoxylin and eosin stain or Warthin-Starry silver-stained tissue sections and anaerobic culture. Spirocheteassociated necrotizing Typhlitis was documented in 11 states. Most cases were reported in the summer and fall and occurred in rheas less than 5 mo of age. Spirochetes isolated from ceca with necrosis were either strongly or weakly 3-hemolytic. All spirochetes isolated from ceca without necrosis were weakly P-hemolytic. Rheas might be host to both pathogenic and nonpathogenic spirochetes.
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Identification of a new intestinal spirochete with pathogenicity for chickens.
Infection and immunity, 1995Co-Authors: David E. Swayne, Kathryn A. Eaton, Darren J. Trott, David J. Hampson, J W Stoutenburg, Neil S. JensenAbstract:Two intestinal spirochete isolates obtained from chickens with diarrhea were examined by electron microscopy, biochemical tests, rRNA gene restriction pattern analysis, and multilocus enzyme electrophoresis. One isolate (strain 91-1207/C1) was pathogenicity tested in vivo in chickens. The chicken spirochetes were morphologically indistinguishable from Serpulina innocens and Serpulina hyodysenteriae and phenotypically similar to S. innocens. However, the chicken spirochetes could be distinguished from S. innocens, S. hyodysenteriae, and other swine intestinal spirochetes by rRNA gene restriction pattern analysis and multilocus enzyme electrophoresis. In pathogenicity tests in 1-day-old chicks and 14-month-old hens, chicken spirochete 91-1207/C1 produced pale-yellow, watery cecal contents and mild lymphocytic Typhlitis. These findings support the conclusion that avian intestinal spirochetes can be pathogenic to commercial poultry and that the microorganisms are different from intestinal spirochetes that infect pigs.
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Necrotizing typhlocolitis associated with a spirochete in rheas (Rhea americana).
Avian Diseases, 1992Co-Authors: John E. Sagartz, Kathryn A. Eaton, David E. Swayne, J. R. Hayes, K. D. Amass, R. Wack, L. KramerAbstract:SUMMARY. Necrotizing typhlocolitis was diagnosed in 13 juvenile common rheas (Rhea americana) from three separate and geographically isolated Ohio flocks, with mortality ranging from 25% to 80%. At postmortem examination, a diphtheritic membrane covered ulcerated cecal mucosa. Histologically, cecal sections showed necrosis and granulomatousto-suppurative inflammation that extended into the submucosa and often surrounded large eosinophilic colonies of bacteria. Warthin-Starry staining showed these colonies to be composed of entangled spirochetes that invaded the submucosa and frequently were present transmurally. Similar organisms were identified by Warthin-Starry staining in the cecum of a juvenile rhea from a fourth flock that histologically had mild lymphocytic Typhlitis. Scanning and transmission electron microscopy demonstrated the presence of a spirochete in the ceca. Anaerobic culture yielded a gram-negative, f-hemolytic spirochete. Coccidia, histomonads, and Salmonella spp. were consistently absent.
Jonathan Youngs - One of the best experts on this subject based on the ideXlab platform.
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An unusual presentation of neutropenic enterocolitis (Typhlitis)
The Lancet. Infectious diseases, 2016Co-Authors: Jonathan Youngs, Cristina Suarez, Mickey KohAbstract:A 40-year-old man who had refractory, very severe, aplastic anaemia 6 months after an unsuccessful allogenic stem-cell transplant, presented with neutropenic (0·1 × 109/L) septic shock. Examination showed a tender papule on his thigh. Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli grew from the skin biopsy. Blood, urine, and stool cultures were all negative (no oganisms grew). CT showed many liver abscesses. The patient recovered after 6 weeks of ertapenem (1 g once a day) with teicoplanin (initially 200 mg once a day), remaining neutropenic throughout, but 12 days after fi nishing therapy he re-presented with pyrexia and additional skin lesions (fi gure A). Blood cultures grew the same ESBL-E coli as was isolated from the skin biopsy. CT showed pulmonary nodules suggestive of septic emboli with a healthy colon and biliary tract. PET showed uptake in the terminal ileum and wall-thickened caecum, con sistent with neutropenic enterocolitis (fi gure B). Neutropenic enterocolitis is a potentially life-threatening condition of the lower gastrointestinal tract (typically the caecum, in which it is termed Typhlitis), where intestinal microbes invade the surrounding tissue of patients with neutropenia. Prevalence of this condition is rising because of liberal use of aggressive chemotherapy agents that damage the intestinal mucosa, and it is being increasingly recognised as a complication of stem-cell transplantation. Typhlitis usually produces a non-specifi c triad of fever, abdominal pain, and diarrhoea but can present as recrudescent fever or bacteraemia. Our patient’s presentation of skin (and probably liver and lung) septicemboli was unusual and emphasises the need for a high index of suspicion for this increasingly prevalent condition. Unexplained bacteraemia with enteric organisms in patients with neutropenia—especially if substantial and long lasting—should raise suspicion of Typhlitis and trigger the necessary investigations, if another source for these organisms cannot be identifi ed. CT is regarded as the diagnostic imaging modality of choice for Typhlitis, and usually shows bowel wall thickening of more than 4 mm. In our patient, CT did not show bowel wall thickening, but subsequent PET and ultrasonography both did. This diff erence shows that repeat imaging studies should be thought about for patients in whom the diagnosis of Typhlitis is suspected. Management of Typhlitis is predominantly conservative involving bowel rest, supportive measures, and correction of coagulopathies, thrombocytopenia, and neutropenia. Appropriate broad-spectrum antibiotics should be started promptly, but surgery is usually reserved for com plications such as perforation or if clinical deterioration continues despite conservative management. Our patient continued to receive ertapenem (1 g once a day) alongside teicoplanin (increased to 800 mg once a day) based on blood-culture sensitivities and allergy status. Unfortunately, he later died of complications arising from a second allogeneic transplant not connected with this episode of sepsis.
Selwyn Arlington Headley - One of the best experts on this subject based on the ideXlab platform.
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systemic histomoniasis in a leucistic indian peafowl pavo cristatus from southern brazil
Avian Diseases, 2017Co-Authors: Mariana De Mello Zanim Michelazzo, Joao Pedro Sasse, Marielen De Souza, V H B Marutani, Ana Angelita Sampaio Baptista, Joao Luis Garcia, Amauri Alcindo Alfieri, Selwyn Arlington HeadleyAbstract:SUMMARY The pathological and molecular findings associated with Histomonas meleagridis are described in a leucistic Indian peafowl (Pavo cristatus) from Southern Brazil. The most significant gross findings were multifocal necrotizing hepatitis and diphtheric Typhlitis. Histopathologic evaluation of the liver, ceca, kidney, spleen, and small intestine revealed systemic histomoniasis (SH) associated with intralesional and intravascular accumulations of histomonad organisms consistent with H. meleagridis. PCR was used to amplify the DNA of H. meleagridis from the liver, ceca, small intestine, spleen, lungs, and kidneys. Direct sequencing and phylogenetic analyses confirmed that the isolate of the flagellated trichomonad identified from this investigation is more phylogenetically related to H. meleagridis than Tetratrichomonas gallinarum, Tritrichomonas foetus, and Dientamoeba fragilis. These results confirmed the occurrence of SH in this peafowl and add to the diagnosis of this disease in birds from Brazil. ...
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Systemic Histomoniasis in a Leucistic Indian Peafowl (Pavo cristatus) from Southern Brazil.
Avian diseases, 2017Co-Authors: Mariana De Mello Zanim Michelazzo, Joao Pedro Sasse, Marielen De Souza, V H B Marutani, Ana Angelita Sampaio Baptista, Joao Luis Garcia, Amauri Alcindo Alfieri, Selwyn Arlington HeadleyAbstract:The pathological and molecular findings associated with Histomonas meleagridis are described in a leucistic Indian peafowl (Pavo cristatus) from Southern Brazil. The most significant gross findings were multifocal necrotizing hepatitis and diphtheric Typhlitis. Histopathologic evaluation of the liver, ceca, kidney, spleen, and small intestine revealed systemic histomoniasis (SH) associated with intralesional and intravascular accumulations of histomonad organisms consistent with H. meleagridis. PCR was used to amplify the DNA of H. meleagridis from the liver, ceca, small intestine, spleen, lungs, and kidneys. Direct sequencing and phylogenetic analyses confirmed that the isolate of the flagellated trichomonad identified from this investigation is more phylogenetically related to H. meleagridis than Tetratrichomonas gallinarum, Tritrichomonas foetus, and Dientamoeba fragilis. These results confirmed the occurrence of SH in this peafowl and add to the diagnosis of this disease in birds from Brazil. This report might represent the first complete identification of spontaneous histomoniasis in a peafowl due to pathological and molecular characteristics and one of the few documented cases of SH in non-commercial birds.
Figen Ozcay - One of the best experts on this subject based on the ideXlab platform.
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The Turkish Journal of Pediatrics 2003; 45: 248-250 Case Successful medical management of neutropenic enterocolitis (Typhlitis) in a child with acute lymphoblastic leukemia
2015Co-Authors: Figen Ozcay, Sinan Mahir Kayýran, Namýk Özbek, Summary Özçay F, Özbek Successful Medical N. ManagementAbstract:of neutropenic enterocolitis (Typhlitis) in a child with acute lymphoblasti
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Successful medical management of neutropenic enterocolitis (Typhlitis) in a child with acute lymphoblastic leukemia.
The Turkish journal of pediatrics, 2003Co-Authors: Figen Ozcay, Sinan Mahir Kayiran, Namik OzbekAbstract:We report a case of acute lymphoblastic leukemia that was complicated by neutropenic enterocolitis (Typhlitis) during the initial period of remission-induction chemotherapy. The patient's clinical symptoms resolved after aggressive treatment with intravenous fluids and electrolytes, nasogastric decompression, bowel rest, total parenteral nutrition, broad-spectrum antibiotics, and granulocyte colony-stimulating factor. Netropenic enterocolitis should always be considered in neutropenic leukemic children with the triad of fever, vomiting, and abdominal pain. Gastrointestinal hemorrhage may also accompany the symptoms described above. Plain roentgenogram, ultrasonography and computed tomography of the abdomen are helpful for making the diagnosis of this clinical condition. Early recognition and proper medical management of neutropenic enterocolitis may prevent the need for surgical intervention, and/or be life-saving.
