list int 6 case DOC-20250210-WA0007. (3).pptx

interesting case presentation

1. Interesting case presentation Dr . G ayath ri , junior resident , General Medicine

2. • Loose stools and vomiting 3 days ago followed by, • Altered sensorium for 1 day • Mr. X • 34 Y/ M • Function c ook

3. • Abdominal pain , diffuse , dull aching for 1 week • Loose stools for 3 days , 4 days ago , - 4-5 episodes / day, watery, low volume , non bloody • Vomiting for 2 days, 3 days ago - 4 episodes/ day, non bloody, non bilious , non projectile • Altered sensorium for 1 day in the form of not responding to commands , not opening eye s

4. • k/c/ o psoriasis and psoariatic arthritis , received 3 doses of A dalimumab and last dose was on July 2024, f rom our I mmunology departmen t • H LA B 27 positive , X ray pelvis s / o b / l grade 4 sacro il itis • Mixed diet • Smoker and alcoholic

5. Had received A dalimumab 30mg SC 3 doses, last dose on July 2024 Methotrexate 15 mg weekly and tab . prednisol one 5 mg od Vitals P ulse rate: 120/ min , BP: 90/60 mmhg , SPO 2 99% R R: 16/ min E1 V1M4

6. Patient was shifted to micu for further ma nagement . Perisstent uprolling of eyes with and episod e of gtcs lasting 2 minutes relieved with anti epileptics. • Blood culture was sent grow ing listeria monocytogenes • Csf picture : 200 cells , 56% neutrophil s and 44% lymphocytes, with 26 mg / dl glucose ,, protein -239, ada -5 • Ampi cillin 2gm q4th hourly and gentamicin 5mg/kg/day in 3 divided doses w a s started

7. Pts sensorium gradually improved to full sensoriu m, extubated and shifted to ward After 5 days of being shifted out , pt had 2 episodes of GTCS followed by persistent upro lling of eyes with no improvement in sensorium , intubated and sh ifted to N euro logy ICU for further management . Continuous EEG monitoring and burst suppresion was achieved

8. Septic shock due to hospital acquired infection – clabsi , VAP+, and difficulty weaning, with sensorium of E3VntM5, fluctualting sensorium

9. • Listeriolysin o , • Actin based motility • Actin polyme risation and subversion of host cytoskeleton • Lysis of vacuole and release of bacteria into cytosol and beginning of another round of replication • Listeria monocytogenes , Gram positi ve rod

10. • Ubiquitous , environmental saprophyte • Ingestion of contaminated food • Ingestion – transcytosis across intestinal epithelium, blood stream , liver and spleen and can migrat e across bbb and placenta • Infection is rare because of innate and adapt ive iimmunity • and interferon gamma

11. • Pregnant women and listeria , pregnancy related complications • What are the sources

12. • Febrile gastroenteritis • Bacteremia • • Incubation period of manifestations … … … … ..

13. Treatment and prevention • High dose genta micin and ampicillin • Role of tmp - smx given for hiv pts in prevention of p neumocystis jirovecii infection in listeriosis prevention • General measures • ?dexamethasone

14. THANK YOU …