American journal of hospital medicine, volume 6, issue 3 (2022 July-September)

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https://hdl.handle.net/10355/92061

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    Persistent meningeal signs despite previous treatment for cryptococcal meningitis -- a case report
    (University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-07) Fabricius, Michela M.; Ejiofor, Shannon
    Cryptococcal meningitis continues to be a life-threatening fungal infection in patients with HIV. Treatment involves a year of antifungal therapy, and persistent meningeal signs months after treatment initiation are uncommon. We report a case of a 29-year-old male with HIV who was diagnosed with cryptococcal meningitis ten months earlier and underwent induction, maintenance and consolidation therapy and ART. Subsequently, he continued to have persistent headaches and developed severe meningeal signs with leptomeningeal enhancement on imaging. This case discusses the importance of keeping both immune reconstitution inflammatory syndrome and a cryptococcal meningitis relapse in the differential diagnosis for patients with persistent meningeal signs.
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    Intradermal moving tracks
    (University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-07) Jamaleddine, Wassim M.; Saleem, Saliha; Roland, William E.
    A 64-year-old female presented in August of 2022 to the infectious disease clinic for pruritic lesion and seeing worms on her left foot. Her medical history includes hyperlipidemia, seborrheic keratosis, actinic keratosis and basal cell carcinoma that was excised in 2020. In November 2021 she traveled to Jamaica, where she used to dance barefoot on the sand. Two months into her stay, her symptoms started with itchiness and burning sensation in her left foot. Moreover, when she got back to the U.S. in July 2022, she developed watery diarrhea that resolved on its own. She denies having any other systemic symptoms. She tried using natural oils and neem powder for the itch. Her symptoms persisted, and she ended up going to a primary care physician who prescribed one course of albendazole. After taking the first dose, her lips swelled, and she felt unwell hence she was referred to the infectious disease clinic. Further history showed that she is a cashier who lives on a farm in Columbia, Missouri. She has cows and a pet dog on her farm where she walks barefoot. Her vital signs were normal. On physical exam she had an erythematous creeping skin lesion with a serpiginous pattern on her left foot.
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    Interventions that can improve the retention in care among patients with HIV: A review
    (University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-07) Ah Kang, Seung; Cardona, Connie
    Introduction: Despite the transformation in healthcare outcomes with the availability of effective antiretroviral therapy, retention in human immunodeficiency virus (HIV) care remains a challenge. Patients with poor retention have higher rates of HIV-related complications and death. Materials and Methods: We conducted a literature search on PubMed, including articles that reported on the adult population in the United States and published between 2002-2022. The keywords used included HIV, retention in care, intervention, support services, missed appointments, barriers to care, text messages, mobile health, telehealth, and telemedicine. Results/Discussion: We found that interventions implementing supportive services such as patient navigators, counseling, HIV education, and providing transportation led to an increase in retention in care. Technological interventions have also improved retention in care and include patient portals, appointment reminders, telehealth, and clinic-based smartphone apps. Lastly, visual, and verbal messages that emphasize the importance of retention in care are easy, low-cost interventions to implement in the HIV clinic. Conclusion: Overall, higher levels of patient retention are needed to secure improved healthcare outcomes in patients with HIV. The diversifying population of people with HIV (PWH) calls for additional research that aims to address unmet patient needs.
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    In-hospital mortality rate and predictors of 30-day readmission in patients with iron deficiency anemia and diastolic heart failure: A cross-sectional study
    (University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-07) Gangu, Karthik; Bobba, Aniesh; Patel, Parth S.; Vellanki, Sruthi; Trikannad, Anup Kumar; Basida, Sanket; Avula, Sindhu; Tripathi, Alok
    Introduction: There is currently strong evidence of the adverse effects of anemia on the prognosis of heart failure with reduced ejection fraction. Unfortunately, the data on the effects of anemia on a large sample of patients with diastolic heart failure (DHF) is lacking. In this study, we aimed to evaluate the effect of iron deficiency anemia on DHF readmission rates and its corresponding causes and burdens on the healthcare system. Methods: We utilized 2018 Nationwide readmission data and included patients aged ≥18 years with ICD-10 CM code indicating acute or acute chronic diastolic heart failure and iron deficiency anemia was included in the study. The primary outcome is 30-day readmission rates. Secondary outcomes were mortality rates, common causes of readmission, and healthcare utilization. Independent predictors for readmission were identified using cox regression analysis. Results: The total number of admissions in our study was 795,777. The mean age was 74.4 years (SD=13.7), and 63.54% were females. The 30-day readmission rate in patients with diastolic heart failure and iron deficiency anemia was 18.32 % vs. 16.01% in patients without anemia. The mortality rate at index admission and readmission was 3.62 % (2601) and 5.82 % (737), respectively. The most common cause of readmission was hypertensive heart and kidney disease with heart failure (17.74%). The independent predictors of readmission were age [less than] 85 years, household income [less than] 59000$/per year, Medicare and Medicaid insurance, higher Elixhauser comorbidities score, longer Length of stay during the index admission, discharge to a nursing home, hospital located in a large metropolitan area. The financial burden on healthcare for all the readmission was $837 million for 2018. Conclusion: The 30-day readmission rate in patients with diastolic heart failure and iron deficiency anemia is 18.32% in the year 2018. The mortality rate increased from 3.62 % to 5.82 % with readmission. The financial burden for readmission during that year was $837 million. Future studies are warranted to treat iron deficiency anemia to prevent readmissions in diastolic heart failure.
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    Campylobacter fetus meningitis and bacteremia in a well-controlled HIV patient
    (University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-07) Wang, Kevin; Sahu, Aniruddha
    We present a case of Campylobacter fetus meningitis and bacteremia in an HIV patient. He was initially admitted due to concern for meningitis. After brief observation, the patient was discharged--once infectious etiologies had been ruled out. Soon after discharge, he was readmitted due to late culture growth demonstrating Campylobacter fetus in his cerebrospinal fluid (CSF) and blood. Our patient declined initially despite being placed on an appropriate, susceptibility-proven antibiotic regimen. He was later treated successfully with carbapenem therapy. This outcome is in alignment with the few previous cases of treatment failure (despite an appropriate antibiotic regimen) and supports the argument that most patients respond best to a carbapenem regimen.