FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W4387267808> ?p ?o ?g. }

• W4387267808 endingPage "A2504" @default.
• W4387267808 startingPage "A2503" @default.
• W4387267808 abstract "SESSION TITLE: Critical Care Case Report Posters 55 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: In the developed world, Enteropathogenic Escherichia Coli (EPEC) is generally associated with a self-limited, non-bloody diarrhea [1]. Due to its non-invasive, nontoxigenic nature EPEC rarely causes sepsis and is not generally associated with hemolytic uremic syndrome (HUS), or severe thrombocytopenia [1]. We present a case of a patient who was found to have an EPEC and Coronavirus-19 (COVID-19) coinfection with profound thrombocytopenia and sepsis. CASE PRESENTATION: A 55-year-old female with history of gastric bypass surgery was admitted to the medicine service for acute bloody diarrhea and altered mental status (AMS). Labs on admission revealed lactic acid: 4.1 mmol/L, anion gap: 24, creatinine: 2.1 mg/dl and a positive COVID-19 polymerase chain reaction (PCR). Vital signs showed blood pressure 80/65 mmHg; respiratory rate 37 breaths per minute. Physical exam revealed an uncomfortable, altered female with severe abdominal pain. Initial imaging with computed tomography of head, abdomen, and pelvis were unremarkable. Blood cultures obtained on admission were positive for Escherichia coli. Gastrointestinal PCR returned positive for EPEC. The patient was fluid resuscitated and broad-spectrum antibiotics were initiated. With increasing abdominal symptoms she underwent exploratory laparotomy with Esophagogastrojejunoscopy which were unrevealing to nature of clinical decline.Acute renal failure ensued with progressing thrombocytopenia. The patient was transferred to the medical intensive care unit with labs remarkable for hemoglobin: 10.7 g/dL, platelet count: 17 x 10(9)/L, LDH: 1625 units/dL, creatinine: 3.10 mg/dL, AST: 2156 units/L, ALT: 885 units/L. Given worsening renal function, AMS, thrombocytopenia (image 1) and anemia, plasmapheresis was initiated for suspected thrombotic thrombocytopenic purpura (TTP)/HUS. However, normal C3/C4, haptoglobin, indirect bilirubin, absence of schistocytes on peripheral blood smear, and ADAMTS13 activity level of 36% ruled out TTP/HUS and plasmapheresis was stopped. Renal biopsy was consistent with acute tubular necrosis (ATN).Despite extensive work-up and intervention, her ICU course was catastrophic. She required hemodialysis and invasive mechanical ventilation through much of her course. Cardiac arrest occurred in which she was resuscitated. She underwent repeat laparotomy with subsequent hemicolectomy. After 30 days in the hospital, in compliance with family wishes, the patient was transitioned to comfort care and expired. DISCUSSION: Notable causes of thrombocytopenia are: TTP/HUS, disseminated intravascular coagulation, liver disease, heparin induced thrombocytopenia, bone marrow disorders and autoimmune disorders [2]. In our case, despite the extensive work up for thrombocytopenia, the diagnosis and hence treatment remained elusive. As her sepsis improved, her platelets improved only to again decrease with hospital course complications. Literature review for cases with patients having coinfections of EPEC and COVID-19 are not reported. COVID-19 is known to cause gastrointestinal symptoms including diarrhea and even change the gut biome [3]. We believe that her initial COVID-19 infection likely contributed to bacterial translocation of EPEC into her blood creating a severe sepsis clinical picture resulting in severe thrombocytopenia. CONCLUSIONS: A seemingly innocuous infection led to catastrophic sequalae in a patient without severe comorbidities. More research and understanding of E.coli strains other than EHEC in the setting of coinfections is needed to delineate the mechanism of thrombocytopenia in severe sepsis, to aid timely and effective intervention. REFERENCE #1: Kessler R, Nisa S, Hazen TH, Horneman A, Amoroso A, Rasko DA, Donnenberg MS. Diarrhea, bacteremia and multiorgan dysfunction due to an extraintestinal pathogenic Escherichia coli strain with enteropathogenic E. coli genes. Pathog Dis. 2015 REFERENCE #2: Stasi, R., How to approach thrombocytopenia. Hematology 2010, the American Society of Hematology Education Program Book, 2012. 2012(1): p. 191-197. REFERENCE #3: Gareau, M.G, Barrett, K.E. Role of the microbiota-gut-brain axis in postacute COVID syndrome. American Journal of Physiology-Gastrointestinal and Liver Physiology 2023 324:4, G322-G328 DISCLOSURES: No relevant relationships by Jonathan Collins No relevant relationships by Jessee Kruse No relevant relationships by hafsa safdar No relevant relationships by Blaine Winterton" @default.
• W4387267808 created "2023-10-03" @default.
• W4387267808 creator A5008238676 @default.
• W4387267808 creator A5022476454 @default.
• W4387267808 creator A5086589848 @default.
• W4387267808 creator A5092988770 @default.
• W4387267808 date "2023-10-01" @default.
• W4387267808 modified "2023-10-03" @default.
• W4387267808 title "A CURIOUS CASE OF VANISHING PLATELETS–UNEXPLAINED THROMBOCYTOPENIA IN THE SETTING OF ENTEROPATHOGENIC ESCHERICHIA COLI SEPSIS" @default.
• W4387267808 doi "https://doi.org/10.1016/j.chest.2023.07.1667" @default.
• W4387267808 hasPublicationYear "2023" @default.
• W4387267808 type Work @default.
• W4387267808 citedByCount "0" @default.
• W4387267808 crossrefType "journal-article" @default.
• W4387267808 hasAuthorship W4387267808A5008238676 @default.
• W4387267808 hasAuthorship W4387267808A5022476454 @default.
• W4387267808 hasAuthorship W4387267808A5086589848 @default.
• W4387267808 hasAuthorship W4387267808A5092988770 @default.
• W4387267808 hasBestOaLocation W43872678081 @default.
• W4387267808 hasConcept C126322002 @default.
• W4387267808 hasConcept C141071460 @default.
• W4387267808 hasConcept C203014093 @default.
• W4387267808 hasConcept C2522874641 @default.
• W4387267808 hasConcept C2776376669 @default.
• W4387267808 hasConcept C2776376844 @default.
• W4387267808 hasConcept C2777813720 @default.
• W4387267808 hasConcept C2778384902 @default.
• W4387267808 hasConcept C2778966966 @default.
• W4387267808 hasConcept C2780955771 @default.
• W4387267808 hasConcept C71924100 @default.
• W4387267808 hasConcept C90924648 @default.
• W4387267808 hasConceptScore W4387267808C126322002 @default.
• W4387267808 hasConceptScore W4387267808C141071460 @default.
• W4387267808 hasConceptScore W4387267808C203014093 @default.
• W4387267808 hasConceptScore W4387267808C2522874641 @default.
• W4387267808 hasConceptScore W4387267808C2776376669 @default.
• W4387267808 hasConceptScore W4387267808C2776376844 @default.
• W4387267808 hasConceptScore W4387267808C2777813720 @default.
• W4387267808 hasConceptScore W4387267808C2778384902 @default.
• W4387267808 hasConceptScore W4387267808C2778966966 @default.
• W4387267808 hasConceptScore W4387267808C2780955771 @default.
• W4387267808 hasConceptScore W4387267808C71924100 @default.
• W4387267808 hasConceptScore W4387267808C90924648 @default.
• W4387267808 hasIssue "4" @default.
• W4387267808 hasLocation W43872678081 @default.
• W4387267808 hasOpenAccess W4387267808 @default.
• W4387267808 hasPrimaryLocation W43872678081 @default.
• W4387267808 hasRelatedWork W1586374228 @default.
• W4387267808 hasRelatedWork W2003938723 @default.
• W4387267808 hasRelatedWork W2047967234 @default.
• W4387267808 hasRelatedWork W2118496982 @default.
• W4387267808 hasRelatedWork W2364998975 @default.
• W4387267808 hasRelatedWork W2369162477 @default.
• W4387267808 hasRelatedWork W2408010109 @default.
• W4387267808 hasRelatedWork W2439875401 @default.
• W4387267808 hasRelatedWork W4238867864 @default.
• W4387267808 hasRelatedWork W2525756941 @default.
• W4387267808 hasVolume "164" @default.
• W4387267808 isParatext "false" @default.
• W4387267808 isRetracted "false" @default.
• W4387267808 workType "article" @default.