Swasth MEDI clinic

16/09/2025

GLP 1 Analogues

22/08/2025

22/01/2025

Newer gram positive antibiotics

03/01/2025

Presently Treating a case of HSP in a elderly Female with Skin , Joints, GI tract,lung involvement with Solumedrol Pulse therapy . Skin biopsy was supported HSP..

Henoch-Schönlein Purpura (HSP), now more commonly referred to as IgA vasculitis, is a type of small blood vessel inflammation (vasculitis) that primarily affects the skin, joints, gastrointestinal tract, and kidneys. It is most common in children but can occur at any age.

Key Features of HSP
1. Skin (Purpura):
• The hallmark of HSP is a purpuric rash, typically located on the lower extremities, especially on the buttocks and legs.
• The rash appears as small, red or purple spots caused by bleeding under the skin.
2. Joints (Arthritis or Arthralgia):
• Joint pain and swelling, often in the knees and ankles, are common but usually resolve without permanent damage.
3. Gastrointestinal Symptoms:
• Abdominal pain, nausea, vomiting, and blood in the stool may occur.
• Intestinal involvement can lead to complications like intussusception.
4. Kidneys (Renal Involvement):
• Hematuria (blood in the urine) and/or proteinuria (protein in the urine) may indicate kidney involvement, which can range from mild to severe (IgA nephropathy).
5. Other Symptoms:
• Rarely, HSP can affect the central nervous system, lungs, or sc***um (in males).

Causes and Pathophysiology
• Cause: The exact cause is unknown but is often triggered by an infection (commonly respiratory infections), medications, or other immune system triggers.
• Pathophysiology: Deposition of immune complexes containing IgA in small blood vessels leads to inflammation and tissue damage.

Diagnosis

HSP is a clinical diagnosis based on the characteristic symptoms, especially the presence of purpura in conjunction with other features. Tests may include:
• Blood Tests: To check for markers of inflammation (e.g., ESR, CRP) and rule out other causes.
• Urinalysis: To assess for hematuria and proteinuria.
• Skin or Kidney Biopsy: Rarely needed but may confirm IgA deposition.

Treatment
• Supportive Care: Most cases are self-limiting, requiring only symptomatic treatment such as hydration, pain management, and rest.
• Medications:
• NSAIDs for joint pain (if no kidney involvement).
• Corticosteroids for severe symptoms, such as significant abdominal pain, nephritis, or complications.
• Follow-Up: Monitoring for kidney involvement is essential, as renal issues may develop weeks to months after the initial onset.

Prognosis
• Most children recover fully without complications.
• Adults are more likely to experience severe kidney involvement, which can lead to long-term kidney issues.

03/01/2025

03/01/2025

One more case of Gastric Mucormycosis was Diagnosed in a Uncontrolled Type 2 Diabetes patient recently

Explanation

Gastric mucormycosis is a rare but severe fungal infection caused by fungi in the order Mucorales. This condition primarily affects immunocompromised individuals and involves the stomach and, sometimes, adjacent areas of the gastrointestinal (GI) tract.

Causes and Risk Factors
• Causative Organisms: Genera like Rhizopus, Mucor, and Lichtheimia.
• Risk Factors:
• Diabetes mellitus (especially with ketoacidosis)
• Immunosuppression (e.g., post-transplant, chemotherapy)
• Hematological malignancies
• Prolonged corticosteroid use
• Neutropenia
• Malnutrition
• GI trauma or surgery

Clinical Features
• Nonspecific symptoms initially, which may delay diagnosis:
• Abdominal pain
• Nausea and vomiting
• Hematemesis (vomiting blood)
• Melena (black, tarry stools)
• Fever
• Peritonitis (in advanced cases due to gastric perforation)

Pathogenesis
• The fungi invade the gastric mucosa, leading to ischemia and necrosis.
• Rapid angioinvasion can cause thrombosis, tissue necrosis, and dissemination.

Diagnosis
• High suspicion in at-risk patients with GI symptoms.
• Endoscopy: Visual identification of necrotic lesions or ulcers in the stomach.
• Biopsy: Histopathological examination showing broad, ribbon-like, nonseptate hyphae with right-angle branching.
• Fungal cultures: Identifies specific fungal species.
• Imaging: CT scans may show thickening or perforation of the gastric wall.

Treatment
1. Antifungal Therapy:
• First-line: Liposomal amphotericin B.
• Alternatives (if intolerant): Posaconazole or Isavuconazole.
2. Surgical Intervention:
• Debridement of necrotic tissue or resection of affected areas may be required.
• Address complications like perforation or abscess formation.
3. Addressing Underlying Conditions:
• Optimizing glycemic control in diabetics.
• Discontinuing or reducing immunosuppressive agents when possible.
4. Supportive Care:
• Nutritional support.
• Management of complications like sepsis or electrolyte imbalances.

Prognosis
• Gastric mucormycosis has a high mortality rate due to late diagnosis and the aggressive nature of the disease. Early diagnosis and prompt initiation of antifungal therapy and surgical management significantly improve outcomes.

03/01/2025

Recently Diagnosed and saw a case of Non typhoidal salmonella causing Aortic Aneurysm thrilled to see a Rare case of Text book Description

03/01/2025

Non-typhoidal Salmonella (NTS) causing an aortic aneurysm is a rare but severe condition known as mycotic aneurysm or infected aneurysm. It occurs when Salmonella bacteria infect the wall of the aorta, leading to inflammation, weakening, and possible dilation or rupture of the arterial wall. This condition requires prompt diagnosis and aggressive treatment due to its high morbidity and mortality.

Pathophysiology
• Non-typhoidal Salmonella species, such as S. enteritidis or S. typhimurium, can cause bloodstream infections (bacteremia), especially in immunocompromised individuals.
• Salmonella has a predilection for damaged or atherosclerotic vessels, grafts, or aneurysms, where it can colonize, proliferate, and induce inflammation.
• The inflammatory response weakens the arterial wall, leading to aneurysm formation or rapid expansion.

Risk Factors
1. Host factors:
• Immunosuppression (e.g., HIV, diabetes, malignancy, corticosteroid use)
• Elderly patients
• Prior aortic aneurysm or vascular graft
2. Bacterial factors:
• NTS with high invasive potential
3. Underlying vascular pathology:
• Atherosclerosis
• Trauma or prior surgery

Clinical Presentation
1. Systemic symptoms:
• Fever
• Chills
• Malaise
2. Localized symptoms:
• Abdominal, back, or flank pain (if the aneurysm is abdominal)
• Pulsatile abdominal mass
3. Complications:
• Rupture of the aneurysm, leading to life-threatening hemorrhage
• Sepsis
• Embolic phenomena

Diagnosis
1. Laboratory studies:
• Positive blood cultures for Salmonella
• Elevated inflammatory markers (CRP, ESR, leukocytosis)
2. Imaging:
• CT angiography: Gold standard for diagnosis. Shows aortic aneurysm with periaortic soft tissue inflammation, gas, or fluid collection.
• Ultrasound: Can help in initial screening.
• MRI: Useful for detailed soft tissue evaluation.
3. Histopathology (post-surgery or biopsy): Confirms diagnosis by demonstrating inflammatory changes and bacterial invasion.

Treatment
1. Antibiotic therapy:
• Empiric broad-spectrum antibiotics followed by targeted therapy based on blood culture results.
• Common choices: Third-generation cephalosporins (e.g., ceftriaxone) or fluoroquinolones (e.g., ciprofloxacin).
• Prolonged therapy for 6-8 weeks or longer is typically required.
2. Surgical intervention:
• Required in most cases to remove the infected aneurysm and prevent rupture.
• Options include:
• Open surgical repair with resection and vascular reconstruction.
• Endovascular aortic repair (EVAR) as a less invasive option but with a risk of reinfection.
3. Supportive care:
• Management of sepsis and hemodynamic stabilization.

Prognosis
• Prognosis depends on early diagnosis and treatment.
• Without treatment, mycotic aneurysms often lead to rupture and death.
• Even with aggressive treatment, the mortality rate can be high due to complications like sepsis and recurrent infection.

Prevention
• Early identification and treatment of invasive Salmonella infections.
• Regular monitoring in high-risk individuals with known vascular abnormalities.

03/01/2025