1naresh
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Pt # Age Sex Major Clinical Problem and Infection Cultured Organism S/S MOD Delay PRES Neurotoxicity BP Base BP Tox MAP Tox Organ/Tissue Blood Group 1 1 39 M Pneumonia with bronchial obstruction, decubitus ulcer S. aureus Staph coag neg Y 13D Headache Seizure 122/61 118/70 86 2 73 F Gastric surgery, pneumonia, aspiration Pseudomonas P. aeruginosa Y CR 6D Altered MS 157/77 128/80 78 3 59 F Bowel perforation, abscess, sepsis, MOD, antiphospholipid syndrome Pseudomonas Staph coag neg Y CP 13D Altered MS 143/79 150/56 87 Staph coag neg 4 56 F Thigh abscess Klebsiella Y CP 27D Seizure 156/68 164/75 104 Enterococcus F1 LR 5 24 F CML in blast crisis, isolated bacteremia, sepsis, chemotherapy Enterobacter Y PL 20D (15D) Slurred speech 122/82 125/85 98 R Ataxia Seizure 6 20 M ALL, chemotherapy, skin infection Staph coag neg 1. Diphtheroids – CP 7D Seizure 120/70 150/88 106 2. Staph coag neg LR 7 68 F Necrotic pancreatitis, pancreatic abscess Staph coag neg Staph coag neg Y CP 7D Altered MS 141/67 168/68 101 Acinetobacter L 8 55 F Liver metastatis, open hepatic chemotherapy infusion, pneumonia S. aureus 1. S. pneumoniae Y CP 3D Altered MS 115/70 150/82 104 2. Staph coag neg LR 9 66 F Toe infection and abscess, diabetic S. aureus R 9D Seizure 132/52 160/60 93 Staph coag neg Yeast 10 79 F Lap-cholecystectomy; severe abdominal hemorrhage Y CP LR 7D Altered MS 138/73 137/74 95 Group 2 11 61 F Postoperative wound infection S. aureus S. aureus 11D Headache 145/65 210/102 138 Vision loss 12 24 F Isolated bacteremia 2 mo post Tx removal S. viridans R 0D Headache Seizure 125/90 170/126 140 13 22 M Original sickle cell crisis w/pneumonia-bacteremia, new sickle cell crisis w/heavy rectal colonization N/A Staph coag neg CR 2M Sickle crisis Seizure 122/80 200/100 133 Enterococcus F2 14 37 M Chronic septic arthritis, shoulder abscess S. aureus N/A CR ? Headache Vision change 175/85 184/111 135 Seizure 15 26 F Crohn disease, bowel perforation, abdominal abscess Enterococcus F1 Staph coag neg Y CP 7D Seizure 115/65 182/100 126 Enterococcus F2 E coli 16 51 F Breast carcinoma, auto-BMT, pneumonia Pseudomonas 1. Micrococcus Y C p L 9D Seizures 121/74 164/100 123 Klebsiella 2. Enterococcus Staph coag neg 3. Staph coag neg 17 55 M Foot infection, diabetic N/A on antibiotics C 0D Headache Vision change 191/88 215/115 148 18 57 F Post gastric stapling, acute UTI Enterococcus F1 Staph coag neg 2D Altered MS Seizure 136/70 203/93 129 19 54 F Pneumonia, severe; intubated N/A outside hosp 9D Vision change Altered MS 112/85 200/100 133 20 81 F Axillary abscess, chemotherapy S. aureus 1. S. aureus Y CL 30D Slurred speech Altered MS 130/52 203/110 141 2. Staph coag neg Seizure 21 37 F Necrotizing pancreatitis, pneumonia N/A outside hosp 7D Headache Seizure 162/92 220/126 157 22 56 F Sickle cell crisis, pneumonia S. viridans R 4D Altered MS Seizure 150/84 170/110 130 23 24 F Alcohol intoxication, shock, bowel perforation N/A on antibiotics Y CP LR 6D Seizure 140/90 203/113 143 24 38 F Peritonitis, PD, renal insufficiency Pseudomonas Pseudomonas 14D Altered MS 145/94 210/110 143 25 19 F Dialysis catheter hemorrhage Y CP R 15D Headache Vision change 149/86 207/106 140 Seizure
Note:—S/S indicates clinically hemorrhagic shock or sepsis, severe sepsis, or septic shock before developing PRES; Y, yes; MOD; multiorgan dysfunction developed coincident with PRES; C, coagulation, drop in platelet count; P, pulmonary dysfunction-edema, intubation; L, hepatic dysfunction, rising and elevated bilirubin; R, renal dysfunction, rising and elevated creatinine; Delay, closest time from recognized infection/bacteremia/shock to onset of neurotoxicity and PRES; MS, mental status; BP, blood pressure (mm Hg); base, baseline; tox, at toxicity; MAP, mean arterial pressure; N/A, not available; Tx, transplant; PD, peritoneal dialysis; UTI, urinary tract infection; PRES, posterior reversible encephalopathy syndrome. CML, chronic myelogenous leukemia; ALL, acute lymphoblastic leukemia; auto-BMT, auto-bone marrow transplant; S aureus, Staphylococcus aureus; Staph coag neg, coagulase-negative Staphylococci; E coli, Escherichia coli; S viridans, Streptococci viridans; S pneumoniae, Streptococci pneumoniae. Multiple organisms listed together correspond to mixed flora infections. Numbered blood culture organisms correspond to separate blood culture results with different organisms in the PRES time frame. F1, faecalis; F2, faecium. In patient 5, initial neurotoxicity began 15 days after sepsis/7 days after chemotherapy. Initial imaging negative (16 days), repeat imaging demonstrating PRESS (20 days).