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Piccolo G, De Rose EL, Bassi M, Napoli F, Minuto N, Maghnie M, Patti G, d’Annunzio G. Infectious diseases associated with pediatric type 1 diabetes mellitus: A narrative review. Front Endocrinol (Lausanne) 2022; 13:966344. [PMID: 36093078 PMCID: PMC9449538 DOI: 10.3389/fendo.2022.966344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Diabetes mellitus (DM) has been frequently associated with an impaired immune response against infectious agents, making affected patients at risk for more severe disease and sometimes causing worse outcomes. The recent COVID-19 pandemic has seriously affected patients with both diabetes, in particular those carrying comorbidities or with poor glycemic control. As regards pediatric diabetes mellitus, the availability of more accurate and technological tools for glycemic management and the improved markers of metabolic control might mitigate the negative impact of infections. Notably, good metabolic control of diabetes since its diagnosis reduces not only the risk of microangiopathic complications but also of impaired immune response to infectious diseases. Therefore, vaccinations are strongly recommended. Our paper aims to provide the most updated evidence regarding infectious diseases in type 1 pediatric DM.
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Affiliation(s)
- Gianluca Piccolo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Neuro-oncology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elena Lucia De Rose
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Marta Bassi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Flavia Napoli
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Minuto
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mohamad Maghnie
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppa Patti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppe d’Annunzio
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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A deceptive case of emphysematous cholecystitis complicated with retroperitoneal gangrene and emphysematous pancreatitis: clinical and computed tomography features. Pol J Radiol 2019; 84:e41-e45. [PMID: 31019593 PMCID: PMC6479146 DOI: 10.5114/pjr.2019.82858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose Emphysematous cholecystitis (EC) is an uncommon, severe variant of acute cholecystitis caused by gas- forming bacteria – most often Clostridium perfringens and Escherichia coli. We present a deceptive case of EC associated with retroperitoneal gas gangrene and emphysematous pancreatitis. Case report An 86-year-old, overweight woman was admitted to the emergency department with non-specific abdominal symptoms. Admission laboratory tests showed elevated diastase levels indicating acute pancreatitis. Computed tomography (CT) demonstrated a substantial amount of gas in the retroperitoneum and peritoneal cavity, which raised a suspicion of duodenal perforation. Primary diagnosis was not confirmed during emergency laparotomy, which revealed a gangrenous gallbladder adjacent to the duodenum and surrounded by purulent fluid. The final diagnosis established after laparotomy and rereading of CT scans was that of emphysematous cholecystitis associated with gangrenous pancreatitis and retroperitoneal gangrene. After surgery, the patient was transferred to the intensive care unit in septic shock. Shortly after, the second laparotomy was undertaken on suspicion of internal bleeding. During surgery, the patient experienced cardiac arrest and died despite immediate resuscitation. Conclusions Emphysematous cholecystitis may be associated with a spread of infection both to the peritoneal cavity and retroperitoneum and result in a substantial amount of gas in those anatomic compartments. The knowledge of this rare complication may be helpful in establishing a correct diagnosis.
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Poddighe D, Sazonov V. Acute acalculous cholecystitis in children. World J Gastroenterol 2018; 24:4870-4879. [PMID: 30487697 PMCID: PMC6250923 DOI: 10.3748/wjg.v24.i43.4870] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/11/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is the inflammatory disease of the gallbladder in the absence of gallstones. AAC is estimated to represent at least 50% to 70% of all cases of acute cholecystitis during childhood. Although this pathology was originally described in critically ill or post-surgical patients, most pediatric cases have been observed during several infectious diseases. In addition to cases caused by bacterial and parasitic infections, most pediatric reports after 2000 described children developing AAC during viral illnesses (such as Epstein-Barr virus and hepatitis A virus infections). Moreover, some pediatric cases have been associated with several underlying chronic diseases and, in particular, with immune-mediated disorders. Here, we review the epidemiological aspects of pediatric AAC, and we discuss etiology, pathophysiology and clinical management, according to the cases reported in the medical literature.
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Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Vitaliy Sazonov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Pediatric Intensive Care Unit, UMC National Research Center for Mother and Child Health, Astana 010000, Kazakhstan
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Liao CY, Tsai CC, Kuo WH, Ben RJ, Lin HC, Lee CC, Su KJ, Wang HE, Wang CC, Chen IH, Chien ST, Tsai MK. Emphysematous cholecystitis presenting as gas-forming liver abscess and pneumoperitoneum in a dialysis patient: a case report and review of the literature. BMC Nephrol 2016; 17:23. [PMID: 26932814 PMCID: PMC4774179 DOI: 10.1186/s12882-016-0237-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/19/2016] [Indexed: 12/19/2022] Open
Abstract
Background Emphysematous cholecystitis is a rare variant of acute cholecystitis with a high mortality rate. The combination of emphysematous cholecystitis, liver abscess and pneumoperitoneum are even rarer. Herein we present a case of emphysematous cholecystitis in a senile diabetic lady who had worsening hemodynamics while undergoing hemodialysis. Case presentation A 64-year-old woman with history of type 2 diabetes mellitus and end stage renal disease with regular hemodialysis presented to the emergency department with a 1-day history of sudden onset of lassitude and hypotension during hemodialysis. The result of a computed tomography (CT)-scan revealed air encircling the gallbladder, liver parenchymal and minimal pneumoperitoneal and liver abscess with no cholelithiasis. The patient had received empirical antibiotics with piperacillin-tazobactam 2.25 g intravenous route every 6 h for 14 days and cholecystectomy with surgical debridement and lead an uneventful postoperative hospital course. Escherichia coli was demonstrated as well as blood culture and peritoneal fluid culture. Conclusion In a senile diabetic and dialysis patient, we should take emphysematous cholecystitis into consideration once vague abdominal pain occurrs. Empirical antibiotic therapy and adequate surgical intervention should take place as soon as possible.
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Affiliation(s)
- Chen-Yi Liao
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C. .,Department of Internal medicine, Division of Nephrology, Tri-service general hospital, National defense Medical center, No.325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan R.O.C.
| | - Chi-Chang Tsai
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Wu-Hsien Kuo
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Ren-Jy Ben
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Ho-Cheng Lin
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Ching-Chang Lee
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Kuan-Jen Su
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Han-En Wang
- Department of Internal medicine, Division of Nephrology, Tri-service general hospital, National defense Medical center, No.325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan R.O.C.
| | - Chih-Chiang Wang
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - I-Hung Chen
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Shang-Tao Chien
- Department of Pathology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan R.O.C.
| | - Ming-Kai Tsai
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
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Abstract
Emphysematous cholecystitis (EC) is a rare but deadly variant of acute cholecystitis noted by the presence of gas in the gallbladder lumen or wall. This gas, emitted by bacteria, is thought to result from gallbladder ischemia caused by vascular compromise with subsequent bacterial invasion. The two most common bacteria responsible for EC are Clostridia perfringens and Escherichia coli. Symptoms of EC are similar, although often less overt, compared to those of acute cholecystitis (AC). Sonography and radiography are common methods of diagnosing EC, but computed tomography (CT) carries the highest diagnostic accuracy rate. Laparoscopic cholecystectomy is the most common method of treating EC, although conservative therapy and hyperbaric oxygen therapy have also been effective in some cases.
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