Journal Article > Case Report/SeriesFull Text
Oxf Med Case Reports. 2020 August 1; Volume 2020 (Issue 8); omaa061.; DOI:10.1093/omcr/omaa061
Haddara MM, Haberisoni JB, Trelles M, Gohou JP, Christella K, et al.
Oxf Med Case Reports. 2020 August 1; Volume 2020 (Issue 8); omaa061.; DOI:10.1093/omcr/omaa061
Hippopotamus is one of the most-loved animals in Africa, yet it is aggressive and dangerous. The co-existence of humans in close proximity to their natural habitat increases the probability of human injury. Hippopotamus attacks have long been recognized to cause serious injuries, but its magnitude and burden are still unknown. The medical literature is very scarce when it comes to documenting hippopotamus bite injuries and their outcomes. We present a cohort of 11 patients who suffered hippopotamus bite injuries in Burundi. To our knowledge, this is the largest case series reporting on the clinical presentation, injury patterns and surgical outcomes of hippopotamus bites. The results show a high incidence of wound infections, amputations and permanent disability among other complications. Hippopotamus-inflicted injuries should, therefore, be triaged as major trauma rather than just 'mammalian bites'.
Journal Article > EditorialFull Text
Oxf Med Case Reports. 2019 April 15; Volume 4; 179.; DOI:10.1093/omcr/omz005
Balinska MA
Oxf Med Case Reports. 2019 April 15; Volume 4; 179.; DOI:10.1093/omcr/omz005
Journal Article > Case Report/SeriesFull Text
Oxf Med Case Reports. 2019 September 1; Volume 2019 (Issue 9); omz090.; DOI:10.1093/omcr/omz090
Bottineau MC, Kouevi KA, Chauvet E, Martinez Garcia D, Galetto-Lacour A, et al.
Oxf Med Case Reports. 2019 September 1; Volume 2019 (Issue 9); omz090.; DOI:10.1093/omcr/omz090
INTRODUCTION
Tuberculosis is a common illness for vulnerable populations in resource-limited settings. Lymph nodes in tuberculosis represent the most frequent extra-pulmonary form of tuberculosis in children, but lymph nodes are rarely generalized and large. We report an atypical pediatric case of tuberculosis with lymphadenopathy.
PATIENT CONCERNS AND FINDINGS
A two-year-old child with severe acute malnutrition presented with painless, generalized, and excessively large nodes which were not compressive and were without fistula. Main diagnoses, interventions, outcomes: Fine needle aspiration was performed and led to the detection of lymph node granulomatous lymphadenitis suggestive of tuberculosis.
CONCLUSIONS
The child was immediately initiated on anti-tuberculosis therapy with a very successful outcome. Clinicians should be aware of atypical manifestations such as the one we describe in the interest of swift diagnosis and initiation of treatment.
Tuberculosis is a common illness for vulnerable populations in resource-limited settings. Lymph nodes in tuberculosis represent the most frequent extra-pulmonary form of tuberculosis in children, but lymph nodes are rarely generalized and large. We report an atypical pediatric case of tuberculosis with lymphadenopathy.
PATIENT CONCERNS AND FINDINGS
A two-year-old child with severe acute malnutrition presented with painless, generalized, and excessively large nodes which were not compressive and were without fistula. Main diagnoses, interventions, outcomes: Fine needle aspiration was performed and led to the detection of lymph node granulomatous lymphadenitis suggestive of tuberculosis.
CONCLUSIONS
The child was immediately initiated on anti-tuberculosis therapy with a very successful outcome. Clinicians should be aware of atypical manifestations such as the one we describe in the interest of swift diagnosis and initiation of treatment.
Journal Article > Case Report/SeriesFull Text
Oxf Med Case Reports. 2020 June 25; Volume 6; omaa041.; DOI:10.1093/omcr/omaa041.
Hiffler L, Escajadillo K, Rocaspana M, Janet S
Oxf Med Case Reports. 2020 June 25; Volume 6; omaa041.; DOI:10.1093/omcr/omaa041.
In paediatrics, the overall clinical picture of thiamine deficiency (TD) is not easy to recognize, because it mimics or can be confused with other diseases even in cases of classic beriberi. Unsurprisingly, the likelihood of misdiagnosis of TD is even greater where beriberi has not been described.
Critically ill patients have increased thiamine body consumption and dextrose-based IV fluid increases thiamine cellular demand even further. Consequently, severe acute conditions may result in TD, or trigger TD signs in patients with borderline thiamine status, with life-threatening consequences.
Here, we describe the case of a young patient admitted to a West African hospital where TD is not well documented and diagnosed with severe pneumonia who responded dramatically to thiamine injection.
The lack of rapid diagnostic capacity and the severe outcome of TD justify the use of a therapeutic thiamine challenge in cases with high clinical suspicion. Increased awareness about TD and low threshold for thiamine use should guide clinicians in their practice.
Critically ill patients have increased thiamine body consumption and dextrose-based IV fluid increases thiamine cellular demand even further. Consequently, severe acute conditions may result in TD, or trigger TD signs in patients with borderline thiamine status, with life-threatening consequences.
Here, we describe the case of a young patient admitted to a West African hospital where TD is not well documented and diagnosed with severe pneumonia who responded dramatically to thiamine injection.
The lack of rapid diagnostic capacity and the severe outcome of TD justify the use of a therapeutic thiamine challenge in cases with high clinical suspicion. Increased awareness about TD and low threshold for thiamine use should guide clinicians in their practice.
Journal Article > Case Report/SeriesFull Text
Oxf Med Case Reports. 2023 July 18; Volume 2023 (Issue 7); omad053.; DOI:10.1093/omcr/omad053
Bublitz A, Manirakiza C, Whitehouse K, Chara A, Musa T, et al.
Oxf Med Case Reports. 2023 July 18; Volume 2023 (Issue 7); omad053.; DOI:10.1093/omcr/omad053
The management of kwashiorkor disease (KD) in children is challenging in resource-limited settings, especially for those cases with severe skin lesions and its complications. There are no evidenced-based management protocols specific to KD. This article describes the clinical presentation and case management of two children with different presentations of complicated kwashiorkor skin lesions and explores kwashiorkor from the perspective of the children’s caretakers in Maiduguri, Nigeria. Our experience shows that a well-structured approach and careful skin care are crucial. This includes simplified wound care guidance, training of medical staff, strict hygiene measures and the correct choice of antibiotics and antifungals, taking into the account low immunity and vulnerability to opportunistic infections amongst malnourished children. Limited knowledge of kwashiorkor amongst caretakers negatively impacts health-seeking behaviour, resulting in late presentation. Engaging caretakers in the process of care is essential to successful treatment.
Journal Article > Case Report/SeriesFull Text
Oxf Med Case Reports. 2023 July 18; Volume 2023 (Issue 7); omad071.; DOI:10.1093/omcr/omad071
Olubiyo R, Chukwumeze F, Lawal AM, Oloruntuyi G, Musoka H, et al.
Oxf Med Case Reports. 2023 July 18; Volume 2023 (Issue 7); omad071.; DOI:10.1093/omcr/omad071
Yeast-related bloodstream infections (BSIs) in pediatric patients are associated with severe acute malnutrition (SAM), hematological/oncological malignancies and admission to an intensive care unit. These infections are rarely described from low- and middle-income countries. We describe a case series of pediatric patients diagnosed with severe sepsis and yeast isolated from their blood culture in a conflict-affected area of Nigeria from October 2018 to November 2021. We identified 20 patients with yeast BSIs, among whom 17 were also diagnosed with SAM. We recommend the inclusion of antifungal treatment for empiric treatment guidelines for children with SAM and severe sepsis in similar settings.
Journal Article > Case Report/SeriesFull Text
Oxf Med Case Reports. 2019 June 24; Volume 2019 (Issue 6); omz049.; DOI:10.1093/omcr/omz049
Najera Villagrana SM, Garcia Naranjo Santisteban A
Oxf Med Case Reports. 2019 June 24; Volume 2019 (Issue 6); omz049.; DOI:10.1093/omcr/omz049
Tungiasis is a highly prevalent yet neglected disease of populations affected by extreme poverty. It causes great discomfort and pain, leads to social stigmatization and, when left untreated, can cause serious complications. Although natural repellents have been shown to be effective, too little is being done in terms of systematic prevention and treatment. In addition, self-treatment (usually extraction of fleas with non-sterile sharp instruments) comports high risks of infection, notably with viral hepatitis and human immunodeficiency virus. In this article, we report seven severe cases of tungiasis in children living in a refugee camp in Tanzania, all of whom were treated with surgical extraction of the fleas because the topical treatment (dimethicone) was not available. Refugee camps-particularly in sub-Saharan Africa where tungiasis is endemic-should be considered high-risk areas for the condition. Aid organizations should engage in active case searching, and health promotion should be systematically carried out.
Journal Article > Case Report/SeriesFull Text
Oxf Med Case Reports. 2021 June 18; Volume 2021 (Issue 6); omab049.; DOI:10.1093/omcr/omab049
Duvivier H, Lashmi K
Oxf Med Case Reports. 2021 June 18; Volume 2021 (Issue 6); omab049.; DOI:10.1093/omcr/omab049
Adherence issues combined with inequitable access to healthcare may increase the risk of discontinuation of care for undocumented migrants with severe mental health illness.
An Ethiopian man with paranoid schizophrenia who relapsed several times after hospitalization was identified by a humanitarian outreach team in Brussels. The team built a relationship with him by offering him access to services including accommodation and mental health care. A treatment buddy was identified to support him adhering to his treatment and accompany him while hospitalized. Effective collaboration between Medecins Sans Frontieres (MSF) and the hospital led to MSF ensuring continuum of care in an outpatient service with the support of the treatment buddy for treatment adherence. The patient was empowered to adhere to medication and attend appointments after hospitalization. After 6 weeks, the man became autonomous with treatment, coming for his injections and collecting his medication every 2 weeks. There has been no relapse requiring hospitalization since.
An Ethiopian man with paranoid schizophrenia who relapsed several times after hospitalization was identified by a humanitarian outreach team in Brussels. The team built a relationship with him by offering him access to services including accommodation and mental health care. A treatment buddy was identified to support him adhering to his treatment and accompany him while hospitalized. Effective collaboration between Medecins Sans Frontieres (MSF) and the hospital led to MSF ensuring continuum of care in an outpatient service with the support of the treatment buddy for treatment adherence. The patient was empowered to adhere to medication and attend appointments after hospitalization. After 6 weeks, the man became autonomous with treatment, coming for his injections and collecting his medication every 2 weeks. There has been no relapse requiring hospitalization since.
Journal Article > Case Report/SeriesFull Text
Oxf Med Case Reports. 2021 January 1; Volume 2021 (Issue 1); omaa120.; DOI:10.1093/omcr/omaa120
Galvin M, Al Qaisy MS, Cajazeiro J
Oxf Med Case Reports. 2021 January 1; Volume 2021 (Issue 1); omaa120.; DOI:10.1093/omcr/omaa120
Nalidixic acid is a commonly prescribed treatment for suspected dysentery in Middle Eastern populations. We describe a case of convulsions resulting from a single dose of nalidixic acid in a previously healthy two-month-old child in Northern Iraq who was being treated for a diarrhoeal illness. The child presented to us with new onset seizures, irritability, and acidaemia. Nalidixic acid was thought to be responsible after the exclusion of other potential causes of seizures. Symptoms resolved by treatment with intravenous (IV) diazepam, and cessation of nalidixic acid, and the child recovered fully and was discharged home neurologically intact after two days of observation. In regions where it is commonly prescribed, such as Northern Iraq, nalidixic acid should be considered as a cause of convulsions in any seizing child who has been exposed to the drug. Furthermore, quinolones such as nalidixic acid are contraindicated in children < 3 months of age.
Journal Article > LetterFull Text
Oxf Med Case Reports. 2019 August 14; Volume 2019 (Issue 11); DOI:10.1093/omcr/omz112
Wind A
Oxf Med Case Reports. 2019 August 14; Volume 2019 (Issue 11); DOI:10.1093/omcr/omz112
In 2015, I was in the Democratic Republic of the Congo (DRC), working as a pediatrician with Médecins Sans Frontières (MSF). As had been the case in my two previous assignments with MSF, I encountered many interesting and challenging cases—cases that I had never experienced prior to working in resource limited settings. Contrary to when I work in the USA and have access to extensive laboratory exams and diagnostic testing, in our hospital in the DRC, no such tools were available, and thus I needed to use a whole new level of clinical skills and deductive reasoning. To make clinical management even more challenging, I rarely saw these types of cases written about or published in the medical literature. I was discouraged that although these clinical examples were perfect fodder for medical case discussions, they did not have the ‘components’ required for a traditional case report. In frustration, I wrote the following:
‘The reason why we, those working in “resource limited settings”, do not often attempt to publish case reports is because we don’t often find an answer. We think that published articles and case reports should be neat and clean. That students or colleagues should be able to read a mystery case, try to solve the puzzle, and at the end be rewarded with an answer brought about by some obscure lab or radiology report. But that’s not what happens. The world of medicine in resource limited settings isn’t neat and clean. It’s frustrating and messy. Mystifying and sad. You can come up with a million differentials but ultimately the child, because of, or in despite of, your chosen treatment, makes it. Or doesn’t make it. And you never get an answer. You don’t learn. And you can try to look in the literature, but the research will talk about IGF1 and MRI and calcium. I can’t even get a cal.ci.um. And so, the mystery disease leads to a mystery death and you are left feeling powerless. And there is not even a take home message.’
I am excited that now with the Oxford Medical Case Reports collaboration, there is a platform to start regaining some power, to start creating a take-home message. There is a platform for collaboration amongst all of us medical professionals working in resource limited settings—a platform to share these unique cases to perhaps discover that they are not so unique at all. They are just not published.
‘The reason why we, those working in “resource limited settings”, do not often attempt to publish case reports is because we don’t often find an answer. We think that published articles and case reports should be neat and clean. That students or colleagues should be able to read a mystery case, try to solve the puzzle, and at the end be rewarded with an answer brought about by some obscure lab or radiology report. But that’s not what happens. The world of medicine in resource limited settings isn’t neat and clean. It’s frustrating and messy. Mystifying and sad. You can come up with a million differentials but ultimately the child, because of, or in despite of, your chosen treatment, makes it. Or doesn’t make it. And you never get an answer. You don’t learn. And you can try to look in the literature, but the research will talk about IGF1 and MRI and calcium. I can’t even get a cal.ci.um. And so, the mystery disease leads to a mystery death and you are left feeling powerless. And there is not even a take home message.’
I am excited that now with the Oxford Medical Case Reports collaboration, there is a platform to start regaining some power, to start creating a take-home message. There is a platform for collaboration amongst all of us medical professionals working in resource limited settings—a platform to share these unique cases to perhaps discover that they are not so unique at all. They are just not published.