T2Candida Assay in the Diagnosis of Intraabdominal Candidiasis: A Prospective Multicenter Study

The T2Candida magnetic resonance assay is a direct-from-blood pathogen detection assay that delivers a result within 3–5 h, targeting the most clinically relevant Candida species. Between February 2019 and March 2021, the study included consecutive patients aged >18 years admitted to an intensive care unit or surgical high-dependency unit due to gastrointestinal surgery or necrotizing pancreatitis and from whom diagnostic blood cultures were obtained. Blood samples were tested in parallel with T2Candida and 1,3-β-D-glucan. Of 134 evaluable patients, 13 (10%) were classified as having proven intraabdominal candidiasis (IAC) according to the EORTC/MSG criteria. Two of the thirteen patients (15%) had concurrent candidemia. The sensitivity, specificity, positive predictive value, and negative predictive value, respectively, were 46%, 97%, 61%, and 94% for T2Candida and 85%, 83%, 36%, and 98% for 1,3-β-D-glucan. All positive T2Candida results were consistent with the culture results at the species level, except for one case of dual infection. The performance of T2Candida was comparable with that of 1,3-β-D-glucan for candidemic IAC but had a lower sensitivity for non-candidemic IAC (36% vs. 82%). In conclusion, T2Candida may be a valuable complement to 1,3-β-D-glucan in the clinical management of high-risk surgical patients because of its rapid results and ease of use.

Ruptured mediastinal pseudocyst with pancreaticopleural fistula formation in a 15-year-old boy presenting with white-out hemithorax: A case report

Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis described more commonly in adults with alcoholic and necrotizing pancreatitis. We report a rare case of ruptured mediastinal pseudocyst with the formation of PPF in a 15-year-old boy who presented with progressive dyspnea and large left-sided pleural effusion that recurred despite repeated drainage. On the basis of imaging findings and pleural fluid analysis, the diagnosis of PPF with ruptured mediastinal pseudocyst was made. The diagnosis of PPF should be considered in patients with non-resolving large left-sided pleural effusions. The diagnosis can be confirmed either by significantly raised amylase levels in pleural fluid or direct visualization of the fistula on Computed tomography/magnetic resonance cholangiopancreatography.

Surgery Management of Pancreatitis with Complication: A Review Article

Introduction: Acute pancreatitis is an inflammatory disease of the pancreas with clinical manifestations that vary from mild to severe manifestations to death. The incidence of pancreatitis varies in various countries in the world and depends on the cause such as alcohol, gallstones, and metabolic factors. The clinical picture and the main symptom in patients with acute pancreatitis is abdominal pain. Abdominal pain varies from mild to severe and excruciating. Abdominal pain that is felt is constant and dull, and is usually felt in the epigastrium and periumbilicus and often spreads to the back, chest, waist, and lower abdomen. Discussion: The onset of acute pancreatitis, the patient should be evaluated for hemodynamic status immediately and receive the necessary resuscitation measures. Patients with acute pancreatitis should receive aggressive intravenous rehydration (250 - 500 ml/hour with isotonic crystalloid fluid) as early as possible with close monitoring, unless contraindicated with cardiovascular and/or renal comorbidities. It is most effective within the first 12-24 hours, but after that the benefits may diminish. Debridement (necrosectomy) is the gold standard in infected acute necrotizing pancreatitis and peripancreatic necrosis. Indications for intervention either through radiological, endoscopic or surgical procedures in necrotizing pancreatitis are suspected or proven infected necrotizing pancreatitis with clinical deterioration, especially after the necrotic tissue has been encapsulated with thick walls (walled-off necrosis). Sterile necrotizing pancreatitis with persistent organ failure several weeks after the onset of acute pancreatitis, particularly after the necrotic tissue has been encapsulated with thick walls (walled-off necrosis). Conclusion: Surgical management is often used in pancreatitis associated with gallstones. Cholecystectomy within 48 hours of the complaint can increase healing time. In addition, cholecystectomy performed early may not increase the risk of complications secondary to surgery. Surgery is not performed in acute necrotizing pancreatitis until the inflammation is reduced and the fluid accumulation no longer increases in size.

A case report of severe acute pancreatitis with infected necrosis and concomitant Coronavirus Disease‑19 (COVID‑19): a nosocomial infection or delayed respiratory manifestation of viral disease?

The association between COVID‑19 and acute pancreatitis (AP) has been extensively analyzed in recent research and review papers worldwide. It should be noted that most studies have focused on AP as a COVID‑19 complication and/or an extra‑pulmonary manifestation of the disease, although the investigation reports on the cases of prior pancreatitis and subsequent COVID‑19 infection are limited. The aim of this case report is to describe the treatment protocol and clinical outcome of a patient with acute necrotizing pancreatitis who developed nosocomial COVID‑19.. Case presentation. The data were collected from patient S., a 42‑year‑old male admitted with AP to the intensive care unit of Kyiv City Clinical Emergency Hospital, in October 2020. This study was reviewed and approved by the local Ethics Committee (Protocol No 25‑15‑60). The patient signed written informed consent to participate in the study, after having been informed of all relevant aspects that could influence his decision. The patient, primarily diagnosed with AP, was admitted to the hospital without a PCR test for detecting SARS‑CoV‑2. 21 days after his admission to the hospital, the patient developed COVID‑19. AP progression to severe AP with infected necrosis, the development of systemic inflammatory response syndrome and multiple organ failure necessitated operative pancreatic debridement, which was postponed due to severe acute respiratory failure. Operative pancreatic debridement was performed on the 45th day of hospital stay after the resolution of COVID‑19‑associated pneumonia. The postoperative period was typical for the disease severity and the extent of the surgery, and was complicated by external pancreatic and colonic fistulas. The length of hospital stay for this patient was 115 days which included 20 days of treatment and monitoring in the intensive care unit due to pneumonia. He was discharged after clinical symptom improvement. Conclusions. It is imperative to screen patients presenting with AP for SARS‑CoV‑2 in order to avoid misdiagnosis and inappropriate treatment strategy. Further detailed investigation of mechanisms of pancreatic injury in patients with SARS‑CoV‑2 is necessary.

Relationship of Arterial Changes in Acute Pancreatitis on CT Angiography with Modified CT Severity Index

Purpose To evaluate the prevalence of arterial changes in patients with acute pancreatitis (AP) on computed tomography angiography (CTA) and determine their association with etiology of AP, presence of necrosis, collections and severity of AP. Materials and Methods A total of 50 patients (20 women, 30 men; mean age: 43.04 ± 13.98; age range: 18–77 years) with AP underwent contrast-enhanced computed tomography (CECT) scan and CTA of abdomen, which was evaluated for necrosis and fluid collection (s). On CTA, splanchnic arterial structures were assessed for vascular complications. Association between vascular changes and presence of necrosis, fluid collections, etiology of AP and severity of AP (as assessed by modified computed tomography severity index CTSI) was determined. Results Arterial complications were seen in 28 percent (14/50). The most frequently involved artery was superior pancreaticoduodenal artery (12 percent), followed by splenic artery (8 percent) and right gastric artery (8 percent; Fig. 1). No significant association was seen between arterial changes and gallstone or alcohol-induced AP. Arterial changes showed a significant association with presence of acute necrotizing pancreatitis (ANP), presence of collections and severe AP (CTSI 8–10) (p < 0.05 for each). Conclusion Arterial changes on CTA are frequently seen in patients of AP having ANP. There is a significant association between arterial changes and presence of necrosis, collections and severe AP.