LUNG CANCER SCREENING IS 55 TOO LATE?
OCHROBACTRUM INTERMEDIUM : A CASE OF BACTEREMIA ASSOCIATED WITH DECOMPENSATED CIRRHOSIS G. Handley¹; D. Maslov² ¹Department of Medicine Ochsner Medical Center, New Orleans ²University of Queensland, Ochsner Clinical School, New Orleans Case: A 56-year-old woman with a history of alcohol abuse presented with 3 days of fevers, abdominal pain, and emesis. Exam was remarkable for generalized muscular tenderness. Labwork revealed white blood cell count 2.6, hemoglobin 9.9, platelets 27, albumin 1.8, bilirubin 4.6, AST 97, and ALT 28. Imaging demonstrated cirrhosis, peri-splenic varices, and an atrophic pancreas with a focus of gas in a dilated pancreatic duct. She was treated for alcohol withdrawal. She developed fever, tachycardia, became obtunded and was found to have leukocytosis to 18 with a lactate of 2.9. Vancomycin, ceftriaxone, piperacillin/ tazobactam and levetiracetam were given. Lumbar puncture, MRI brain, electroencephalogram, urine and respiratory cultures were unremarkable. Blood cultures from two sites grew Ochrobactrum intermedium sensitive to fluoroquinolones and aminoglycosides but resistant to beta-lactams except for carbapenems. Repeat abdominal imaging did not reveal an infectious nidus. She received ciprofloxacin at 750mg twice daily for two weeks with clinical cure. Discussion: Ochrobactrum are gram- negative rod-shaped flagellated bacteria most similar to Brucella species. O. anthropi was first described in 1988 as normal colonic flora, but is now as a recognized opportunistic pathogen. A decade later, O. intermedium was discovered. Cases are limited but include a patient with O. intermedium septicemia due to cholangitis a month after orthotopic liver transplant. Another case describes a man with end-stage renal disease on immunosuppression undergoing hemodialysis through a long- term catheter after a failed transplant developed endocarditis with a right atrial vegetation due to O. intermedium . A 6-week course of meropenem and minocycline achieved cure. Additional cases include endophthalmitis due to intraocular foreign body, and bacteremia
diagnosed/initially treated at UHC in 2017, if screening were to begin at age fifty, 57/58 of our patients would have been eligible for screening. This would have led to earlier diagnosis and potential better outcomes.
J. Patel; R. Patel; G. Jacob; C. Clark; T. Benoit-Clark Department of Internal Medicine, LSU Health Sciences Center- Lafayette Introduction: In 2014 24% of adults in Louisiana reported having had a history of smoking. Lung cancer was the most common cancer and the leading cause of cancer related deaths in Louisiana from 2010 to 2014. It has been estimated that 3510 new cases of lung cancer were diagnosed in Louisiana in 2017, with an estimated 2610 patients dying of lung cancer. The USPSTF recommends annual screening for lung cancer with low- dose computed tomography in adults between the ages of 55-80 years who have a 30-pack-year smoking history and currently smoke or have quit within the past 15 years. This study was designed to look at the age of patients initially diagnosed/treated at UHC in Lafayette, LA with lung cancer in 2017 and see if there was a statistically significant population that had lung cancer who did not meet lung cancer screening criteria. University Hospitals and Clinics in Lafayette, LA directly services the Louisiana parishes of Acadia, Iberia, Lafayette, St. Landry, St. Martin, and Vermillion. Methods: A retrospective analysis of the lung cancer patients that were diagnosed/ treated at UHC in2017 was performed. Charts of the patients were evaluated with the age of diagnosis of lung cancer documented. Results: In 2017, fifty-eight patients were diagnosed/initially treated at UHC for lung cancer. The age at the time of diagnosis ranged from 46-70 years. Fifteen of the 58 patients diagnosed were between the ages of 46-55 years. Following guidelines set by the USPSTF for lung cancer screening, 25.8% of the patients seen at UHC would not have been screened or screened early enough to diagnose lung cancer at a more treatable stage. Conclusions: The USPSTF has set the age to begin annual screening for lung cancer at 55 years. In the lung cancer patients
21 J LA MED SOC | VOL 171 | NO. 1
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