Cardiac failure is the leading cause of mortality in patients with thyroid storm. But the underlying cardiac pathology is unclear. Here, we report a 46-year-old woman who presented with hyperpyrexia and sinus tachycardia subsequent to accidental neck contusion. Her hyperthyroidism was verified by abnormal biochemical changes. Despite vigorous antithyroid treatment including a beta-blocker, glucocorticoid and potassium iodide, the patient eventually succumbed to refractory congestive heart failure in 4 days. Autopsy revealed lymphocytic myocarditis. We propose that lymphocytic myocarditis played a prominent role in her demise.

Central nervous system symptoms occur in more than 80% of patients with scrub typhus infection; however, the entity of central nervous system involvement is still not fully understood. We present the case of a patient with fulminant scrub typhus with multiple organ failure, including prolonged deep coma, and detail the sequential neurological symptoms, signs, laboratory data, and neuroradiological findings.

Objectives: The objective of the study is to understand the prevalence of bacterial co-infection and secondary infection in severe coronavirus disease 2019 (COVID-19) pneumonia in a tertiary hospital intensive care unit (ICU), the spectrum of pathogens, and the impact of these infections on clinical outcomes. Materials and Methods: Retrospective analysis of all patients with COVID-19 with acute hypoxemic respiratory failure who were admitted to the ICU requiring invasive mechanical ventilation (IMV) or high-flow nasal cannula (HFNC) from January 2021 to August 2022. Results: Of the 123 cases, 59.3% had culture-confirmed bacterial co-infection, mostly lower respiratory tract infections (LRTIs). Patients with bacterial co-infection had higher 30-day mortality (28.8% vs. 12%, hazard ratio [HR] = 2.96, %95 confidence interval [CI] =1.1–7.99; adjusted HR [aHR] = 1.34, %95 CI = 0.43–4.17). Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa were the most common co-infection pathogens. Of the 108 cases who stayed in the ICU for >2 days, 34 (31.5%) cases developed secondary bacterial infections within 30 days, of whom all cases had LRTI, 4 had bacteremia, and 8 had urinary tract infections. IMV users had a higher 1-month incidence of secondary bacterial infections than HFNC users (47.5% vs. 8.9%, P < 0.0001). Patients with secondary bacterial infections had higher 60-day mortality (32.4% vs. 11.2% HR = 3.45, 95% CI = 1.27–9.4; aHR = 2.29, %95 CI =0.8–6.67). The most common secondary infection pathogens were Acinetobacter species, P. aeruginosa, Stenotrophomonas maltophilia, and K. pneumoniae. At the 30-day follow-up, 54 events of ICU-acquired secondary bacterial LRTI were noted in 34 patients, 18 (33.3%) events, and 15 (44%) patients were infected by carbapenem-resistant Gram-negative bacilli. Conclusion: The high incidence of bacterial co-infection and secondary infection in critically ill patients with COVID-19 might associated with increased mortality. Infection by drug-resistant pathogens may develop during the treatment course.

Sepsis remains a leading cause of morbidity and mortality worldwide, representing a substantial burden on healthcare systems

Background: Sepsis is a leading cause of mortality in intensive care units (ICUs). Cell-free hemoglobin (CFH) released during sepsis interacts with lysosomal enzymes from neutrophils and macrophages. This study aims to examine the association of LVV-hemorphin-7 (LVV-H7), cathepsin D, and cathepsin G with sepsis and shock in ICU patients. Methods: A prospective observational cohort study was conducted in the medical ICU of a tertiary referral hospital in Taiwan. The patients with an acute increasing sequential organ failure assessment (SOFA) score ≥ 2 between 2022 and 2023. Blood samples from 40 healthy controls were obtained from the hospital biobank. CFH metabolites, including LVV-H7 and lysosomal enzyme cathepsin D and cathepsin G, were compared between the sepsis (definite and probable) and non-sepsis (possible sepsis) groups. Multivariate logistic regression analyzed factors associated with sepsis and shock. Results: Among 120 patients, 75 were classified as septic and 45 as non-septic. Significant differences were observed in CFH, cathepsin D, cathepsin G, and LVV-H7 levels between sepsis and non-sepsis groups. LVV-H7 was a significant predictor for sepsis (adjusted OR [aOR] 1.009, 95% CI 1.005–1.013; p < 0.001) and shock (aOR 1.005, 95% CI 1.002–1.008; p < 0.05). Cathepsin G predicted non-shock (aOR 0.917, 95% CI 0.848–0.991; p < 0.05), while cathepsin D predicted septic shock (aOR 1.001, 95% CI 1.000–1.002; p < 0.05). Conclusions: LVV-H7, cathepsin D, and cathepsin G are associated with the classification of sepsis and shock episodes in critically ill patients with elevated SOFA scores.