Publications by authors named "Charles Mallia Azzopardi"

16 Publications

  • Page 1 of 1

Variegate Porphyria Triggered by Acute Hepatitis A Infection.

Eur J Case Rep Intern Med 2020 22;7(12):001688. Epub 2020 Sep 22.

Department of Dermatology, Mater Dei Hospital, Msida, Malta.

Background: Variegate porphyria (VP) is a rare disorder of haem biosynthesis. We report a novel association with hepatitis A infection.

Patient And Methods: A 31-year-old man was diagnosed with acute hepatitis A infection. During recovery, he presented with abdominal pain and a photoaggravated blistering skin eruption.

Results: Urine porphyrin precursors were markedly raised with high coproporphyrin III isomer levels. Faecal protoporphyrin levels were markedly increased and a maximum plasma fluorescence emission at 629 nm was noted.

Discussion: Acute hepatitis A infection, and the associated metabolic stress exerted on the haem biosynthetic pathway, induced overt presentation of latent VP.

Learning Points: There should be a high index of suspicion for an acute cutaneous porphyria when a photosensitive rash is accompanied by neurovisceral symptoms.Latent porphyria may be overtly manifested after appropriate triggers which stress the metabolic haem biosynthetic pathway. One such trigger demonstrated by this case presentation is acute hepatitis A infection.The diagnostic approach to the investigation of a suspected acute cutaneous porphyria is initially with light-protected samples for urinary porphyrin precursors and plasma for fluorescence scanning. These should be sampled ideally during symptomatic periods. Further specialist analysis with fractionation of urinary and faecal porphyrins is necessary to distinguish between the two different acute cutaneous porphyrias.
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http://dx.doi.org/10.12890/2020_001688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727627PMC
September 2020

The first wave of COVID-19 in Malta; a national cross-sectional study.

PLoS One 2020 15;15(10):e0239389. Epub 2020 Oct 15.

Department of Infectious Diseases, Mater Dei Hospital, Msida, Malta.

Introduction: The COVID-19 pandemic has posed major challenges to all aspects of healthcare. Malta's population density, large proportion of elderly and high prevalence of diabetes and obesity put the country at risk of uncontrolled viral transmission and high mortality. Despite this, Malta achieved low mortality rates compared to figures overseas. The aim of this paper is to identify key factors that contributed to these favorable outcomes.

Methods: This is a retrospective, observational, nationwide study which evaluates outcomes of patients during the first wave of the pandemic in Malta, from the 7th of March to the 24th of April 2020. Data was collected on demographics and mode of transmission. Hospitalization rates to Malta's main general hospital, Mater Dei Hospital, length of in-hospital stay, intensive care unit admissions and 30-day mortality were also analyzed.

Results: There were 447 confirmed cases in total; 19.5% imported, 74.2% related to community transmission and 6.3% nosocomially transmitted. Ninety-three patients (20.8%) were hospitalized, of which 4 were children. Patients with moderate-severe disease received hydroxychloroquine and azithromycin, in line with evidence available at the time. A total of 4 deaths were recorded, resulting in an all-cause mortality of 0.89%. Importantly, all admitted patients with moderate-severe disease survived to 30-day follow up.

Conclusion: Effective public health interventions, widespread testing, remote surveillance of patients in the community and a low threshold for admission are likely to have contributed to these favorable outcomes. Hospital infection control measures were key in preventing significant nosocomial spread. These concepts can potentially be applied to stem future outbreaks of viral diseases. Patients with moderate-severe disease had excellent outcomes with no deaths reported at 30-day follow up.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239389PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7561161PMC
October 2020

Treatment of renal AA-Amyloidosis associated with human immunodeficiency virus infection: a case report.

CEN Case Rep 2021 02 5;10(1):88-93. Epub 2020 Sep 5.

Infectious Diseases Unit, Mater Dei Hospital, Triq Dun Karm, Msida, MSD 2090, Malta.

We present a case of a young adult male who was treated successfully for renal AA-amyloidosis secondary to human immunodeficiency virus (HIV) infection using highly active anti-retroviral therapy (HAART). He presented with lobar pneumonia, acute kidney injury, nephrotic syndrome and newly diagnosed HIV infection and was initiated on HARRT and haemodialysis. Kidney biopsy was consistent with amyloid deposition of the AA-type. His clinical condition improved gradually and after 10 months of therapy, he regained sufficient excretory function to become dialysis independent. Two years later, he remained well, with a recovered CD4 count and a glomerular filtration rate of 63 mL/min/1.73 m. Patients with renal AA-amyloidosis typically present with slowly progressive chronic kidney disease, often leading to end-stage kidney disease within months. To our knowledge, this is the first reported case of biopsy proven renal AA-amyloidosis in a newly diagnosed HIV positive patient to present with acute kidney injury leading to dialysis dependence over a period of 2 weeks, which was successfully treated using HAART.
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http://dx.doi.org/10.1007/s13730-020-00525-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829295PMC
February 2021

Infective complications of midline destruction in a cocaine user.

BMJ Case Rep 2019 Jul 26;12(7). Epub 2019 Jul 26.

Infectious Diseases, Mater Dei Hospital, Msida, Malta.

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http://dx.doi.org/10.1136/bcr-2019-231743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6663203PMC
July 2019

Antiphospholipid syndrome masquerading as a case of infective endocarditis.

BMJ Case Rep 2018 Jun 4;2018. Epub 2018 Jun 4.

Infectious Diseases, Mater Dei Hospital, Msida, Malta.

A 54-year-old Caucasian woman presented with an episode of loss of consciousness and dysphasia. MRI revealed a number of ischaemic foci indicating an embolic source. Echocardiography showed a mitral valve vegetation. After taking three sets of blood cultures, she was started on empirical treatment for infective endocarditis. The blood cultures remained negative and a presumed diagnosis of culture-negative endocarditis was entertained. However, despite the antibiotic therapy, the patient deteriorated further. Subsequently the patient was found to be positive for antiphospholipid antibodies. Eventually, after a convoluted hospital stay, a diagnosis of antiphospholipid syndrome complicated by Libman-Sacks endocarditis was reached. The patient was treated with steroids and anticoagulation with dramatic improvement.
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http://dx.doi.org/10.1136/bcr-2018-224404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990064PMC
June 2018

Fever of unknown origin: a challenging case.

BMJ Case Rep 2018 Jun 4;2018. Epub 2018 Jun 4.

Infectious Diseases, Mater Dei Hospital, Msida, Malta.

We report a case of Cogan's syndrome presenting as fever of unknown origin in a 31-year-old woman who was admitted to the hospital with a 7-week history of fever, night sweats and other constitutional symptoms. The diagnosis remained elusive despite numerous investigations, and the patient subsequently developed rash, episcleritis, dizziness and sensorineural hearing loss. While initially thought to be a postinflammatory response to a previous infection, confirmation of the rash as a vasculitis together with the audiovestibular and ocular involvement led to a clinical diagnosis of Cogan's syndrome. This was further corroborated by resolution of her symptoms once immunosuppressive therapy was instituted. Early recognition of Cogan's syndrome is crucial to reducing the risk of serious complications through the timely initiation of treatment.
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http://dx.doi.org/10.1136/bcr-2017-224031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990099PMC
June 2018

The non-resolving lung cavity: a case of pulmonary cystic echinococcosis.

BMJ Case Rep 2017 Jul 31;2017. Epub 2017 Jul 31.

Department of Medicine, Respiratory Division, Mater Dei Hospital, Msida, Malta.

The authors report a case of a 20-year-old woman who was diagnosed with pulmonary cystic echinococcosis. She was admitted to hospital with a 1-week history of unresolving cough, coloured sputum with occasional haemoptysis and fever despite oral antibiotics. Radiology revealed a cavitating right lower lobe lung abscess. After 4 weeks of treatment, follow-up radiology showed incomplete resolution. Bronchoscopy revealed a white, avascular cystic lesion in the right lower lobe and serology testing for was positive. Repeat imaging eventually confirmed the cystic lesion with the 'air bubble'sign. A thorough travel history, a high index of clinical suspicion and close follow-up are essential in making a diagnosis of pulmonary cystic echinococcosis.
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http://dx.doi.org/10.1136/bcr-2017-220909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623306PMC
July 2017

Rare case of dermonecrosis caused by a recluse spider bite in Europe.

BMJ Case Rep 2016 Jul 20;2016. Epub 2016 Jul 20.

Department of Dermatovenerology, Sir Paul Boffa Hospital, Floriana, Malta.

Spider poisoning is rare in Europe, with very few reported cases in the literature. Recluse spider (genus Loxosceles) bites may lead to cutaneous and systemic manifestations known as loxoscelism. We report the second known case of spider bite poisoning in Malta caused by Loxosceles rufescens (Mediterranean recluse spider). A young adult female presented with localised erythema and pain on her left thigh after a witnessed spider bite. Over a few days, the area developed features of dermonecrosis together with systemic symptoms, including fever, fatigue and a generalised erythematous eruption. She was managed by a multidisciplinary team and the systemic symptoms resolved within 6 days, while the skin lesion healed with scarring within 2 months. A recluse spider bite should be considered in patients with dermonecrosis. Although spider bite poisoning is uncommon in Europe, it is important to diagnose and manage it appropriately since it could lead to potentially serious sequelae.
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http://dx.doi.org/10.1136/bcr-2016-215832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4964194PMC
July 2016

Pacemaker lead-associated thrombosis in cardiac resynchronisation therapy.

BMJ Case Rep 2015 Jul 7;2015. Epub 2015 Jul 7.

Department of Internal Medicine and Infectious Diseases Medicine, Mater Dei Hospital, Msida, Malta.

Pacemaker lead-associated thrombosis is a possible complication of any cardiac implantable electronic device. We present a case of a middle-aged woman with a history of ischaemic left ventricular failure, who presented with fever and other non-specific symptoms 4 months after cardiac resynchronisation therapy. A transoesophageal echocardiogram confirmed a vegetation-like structure originating from the pacemaker lead in the right atrium. The patient was treated with intravenous antibiotics followed by open heart surgery in order to remove this mass as well as the pacing device, including all three pacing leads. Histology and culture of the retrieved mass confirmed a sterile thrombus with no features to suggest an infected mass (vegetation). The patient made an uncomplicated recovery and there were no long-term sequelae on follow-up during the 2 years after the event.
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http://dx.doi.org/10.1136/bcr-2015-210314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499717PMC
July 2015

Atypical cutaneous leishmaniasis in the immunosuppressed.

BMJ Case Rep 2014 Jun 10;2014. Epub 2014 Jun 10.

Infectious Disease Unit, Mater Dei Hospital, Msida, Malta.

A 45-year-old woman, known case of seronegative arthritis and on immunosuppressive therapy, presented with a 2-week history of a macular lesion on the left calf that became papular and eventually ulcerated. The rest of the history was otherwise unremarkable and systemic examination did not reveal any abnormalities. The lesion was repeatedly biopsied but failed to reveal Leishmania donovani bodies. Concurrent Leishmania IgG was positive but IgM was negative. Leishmania IgG confirmatory testing by ELISA was negative. A biopsy from the lesion eventually tested positive for L. donovani through PCR. The patient was treated with sodium stibogluconate together with intravenous ciprofloxacin and amoxicillin to cover the secondary cutaneous bacterial infection. This led to complete resolution of the lesion.
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http://dx.doi.org/10.1136/bcr-2014-204914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4054259PMC
June 2014

Multifocal necrotising fasciitis and septic shock complicating varicella infection in an adult.

BMJ Case Rep 2013 Oct 15;2013. Epub 2013 Oct 15.

University of Malta, Msida, Malta.

A 35-year-old woman with a 3-day history of chickenpox, presented to the hospital in septic shock and with multifocal, non-adjacent lesions of necrotising fasciitis. Necrotising fasciitis is a rare yet life-threatening complication of chickenpox. Blood cultures and wound swabs confirmed the presence of Streptococcus pyogenes. The initial emergency management included oxygen, aggressive fluid resuscitation and antimicrobial therapy. Once the patient was stabilised, surgical management ensued. This included debridement and eventual grafting of the necrotic skin lesions. Intensive management and follow-up for 8 weeks were required before the patient was deemed fit for discharge.
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http://dx.doi.org/10.1136/bcr-2013-201984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822241PMC
October 2013

Aspiration of a speaking valve.

BMJ Case Rep 2013 Jul 16;2013. Epub 2013 Jul 16.

Department of Medicine, Department of Health, Dingli, Malta.

Foreign body aspiration (FBA) is a relatively common and serious condition that can result in a spectrum of presentations ranging from incidental to acutely life-threatening. Described here is a case of aspiration of a tracheo-oesophageal speaking valve through a permanent tracheostomy that went unnoticed for a number of years, and an overview of the technique used for its removal. A 70-year-old ex-heavy smoker with a permanent tracheo-oesophageal fistula presented with a relatively recent history of increasing shortness of breath, sputum purulence and haemoptysis. Further investigation with a CT scan and bronchoscopy revealed the presence of a foreign body within his right lower lobe bronchus which was later removed by advancing a flexible bronchoscope over a rigid one.
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http://dx.doi.org/10.1136/bcr-2013-200066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736530PMC
July 2013

Two cases of aspiration of calcium tablets.

Lung India 2011 Oct;28(4):312-4

Department of Respiratory and Internal Medicine, Mater Dei Hospital, Birkirkara, Malta.

Two clinical cases of aspiration are reported in elderly ladies with differing presentations following inhalation of the same brand of calcium tablet. One of the patients distinctly recalled the choking episode, whereas the other failed to do so making the diagnosis of aspiration difficult. One of the aspirated tablets was successfully retrieved during rigid bronchoscopy after the patient reported several months of cough requiring multiple courses of antibiotics. The other aspirated tablet was coughed up by the patient after the successful treatment of a pneumonia complicated by a parapneumonic effusion.
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http://dx.doi.org/10.4103/0970-2113.85700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213725PMC
October 2011

A time and motion study of patients presenting at the accident and emergency department at Mater Dei Hospital.

BMC Res Notes 2011 Oct 18;4:421. Epub 2011 Oct 18.

Mater Dei Hospital, Msida, MSD2090, Malta.

Background: To carry out a time and motion study of patients presenting at the Emergency Department (ED) by measuring waiting times at the ED dept throughout the day. The objectives were:• to determine whether waiting times are prolonged, and• if prolonged, at which station(s) bottlenecks occur most often in terms of duration and frequency.Results will be compared to the United Kingdom guidelines of stay at the emergency department.

Methods: A group of 11 medical students monitored all patients who attended ED between 0600 hours on the 25th August and 0600 hours on the 1st September 2008. For each 24 hour period, students were assigned to the triage room and the 3 priority areas where they monitored all patient-related activity, movement and waiting times so that length of stay (LOS) could be recorded. The key data recorded included patient characteristics, waiting times at various ED process stages, tests performed, specialist consultations and follow up until admitted, discharged, or referred to another hospital area. Average waiting times were calculated for each priority area. Bottle-necks and major limiting factors were identified. Results were compared against the United Kingdom benchmarks - i.e. 1 hour until first assessment, and 4 hours before admitting/discharge.

Results: 1779 patients presented to the ED in the week monitored. As expected, patients in the lesser priority areas (i.e. 2 & 3) waited longer before being assessed by staff. Patients requiring laboratory and imaging investigations had a prolonged length of stay, which varied depending on specific tests ordered. Specialty consultation was associated with longer waiting times. A major bottleneck identified was waiting times for inpatient admission.

Conclusions: In conclusion, it was found that 30.3% of priority 1 patients, 86.3% of priority 2 patients and 76.8% of priority 3 patients waited more than 1 hour for first assessment. We conclude by proposing several changes that may expedite throughput.
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http://dx.doi.org/10.1186/1756-0500-4-421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3212980PMC
October 2011

Carbamazepine-induced drug reaction with eosinophilia and systemic symptoms syndrome in a 35-year-old man with epilepsy.

Clin Neuropharmacol 2008 Sep-Oct;31(5):295-8

Infectious Diseases Unit, St Luke's Hospital, Gwardamangia, Malta.

The drug reaction with eosinophilia and systemic symptoms syndrome describes a hypersensitivity reaction to a number of drugs. It is characterized by a triad of fever, rash, and internal organ involvement. Carbamazepine is suspected to be the cause of the drug reaction with eosinophilia and systemic symptoms syndrome in this young man who presented with fulminant hepatitis and an exfoliating rash 8 weeks after starting carbamazepine. Symptoms gradually resolved after stopping carbamazepine and starting systemic steroids.Because we encountered only a few similar cases in the literature, we wish to highlight the importance of recognizing these symptoms as a syndrome that can be fatal, especially if not recognized early.
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http://dx.doi.org/10.1097/WNF.0b013e31815a3ed6DOI Listing
May 2009

Leishmaniasis.

Postgrad Med J 2007 Feb;83(976):649-57

St Luke's Hospital, Guardamangia Hill, Guardamangia, MSD 09, Malta.

Epidemiology, disease patterns, immunology, diagnosis, treatment and control measures of leishmaniasis are described. Various issues relating to leishmaniasis are highlighted: the relative lack of importance given to this disease compared with other infections, climate change and its possible impact on extension of endemicity of this infection, and new diagnostic tests which are improving diagnosis, especially in resource poor areas. Other important aspects discussed include the potential for newer oral therapy to change the way this disease is managed; Leishmania-HIV coinfection and groups at risk; and development of an effective vaccine.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202701PMC
http://dx.doi.org/10.1136/pgmj.2006.047340corr1DOI Listing
February 2007