RESUMO
We report the first known case of hemophagocytic lymphohistiocytosis (HLH) secondary to imported Plasmodium ovale wallikeri infection in a 58-year-old white woman. A delayed diagnosis of malaria and HLH was made after protracted fever and pancytopenia failed to respond adequately to antimalarial treatment, which required intravenous methylprednisolone and gamma-globulin therapy to resolve.
Assuntos
Antimaláricos , Linfo-Histiocitose Hemofagocítica , Malária , Pancitopenia , Plasmodium ovale , Feminino , Humanos , Pessoa de Meia-Idade , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Malária/complicações , Malária/diagnóstico , Malária/tratamento farmacológico , Antimaláricos/uso terapêuticoAssuntos
Infecções por Actinomycetales/microbiologia , Bactéria Gordonia/isolamento & purificação , Dermatopatias Bacterianas/microbiologia , Idoso , DNA Bacteriano/isolamento & purificação , Bactéria Gordonia/genética , Humanos , Masculino , Filogenia , RNA Ribossômico 16S/isolamento & purificação , Análise de Sequência de DNAAssuntos
Anticorpos Monoclonais Murinos/efeitos adversos , Antineoplásicos/efeitos adversos , Neoplasias Hematológicas/complicações , Hepatite B/etiologia , Linfoma de Células B/complicações , Idoso , Anticorpos Monoclonais Murinos/uso terapêutico , Antineoplásicos/uso terapêutico , Neoplasias Hematológicas/tratamento farmacológico , Hepatite B/fisiopatologia , Humanos , Linfoma de Células B/tratamento farmacológico , Masculino , RituximabRESUMO
OBJECTIVE: To analyze the most related clinical data for influenza and the utility of influenza-like illness criteria as the clinical threshold for sampling in an influenza sentinel surveillance over a 3-year period. METHODS: Sentinel physicians collected throat specimens and data from outpatients with acute respiratory infection (< or = 72 hours duration). Laboratory-confirmed influenza infection was compared with independent symptoms and the influenza-like illness criteria, as defined by the Classification Committee of the World Organization of Family Doctors. RESULTS: From 1934 patients, 359 (18.56%) yielded positive results for influenza viruses. Only 199 (55.4%) of laboratory-confirmed cases fulfilled clinical criteria of influenza-like illness: positive and negative predictive value (PPV and NPV) of 0.36 and 0.88, respectively. Fever, cough, and rhinorrhea individually correlated with influenza infections (PPV: 0.30, 0.20, and 0.20, respectively; NPV: 0.92, 0.87, and 0.85, respectively). Multivariate analysis demonstrated that the correlation of influenza infection with the presence of fever and cough was similar to the correlation between influenza infection and influenza-like illness criteria (odds ratio 2.24 vs. 2.71, respectively). CONCLUSION: Influenza-like illness criteria are poorly related to laboratory-confirmed influenza. For early detection of influenza viruses in surveillance systems, a less restrictive clinical criterion (specifically, acute respiratory infection) perhaps should be followed.