RESUMO
OBJECTIVE: Patients suffering from haemato-oncological diseases tend to have a weakened immune system after the end of their therapy. To avoid infections, patients are advised to limit contact with other people. This poses the question whether a stay at a rehabilitation facility can be recommended. METHODS: We report about 134 rehabilitation stays of patients. Premature discontinuation of the rehabilitation stay was selected as the criterion for a serious complication during the rehabilitation, and the underlying reasons were analysed. RESULTS: Compared to the discontinuation rates of patients suffering from solid tumours (2.4%), the percentage of haemato-oncological patients ending prematurely their rehabilitation stay (8.2%) is significantly increased. This rises to 17.1% for patients who have undergone an allogeneic stem cell transplantation. The analysis of the discontinuation reasons revealed that they were not directly connected to the rehabilitation. Apart from the already known risk factors for premature termination of the rehabilitation stay, we have identified the period (days) between the last therapy and the beginning of the rehabilitation stay as a risk factor. CONCLUSIONS: We show for the first time that a rehabilitation stay does not pose additional risks for patients suffering from haemato-oncological diseases.
Assuntos
Febre de Causa Desconhecida/epidemiologia , Neoplasias Hematológicas/reabilitação , Hospedeiro Imunocomprometido , Reinfecção/epidemiologia , Idoso , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/imunologia , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/imunologia , Neutropenia Febril/epidemiologia , Neutropenia Febril/imunologia , Feminino , Febre de Causa Desconhecida/imunologia , Alemanha/epidemiologia , Neoplasias Hematológicas/imunologia , Hospitais de Reabilitação , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Pancitopenia/epidemiologia , Pancitopenia/imunologia , Centros de Reabilitação , Reinfecção/imunologia , Estudos Retrospectivos , Risco , Transplante de Células-Tronco , Fatores de Tempo , Transplante HomólogoRESUMO
BACKGROUND: Few studies have been performed to identify factors that are associated with an increased risk of infections during the neutropenic period in patients undergoing allogeneic stem cell transplantation (allo-SCT). The aim of this study was to identify the host immune cells responsible for infections before engraftment. METHODS: A total of 282 patients who underwent allo-SCT were enrolled. Peripheral blood samples were collected before conditioning therapy. Expression of CD161-expressing T cells, natural killer cells, and immature myeloid cells was analyzed by flow cytometry. Microbially and clinically defined infections and fevers of unknown origin as proposed by the Immunocompromised Host Society were included in this study. RESULTS: The median age was 45 years (range, 16-68 years). Patients had various hematologic disorders and were transplanted from human leukocyte antigen (HLA)-matched siblings, unrelated donors, and familial HLA-mismatched donors. In univariate analysis, younger age and a familial HLA-mismatched donor were risk factors for the occurrence of infections. After adjusting for potential variables in univariate analysis, multivariate analyses revealed that a lower frequency of CD3+ CD4+ CD161+ cells was significantly associated with the occurrence of neutropenic infections. An age of 35 years or younger and allografting from familial HLA-mismatched donors showed a trend toward higher infection rates. CONCLUSION: Our data indicated that a lower frequency of CD3+ CD4+ CD161+ T cells in peripheral blood before conditioning therapy was associated with a higher incidence of infection during the neutropenic period. These results suggest that recipient innate T cells with expression of C-type lectin CD161 can guard against infections before engraftment.
Assuntos
Febre de Causa Desconhecida/imunologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Imunidade Celular , Hospedeiro Imunocomprometido/imunologia , Neutropenia/imunologia , Linfócitos T/imunologia , Condicionamento Pré-Transplante/efeitos adversos , Adolescente , Adulto , Idoso , Complexo CD3/metabolismo , Linfócitos T CD4-Positivos/imunologia , Feminino , Febre de Causa Desconhecida/sangue , Febre de Causa Desconhecida/epidemiologia , Citometria de Fluxo , Doença Enxerto-Hospedeiro/prevenção & controle , Humanos , Células Matadoras Naturais/metabolismo , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Agonistas Mieloablativos/efeitos adversos , Agonistas Mieloablativos/uso terapêutico , Células Mieloides/metabolismo , Subfamília B de Receptores Semelhantes a Lectina de Células NK/metabolismo , Neutropenia/sangue , Neutropenia/epidemiologia , Linfócitos T/metabolismo , Transplante Homólogo/efeitos adversos , Adulto JovemRESUMO
The systemic autoinflammatory syndromes often present with recurrent fevers. They have proved exceptionally informative about the innate immune system. Although extremely rare, they are important to recognise, as many can now be completely controlled by long-term drug therapies. Diagnosis relies on clinical suspicion followed by genetic testing.
Assuntos
Febre de Causa Desconhecida/etiologia , Doenças Hereditárias Autoinflamatórias/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Febre de Causa Desconhecida/imunologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto JovemAssuntos
Febre de Causa Desconhecida/imunologia , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Adolescente , Anfotericina B/administração & dosagem , Antígenos de Fungos/sangue , Antígenos de Fungos/imunologia , Antivirais/administração & dosagem , Biópsia , Medula Óssea/patologia , Citomegalovirus/imunologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/imunologia , Feminino , Febre de Causa Desconhecida/sangue , Febre de Causa Desconhecida/tratamento farmacológico , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Histoplasma/imunologia , Histoplasma/isolamento & purificação , Histoplasmose/sangue , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Histoplasmose/imunologia , Humanos , Imunossupressores/administração & dosagem , Falência Renal Crônica/terapia , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Linfo-Histiocitose Hemofagocítica/imunologia , Ácido Micofenólico/administração & dosagem , Ácido Micofenólico/efeitos adversos , Diálise Renal , Resultado do Tratamento , Carga ViralRESUMO
Pathogenic yeast forms are commonly associated with invasive fungal disease in the immunocompromised host, including patients with haematological malignancies and patients of haemopoietic stem cell transplants. Yeasts include the Candida spp., Cryptococcus spp., Pneumocystis jirovecii and some lesser-known pathogens. Candida species remain the most common cause of invasive yeast infections (and the most common human pathogenic fungi). These guidelines present evidence-based recommendations for the antifungal management of established, invasive yeast infections in adult and paediatric patients in the haematology/oncology setting. Consideration is also given to the critically ill patient in intensive care units, including the neonatal intensive care unit. Evidence for 'pre-emptive' or 'diagnostic-driven antifungal therapy' is also discussed. For the purposes of this paper, invasive yeast diseases are categorised under the headings of invasive candidiasis, cryptococcosis and uncommon yeast infections. Specific recommendations for the management of Pneumocystis jirovecii are presented in an accompanying article (see consensus guidelines by Cooley et al. appearing elsewhere in this supplement).
Assuntos
Antifúngicos/administração & dosagem , Febre de Causa Desconhecida/microbiologia , Hospedeiro Imunocomprometido/imunologia , Infecções Oportunistas/imunologia , Infecções Oportunistas/microbiologia , Adolescente , Adulto , Candidíase Invasiva/imunologia , Candidíase Invasiva/prevenção & controle , Criança , Pré-Escolar , Consenso , Estado Terminal , Criptococose/imunologia , Criptococose/prevenção & controle , Esquema de Medicação , Equinocandinas/administração & dosagem , Medicina Baseada em Evidências , Febre de Causa Desconhecida/imunologia , Fluconazol/administração & dosagem , Humanos , Lactente , Unidades de Terapia Intensiva , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , Infecções Oportunistas/prevenção & controle , Infecções por Pneumocystis/imunologia , Infecções por Pneumocystis/prevenção & controle , Pneumocystis carinii , Guias de Prática Clínica como AssuntoRESUMO
A 55-year-old woman presented 18 months after a trip to Ecuador with night sweat, malaise, and an unclear lesion of the lung. Computed tomography of the lung showed a nodular lesion of 14 mm. Antibodies against Histoplasma capsulatum were detected in the complement fixation text (CFT) and IgG western blot. Re-examination of a formalin fixed paraffin embedded (FFPE) lung-biopsy revealed yeasts after silver staining, compatible with H. capsulatum , which was verified by extraction and amplification of DNA from FFPE. After therapy with itraconazole 400 mg/day, the patient showed an uneventful clinical recovery without regression of the lung lesion. The serological follow-up examination after 17 months showed CFT without pathological findings.
Assuntos
Artrite/prevenção & controle , Exantema/prevenção & controle , Febre de Causa Desconhecida/prevenção & controle , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Viagem , Antifúngicos/uso terapêutico , Artrite/diagnóstico , Artrite/imunologia , Testes de Fixação de Complemento , Tosse/diagnóstico , Tosse/imunologia , Tosse/prevenção & controle , Equador , Exantema/diagnóstico , Exantema/imunologia , Feminino , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/imunologia , Histoplasmose/imunologia , Humanos , Itraconazol/uso terapêutico , Pessoa de Meia-IdadeRESUMO
BACKGROUND: fungal invasive infections are frequent in patients with immunosuppression. A common clinical feature is the presence of fever of unknown origin (FUO) in any of its several presentations. The aim of this study was to know the frequency of FUO associated to invasive mycosis in hospitalized patients. METHODS: samples from 34 patients were studied by immunological and microbiological procedures in order to investigate candidiasis, cryptococcosis, aspergillosis and Pneumocystis infection. RESULTS: fungal infection diagnosis was established in 12 (35 %) from 34 patients who full criterion. The fungal species isolated were Candida albicans (six), Aspergillus fumigates (four) and Cryptococcus sp. (two). All candidiasis cases were diagnosed only by microbiological studies, aspergillosis by immunological and microbiological studies, and cryptococcosis only by immunological studies. CONCLUSIONS: we concluded that is important the searching of mycosis in immunocompromised patients with fever of unknown origin by microbiological and immunological procedures.
Assuntos
Febre de Causa Desconhecida/imunologia , Hospedeiro Imunocomprometido , Micoses/imunologia , Adulto , Idoso , Feminino , Febre de Causa Desconhecida/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/complicações , Micoses/microbiologia , Adulto JovemRESUMO
Myxoma is the most common primary tumor of the heart. The typical presentations include a triad of embolic phenomena, intracardiac flow obstruction, and constitutional symptoms. We report a case of cardiac myxoma presenting as prolonged fever. Leukocytosis with a left shift, anemia, and elevated C-reactive protein were noted. A large left atrial myxoma was found incidentally by chest computed tomography. The fever subsided after surgical removal of the myxoma. His elevated serum interleukin-4 (IL-4), IL-6, IL-12 p70, interferon-γ, and tumor necrosis factor-α returned to undetectable levels four days after surgery. Cardiac myxomas should be included in the differential diagnosis of prolonged fever, even though no typical symptoms could be found.
Assuntos
Citocinas/sangue , Febre de Causa Desconhecida/etiologia , Átrios do Coração , Neoplasias Cardíacas/complicações , Mixoma/complicações , Febre de Causa Desconhecida/imunologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/imunologia , Humanos , Interferon gama/sangue , Interleucina-12/sangue , Interleucina-4/sangue , Interleucina-6/sangue , Leucocitose/etiologia , Leucocitose/imunologia , Masculino , Pessoa de Meia-Idade , Mixoma/diagnóstico , Mixoma/imunologia , Fator de Necrose Tumoral alfa/sangueRESUMO
To evaluate the feasibility of serum HMGB1, anti-HMGB1 antibodies, and HMGB1/anti-HMGB1 ratio as a diagnosis indicator of initial clinical classification in patients with fever of unknown origin (FUO). Ninety-four patients with classical FUO and ninety healthy controls were enrolled in this study. The subjects' clinical data and serum were collected. The serum concentration of HMGB1 was detected by a commercial HMGB1 ELISA kit, while the serum concentration of anti-HMGB1 antibodies were detected by an in-house built anti-HMGB1 antibodies ELISA kit and further confirmed by immunoblotting. According to the hospital diagnosis on discharge, ninety-four FUO patients were divided into four groups, Infectious disease subgroup, autoimmune disease subgroup, malignant tumor subgroup, and undetermined subgroup. The concentrations of HMGB1 in the infectious disease subgroup and autoimmune disease subgroup were higher than those in the malignant tumor subgroup, undetermined subgroup, and healthy control group. The concentration of anti-HMGB1 antibodies in autoimmune disease subtype group was higher than those in other subgroups as well as healthy control group. According to the distribution of HMGB1 and anti-HMGB1 in scatter plots of the patients with FUO, we found that the ratio of serum HMGB1/anti-HMGB1 is an ideal clinical indicator for differential diagnosis of different subtypes of FUO. The best cut-off was 0.75, and the sensitivity, specificity, and AUC were 66.67%, 87.32%, and 0.8, respectively. Correlation analysis showed that serum concentration of HMGB1 was moderately correlated with CRP in infectious diseases subgroup, and the serum concentration of anti-HMGB1 antibodies was strongly correlated with erythrocyte sedimentation rate in autoimmune disease subgroup. Our study had showed that serum HMGB1/anti-HMGB1 antibodies ratio can help clinicians identify FUO subtypes, thereby avoiding many unnecessary examinations and tests, and improving the effectiveness of clinical diagnosis and treatment of FUO.
Assuntos
Anticorpos/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/complicações , Doenças Transmissíveis/sangue , Doenças Transmissíveis/complicações , Febre de Causa Desconhecida/sangue , Febre de Causa Desconhecida/etiologia , Proteína HMGB1/sangue , Proteína HMGB1/imunologia , Neoplasias/sangue , Neoplasias/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sedimentação Sanguínea , Proteína C-Reativa/análise , Estudos de Casos e Controles , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Febre de Causa Desconhecida/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
In its strict sense, the term "autoinflammatory syndromes" comprises the hereditary periodic fever syndromes (HPF), which are caused by mutations of pattern-recognition receptors (PRR) and perturbations of the cytokine balance. These include the crypyrinopathies, familial Mediterranean fever, TNF-receptor associated periodic fever syndrome (TRAPS), hyper-IgD and periodic syndrome (HIDS), pyogenic sterile arthritis, pyoderma gangrenosum and acne (PAPA) syndrome, NALP12-HPF, and the Blau syndrome. The diseases are characterized by spontaneous activation of cells of the innate immunity in the absence of ligands. Autoantibodies are usually not found. HPF clinically present with recurrent fever episodes and inflammation, especially of serosal and synovial interfaces and the skin. Intriguingly, PRR-mediated autoinflammtory mechanisms also play a role in a number of chronic inflammatory and autoimmune diseases.
Assuntos
Doenças Autoimunes/imunologia , Autoimunidade/imunologia , Citocinas/imunologia , Febre de Causa Desconhecida/imunologia , Inflamação/imunologia , Modelos Imunológicos , Humanos , SíndromeRESUMO
Five-year clinico-laboratory data from 99 (one HIV seropositive) adults (mean age = 41.3 ± 20.4 years) who underwent bone marrow examination for fever persisting for ≥ 1 week were analysed and correlated with microbiological characteristics. Infections, reactive marrow changes and haematolymphoid malignancies were most commonly associated with fever. A high concordance rate of 71% was noted between aspiration and trephine biopsies. Bone marrow granulomas (BMG) were seen exclusively on sections and were most commonly of tubercular and typhoidal in origin (two Salmonella Typhi, one Salmonella Paratyphi A). The common aetiologies associated with fever and cytopenia(s) were BMG, acute leukaemia and haemophagocytic lymphohistiocytosis (HLH; n = 3). The yield from bone marrow culture was inferior compared to other body fluids. In conclusion, bone marrow histology is superior to smears in the evaluation of prolonged fever. Marrow culture may not be useful in immunocompetent individuals other than if Salmonellosis is suspected.
Assuntos
Exame de Medula Óssea , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/imunologia , Hospedeiro Imunocomprometido , Adulto , Biópsia/métodos , Medula Óssea/microbiologia , Medula Óssea/patologia , Feminino , Febre de Causa Desconhecida/microbiologia , Febre de Causa Desconhecida/patologia , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Atenção Terciária à Saúde , Adulto JovemRESUMO
BACKGROUND: Scrub typhus is lesser known cause of fever of unknown origin in India. Even if there have been reports documenting the prevalence of scrub typhus in different parts of India, it is still an unknown entity, and clinicians usually do not consider it as differential diagnosis. The present study was performed to document the prevalence of scrub typhus among febrile patients in western part of Uttar Pradesh and to assess the clinical profile of infected patients on the one hand and knowledge, attitude, and practices among clinicians on the other. MATERIALS AND METHODS: A total of 357 adult patients with fever of more than 5-day duration were recruited. All patients underwent complete physical examination, and detailed clinical history was elicited as per predesigned pro forma. After primary screening to rule out malaria, enteric fever, and leptospirosis infection, secondary screening for scrub typhus was done by rapid screen test and IgM ELISA. RESULTS: Scrub typhus infection was positive in 91 (25.5%) cases. The most common symptoms among the patients were fever (100%), pain in abdomen (79.1%), pedal edema 56 (61.5%), rash 44 (48.3%), headache 44 (48.3%), vomiting 42 (46.1%), constipation 33 (36.2%), cough 28 (30.7%), and lymphadenopathy 20 (21.9%). The median values of interleukin-8, interferon-gamma, and tumor necrosis factor-alpha in healthy controls were 15.54 pg/ml, 7.77 pg/ml, and 54.1 pg/ml, respectively, while the median values of these cytokines in scrub typhus-positive patients were 21.04 pg/ml, 8.74 pg/ml, and 73.8 pg/ml, respectively. CONCLUSION: Our results highlight that scrub typhus infection is an important cause of pyrexia of unknown origin, and active surveillance is necessary to assess the exact magnitude and distribution of the disease.
Assuntos
Febre/imunologia , Interferon gama/sangue , Interleucina-8/sangue , Tifo por Ácaros/epidemiologia , Tifo por Ácaros/imunologia , Fator de Necrose Tumoral alfa/sangue , Adulto , Anticorpos Antibacterianos/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Febre/epidemiologia , Febre/etiologia , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/epidemiologia , Febre de Causa Desconhecida/imunologia , Febre de Causa Desconhecida/parasitologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Orientia tsutsugamushi/imunologia , Orientia tsutsugamushi/isolamento & purificação , Médicos/psicologia , Médicos/estatística & dados numéricos , Prevalência , Tifo por Ácaros/sangue , Tifo por Ácaros/diagnósticoAssuntos
Injúria Renal Aguda/etiologia , Reservatórios de Doenças , Febre de Causa Desconhecida/etiologia , Infecções por Hantavirus/diagnóstico , Infecções por Hantavirus/transmissão , Camundongos/virologia , Injúria Renal Aguda/imunologia , Animais , Anticorpos Antivirais/sangue , Fezes/virologia , Febre de Causa Desconhecida/imunologia , Orthohantavírus/imunologia , Infecções por Hantavirus/imunologia , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-IdadeRESUMO
Fever is the most leading symptom of autoinflammatory diseases (AID). Therefore, AID have to be considered in differential diagnosis concerning fever of unknown origin. Unspecific Inflammatory manifestations may lead to misinterpretations that possibly cause irreversible organ damage. Effective treatment options are available and imply profound diagnostics.
Assuntos
Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/etiologia , Doenças Hereditárias Autoinflamatórias/complicações , Doenças Hereditárias Autoinflamatórias/diagnóstico , Diagnóstico Diferencial , Medicina Baseada em Evidências , Febre de Causa Desconhecida/imunologia , Doenças Hereditárias Autoinflamatórias/imunologia , HumanosRESUMO
OBJECTIVE: Although inflammatory markers, such as the white blood cell (WBC) count, erythrocyte sedimentation rate (ESR) and levels of C-reactive protein (CRP) and procalcitonin, are widely used to differentiate causes of fever of unknown origin (FUO), little is known about the usefulness of this approach. We evaluated relationships between the causes of classical FUO and the levels of inflammatory markers. METHODS: A nationwide retrospective study including 17 hospitals affiliated with the Japanese Society of Hospital General Medicine was conducted. PATIENTS: This study included 121 patients ≥18 years old diagnosed with "classical FUO" (axillary temperature ≥38.0°C at least twice over a ≥3-week period without elucidation of the cause on three outpatient visits or during three days of hospitalization) between January and December 2011. RESULTS: The causative disease was infectious diseases in 28 patients (23.1%), non-infectious inflammatory disease (NIID) in 37 patients (30.6%), malignancy in 13 patients (10.7%), other in 15 patients (12.4%) and unknown in 28 patients (23.1%). The rate of malignancy was significantly higher for a WBC count of <4,000/µL than for a WBC count of 4,000-8,000/µL (p=0.015). Among the patients with a higher WBC count, the rate of FUO due to NIID tended to be higher and the number of unknown cases tended to be lower. All FUO patients with malignancy showed an ESR of >40 mm/h. A normal ESR appeared to constitute powerful evidence for excluding a diagnosis of malignancy. In contrast, the concentrations of both serum CRP and procalcitonin appeared to be unrelated to the causative disease. CONCLUSION: The present study identified inflammatory markers that should be considered in the differential diagnosis of classical FUO, providing useful information for future diagnosis.
Assuntos
Sedimentação Sanguínea , Temperatura Corporal , Febre de Causa Desconhecida/etiologia , Infecções/diagnóstico , Inflamação/diagnóstico , Contagem de Leucócitos , Neoplasias/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Proteína C-Reativa/metabolismo , Calcitonina/sangue , Peptídeo Relacionado com Gene de Calcitonina , Diagnóstico Diferencial , Feminino , Febre de Causa Desconhecida/imunologia , Humanos , Infecções/complicações , Inflamação/complicações , Japão , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Valor Preditivo dos Testes , Precursores de Proteínas/sangue , Estudos RetrospectivosRESUMO
PURPOSE: PFAPA syndrome is a benign, recurrent inflammatory disease of childhood. Tonsillectomy is one of the therapeutic options with a yet unexplained biological mechanism. We tested whether specific lymphocyte subsets recruited from blood to human tonsils participate in PFAPA pathogenesis. METHODS: Paired tonsils/peripheral blood (PB) samples were investigated (a) from children with PFAPA that successfully resolved after tonsillectomy (n=10) (b) from children with obstructive sleep apnoea syndrome as controls (n=10). The lymphocyte profiles were analysed using 8-colour flow cytometry, immunoglobulin (IGH) and T-cell receptor (TCR) gene rearrangements via PCR and next generation sequencing; a TREC/KREC analysis was performed using qPCR. RESULTS: The PFAPA tonsils in the asymptomatic phase had a lower percentage of B-lymphocytes than controls; T-lymphocyte counts were significantly higher in PB. The percentages of cytotoxic CD8pos T-lymphocytes were approximately 2-fold higher in PFAPA tonsils; the transitional B cells and naïve stages of both the CD4pos and CD8pos T-lymphocytes with a low expression of PD-1 molecule and high numbers of TREC were also increased. With the exception of elevated plasmablasts, no other differences were significant in PB. The expression levels of CXCL10, CXCL9 and CCL19 genes were significantly higher in PFAPA tonsils. The IGH/TCR pattern showed no clonal/oligoclonal expansion. DNA from the Epstein-Barr virus, Human Herpervirus-6 or adenovirus was detected in 7 of 10 PFAPA tonsils but also in 7 of 9 controls. CONCLUSIONS: Our findings suggest that the uninhibited, polyclonal response of newly derived lymphocytes participate in the pathogenesis of PFAPA. Because most of the observed changes were restricted to tonsils and were not present in PB, they partly explain the therapeutic success of tonsillectomy in PFAPA syndrome.
Assuntos
Linfócitos T CD8-Positivos/imunologia , Febre de Causa Desconhecida/imunologia , Tonsila Palatina/imunologia , Receptor de Morte Celular Programada 1/biossíntese , Subpopulações de Linfócitos T/imunologia , Adenoviridae/genética , Adenoviridae/isolamento & purificação , Linfócitos B/imunologia , Quimiocina CCL19/biossíntese , Quimiocina CXCL10/biossíntese , Quimiocina CXCL9/biossíntese , Criança , Pré-Escolar , Feminino , Febre de Causa Desconhecida/complicações , Febre de Causa Desconhecida/cirurgia , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/isolamento & purificação , Herpesvirus Humano 6/genética , Herpesvirus Humano 6/isolamento & purificação , Humanos , Lactente , Linfadenite/complicações , Linfadenite/imunologia , Linfadenite/cirurgia , Contagem de Linfócitos , Masculino , Tonsila Palatina/citologia , Tonsila Palatina/cirurgia , Faringite/complicações , Faringite/imunologia , Faringite/cirurgia , Receptores de Antígenos de Linfócitos T/genética , Apneia Obstrutiva do Sono/imunologia , Apneia Obstrutiva do Sono/cirurgia , Estomatite Aftosa/complicações , Estomatite Aftosa/imunologia , Estomatite Aftosa/cirurgia , TonsilectomiaRESUMO
AIMS: The utility of bone marrow aspiration and biopsy (BMAB) as a diagnostic tool in patients with HIV/AIDS and fever of unknown origin (FUO) is a subject of debate. Because highly active antiretroviral therapy has reduced incidence of opportunistic infections, it is important to reassess the efficacy of BMAB for this diagnostic purpose. To our knowledge, no such studies have been performed in Harris County which has the highest incidence of HIV in the state of Texas. METHODS: We reviewed all BMABs from patients with HIV/AIDS and FUO or persistent cytopenia(s) from 2007 to 2011. RESULTS: Of 57 evaluable patients, BMAB was positive in 24 samples by acid fast bacilli (AFB) or Gomori methenamine silver (GMS) stains (17.5%), presence of granuloma and/or lymphohistiocytic aggregates (31.6%), culture (21.0%) or a combination. Cultures demonstrated Mycobacterium avium/intracellulare (4), M tuberculosis (2), M gordonae (1), Histoplasma capsulatum (3) and Cryptococcus neoformans (2). There were three cases in which a pathogen was grown in culture but that had a negative of 'direct examination' on tissue sections (negative AFB and GMS special stains, no morphological evidence of granuloma/lymphohistiocytic infiltrates). CONCLUSIONS: This study supports the use of diagnostic BMAB as a rapid decision-making tool in patients with HIV and FUO in the proper clinical setting. BMAB demonstrated infection-related evidence prior to positive bone marrow culture in 75% of cases. Special stains and blood cultures had similar diagnostic yield, but BMAB offers faster results. Thus, this procedure assists in clinical decision making and the refinement of treatment in a more timely manner.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Bacterianas/diagnóstico , Exame de Medula Óssea , Medula Óssea , Criptococose/diagnóstico , Febre de Causa Desconhecida/etiologia , Infecções por HIV/complicações , Infecções Oportunistas Relacionadas com a AIDS/etiologia , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Bactérias/isolamento & purificação , Infecções Bacterianas/etiologia , Infecções Bacterianas/imunologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/patologia , Técnicas Bacteriológicas , Biópsia , Medula Óssea/imunologia , Medula Óssea/microbiologia , Medula Óssea/patologia , Criptococose/etiologia , Criptococose/imunologia , Criptococose/microbiologia , Criptococose/patologia , Cryptococcus neoformans/isolamento & purificação , Feminino , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/imunologia , Febre de Causa Desconhecida/microbiologia , Febre de Causa Desconhecida/patologia , Infecções por HIV/diagnóstico , Infecções por HIV/imunologia , Humanos , Hospedeiro Imunocomprometido , Leucopenia/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Texas , Adulto JovemRESUMO
The participation of Bartonella henselae and Coxiella burnetii in the pathogenesis of fever of unknown origin (FUO) and lymphadenopathy has not been completely clarified. Prevalence of these two agents in Japanese children is also unknown. Serum IgG and IgM antibodies to B. henselae and to C. burnetii were examined by the indirect fluorescence antibody assay. Enzyme immunoassay kits were used to detect serum IgG and IgA antibodies against Chlamydia trachomatis. Out of 200 healthy normal pregnant women, two (1.0%) had serum IgG antibodies to B. henselae, four (2.0%) to C. burnetii and 49 (24.5%) to C. trachomatis. Out of 29 patients with FUO, one (3.4%) had serum IgG antibodies to B. henselae, four (13.8%) to C. burnetii and none to C. trachomatis. Out of 31 patients with cervical lymphadenopathy, three (9.6%) had serum IgG antibodies to B. henselae, two (6.5%) to C. burnetii and none to C. trachomatis. Out of 22 patients with generalized lymphadenopathy, one (4.5%) had serum IgG antibodies to B. henselae, three (13.6%) to C. burnetii and none to C. trachomatis. Prevalences of serum antibodies to C. burnetii in the patients with FUO and generalized lymphadenopathy and to B. henselae in the patients with cervical lymphadenopathy were significantly higher than those of normal pregnant women (Welch's t-test; P<0.01). These two agents may have some roles in the pathogenesis of FUO and lymphadenopathy in Japanese children.
Assuntos
Anticorpos Antibacterianos/sangue , Bartonella henselae/imunologia , Coxiella burnetii/imunologia , Febre de Causa Desconhecida/microbiologia , Doenças Linfáticas/microbiologia , Complicações Infecciosas na Gravidez/imunologia , Adolescente , Infecções por Bartonella/complicações , Infecções por Bartonella/imunologia , Infecções por Bartonella/microbiologia , Criança , Pré-Escolar , Chlamydia trachomatis/imunologia , Reações Cruzadas , Feminino , Sangue Fetal/imunologia , Febre de Causa Desconhecida/complicações , Febre de Causa Desconhecida/imunologia , Humanos , Lactente , Japão , Doenças Linfáticas/complicações , Doenças Linfáticas/imunologia , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Febre Q/complicações , Febre Q/imunologia , Febre Q/microbiologiaRESUMO
Between October, 1985, and February, 1987, 28 (8.7%) cases of scrub and murine typhus were diagnosed among 320 children with greater than or equal to 1 week history of obscure fever. Scrub typhus is a rural disease and characterized by fever, tachypnea and hepatosplenomegaly. Skin rash was rare and eschar was absent. Four patients had pneumonia and two had meningitis. Murine typhus, more an urban disease, was milder and half the patients presented exclusively because of night fever. Slightly enlarged liver and skin rash were the only significant physical signs. Lacking the classical textbook presentations, both rickettsioses often were missed or diagnosed as enteric fever. Recognition is important because patients with either disease respond well to treatment with chloramphenicol or doxycycline.
Assuntos
Febre de Causa Desconhecida/etiologia , Tifo por Ácaros/complicações , Tifo Endêmico Transmitido por Pulgas/complicações , Criança , Feminino , Febre de Causa Desconhecida/imunologia , Imunofluorescência , Humanos , Técnicas Imunoenzimáticas , Incidência , Masculino , Tifo por Ácaros/diagnóstico , Tifo por Ácaros/epidemiologia , Testes Sorológicos , Tailândia/epidemiologia , Tifo Endêmico Transmitido por Pulgas/diagnóstico , Tifo Endêmico Transmitido por Pulgas/epidemiologiaRESUMO
In the years to come, it is likely that with the advent of cytokines and even more with possibility to insert drug-resistant genes into hematopoietic stem cells, the risk of infection will be decreased because the severity and duration of neutropenia will be minimized. It is true that the ideal empiric antimicrobial regimen--a single antibiotic with a low incidence of superinfection and a low toxicity, without need for subsequent additions and readjustments--is still a wish. In the meantime and while living in the neutropenic area, physicians, for the benefit of patients, have to follow guidelines and create algorithms (see Fig. 1). Recommendations, however, should be always adjustable to the individual characteristics of the patient and the institution and to progress in antimicrobial chemotherapy. It is inevitable that research and clinical practice should go "hand in hand" in these "difficult-to-manage" and "difficult-to-treat" patients. After all, it should never be forgotten that the ultimate goal of empiric antimicrobial regimens in febrile neutropenia is to ensure patients' survival.