Asunto(s)
Tuberculosis Esplénica/diagnóstico , Antituberculosos/uso terapéutico , Femenino , Fiebre de Origen Desconocido/microbiología , Humanos , Laparoscopía , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Radiografía Abdominal , Bazo/diagnóstico por imagen , Bazo/microbiología , Bazo/patología , Tomografía Computarizada por Rayos X , Tuberculosis Esplénica/tratamiento farmacológico , Tuberculosis Esplénica/microbiología , Tuberculosis Esplénica/patologíaRESUMEN
We report a case of Q fever in a man who presented with fever of 40 days duration associated with thrombocytosis. Serological and molecular analysis (polymerase chain reaction) confirmed infection with Coxiella burnetii. A field study was conducted by collecting blood samples from the patient's family and from the animals in the patient's house. The patient's wife and 2 of 13 dogs showed seroreactivity. Our data indicate that C. burnetii may be an underrecognized cause of fever in Brazil and emphasize the need for clinicians to consider Q fever in patients with a febrile illness, particularly those with a history of animal contact.
Asunto(s)
Coxiella burnetii/genética , Fiebre de Origen Desconocido/microbiología , Fiebre Q/diagnóstico , Trombocitosis/microbiología , Animales , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/inmunología , Antígenos Bacterianos/inmunología , Brasil , Coxiella burnetii/inmunología , Coxiella burnetii/aislamiento & purificación , ADN Bacteriano/análisis , ADN Bacteriano/genética , Perros , Femenino , Humanos , Masculino , Reacción en Cadena de la Polimerasa , Fiebre Q/sangreAsunto(s)
Síndrome de Down/complicaciones , Fiebre de Origen Desconocido/complicaciones , Fiebre de Origen Desconocido/etiología , Tuberculosis Ganglionar/complicaciones , Antibacterianos/uso terapéutico , Resultado Fatal , Fiebre de Origen Desconocido/microbiología , Foramen Oval Permeable/complicaciones , Humanos , Lactante , Masculino , Derrame Pericárdico , Tuberculosis Ganglionar/tratamiento farmacológicoRESUMEN
INTRODUCTION: Total white blood cell count (WBC), erythrosedimentation rate (ESR) and C-reactive protein (CRP) are frequently used by primary care physicians attending infants < 90 days old with fever without localizing signs to distinguish those with a serious bacterial infection (SBI). The main objective of this study was to obtain the diagnostic values of these parameters in infants with fever. PATIENTS AND METHODS: We analyzed previously healthy infants aged 0 to 90 days old and fever with no source of infection admitted to the emergency room and/or hospitalized. The main outcome measure was the presence or absence of a SBI (urinary tract infection, bacteremia, meningitis, pneumonia, enteritis) and diagnostic values of WBC, ESR and CRP. RESULTS: A total of 103 infants met the inclusion criteria. Of these, 22 infants (21.3%) had a SBI, the most common being urinary tract infection. Absolute neutrophil count (ANC) and WBC had an area under the ROC curve (AUC) of 0.6 (95% CI: 0.46-0.73) and 0.55 (95% CI: 0.44-0.68) respectively. An ANC>or=10,000/microl had a sensitivity and specificity of 9% (95% CI: 1-21) and 92.5% (95% CI: 86-98) respectively. A WBC>or=15,000/microl had a sensitivity and specificity of 13.6% (95% CI: 1-28) and 85% (95% CI: 77-93) respectively. CRP showed an AUC of 0.71 (95% CI: 0.55-0.86) and a best cut-off point of 2 mg/dL (sensitivity 53% [95% CI: 29-76] and specificity of 85% [95% CI: 75-94]). ESR>or=20 mm/hour had an AUC, sensitivity and specificity of 0.53 (95% CI: 0.37-0.7), 38% (95% CI: 16-62) and 75% (95% CI: 65-85) respectively. CONCLUSIONS: None of these parameters alone, commonly used by physicians, is a reliable diagnostic tool to rule out SBI in infants<90 days old with fever without source of infection.
Asunto(s)
Infecciones Bacterianas/sangre , Proteína C-Reactiva/análisis , Fiebre de Origen Desconocido/sangre , Fiebre de Origen Desconocido/microbiología , Algoritmos , Sedimentación Sanguínea , Femenino , Humanos , Lactante , Recién Nacido , Recuento de Leucocitos , Masculino , Estudios Retrospectivos , Índice de Severidad de la EnfermedadAsunto(s)
Brucelosis/diagnóstico , Brucelosis/tratamiento farmacológico , Enfermería de Urgencia/métodos , Tratamiento de Urgencia/métodos , Fiebre de Origen Desconocido , Adolescente , Antibacterianos/uso terapéutico , Brucelosis/complicaciones , Brucelosis/transmisión , Diagnóstico Diferencial , Tratamiento de Urgencia/enfermería , Fiebre de Origen Desconocido/diagnóstico , Fiebre de Origen Desconocido/microbiología , Humanos , Masculino , Massachusetts , México , Evaluación en Enfermería/métodos , ViajeRESUMEN
We report a 42 years old HIV negative male admitted for fever of unknown origin. Initial laboratory evaluation showed elevated hepatic transaminases and alkaline phosphatase and an hipodense hepatic imagen was visualized in the CT scan. Hepatic biopsy demonstrated tuberculous granulomas and alcohol fast acid rods with Ziehl Neelsen stain. Anti-tuberculous treatment resulted in resolution of fever, improvement of general condition and normalization of laboratory parameters.
Asunto(s)
Antituberculosos/uso terapéutico , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Hepática/diagnóstico , Tuberculosis Esplénica/diagnóstico , Adulto , Biopsia , Fiebre de Origen Desconocido/microbiología , Seronegatividad para VIH , Humanos , Masculino , Tomografía Computarizada por Rayos X , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Esplénica/tratamiento farmacológicoRESUMEN
Reportamos el caso de un hombre de 42 años, seronegativo para VIH, con fiebre de origen desconocido (FOD), asociada a elevación de transaminasas y fosfatasas alcalinas con patrón colestásico e imágenes hepáticas hipodensas en la tomografía axial computada. La biopsia hepática demostró la presencia de granulomas tuberculosos con visualización de un bacilo con alcohol-ácido resistencia. El cuadro respondió al tratamiento con fármacos antituberculosos presentando caída de curva febril, mejoría del estado general y normalización de parámetros de laboratorio.
We report a 42 years old HIV negative male admitted for fever of unknown origin. Initial laboratory evaluation showed elevated hepatic transaminases and alkaline phosphatase and an hipodense hepatic imagen was visualized in the CT scan. Hepatic biopsy demonstrated tuberculous granulomas and alcohol fast acid rods with Ziehl Neelsen stain. Anti-tuberculous treatment resulted in resolution of fever, improvement of general condition and normalization of laboratory parameters.
Asunto(s)
Humanos , Masculino , Adulto , Antituberculosos/uso terapéutico , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Hepática/diagnóstico , Tuberculosis Esplénica/diagnóstico , Biopsia , Fiebre de Origen Desconocido/microbiología , Tomografía Computarizada por Rayos X , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Esplénica/tratamiento farmacológicoRESUMEN
We reviewed the incidence of occult bacteremia, to identify the most frequent etiological agents of bacteremias in otherwise healthy children from one month to 10 years old, who had fever of unknown origin attended at the emergency ward of an urban, university-affiliated pediatric referral center. This was a retrospective medical record review, evaluating children with fever. Data were collected from the initial visit, when blood cultures, hematological properties and hemosedimentation rates were examined. Fever was considered as the highest temperature assessed in the hospital or reported by the responsible adult. Occult bacteremia was discovered in 1.4 percent of the 1,051 children evaluated, and the most common etiologic agent was Streptococcus pneumoniae. Total leukocyte count and blood sedimentation rates greater than 30 mm³ were not predictive factors for occult bacteremia. Fever greater than 39°C was the most important factor for predicting occult bacteremia (P<0.001). The presence of occult bacteremia was significantly correlated with patient hospitalization.
Asunto(s)
Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Bacteriemia/complicaciones , Fiebre de Origen Desconocido/microbiología , Bacteriemia/epidemiología , Bacteriemia/microbiología , Brasil/epidemiología , Fiebre de Origen Desconocido/epidemiología , Incidencia , Estudios Retrospectivos , Población UrbanaRESUMEN
We reviewed the incidence of occult bacteremia, to identify the most frequent etiological agents of bacteremias in otherwise healthy children from one month to 10 years old, who had fever of unknown origin attended at the emergency ward of an urban, university-affiliated pediatric referral center. This was a retrospective medical record review, evaluating children with fever. Data were collected from the initial visit, when blood cultures, hematological properties and hemosedimentation rates were examined. Fever was considered as the highest temperature assessed in the hospital or reported by the responsible adult. Occult bacteremia was discovered in 1.4% of the 1,051 children evaluated, and the most common etiologic agent was Streptococcus pneumoniae. Total leukocyte count and blood sedimentation rates greater than 30 mm(3) were not predictive factors for occult bacteremia. Fever greater than 39 masculineC was the most important factor for predicting occult bacteremia (P<0.001). The presence of occult bacteremia was significantly correlated with patient hospitalization.
Asunto(s)
Bacteriemia/complicaciones , Fiebre de Origen Desconocido/microbiología , Bacteriemia/epidemiología , Bacteriemia/microbiología , Brasil/epidemiología , Niño , Preescolar , Femenino , Fiebre de Origen Desconocido/epidemiología , Humanos , Incidencia , Lactante , Masculino , Estudios Retrospectivos , Población UrbanaRESUMEN
Nocardiosis es una infección poco frecuente en pediatría, que se presenta habitual, pero no exclusivamente, en pacientes inmunocomprometidos, pudiendo producir cuadros localizados o diseminados. El diagnóstico se hace muchas veces mediante estudio histológico por visualización del microorganismo en los tejidos, dada la dificultad de confirmación bacteriológica, estudio que debe ser orientado por la sospecha clinica. Se presenta el caso de una preescolar inmunocompetente que cursó con un síndrome febril prolongado en que se descartaron múltiples causas infecciosas, tumores y mesenquimopatías; la histología de las lesiones nodulares hepato-esplénicas, aparecidas durante su estudio, confirmada con tomografía. Es importante considerar Nocardia sp entre las etiologías a estudiar en un cuadro febril de origen obscuro, ya que es posible su demostración mediante un estudio de laboratorio bien orientado frente a la sospecha clínica
Asunto(s)
Humanos , Preescolar , Femenino , Nocardiosis/diagnóstico , Nocardia/patogenicidad , Antibacterianos/uso terapéutico , Infecciones del Sistema Nervioso Central/microbiología , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Fiebre de Origen Desconocido/microbiología , Enfermedades Pulmonares/microbiología , Nocardiosis/epidemiología , Enfermedades Cutáneas Bacterianas/microbiología , Sulfonamidas/uso terapéuticoRESUMEN
OBJECTIVE: To assess the relative risks and benefits of 10 potential urine testing strategies (compared with no testing) involving urinalysis and urine culture for children aged 3 to 24 months with fever but no focus of bacterial infection. DESIGN: Decision analysis based on the literature. The 10 testing strategies consist of five pairs; within each pair of strategies, one calls for urinalysis and urine culture of a clean-voided (bag) specimen, and urine culture, and in the other, the urine specimen is sent for culture only if the result of the urinalysis is abnormal. The five pairs differ in selectivity for testing: all children, girls only, temperature > or = 39 degrees C only, fever only (no respiratory or gastrointestinal symptoms), or temperature > or = 40 degrees C only. The results of the decision analysis are expressed as the preventive fraction (the proportion of cases prevented) for end-stage renal disease (ESRD) and hypertension, and as two risk/benefit (RB) ratios: the number of children tested per case of ESRD prevented (RB1), and the number of children with false-positive diagnosis and treatment of urinary tract infection per case of ESRD prevented (RB2). RESULTS: On the basis of the available evidence, none of the testing strategies succeeds in preventing the majority of cases of ESRD and hypertension (preventive fraction = 0.10 to 0.50), and all are associated with high ratios of children tested (RB1 = 4167 to 12,500) and false-positive diagnosis and treatment (RB2 = 563 to 1800) per case of ESRD prevented. A strategy of combined urinalysis and urine culture in children with temperature > or = 39 degrees C is associated with the most favorable RB profile: preventive fraction = 0.45, RB1 = 5556; RB2 = 776. Sensitivity analyses indicate that the relative ranking of the strategies is relatively robust in regard to alterations in the estimates of the sensitivity or specificity of the urinalysis, the relative risk of renal scarring associated with delayed diagnosis and treatment, and the risk of scarring-induced hypertension or ESRD. CONCLUSIONS: Up to 50% of the long-term sequelae of occult urinary tract infections in young febrile children appear preventable by urine testing, but even the most favorable strategies require testing of thousands of children, and unnecessarily treating hundreds, for every case prevented. Our analysis reveals those strategies with more favorable RB profiles and emphasizes the need for rapid and convenient urine tests with much higher sensitivity and specificity or the need for less aggressive management strategies for febrile infants and young children with urinary tract infection.
Asunto(s)
Técnicas de Apoyo para la Decisión , Fiebre de Origen Desconocido/orina , Hipertensión/prevención & control , Fallo Renal Crónico/prevención & control , Urinálisis , Infecciones Urinarias/diagnóstico , Antibacterianos/uso terapéutico , Árboles de Decisión , Reacciones Falso Positivas , Femenino , Fiebre de Origen Desconocido/etiología , Fiebre de Origen Desconocido/microbiología , Humanos , Hipertensión/etiología , Lactante , Fallo Renal Crónico/etiología , Masculino , Valor Predictivo de las Pruebas , Riesgo , Sensibilidad y Especificidad , Urinálisis/efectos adversos , Urinálisis/métodos , Infecciones Urinarias/complicaciones , Infecciones Urinarias/tratamiento farmacológico , Orina/microbiologíaRESUMEN
Bacteremia was documented in 14 of 156 previously healthy children with temperatures of at least 40.0 degrees C but without focal signs, seen in an emergency department; 116 children had malaria, and no infections were identified in 26. Concurrent malaria infection was frequent in children with bacteremia. The highly febrile child without focal signs in the tropics requires evaluation for bacteremia even when a diagnosis of malaria has been confirmed.
Asunto(s)
Bacteriemia/complicaciones , Fiebre de Origen Desconocido/etiología , Malaria Falciparum/complicaciones , Enfermedad Aguda , Factores de Edad , Ampicilina/administración & dosificación , Ampicilina/uso terapéutico , Anemia/etiología , Preescolar , Cloxacilina/administración & dosificación , Cloxacilina/uso terapéutico , Diagnóstico Diferencial , Infecciones por Enterobacteriaceae/complicaciones , Femenino , Fiebre de Origen Desconocido/microbiología , Fiebre de Origen Desconocido/parasitología , Gentamicinas/administración & dosificación , Gentamicinas/uso terapéutico , Humanos , Lactante , Masculino , Nigeria , Prevalencia , Estudios Prospectivos , Convulsiones/etiología , Infecciones Estafilocócicas/complicacionesRESUMEN
Since the usefulness of liver biopsy in the diagnosis of fever of unknown origin is still controversial, we analyzed the charts of 54 patients with fever of unknown origin in whom histological and microbiological studies of a liver biopsy were performed. The cause of fever was established in 43 (80%) patients and it was most frequently of an infectious origin (52%). Histological analysis of liver biopsy was useful in determining the final diagnosis in 26 patients (48%) and was the main/only diagnostic method in a third of them. It was useful even in patients with no evidence of hepatic disfunction. Microbiological analysis of liver biopsy was positive in 7 cases (25% of infectious causes). We consider that liver biopsy should be performed early in the work-up of patients with fever of unknown origin.
Asunto(s)
Fiebre de Origen Desconocido/microbiología , Fiebre de Origen Desconocido/patología , Hígado/microbiología , Hígado/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
To determine the value of using blood cultures in the detection and prevention of serious focal infections in young febrile outpatients, we reviewed the records of all patients with positive blood cultures for Streptococcus pneumoniae, Haemophilus influenzae type b, or Neisseria meningitidis from January 1971 to June 1983. Of the 482 episodes of bacteremia, 164 (34%) were in children initially managed as outpatients. Of these 164 patients, 20 (12%) either had a serious focal complication subsequently or had persistent bacteremia at follow-up. However, 9 of these 20 children with complications were returned by their parents for reevaluation because of persistent symptoms and signs before the results of the blood cultures were known to clinicians. During the 12 years of the study, four cases of meningitis were detected directly as a result of the positive blood culture. Careful clinical follow-up is critical in the management of febrile outpatients.
Asunto(s)
Fiebre de Origen Desconocido/microbiología , Sepsis/diagnóstico , Preescolar , Femenino , Fiebre de Origen Desconocido/etiología , Infecciones por Haemophilus/complicaciones , Infecciones por Haemophilus/diagnóstico , Haemophilus influenzae , Humanos , Lactante , Masculino , Infecciones Meningocócicas/complicaciones , Infecciones Meningocócicas/diagnóstico , Sepsis/complicaciones , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnósticoRESUMEN
Twenty nine patients with the histological diagnosis of cancer and with positive blood cultures are presented. The majority of this group presented tumor activity at the time of developing septicemia. Some of these patients presented a history of recurrent infections. Only 20% of this population had no history of infection preceeding septicemia. The majority of the patients presented leucopenia and thrombocytopenia. All of the patients admitted to the Oncology Unit showed fever but no clinical evidence of the site of the infection. Several cultures were made but the patients were started at once on systemic antibiotics. The antibiotic combination used in every case was freely selected according with the physician's criteria; however, six patients were not treated with antibiotics and died. There was a definitive predominance of gram-negative blood cultures. The mortality in this group was 68% and was secondary to three main factors: those patients which were not treated with any antibiotic; granulocitopenia and inadequate selection of the antibiotic used in some of the patients. Pertinent literature regarding infection and cancer was reviewed, including the cause/effect of chemotherapy, radiotherapy and surgery, as well as other factors, such as the immunosuppression produced by the malignant disease. Emphasis is placed on the usage of prophylactic antibiotics in patients with cancer, neutropenia and fever of unknown origin.