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1.
Ned Tijdschr Geneeskd ; 1642020 Apr 02.
Artículo en Holandés | MEDLINE | ID: mdl-32391997

RESUMEN

Here we describe the characteristics of the first 100 laboratory confirmed COVID-19 patients admitted to the Elisabeth-Tweesteden Hospital (Tilburg, The Netherlands). The median age was 72 years, 67% was male, approximately 80% had co-morbidity, approximately 50% of which consisted of hypertension, cardiac and or pulmonary conditions and 25% diabetes. At admission 61% of patients had fever and about 50% presented at day 6 or more after onset of symptoms. At the time of writing 38 patients were discharged, 19 admitted to the intensive care unit (ICU) and 20 patients had died. The median age of ICU patients was 67 years and 63% had co-morbidity. The median time to discharge or to death was 6 and 5.5 days, respectively.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Mortalidad Hospitalaria , Neumonía Viral/epidemiología , Anciano , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Cuidados Críticos , Femenino , Fiebre/diagnóstico , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Pandemias , Alta del Paciente/estadística & datos numéricos , Neumonía Viral/diagnóstico
2.
Ned Tijdschr Geneeskd ; 1642020 Apr 02.
Artículo en Holandés | MEDLINE | ID: mdl-32392009

RESUMEN

OBJECTIVE: To describe disease presentation and clinical characteristics of patients with COVID-19 presenting to the Emergency Department (ED) of Bernhoven hospital in Uden, the Netherlands. DESIGN: Prospective, descriptive study. METHOD: The registry focused on atypical symptoms and co-infections. We hypothesized that patients older than 70 years more often have atypical symptoms. The number of co-infections is unknown. Therefore, we prospectively registered medical history, duration of symptoms, symptoms, temperature, lab results and co-infections of patients with confirmed COVID-19 in the period March 4-16th. RESULTS: The clinical characteristics of 107 patients were registered. The average age was 71 years and 41% was female. The median duration of symptoms was 5 days. 19% of patients had not been referred to pulmonary or internal medicine. Symptoms were fever (78%), respiratory complaints (78%), chest pain (28%), abdominal pain (13%), and diarrhea (34%). In 54% of the COVID-19 patients at the ED, the temperature was ≥ 38,0°C, CRP ≥ 50 in 51%, leucocytosis in 12% and elevated LD in 61%. Of 31 patients 24 (77%) had an absolute lymphopenia. Co-infections were seen in 16% of patients. The mortality in the ED was 2% and ICU-admission 5%. On March 25th, 2020 the overall mortality was 22% and ICU-admission 15%. CONCLUSION: We have seen patients with a very serious disease resulting in a high mortality and ICU-admission. Over 35% of patient did not have the typical symptoms of fever and respiratory complaints; atypical symptoms like chest pain, abdominal pain and diarrhea are frequently seen. There is no difference between patients over and under 70 years. COVID-19 patients can present with atypical symptoms, co-infections and distributed over various medical specialties.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Servicio de Urgencia en Hospital/estadística & datos numéricos , Neumonía Viral/diagnóstico , Dolor Abdominal/diagnóstico , Adulto , Anciano , Dolor en el Pecho/diagnóstico , Comorbilidad , Infecciones por Coronavirus/epidemiología , Femenino , Fiebre/diagnóstico , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Pandemias , Neumonía Viral/epidemiología , Estudios Prospectivos , Sistema de Registros/estadística & datos numéricos
3.
Spinal Cord Ser Cases ; 6(1): 22, 2020 04 17.
Artículo en Inglés | MEDLINE | ID: mdl-32303672

RESUMEN

INTRODUCTION: We present the report of the first, to our best knowledge, case of COVID-19 in a tetraplegic person. CASE PRESENTATION: A 56-year-old male with AIS A C4 tetraplegia developed fever during the night, without any prodrome. His general practitioner suspected a urinary tract infection and prescribed him antibiotic therapy. After 2 days of antibiotic therapy the fever still persisted, so the individual was admitted to the local hospital and treated with broad-spectrum antibiotics. After 2 days he was transferred to our spinal unit. Considering the worsening of the chest X-ray and fever despite 48 h of broad-spectrum antibiotic therapy, we strongly suspected viral pneumonia. SARS-CoV-2 was detected and antiviral therapy with Lopinavir/Ritonavir, associated with hydroxychloroquine, was promptly started. Fever ceased after 2 days of therapy. DISCUSSION: Blood test and chest X-ray findings in this patient were similar to previously published findings regarding COVID-19. One difference between this case and the known clinical course of COVID-19 is that did not develop cough. Another interesting feature of our case is that, despite tetraplegia, the clinical course was not severe. Persons with COVID-19 remain asymptomatic, these results underscore the need for rehabilitation and SCI professionals to have a high index of suspicion for COVID-19 in their inpatient and outpatient clients. Only inpatient with fever hase being tested for COVID-19. All new patients are submitted to SARS-COV-2 Test. Moreover, routine testing of patients who have to participate in therapy in common gym areas may be warranted.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Cuadriplejía/complicaciones , Antibacterianos/uso terapéutico , Antirretrovirales/uso terapéutico , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Tos , Fiebre/diagnóstico , Hospitalización , Humanos , Italia , Lopinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/tratamiento farmacológico , Respiración Artificial , Ritonavir/uso terapéutico , Virus del SRAS , Traumatismos de la Médula Espinal/complicaciones
4.
Geroscience ; 42(2): 505-514, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32274617

RESUMEN

SARS-CoV-2 virus, the causative agent of the coronavirus infectious disease-19 (COVID-19), is taking the globe by storm, approaching 500,000 confirmed cases and over 21,000 deaths as of March 25, 2020. While under control in some affected Asian countries (Taiwan, Singapore, Vietnam), the virus demonstrated an exponential phase of infectivity in several large countries (China in late January and February and many European countries and the USA in March), with cases exploding by 30-50,000/day in the third and fourth weeks of March, 2020. SARS-CoV-2 has proven to be particularly deadly to older adults and those with certain underlying medical conditions, many of whom are of advanced age. Here, we briefly review the virus, its structure and evolution, epidemiology and pathogenesis, immunogenicity and immune, and clinical response in older adults, using available knowledge on SARS-CoV-2 and its highly pathogenic relatives MERS-CoV and SARS-CoV-1. We conclude by discussing clinical and basic science approaches to protect older adults against this disease.


Asunto(s)
Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/patología , Neumonía Viral/inmunología , Neumonía Viral/patología , Anciano , Animales , Anticuerpos Antivirales/inmunología , Betacoronavirus/genética , Betacoronavirus/patogenicidad , Quimiocinas/inmunología , Citocinas/inmunología , Fiebre/diagnóstico , Fiebre/virología , Geriatría , Humanos , Inmunosenescencia , Coronavirus del Síndrome Respiratorio de Oriente Medio , Pandemias , Peptidil-Dipeptidasa A/genética , Virus del SRAS , Glicoproteína de la Espiga del Coronavirus/genética
5.
Medicine (Baltimore) ; 99(15): e19806, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282746

RESUMEN

RATIONALE: Acute lymphoblastic leukemia (ALL) has acute and severe onset characterized by fever, moderate to severe anemia, bone and joint pain, and sternal tenderness. It is easy to be misdiagnosed as rheumatic disease when joint pain is the first symptom. PATIENT CONCERNS: A male Han, 18 years of age was admitted on July 15th, 2016 for multi-joint swelling and pain with intermittent fever for half a year which had aggravated in the last 10 days. DIAGNOSIS: Based on symptoms, imaging, family history, and blood tests, he was first diagnosed with ankylosing spondylitis, but he was refractory to treatment. Bone marrow biopsy then revealed acute B-lymphoblastic leukemia (possibility Pro-B-ALL). INTERVENTIONS: The patient was transferred to the hematology department on July 23rd, 2016 for chemotherapy. OUTCOMES: No joint pain occurred during follow-up, which ended on November 4th, 2018. LESSONS: ALL may present with symptoms suggestive of rheumatic diseases like ankylosing spondylitis. Physicians should be aware of this possibility, especially in young patients.


Asunto(s)
Artralgia/etiología , Leucemia Linfocítica Crónica de Células B/patología , Espondilitis Anquilosante/diagnóstico , Adolescente , Antineoplásicos/uso terapéutico , Artralgia/diagnóstico , Biopsia , Médula Ósea/patología , Diagnóstico Diferencial , Errores Diagnósticos , Fiebre/diagnóstico , Fiebre/etiología , Humanos , Artropatías/diagnóstico por imagen , Artropatías/patología , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Masculino , Espondilitis Anquilosante/sangre , Espondilitis Anquilosante/terapia , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
6.
J Comput Assist Tomogr ; 44(3): 311-313, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32217900

RESUMEN

We present clinical and chest computed tomography (CT) features of 5 cases of pediatric patients with 2019 novel coronavirus. Two patients had fever and dry cough, whereas the rest of 3 patients were asymptomatic. Three patients had unilateral ground glass opacities with or without consolidation in the subpleural region on high-resolution chest CT, 1 patient had bilateral ground glass opacities, and 1 patient was negative for CT. We note that up to 66.7% asymptomatic patients had pulmonary lesions, so the asymptomatic children with Wuhan contact are recommended to do a 2019 novel coronavirus real-time fluorescence polymerase chain reaction screening. Unlike adult patients, only a small amount of patients had multilobes affected, so we speculate that the pediatric patients generally have milder CT findings than adults.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Adolescente , Betacoronavirus , Niño , Preescolar , Infecciones por Coronavirus/diagnóstico por imagen , Tos/diagnóstico , Femenino , Fiebre/diagnóstico , Humanos , Lactante , Pulmón , Masculino , Pandemias , Neumonía Viral/diagnóstico por imagen , Radiografía Torácica , Reacción en Cadena en Tiempo Real de la Polimerasa , Tomografía Computarizada por Rayos X
7.
PLoS Negl Trop Dis ; 14(3): e0008086, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32203509

RESUMEN

BACKGROUND: Arboviruses are a cause of acute febrile illness and outbreaks worldwide. Recent outbreaks of Chikungunya virus (CHIKV) in dengue endemic areas have alarmed clinicians as unique clinical features differentiating CHIKV from Dengue virus (DENV) are limited. This has complicated diagnostic efforts especially in resource limited countries where lab testing is not easily available. Therefore, it is essential to analyse and compare clinical features of laboratory confirmed cases to assist clinicians in suspecting possible CHIKV infection at time of clinical presentation. METHODOLOGY: A prospective point prevalence study was conducted, with the hypothesis that not all patients presenting with clinical suspicion of dengue infections at local hospitals are suffering from dengue and that other arboviruses such as Chikungunya, West Nile viruses, Japanese Encephalitis virus and Zika virus are co-circulating in the Sindh region of Pakistan. Out-patients and hospitalized (in-patients) of selected district hospitals in different parts of Sindh province of Pakistan were recruited. Patients with presumptive dengue like illness (Syndromic diagnosis) by the treating physicians were enrolled between 2015 and 2017. Current study is a subset of larger study mentioned above. Here-in we compared laboratory confirmed cases of CHIKV and DENV to assess clinical features and laboratory findings that may help differentiate CHIKV from DENV infection at the time of clinical presentation. RESULTS: Ninety-eight (n = 98) cases tested positive for CHIKV, by IgM and PCR and these were selected for comparative analysis with DENV confirmed cases (n = 171). On multivariable analysis, presence of musculoskeletal [OR = 2.5 (95% CI:1.6-4.0)] and neurological symptoms [OR = 4.4 (95% CI:1.9-10.2)], and thrombocytosis [OR = 2.2 (95% CI:1.1-4.0)] were associated with CHIKV infection, while atypical lymphocytes [OR = 8.3 (95% CI:4.2-16.7)] and thrombocytopenia [OR = 8.1 (95% CI:1.7-38.8)] were associated with DENV cases at time of presentation. These findings may help clinicians in differentiating CHIKV from DENV infection. CONCLUSION: CHIKV is an important cause of illness amongst patients presenting with acute febrile illness in Sindh region of Pakistan. Arthralgia and encephalitis at time of presentation among patients with dengue-like illness should prompt suspicion of CHIKV infection, and laboratory confirmation must be sought.


Asunto(s)
Fiebre Chikungunya/diagnóstico , Fiebre Chikungunya/fisiopatología , Dengue/diagnóstico , Dengue/fisiopatología , Fiebre/diagnóstico , Fiebre/fisiopatología , Adolescente , Adulto , Anticuerpos Antivirales , Fiebre Chikungunya/epidemiología , Virus Chikungunya , Niño , Coinfección/epidemiología , Estudios Transversales , Dengue/epidemiología , Virus del Dengue , Brotes de Enfermedades , Virus de la Encefalitis Japonesa (Especie) , Femenino , Fiebre/epidemiología , Humanos , Inmunoglobulina M , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Resultado del Tratamiento , Virus del Nilo Occidental , Adulto Joven , Virus Zika , Infección por el Virus Zika/epidemiología
9.
Anaesthesiol Intensive Ther ; 52(1): 34-41, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32191830

RESUMEN

Over the past three months, the world has faced an unprecedented health hazard. The World Health Organization has announced a pandemic infection with an unknown species of coronavirus called SARS-CoV-2. Spreading mainly through the droplet route, the virus causes mild symptoms in the majority of cases, the most common being: fever (80%), dry cough (56%), fatigue (22%) and muscle pain (7%); less common symptoms include a sore throat, a runny nose, diarrhea, hemoptysis and chills. A life-threatening complication of SARS-CoV-2 infection is an acute respiratory distress syndrome (ARDS), which occurs more often in older adults, those with immune disorders and co-morbidities. Severe forms of the infection, being an indication for treatment in the intensive care unit, comprise acute lung inflammation, ARDS, sepsis and septic shock. The article presents basic information about etiology, pathogenesis and diagnostics (with particular emphasis on the importance of tomocomputer imaging), clinical picture, treatment and prevention of the infection. It goes on to emphasize the specific risks of providing anesthesiology and intensive care services. Due to the fact that effective causal treatment is not yet available and the number of infections and deaths increases day by day, infection prevention and strict adherence to recommendations of infection control organizations remain the basis for fighting the virus.


Asunto(s)
Anestesiólogos/psicología , Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Factores de Edad , Infecciones por Coronavirus/etiología , Infecciones por Coronavirus/prevención & control , Tos/diagnóstico , Tos/etiología , Progresión de la Enfermedad , Fiebre/diagnóstico , Fiebre/etiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Neumonía Viral/etiología , Neumonía Viral/prevención & control , Factores de Riesgo
10.
Arerugi ; 69(1): 53-58, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-32051370

RESUMEN

We report an adult case of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, who had a tonsillectomy at 10 years old and relapsed later. An early 40's-year-old man had been suffering from recurrent fever attack once in 1-2 months during childhood. He was accompanied by fever which was persist for several days, aphthous stomatitis, tongued tonsillitis with moss, pharyngitis, and submandibular lymphadenitis with tenderness. He was not doing well during fare-up. At the time of admission, CRP level was 12.5mg/dl and the remarkably increased expression of CD64 on neutrophils was found. Bacterial infections and collagen diseases were excluded by the several examinations. We suspected PFAPA syndrome, and treated with cimetidine, but cimetidine was not effective. At the time of flare up, administration of prednisolone was remarkably effective. We diagnosed PFAPA syndrome on the basis of clinical courses. Genetic analysis of responsible gene of familial Mediterranean fever, MEFV showed E148Q heterozygous mutation in exon 2.Since an adult case of PFAPA syndrome is likely to be made misunderstanding for infectious recurrent pharyngitis, it is important to note that we should consider PFAPA syndrome as a differential diagnosis when we meet with the adult patient of recurrent fever.


Asunto(s)
Fiebre/diagnóstico , Linfadenitis/diagnóstico , Faringitis/diagnóstico , Pirina/genética , Estomatitis Aftosa/diagnóstico , Adulto , Niño , Humanos , Masculino , Recurrencia , Síndrome
12.
BMC Infect Dis ; 20(1): 117, 2020 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-32041536

RESUMEN

BACKGROUND: Severe febrile illness without a known source (SFWS) is a challenge for clinicians when deciding how to manage a patient, particularly given the wide spectrum of potential aetiologies that contribute to fever. These infections are difficult to distinguish clinically, and accurate diagnosis requires a plethora of diagnostics including blood cultures, imaging techniques, molecular or serological tests, and more. When laboratory services are available, a limited test menu hinders clinical decision-making and antimicrobial stewardship, leading to empiric treatment and suboptimal patient outcomes. To specifically address SFWS, this work aimed to identify priority pathogens for a globally applicable panel for fever causing pathogens. METHOD: A pragmatic two-pronged approach combining currently available scientific data in an analytical hierarchy process and systematically gathered expert input, was designed to address the lack of comprehensive global aetiology data. The expert re-ranked list was then further adapted for a specific use case to focus on community acquired infections in whole blood specimens. The resulting list was further analysed to address different geographical regions (Asia, Africa, and Latin America), and Cohen kappa scores of agreement were calculated. RESULTS: The expert ranked prioritized pathogen list generated as part of this two-pronged approach included typhoidal Salmonella, Plasmodium species and Mycobacterium tuberculosis as the top 3 pathogens. This pathogen list was then further adapted for the SFWS use case to develop a final pathogen list to inform product development. Subsequent analysis comparing the relevance of the SFWS pathogen list to multiple populations and geographical regions showed that the SFWS prioritized list had considerable utility across Africa and Asia, but less so for Latin America. In addition, the list showed high levels of agreement across different patient sub-populations, but lower relevance for neonates and symptomatic HIV patients. CONCLUSION: This work highlighted once again the challenges of prioritising in global health, but it also shows that taking a two-pronged approach, combining available prevalence data with expert input, can result in a broadly applicable priority list. This comprehensive utility is particularly important in the context of product development, where a sufficient market size is essential to achieve a sustainable commercialized diagnostic product to address SFWS.


Asunto(s)
Pruebas Diagnósticas de Rutina/normas , Fiebre/diagnóstico , África/epidemiología , Asia/epidemiología , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/parasitología , Infecciones Comunitarias Adquiridas/virología , Países en Desarrollo , Fiebre/microbiología , Fiebre/parasitología , Fiebre/virología , Salud Global/normas , Humanos , América Latina/epidemiología , Prevalencia
13.
Euro Surveill ; 25(5)2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32046816

RESUMEN

We evaluated effectiveness of thermal passenger screening for 2019-nCoV infection at airport exit and entry to inform public health decision-making. In our baseline scenario, we estimated that 46% (95% confidence interval: 36 to 58) of infected travellers would not be detected, depending on incubation period, sensitivity of exit and entry screening, and proportion of asymptomatic cases. Airport screening is unlikely to detect a sufficient proportion of 2019-nCoV infected travellers to avoid entry of infected travellers.


Asunto(s)
Viaje en Avión , Temperatura Corporal , Infecciones por Coronavirus/diagnóstico , Fiebre/diagnóstico , Tamizaje Masivo , Neumonía Viral/diagnóstico , Enfermedades Transmisibles Emergentes , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Toma de Decisiones , Humanos , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Modelos Teóricos , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Vigilancia de la Población , Salud Pública
14.
15.
BMC Infect Dis ; 20(1): 22, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31914937

RESUMEN

BACKGROUND: Brucellosis is one of the most widespread zoonosis in the world. In China, 90% of human brucellosis occurs in six northern agricultural provinces. However, there is a recent increase in the trend of human brucellosis in southern provinces with limited cases reported in the literature. Our study aims to describe the clinical features and epidemiology of brucellosis in a tertiary hospital in southern China. METHODS: A retrospective case series of brucellosis was conducted between January 1, 2014 and October 31. 2018. Cases were identified based on positive Brucella serology by tube agglutination test, or positive culture from clinical specimen identified by Vitek 2 and MALDL-TOF MS. Clinical details of brucellosis including patients' occupation, risk factors, and complications were analyzed. Clinical characteristics between patients from Guangdong and other provinces were also compared. RESULTS: A total of 13 cases of laboratory-confirmed brucellosis were identified. 7 (53.8%) of the patients were male, 6 (46.2%) were female, with age ranging from 29 to 73 years old (median age: 51 years). 5 patients (38.5%) were from Guangdong province, while the remaining patients (61.5%) were from other provinces. The commonest risk factors of acquisition were consumption of undercooked meat and goat placenta. Patients from Guangdong province were found to be more likely to have prior placenta consumption. The commonest clinical presentations were fever, osteoarticular pain, urinary symptoms, splenomegaly, and lymphadenopathy. Spondylodiscitis/ peripheral joint arthritis (5 patients, 38.5%) was the most prevalent complication, while extra-osteoarticular complications including abdominal aortitis, hepatosplenic abscess, chest wall abscess, and epididymo-orchitis were observed in 4 other patients. Furthermore, it was demonstrated that MALDI-TOF MS is reliable in Brucella identification after additional of reference spectra with standard Brucella strain. CONCLUSIONS: Brucellosis, previously thought to be only found in northern China, is now increasingly seen in highly cosmopolitan part of southern China. MALDI-TOF MS in hospitals in China should include reference spectra with standard Brucella strain to aid bacterial identification in routine clinical practice. In addition to tuberculosis, typhoid fever and typhus, brucellosis should be considered in patients with fever of unknown origin in this locality.


Asunto(s)
Brucelosis/epidemiología , Adulto , Anciano , Brucella/aislamiento & purificación , Brucelosis/diagnóstico , China/epidemiología , Diagnóstico Diferencial , Femenino , Fiebre/complicaciones , Fiebre/diagnóstico , Fiebre/microbiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Urbanización
16.
PLoS Negl Trop Dis ; 14(1): e0007927, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31923174

RESUMEN

BACKGROUND: The epidemiology of acute febrile illness, a common cause of hospitalization in Indonesia, has not been systematically studied. METHODOLOGY/PRINCIPAL FINDINGS: This prospective observational study enrolled febrile patients (temperature ≥38°C) aged ≥1 year from July 2013 until June 2016 at eight government referral teaching hospitals in seven provincial capitals in Indonesia. Patients were managed according to the hospital standard-of-care (SOC), and blood samples were drawn for molecular and serological assays. Clinical data, laboratory results, and specimens for additional tests were collected at enrollment, days 14-28, and at three months. Regular follow-up visits were then scheduled for every three months either until symptoms resolved or until one year. In total, this study included 1,486 adult and pediatric patients presenting with multi-organ (768, 51.7%), gastrointestinal (497, 33.0%), respiratory (114, 7.7%), constitutional (62, 4.2%), skin and soft-tissue (24, 1.6%), central nervous system (17, 1.1%), or genitourinary (4, 0.3%) manifestations. Microbiological diagnoses were found in 1,003/1,486 (67.5%) participants, of which 351/1,003 (35.0%) were not diagnosed during hospitalization using SOC diagnostic tests. Missed diagnoses included all cases caused by Rickettsia spp., chikungunya, influenza, and Seoul virus. The most common etiologic agents identified were dengue virus (467, 46.6%), Salmonella spp. (103, 10.3%), and Rickettsia spp. (103, 10.3%). The overall mortality was 89 (5.9%). CONCLUSIONS/SIGNIFICANCE: Febrile illness in Indonesia has various microbiologic etiologies and substantial overall mortality. Diagnostic limitations and lack of epidemiologic data resulted in potentially treatable, and at times fatal, diseases being missed.


Asunto(s)
Fiebre/diagnóstico , Fiebre/epidemiología , Pacientes Internos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Femenino , Fiebre/microbiología , Fiebre/mortalidad , Estudios de Seguimiento , Hospitales de Enseñanza , Humanos , Indonesia/epidemiología , Lactante , Masculino , Persona de Mediana Edad , Diagnóstico Erróneo/estadística & datos numéricos , Estudios Prospectivos
17.
PLoS Negl Trop Dis ; 14(1): e0007805, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31945052

RESUMEN

BACKGROUND: In surveillance for typhoid fever, under-detection of cases occurs when patients with fever do not seek medical care, or seek medical care but do not receive a blood test. Missing data may result in incorrect estimates of disease incidence. METHODS: We used data from an ongoing randomised clinical trial of typhoid conjugate vaccine among children in Nepal to determine if eligible patients attending our fever clinics who did not have blood taken for culture had a lower risk of disease than those who had blood drawn. We assessed clinical and demographic predictors of having blood taken for culture, and predictors of culture-positive results. Missing blood culture data were imputed using multiple imputations. RESULTS: During the first year of surveillance, 2392 fever presentations were recorded and 1615 (68%) of these had blood cultures. Children were more likely to have blood taken for culture if they were older, had fever for longer, a current temperature ≥38 degrees, or if typhoid or a urinary tract infection were suspected. Based on imputation models, those with blood cultures were 1.87 times more likely to have blood culture-positive fever than those with missing data. CONCLUSION: Clinical opinion on the cause of the fever may play a large part in the decision to offer blood culture, regardless of study protocol. Crude typhoid incidence estimates should be adjusted for the proportion of cases that go undetected due to missing blood cultures while adjusting for the lower likelihood of culture-positivity in the group with missing data.


Asunto(s)
Cultivo de Sangre/estadística & datos numéricos , Fiebre/diagnóstico , Fiebre Tifoidea/diagnóstico , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Masculino , Diagnóstico Erróneo , Nepal/epidemiología , Fiebre Paratifoidea/sangre , Fiebre Paratifoidea/diagnóstico , Fiebre Paratifoidea/epidemiología , Salmonella paratyphi A/aislamiento & purificación , Salmonella typhi/aislamiento & purificación , Fiebre Tifoidea/sangre , Fiebre Tifoidea/epidemiología , Infecciones Urinarias
18.
Infect Dis Poverty ; 9(1): 6, 2020 Jan 16.
Artículo en Inglés | MEDLINE | ID: mdl-31948465

RESUMEN

BACKGROUND: Human brucellosis is a neglected public health issue in China and reports of HIV-infected individuals complicated with brucellosis are rare. This report describes the case of an HIV-infected patient complicated with brucellosis. We want to raise awareness of clinical diagnosis of brucellosis among clinicians. Furthermore, we should be more concerned about cases with pyrexia of unknown origin, especially in non-epidemic areas of brucellosis in China. CASE PRESENTATION: We encountered the case of a 31-year-old HIV-infected male with a CD4+ T lymphocyte count of approximately 300. On May 1, 2019, the patient had onset of non-specific caustic irregular fever with body temperature reaching 41.0 °C. He was admitted to two medical institutions in Yunnan with pyrexia of unknown origin. Finally, on day 7 of hospitalization in the Public Health Clinical Medical Center in Chengdu City, he was diagnosed as having brucellosis infection based on blood culture results. CONCLUSIONS: This is the first reported case of brucellosis concomitant with HIV infection in China. Laboratories in infectious disease hospitals and category A level III hospitals in the southern provinces of China should be equipped with reagents for clinical diagnosis of brucellosis and to strengthen the awareness of brucellosis diagnosis in China. Secondly, in provinces with a high incidence of AIDS and brucellosis such as Xinjiang and Henan, it is recommended to implement a joint examination strategy to ensure the early detection, diagnosis, and treatment of this infection.


Asunto(s)
Brucelosis/diagnóstico , Fiebre/diagnóstico , Infecciones por VIH/virología , Adulto , Brucelosis/tratamiento farmacológico , Brucelosis/microbiología , China , Comorbilidad , Fiebre/tratamiento farmacológico , Fiebre/microbiología , Humanos , Masculino , Resultado del Tratamiento
19.
PLoS Negl Trop Dis ; 14(1): e0007971, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31995560

RESUMEN

BACKGROUND: Dengue is an important arboviral disease with about 100 million dengue cases per year, of which, ~5% result in severe disease. Clinical differentiation of dengue from other acute febrile illnesses (AFI) is difficult, and diagnostic blood tests are costly. We evaluated the utility of anti-DENV IgM in urine to identify dengue cases among AFI patients enrolled in a clinical study. METHODS: Between May 2012-March 2013, 1538 study participants with fever for ≤7 days were enrolled, a medical history was obtained, and serum and urine specimens were collected. Serum was tested for DENV RNA and anti-DENV IgM. Urine was tested for anti-DENV IgM, and its sensitivity and specificity to detect sera laboratory-positive dengue cases were calculated. We evaluated if urine anti-DENV IgM positivity early (≤5 days post-illness onset [DPO]) and late (6-14 DPO) in the clinical course was associated with dengue severity. RESULTS: Urine anti-DENV IgM sensitivity and specificity were 47.4% and 98.5%, respectively, when compared with serum anti-DENV IgM ELISA results, and 29.7% and 91.1% when compared with serum rRT-PCR results. There was no correlation between urine anti-DENV IgM positivity and patient sex or pre-existing chronic disease. Early in the clinical course, a significantly higher proportion of those who developed dengue with warning signs had anti-DENV IgM in their urine when compared to those without warning signs (20.4% vs. 4.3%). There was no difference in the proportion with urine anti-DENV IgM positivity between severity groups late in the clinical course. CONCLUSION: While detection of urine anti-DENV IgM lacked adequate diagnostic sensitivity, it is a highly specific marker for laboratory-positive dengue, and its presence early in the clinical course may distinguish those with more severe disease. Further assessment of urine anti-DENV IgM by DPO is warranted to determine its utility as an early diagnostic (and possibly prognostic) marker for dengue.


Asunto(s)
Anticuerpos Antivirales/orina , Virus del Dengue/inmunología , Dengue/diagnóstico , Dengue/orina , Inmunoglobulina M/orina , Adolescente , Adulto , Niño , Dengue/epidemiología , Pruebas Diagnósticas de Rutina/métodos , Femenino , Fiebre/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Puerto Rico/epidemiología , Sensibilidad y Especificidad , Adulto Joven
20.
BMC Infect Dis ; 20(1): 21, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910823

RESUMEN

BACKGROUND: Meningitis is a very rare atypical presenting feature of anti-NMDA receptor encephalitis. In our case report, we describe an unusual clinical presentation of anti-NMDA receptor encephalitis with a biphasic pattern of meningitis followed by encephalitis and discuss potential mechanisms underlying this presentation. We aim to widen the differential diagnosis to be considered in a patient presenting with clinical meningitis and pyrexia. CASE PRESENTATION: This is a case of a 33-year old Caucasian woman who initially presented with a lymphocytic meningitis attributed to a viral infection. She subsequently developed fluctuating consciousness, agitation, visual hallucinations, dyskinetic movements, a generalized tonic-clonic seizure, and autonomic instability. Investigations revealed a diagnosis of anti-NMDA receptor encephalitis secondary to a previously unidentified ovarian teratoma. She made an excellent recovery with immunotherapy and removal of the teratoma. CONCLUSION: Clinicians should consider autoimmune encephalitides in individuals with meningitis, particularly where extensive investigations fail to identify a causative pathogen and there is rapid development of an encephalitic phenotype.


Asunto(s)
Encefalitis Antirreceptor N-Metil-D-Aspartato/diagnóstico , Meningitis Viral/diagnóstico , Neoplasias Ováricas/patología , Teratoma/patología , Administración Intravenosa , Adulto , Encefalitis Antirreceptor N-Metil-D-Aspartato/complicaciones , Encefalitis Antirreceptor N-Metil-D-Aspartato/tratamiento farmacológico , Anticuerpos/sangre , Diagnóstico Diferencial , Encefalitis/diagnóstico , Femenino , Fiebre/diagnóstico , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Enfermedad de Hashimoto/diagnóstico , Humanos , Inmunoterapia , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/etiología , Neoplasias Ováricas/cirugía , Intercambio Plasmático , Receptores de N-Metil-D-Aspartato/inmunología , Convulsiones/diagnóstico , Teratoma/tratamiento farmacológico , Teratoma/etiología , Teratoma/cirugía , Resultado del Tratamiento
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