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1.
Zhongguo Zhong Yao Za Zhi ; 44(18): 3869-3875, 2019 Sep.
Artículo en Chino | MEDLINE | ID: mdl-31872717

RESUMEN

Mahuang Fuzi Xixin Decoction recorded in Treatise on Febrile Diseases by Zhang Zhongjing in the Han Dynasty have been widely used in treating Yang deficiency and exogenous wind-cold syndrome by traditional Chinese medicine physicians for thousands of years. The indications of Mahuang Fuzi Xixin Decoction include bradyarrhythmia,sinus bradycardia,sick sinus node syndrome,senile exogenous,asthmatic cold,rhinitis,bronchial asthma,optic neuritis,optic atrophy,sudden blindness,sudden onset of cough,laryngeal obstruction,migraine,joint pain,low back pain,insomnia,shock,heart failure,renal failure,accompanied by fever or nosocomial infection,and hyperpyrexia after tracheotomy; dark complexion,chills,cold limbs,listlessness,fatigue,insomnia,lack of thirst,liking hot drinks,slightly swollen limbs or whole body,pale fat tongue,greasy fur,and deep pulse. Mahuang Fuzi Xixin Decoction is a potential drug for Shaoyin disease complicated with fever and pain. Tracheal intubation is an artificial ephedrine syndrome. It is necessary to distinguish Yin and Yang syndrome in treating hyperpyrexia after tracheotomy. However,it belongs to Yin syndrome,which could be treated by Mahuang Fuzi Xixin Decoction. Mahuang Fuzi Xixin Decoction is effective in the treatment of sick sinus syndrome,second degree atrioventricular block and third degree atrioventricular block. It can significantly alleviate symptoms,improve heart rate,and heart rhythm in a short period of time. However,after one year of drug withdrawal,the diseases may recur,indicating that Mahuang Fuzi Xixin Decoction may not improve the long-term prognosis of slow arrhythmia. Mahuang Fuzi Xixin Decoction is often used for fever or nosocomial infection in critical care medicine. In the treatment of critical care medicine complicated with high fever,Mahuang Fuzi Xixin Decoction is often taken continuously by stomach tube.


Asunto(s)
Infección Hospitalaria/tratamiento farmacológico , Neuropatías Diabéticas/complicaciones , Medicamentos Herbarios Chinos/farmacología , Fiebre/tratamiento farmacológico , Infarto del Miocardio/complicaciones , Dolor Postoperatorio/tratamiento farmacológico , Traqueotomía/efectos adversos , Cuidados Críticos , Diabetes Mellitus , Humanos , Medicina China Tradicional , Fitoterapia , Síndrome
2.
Zhongguo Zhong Yao Za Zhi ; 44(18): 3876-3882, 2019 Sep.
Artículo en Chino | MEDLINE | ID: mdl-31872718

RESUMEN

Chaige Jieji Decoction recorded in Six Books of Exogenous Febrile Disease could be used to treat exterior syndrome due to wind-cold and heat caused by stagnation. The indications of Chaige Jieji Decoction include acute exogenous febrile diseases,such as influenza,upper respiratory tract infection,nosocomial infection; symptoms and signs,such as headache,eye pain,orbital pain,dizziness; fever,cold and hot exchanges; dry mouth,thirst,cold drinks,bitter mouth,dry throat; dry nose,stuffy nose,runny nose; poor appetite,silent appetite; strong neck,stiff back; insomnia,difficulty in sleeping; cough and sputum; abdominal pain,limb twitching;slightly torrent pulse. Disease involving all three Yang channels is very common in acute exogenous febrile diseases; the pathogenesis of exogenous diseases is quite different between cases in South China and North China. Most of the exogenous diseases in North China involves all three Yang channels. Disease involving all three Yang channels is the core of the pathogenesis of Chaige Jieji Decoction syndrome,in which headache is the key indications. Chaige Jieji Decoction can not only treat exogenous diseases,but also treat nosocomial infections in critically ill patients during hospitalization. Although Chaige Jieji Decoction,Xiaochaihu-Maxing Shigan Decoction,and Xiaochaihu-Daqinglong Decoction could be used to treat disease involving all three Yang channels,there are differences in indicators among them.


Asunto(s)
Infección Hospitalaria/tratamiento farmacológico , Medicamentos Herbarios Chinos/farmacología , Fiebre/tratamiento farmacológico , China , Cuidados Críticos , Humanos , Medicina China Tradicional , Síndrome
3.
Zhongguo Zhong Yao Za Zhi ; 44(18): 3890-3894, 2019 Sep.
Artículo en Chino | MEDLINE | ID: mdl-31872720

RESUMEN

The theory of " treating same syndrome with different methods" has been widely used in traditional Chinese medicine( TCM). It originated from Treatise on Febrile and Miscellaneous Diseases,and had objective formation factors. The " syndrome" in TCM was a comprehensive manifestation of etiology,characteristics,disease location and trend of disease. Considering the rich connotation of " syndrome",the diverse treatment methods,and the complex ingredients in prescriptions,different specific methods or prescriptions have been often applied to treat the same syndrome. Therefore,based on the theory of " treating same syndrome with different methods",the concept of " prescriptions corresponding to syndromes" was extended,suggesting one syndrome treated with several different prescriptions. Moreover,the concept of " prescription corresponding to syndrome" doesn't refer to a random match between the " syndrome" and the " prescription". Instead,it would refine and objectify the " same syndrome" and seek subtle differences in symptoms,signs and chemical indicators of different diseases and individuals. It further embodied the new diagnosis and treatment model of " pathogenesis combined with pathology,drug properties combined with pharmacology". As a result,the nature of " treating same syndrome with different methods" lies in different microscopic pathological changes or trends,which traditionally expressed as the same syndrome with different symptoms,the same syndrome with different trends,and the same syndrome with different diseases and the same syndrome with different physiques. Therefore,by enriching the connotation of " syndrome",and further defining its objective pathology and development trend,the correspondence between " syndrome" and " prescription" became more precise. By carefully identifying the different characterizations,trends and prognosis in same syndrome,medical practitioners could give individual and dynamic prescriptions,so as to improve the clinical efficacy.


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Fiebre/tratamiento farmacológico , Medicina China Tradicional , Humanos , Prescripciones , Síndrome
4.
An. pediatr. (2003. Ed. impr.) ; 91(6): 386-393, dic. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-186786

RESUMEN

Introducción: No existen datos actuales de prevalencia de infección de orina (ITU) en niños menores de 2 años con fiebre elevada en nuestro medio. Se realizó este estudio para evaluar la prevalencia puntual de ITU en niños menores de 2 años con fiebre elevada en urgencias. Método: Estudio prospectivo, multicéntrico, observacional incluyendo niños con fiebre a los que se realizó análisis de orina para descartar ITU en un periodo de un año en siete servicios de urgencia pediátricos españoles. Se incluyeron niños menores de un año y niñas menores de 2 años con fiebre sin focalidad > 39°C y sin antibioterapia previa. El diagnóstico de ITU se basó en la presencia de leucocituria y urocultivo positivo. Resultados: Un total de 1675 pacientes fueron incluidos. Doscientos sesenta niños (15,5%, 95% IC 13,8-17,3) fueron diagnosticados de ITU. La prevalencia puntual de ITU fue 32,9% (95% IC 26,6-39,9) en lactantes febriles menores de 6 meses y 19,3% (95% IC 16,1-22,9) en lactantes febriles menores de 12 meses. La prevalencia puntual de ITU fue 13% (95% IC 10,8-15,6) en niños menores de 2 años con fiebre de menos de 24 horas de evolución versus 17,5% (95% IC 15,2-20,1) en aquellos con más horas de evolución de fiebre (p = 0,014). Conclusiones: La prevalencia puntual de ITU en niños con fiebre sin focalidad > 39°C en nuestro medio es superior a la referida previamente, especialmente en lactantes varones < 6 meses y lactantes mujeres <12 meses. Nuestros resultados sugieren que los pediatras deben buscar de forma estrecha ITU en niños menores de 2 años con fiebre sin causa > 39°C


Introduction: There is no current data on the prevalence of urinary tract infection (UTI) in infants and toddlers with high fever. We conducted this study to assess the point prevalence of UTI in children aged less than 2 years presenting with high fever to the emergency department. Method: We conducted a prospective, multicentre, observational study including febrile children aged less than 2 years in whom urinalysis was performed to rule out UTI over a 1-year period in seven paediatric emergency departments in Spain. Boys younger than 1 year and girls younger than 2 years of age were eligible for the study if they had a rectal temperature greater than 39°C, were not taking antibiotics, and there was no identifiable source of fever. The diagnosis of UTI was based on the presence of leukocyturia and positive urine culture results. Results: We included a total of 1675 patients. Two hundred sixty infants (15.5%; 95% CI, 13.8-17.3) received a diagnosis of UTI. The point prevalence of UTI was 32.9% (95% CI, 26.6-39.9) in febrile boys aged less than 6 months and 19.3% (95% CI, 16.1-22.9) in febrile girls aged less than 12 months. The point prevalence of UTI was 13% (95% CI, 10.8-15.6) in children with a duration of fever of less than 24hours, compared to 17.5% (95% CI, 15.2-20.1) in those with a longer duration of fever (p = 0.014). Conclusions: The point prevalence of UTI in infants and toddlers with fever without source greater than 39°C was higher in our study compared to previous studies of UTI prevalence, especially in male infants aged less than 6 months and female infants aged less than 12 months. Our findings suggest that clinicians need to carefully assess for UTI in infants with unexplained fever greater than 39°C


Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Infecciones Urinarias/epidemiología , Fiebre/etiología , Fiebre/tratamiento farmacológico , Servicios Médicos de Urgencia/estadística & datos numéricos , Estudios Prospectivos , Infecciones Urinarias/orina , Infecciones Urinarias/diagnóstico
5.
BMC Infect Dis ; 19(1): 952, 2019 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-31703612

RESUMEN

BACKGROUND: Osteomyelitis of the pubic symphysis is a rare cause of pelvic pain after delivery, mainly caused by Staphylococcus aureus and Pseudomonas aeruginosa. The clinical context is the same as the more common diastasis of the pubic bone, but the presence of intense local pain in association with fever should prompt further clinical work-up based on blood chemistry, microbiology and diagnostic imaging. We report the first case of methicillin-resistant Staphylococcus aureus osteomyelitis of the pubic symphysis occuring after the delivery. CASE PRESENTATION: A 39-year-old woman developed pain over the pubic bone 12 h after the delivery. After 72 h fever rose and laboratory examination showed elevation of C-reactive protein and procalcitonin levels. Pelvic x-rays and magnetic resonance showed pubic diastasis, joint effusion, tiny irregularities of articular surfaces and, severe bone edema. The patient was started on broad spectrum intravenous (IV) antibiotics (piperacillin-tazobactam) and then replaced to IV vancomycin and oral levofloxacin based on antibiogram result. She was then discharged with oral antibiotic therapy and fully recovered. CONCLUSIONS: Due to the rarity of this disease, we compared our experience with the other cases of osteomyelitis of pubic symphysis occurring in peri-postpartum reported in the literature. The course of osteomyelitis was favourable in all patients, and only in one case an additional orthopedic procedure for symphysis fixation was necessary. Knowledge of this rare condition is important to enable prompt diagnosis and treatment.


Asunto(s)
Parto Obstétrico , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Osteomielitis/microbiología , Sínfisis Pubiana/patología , Infecciones Estafilocócicas/microbiología , Adulto , Antibacterianos/uso terapéutico , Femenino , Fiebre/tratamiento farmacológico , Humanos , Levofloxacino/uso terapéutico , Imagen por Resonancia Magnética , Pruebas de Sensibilidad Microbiana , Osteomielitis/diagnóstico por imagen , Osteomielitis/tratamiento farmacológico , Periodo Posparto , Embarazo , Pseudomonas aeruginosa/aislamiento & purificación , Sínfisis Pubiana/diagnóstico por imagen , Enfermedades Raras/diagnóstico por imagen , Enfermedades Raras/tratamiento farmacológico , Enfermedades Raras/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Resultado del Tratamiento , Vancomicina/uso terapéutico
6.
BMC Infect Dis ; 19(1): 905, 2019 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-31660864

RESUMEN

BACKGROUND: Antibiotic resistance is rising at disturbing rates and contributes to the deaths of millions of people yearly. Antibiotic resistant infections disproportionately affect those with immunocompromising conditions, chronic colonization, and frequent antibiotic use such as transplant patients or those with cystic fibrosis. However, clinicians lack the diagnostic tools to confidently diagnose and treat infections, leading to widespread use of empiric broad spectrum antimicrobials, often for prolonged duration. CASE PRESENTATION: A 22 year-old Caucasian female with cystic fibrosis received a bilateral orthotopic lung transplantation 5 months prior to the index hospitalization. She underwent routine surveillance bronchoscopy and was admitted for post-procedure fever. A clear cause of infection was not identified by routine methods. Imaging and bronchoscopic lung biopsy did not identify an infectious agent or rejection. She was treated with a prolonged course of antimicrobials targeting known colonizing organisms from prior bronchoalveolar lavage cultures (Pseudomonas, Staphylococcus aureus, and Aspergillus). However, we identified Stenotrophomonas maltophilia in two independent whole blood samples using direct-pathogen sequencing, which was not identified by other methods. CONCLUSIONS: This case represents a common clinical conundrum: identification of infection in a high-risk, complex patient. Here, direct-pathogen sequencing identified a pathogen that would not otherwise have been identified by common techniques. Had results been clinically available, treatment could have been customized, avoiding a prolonged course of broad spectrum antimicrobials that would only exacerbate resistance. Direct-pathogen sequencing is poised to fill a diagnostic gap for pathogen identification, allowing early identification and customization of treatment in a culture-independent, pathogen-agnostic manner.


Asunto(s)
Broncoscopía/efectos adversos , Fiebre/etiología , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/etiología , Secuenciación de Nucleótidos de Alto Rendimiento , Análisis de Secuencia de ARN , Stenotrophomonas maltophilia/genética , Antibacterianos/uso terapéutico , Lavado Broncoalveolar , Toma de Decisiones Clínicas , Fibrosis Quística/cirugía , Farmacorresistencia Bacteriana , Femenino , Fiebre/tratamiento farmacológico , Humanos , Trasplante de Pulmón , Pseudomonas/aislamiento & purificación , Staphylococcus aureus/aislamiento & purificación , Resultado del Tratamiento , Adulto Joven
7.
Lakartidningen ; 1162019 Oct 29.
Artículo en Sueco | MEDLINE | ID: mdl-31661147

RESUMEN

Periodic Fever, Aphthous Stomatitis, Pharyngitis and Cervical Adenitis (PFAPA) syndrome is the most common autoinflammatory disorder among children in many parts of the world and an important differential diagnosis in children presenting with recurrent fever episodes. Commonly, PFAPA has an onset under the age of 5 years. Fever episodes in PFAPA usually last 3-6 days and are associated with one or more of the cardinal symptoms aphthous stomatitis, pharyngitis and cervical adenitis. The fever episodes typically recur with an interval of 3-6 weeks, often with a striking regularity. During the episodes, the patient has elevated inflammatory variables such as CRP and serum amyloid A (SAA) and may sometimes have additional symptoms such as abdominal pain, nausea and leg pain. Between the fever episodes, the patient is typically free of symptoms with normalized inflammatory variables and grows normally. Awareness and recognition of PFAPA is key to providing the patient with adequate treatment and avoiding misdiagnosis.


Asunto(s)
Enfermedades Autoinflamatorias Hereditarias/diagnóstico , Biomarcadores/sangre , Preescolar , Diagnóstico Diferencial , Femenino , Fiebre/diagnóstico , Fiebre/tratamiento farmacológico , Fiebre/etiología , Enfermedades Autoinflamatorias Hereditarias/clasificación , Enfermedades Autoinflamatorias Hereditarias/complicaciones , Enfermedades Autoinflamatorias Hereditarias/tratamiento farmacológico , Humanos , Inflamación/sangre , Linfadenitis/diagnóstico , Linfadenitis/tratamiento farmacológico , Linfadenitis/etiología , Masculino , Faringitis/diagnóstico , Faringitis/tratamiento farmacológico , Faringitis/etiología , Estomatitis Aftosa/diagnóstico , Estomatitis Aftosa/tratamiento farmacológico , Estomatitis Aftosa/etiología , Síndrome
8.
Ned Tijdschr Geneeskd ; 1632019 10 10.
Artículo en Holandés | MEDLINE | ID: mdl-31609560

RESUMEN

BACKGROUND Tick-borne relapsing fever is a disease that is caused by infection with a Borrelia bacterium, and is transmitted by ticks. This infectious disease is characterised by relapsing episodes of high fever, often accompanied by aspecific symptoms. CASE DESCRIPTION We describe the history of a 20-year-old woman who developed recurrent episodes of fever with headache and vomiting after a holiday in Morocco. Additional examination showed pleiocytosis in the cerebrospinal fluid, which was initially suggestive of viral meningitis. However, Borrelia spp. were isolated from a 16S-rRNA-PCR-test which led to the diagnosis 'tick-borne relapsing fever'. The patient was treated with intravenous ceftriaxone for two weeks, after which time her symptoms gradually improved. CONCLUSION Prompt antibiotic treatment of tick-borne relapsing fever can prevent a serious course of the disease. For this reason, in patients with recurrent episodes of fever, it is important to consider this diagnosis if they have recently made a trip to Africa, America or the Middle East.


Asunto(s)
Borrelia/aislamiento & purificación , Meningitis/microbiología , Fiebre Recurrente/microbiología , Animales , Antibacterianos/uso terapéutico , Femenino , Fiebre/tratamiento farmacológico , Humanos , Medio Oriente , Marruecos , Garrapatas/microbiología , Adulto Joven
9.
Medicine (Baltimore) ; 98(43): e17720, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31651906

RESUMEN

The study aimed to determine the pattern of fever resolution among febrile patients undergoing treatment for acute pyelonephritis (APN) and prove that switching therapy based solely on persistent fever beyond 72 hours of antibiotics treatment may be unwarranted.For the purpose of this study, non-responders were defined as those patients who had a persistent fever over 72 hours after the initiation of antibiotic therapy. Responders were defined as those patients who became afebrile in less than 72 hours after the initiation of antibiotic therapy. Clinical cure was defined as the complete resolution of all symptoms during antibiotic therapy without recurrence during the follow-up period.A total of 843 female patients with uncomplicated community-acquired APN met all inclusion criteria. The non-responder group comprised of 248 patients (29%), and the remaining patients constituted the responder group. The median initial C-reactive protein level was higher (15.6 mg/dl vs 12.6 md/dl, P < .001) and bacteremia was more frequent (31% vs 40%, P = .001) in the non-responder group. Escherichia coli (E. coli) was the most common pathogen in both groups; there was no significant difference between the groups in the etiology of APN. Antimicrobial resistance and extended spectrum ß-lactamase producing strains had an increasing trend in the non-responder group but there was no significant difference between the groups.This study shows that it is difficult to identify patients at risk of uncomplicated community-acquired APN by antibiotic-resistant pathogens based exclusively on persistent fever. Patients with a prolonged fever for more than 72 hours show similar antibiotic susceptibility patterns and are not associated with adverse treatment outcomes. Therefore, switching of current antibiotics to broad-spectrum antibiotics should be reserved in this patient population until antibiotic susceptibility test results are available.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Fiebre/tratamiento farmacológico , Pielonefritis/tratamiento farmacológico , Adulto , Anciano , Farmacorresistencia Bacteriana/efectos de los fármacos , Femenino , Humanos , Persona de Mediana Edad , República de Corea , Estudios Retrospectivos , Resultado del Tratamiento
10.
BMC Health Serv Res ; 19(1): 735, 2019 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-31640676

RESUMEN

BACKGROUND: Reducing the burden of malaria highly depends on access to prompt and effective malaria diagnosis and treatment. The aim of this study was to identify challenges affecting prompt access to effective uncomplicated malaria case management in children below 10 years old in rural primary health care facilities in Malawi. METHODS: A cross sectional health facility survey was conducted in six primary health facilities in Chikhwawa district, Malawi. Officers-in-charge of health facilities were interviewed on availability of staff, supplies and drugs. All consecutive children presenting at the facility with fever or suspected malaria, aged 6 months to 10 years old, were eligible to participate in exit interviews. Exit interviews with participants' guardians assessed duration of illness, demographic information and distance travelled. Adherence to recommended malaria case management guidelines included performing malaria rapid diagnostic tests (mRDTs) in children with fever or suspected malaria and prescribing recommended weight-based dose of artemether-lumefantrine (AL) when mRDT was positive. Multivariate logistic regression was used to determine factors associated with prompt care seeking within 24 h of onset of illness. RESULTS: Health facilities were staffed by at least two health workers. Of 265 children screened, nine were excluded due to severe illness. Twenty-one percent of children presenting at a health facility with fever were not tested for malaria. Adherence to positive and negative mRDT results for those tested was 99.4, 95% CI [98.1-100] and 97, 95% CI [88.9-100], respectively. AL was prescribed as recommended by weight in 152 children (92.2%). Temporary stock outs of AL occurred in five of six facilities. In total, 146 (57, 95% CI [52.7-64.1]) guardians of patients sought care within 24 h after fever onset. Children aged 5 to 10 years were less likely to present within 24 h of fever onset than children below 5 years of age (unadjusted odds ratio 0.40, 95% CI [0.2-0.7]). CONCLUSION: Adherence to malaria diagnosis and treatment guidelines was high. However, delayed care seeking and stock outs may affect prompt and effective malaria case management. Further qualitative work is required to determine, and address factors associated with delay in care seeking for fever.


Asunto(s)
Fiebre/diagnóstico , Malaria/diagnóstico , Aceptación de la Atención de Salud/estadística & datos numéricos , Antimaláricos/uso terapéutico , Manejo de Caso , Niño , Preescolar , Estudios Transversales , Femenino , Fiebre/tratamiento farmacológico , Humanos , Lactante , Malaria/tratamiento farmacológico , Malaui , Masculino , Población Rural , Factores de Tiempo
11.
Cochrane Database Syst Rev ; 9: CD006110, 2019 09 18.
Artículo en Inglés | MEDLINE | ID: mdl-31531967

RESUMEN

BACKGROUND: The clinical presentation of acute chest syndrome is similar whether due to infectious or non-infectious causes, thus antibiotics are usually prescribed to treat all episodes. Many different pathogens, including bacteria, have been implicated as causative agents of acute chest syndrome. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country. Thus, there is a need to identify the efficacy and safety of different antibiotic treatment approaches for people with sickle cell disease suffering from acute chest syndrome. This is an update of a Cochrane Review first published in 2007, and most recently updated in 2015. OBJECTIVES: To determine whether an empirical antibiotic treatment approach (used alone or in combination):1. is effective for acute chest syndrome compared to placebo or standard treatment;2. is safe for acute chest syndrome compared to placebo or standard treatment;Further objectives are to determine whether there are important variations in efficacy and safety:3. for different treatment regimens,4. by participant age, or geographical location of the clinical trials. SEARCH METHODS: We searched The Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched the LILACS database (1982 to 23 October 2017), African Index Medicus (1982 to 23 October 2017) and trial registries (23 October 2017).Date of most recent search of the Haemoglobinopathies Trials Register: 10 July 2019. SELECTION CRITERIA: We searched for published or unpublished randomised controlled trials. DATA COLLECTION AND ANALYSIS: Each author intended to independently extract data and assess trial quality by standard Cochrane methodologies, but no eligible randomised controlled trials were identified. MAIN RESULTS: For this update, we were unable to find any randomised controlled trials on antibiotic treatment approaches for acute chest syndrome in people with sickle cell disease. AUTHORS' CONCLUSIONS: This update was unable to identify randomised controlled trials on efficacy and safety of the antibiotic treatment approaches for people with sickle cell disease suffering from acute chest syndrome. While randomised controlled trials are needed to establish the optimum antibiotic treatment for this condition, we do not envisage further trials of this intervention will be conducted, and hence the review will no longer be regularly updated.


Asunto(s)
Síndrome Torácico Agudo/tratamiento farmacológico , Antibacterianos/uso terapéutico , Síndrome Torácico Agudo/microbiología , Tos/tratamiento farmacológico , Fiebre/tratamiento farmacológico , Humanos , Hipoxia/tratamiento farmacológico , Esputo/metabolismo
12.
Malar J ; 18(1): 331, 2019 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-31558149

RESUMEN

BACKGROUND: Febrile children seen in malaria hypo-endemic settings, such as the Greater Accra region (GAR) of Ghana are more likely to be suffering from a non-malarial febrile illness compared to those seen in hyper-endemic settings. The need for prescribers to rely on malaria test results to guide treatment practices in the GAR is even greater. This study was designed to investigate the factors associated with inappropriate artemisinin-based combination therapy (ACT) prescription. METHODS: A survey was conducted in six health facilities in the region in 2015. Treatment practices for febrile outpatient department (OPD) patients were obtained from their records. Prescribers were interviewed and availability of malaria commodities were assessed. The primary outcome was the proportion of patients prescribed ACT inappropriately. Independent variables included patient age and access to care, prescriber factors (professional category, work experience, access to guidelines, exposure to training). Data were analysed using Stata at 95% CI (α-value of 0.05). Frequencies and means were used to describe the characteristics of patients and prescribers. To identify the predictors of inappropriate ACT prescription, regression analyses were performed accounting for clustering. RESULTS: Overall, 2519 febrile OPD records were analysed; 45.6% (n = 1149) were younger than 5 years. Only 40.0% of patients were tested. The proportion of patients who were prescribed ACT inappropriately was 76.4% (n = 791 of 1036). Of these 791 patients, 141 (17.8%) were prescribed anti-malarial injections. Patients seen in facilities with rapid diagnostic tests (RDT) in stock were less likely to be prescribed ACT inappropriately, (AOR: 0.04, 95% CI 0.01-0.14, p < 0.001) compared to those seen in facilities with RDT stock-outs. Prescribers who had been trained on malaria case management within the past year were 4 times more likely to prescribe ACT inappropriately compared to those who had not been trained (AOR: 4.1; 95% CI (1.5-11.6); p < 0.01). Patients seen by prescribers who had been supervised were 8 times more likely to be  prescribed ACT inappropriately. CONCLUSION: Inappropriate ACT prescription to OPD febrile cases was high. Training and supervision of health workers appears not to be yielding the desired outcomes. Further research is needed to understand this observation.


Asunto(s)
Antimaláricos/uso terapéutico , Artemisininas/uso terapéutico , Fiebre/tratamiento farmacológico , Fiebre/parasitología , Prescripción Inadecuada/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios Transversales , Femenino , Fiebre/epidemiología , Ghana/epidemiología , Personal de Salud , Humanos , Lactante , Inyecciones , Malaria/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Encuestas y Cuestionarios , Adulto Joven
13.
Artículo en Inglés | MEDLINE | ID: mdl-31491922

RESUMEN

Background: Kawasaki disease (KD) is a childhood acute febrile vasculitis of unknown aetiology. The diagnosis is based on clinical criteria, including unilateral cervical lymphadenopathy, which is the only presenting symptom associated with fever in 12% of cases. A prompt differential diagnosis distinguishing KD from infective lymphadenitis is therefore necessary to avoid incorrect and delayed diagnosis and the risk of cardiovascular sequelae. Case presentation: We describe the case of a 4 years old boy presenting with febrile right cervical lymphadenopathy, in which the unresponsiveness to broad-spectrum antibiotics, the following onset of other characteristic clinical features and the evidence on the magnetic resonance imaging (MRI) of retropharyngeal inflammation led to the diagnosis of incomplete and atypical KD. On day 8 of hospitalisation (i.e., 13 days after the onset of symptoms), one dose of intravenous immunoglobulins (IVIG; 2 g/kg) was administered with rapid defervescence, and acetylsalicylic acid (4 mg/kg/day) was started and continued at home for a total of 8 weeks. Laboratory examinations revealed a reduction in the white blood cell count and the levels of inflammatory markers, thrombocytosis, and persistently negative echocardiography. Clinically, we observed a gradual reduction of the right-side neck swelling. Fifteen days after discharge, the MRI of the neck showed a regression of the laterocervical lymphadenopathy and a resolution of the infiltration of the parapharyngeal and retropharyngeal spaces. Conclusion: Head and neck manifestations can be early presentations of KD, which is frequently misdiagnosed as suppurative lymphadenitis or retropharyngeal infection. A growing awareness of the several possible presentations of KD is therefore necessary. Computed tomography (CT) or MRI can be utilised to facilitate the diagnosis.


Asunto(s)
Síndrome Mucocutáneo Linfonodular/patología , Faringe/patología , Aspirina/uso terapéutico , Biomarcadores , Preescolar , Diagnóstico Diferencial , Edema , Fiebre/tratamiento farmacológico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Inflamación/complicaciones , Masculino , Síndrome Mucocutáneo Linfonodular/diagnóstico , Síndrome Mucocutáneo Linfonodular/tratamiento farmacológico
14.
Indian J Med Res ; 149(6): 790-794, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31496533

RESUMEN

Scrub typhus is largely ignored in India particularly during outbreaks of viral fever. The disease course is often complicated leading to fatalities in the absence of treatment. However, if diagnosed early and a specific treatment is initiated, the cure rate is high. We report here five cases of scrub typhus to highlight the fact that high clinical suspicion for such a deadly disease is an absolute necessity.


Asunto(s)
Fiebre/microbiología , Orientia tsutsugamushi/patogenicidad , Tifus por Ácaros/mortalidad , Adolescente , Adulto , Brotes de Enfermedades , Femenino , Fiebre/tratamiento farmacológico , Fiebre/mortalidad , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Tifus por Ácaros/tratamiento farmacológico , Tifus por Ácaros/microbiología
15.
Int J Equity Health ; 18(1): 131, 2019 08 22.
Artículo en Inglés | MEDLINE | ID: mdl-31438952

RESUMEN

BACKGROUND: The presence of insufficient effort responding participants (IERPs) in a survey can produce systematic bias. Validation questions are commonly used to exclude IERPs. Participants were defined as IERPs if responding inconsistently to two matched validation questions, and non-insufficient effort responding participants (non-IERPs) if responding consistently. However, it has not been tested whether validation questions themselves could result in selection bias. METHODS: This study was a cross-sectional survey conducted in Guangxi, China. Participants' intentions to use antibiotics for their children when they have self-limiting diseases, including sore throat, cold, diarrhea, and fever, were measured. The Chi-square tests were used to compare the socio-economic status (SES) between non-IERPs and IERPs. Logistic regression was adopted to test the association between intentions to misuse antibiotics and groups (non-IERPs, IERPs with high SES, and IERPs with low SES). RESULTS: Data with 3264 non-IERPs and 1543 IERPs were collected. The results showed IERPs had a lower education level (χ2 = 6.100, p = 0.047) and a higher proportion of rural residence (χ2 = 4.750, p = 0.030) compared with non-IERPs. Rural IERPs reported significantly higher rates of intentions to misuse antibiotics when their children have a sore throat (OR = 1.32; 95% CI = 1.11,1.56; p < 0.01), cold (OR = 1.33; 95%CI = 1.13,1.58; p < 0.01), diarrhea (OR = 1.46; 95%CI = 1.20,1.77; p < 0.001), and fever (OR = 1.22; 95% CI = 1.04,1.43; p < 0.05) compared with non-IERPs. IERPs living in urban areas reported significantly lower rates of intentions to use antibiotics when their children have a sore throat (OR = 0.76; 95%CI = 0.62,0.93; p < 0.01) compared with non-IERPs. IERPs with lower levels of education reported significantly higher rates of intentions to use antibiotics when their children have a sore throat (OR = 1.19; 95%CI = 1.02,1.39; p < 0.05), cold (OR = 1.43; 95% CI = 1.23,1.66; p < 0.001), diarrhea (OR = 1.38; 95%CI = 1.15,1.64; p < 0.01), and fever (OR = 1.25; 95% CI = 1.09,1.44; p < 0.01) compared with non-IERPs. IERPs with higher education levels reported significantly lower rates of intentions to use antibiotics when their children have a sore throat (OR = 0.72; 95% CI = 0.56,0.94; p < 0.05), cold (OR = 0.66; 95% CI = 0.51,0.86; p < 0.01), and fever (OR = 0.74; 95% CI = 0.60,0.92; p < 0.01) compared with non-IERPs. IERPs with low-income reported significantly higher rates of intentions to use antibiotics when their children have a cold (OR = 1.36; 95% CI = 1.13,1.64; p < 0.01) and diarrhea (OR = 1.30; 95% CI = 1.05,1.62; p < 0.05) compared with non-IERPs. CONCLUSIONS: Using validation questions to exclude IERPs can result in selection bias in which participants with lower socio-economic standing and poor antibiotic use intentions were disproportionately excluded.


Asunto(s)
Antibacterianos/uso terapéutico , Encuestas Epidemiológicas/normas , Intención , Padres , Sesgo de Selección , Adolescente , Adulto , Niño , Preescolar , China , Resfriado Común/tratamiento farmacológico , Estudios Transversales , Diarrea/tratamiento farmacológico , Femenino , Fiebre/tratamiento farmacológico , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Faringitis/tratamiento farmacológico , Población Rural , Clase Social , Estudios de Validación como Asunto
16.
J Stroke Cerebrovasc Dis ; 28(11): 104313, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31405792

RESUMEN

BACKGROUND: Fever occurs in the majority of subarachnoid hemorrhage (SAH) patients. Nearly 50% of SAH patients have noninfectious fevers. Data are lacking describing the effects of fever burden in the SAH patient population. METHODS: This was a single-center, retrospective observational cohort study in patients more or equal to 18 years of age with a diagnosis of nontraumatic SAH admitted to an ICU between January 1, 2010 and September 1, 2015. Exclusion criteria were SAH secondary to trauma or admission for more than 48 hours. Temperature measurements, demographic data, and other pertinent information were collected from Day 0 to Day 13. Daily fever burden was calculated for each patient by calculating an area under the curve. RESULTS: A total of 194 subjects were included. The mean study period maximum temperature (Tmax) for all 194 patients was 40.8 ± 0.83°C. The mean overall fever burden for all 194 patients was 89.2 ± 99.59°C h more than 37°C. The overall fever burden peaked on day 5 and declined thereafter. Fever burden, Tmax, and length of stay in the hospital were all significantly associated with receipt of antibiotics. Only Tmax was associated with poor outcome. The 31 patients who had fever but no identified cause of infection received 1000 doses of antibiotics or 32.25 doses per patient. CONCLUSION: Fever is common in SAH patients and is associated with antibiotic use, infection, vasospasm, and poor outcome. Some SAH patients may receive antibiotics unnecessarily for noninfectious fever. Clinicians should consider using site-specific parameters related to infection rather than systemic symptoms such as fever to evaluate infection in SAH patients.


Asunto(s)
Antibacterianos/uso terapéutico , Regulación de la Temperatura Corporal/efectos de los fármacos , Fiebre/tratamiento farmacológico , Prescripción Inadecuada , Hemorragia Subaracnoidea/complicaciones , Programas de Optimización del Uso de los Antimicrobianos , Femenino , Fiebre/microbiología , Fiebre/fisiopatología , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
17.
Eur J Pharmacol ; 861: 172609, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31421091

RESUMEN

Paracetamol (acetaminophen), is a centrally-acting antipyretic analgesic drug, which can also lower body temperature. Despite a century of clinical use, its mechanism of pharmacological action has not been completely elucidated. Previously, we demonstrated significant attenuation in the paracetamol induced hypothermia in parallel with its inhibitory action on the synthesis of brain prostaglandin E2 (PGE2) in cyclooxygenase-1 (COX-1) knockout mice in comparison to wild-type mice. The above reported pharmacological actions by paracetamol were completely retained in COX-2 knockout mice. We thus concluded that the mechanism of hypothermic action of paracetamol is dependent on inhibition of a COX-1 gene-derived enzyme. In the current investigation, we provide further support for this notion by demonstrating that the paracetamol-induced hypothermia is not mediated through inhibition of COX-1 as neither the COX-1 selective inhibitor, SC560, nor the COX-1/COX-2 dual inhibitor, indomethacin, induced hypothermia at pharmacologically active doses in mice. In addition, using a COX-2-dependent and PGE2-mediated model of endotoxin-induced fever, paracetamol induced anti-pyretic and hypothermic actions in COX-1 wild-type mice. These effects were fully or partially attenuated in COX-1 knockout mice after prophylactic or therapeutic administration, respectively. Therapeutically-administered paracetamol also reduced hypothalamic PGE2 biosynthesis in febrile COX-1 wild-type mice, but not in febrile COX-1 knockout mice. In conclusion, we provide further evidence which suggests that the hypothermic and now anti-pyretic actions of paracetamol are mediated through inhibition of a COX-1 variant enzyme.


Asunto(s)
Acetaminofén/farmacología , Ciclooxigenasa 1/genética , Ciclooxigenasa 1/metabolismo , Fiebre/tratamiento farmacológico , Técnicas de Inactivación de Genes , Hipotermia Inducida , Mutación , Acetaminofén/uso terapéutico , Animales , Ciclooxigenasa 1/deficiencia , Ciclooxigenasa 2/metabolismo , Inhibidores de la Ciclooxigenasa/farmacología , Inhibidores de la Ciclooxigenasa/uso terapéutico , Dinoprostona/metabolismo , Fiebre/enzimología , Fiebre/genética , Fiebre/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL
18.
BMC Res Notes ; 12(1): 464, 2019 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-31362783

RESUMEN

OBJECTIVE: The aim of this study was to determine the predominant bacterial species causing bacteremia among febrile cancer patients, and their antibacterial resistance profiles at the Uganda Cancer Institute. RESULTS: We enrolled in-patients with a documented fever (≥ 37.5 °C). Bacteria from positive blood cultures were identified using standard methods biochemically. Antibacterial susceptibility testing was performed with the Kirby-Bauer disc diffusion method. From a total of 170 febrile episodes, positive blood cultures were obtained from 24 (14.1%). A positive culture was more likely to be obtained from a patient with neutropenia (P = 0.017). Of 22 (66.7%) Gram-negative bacteria isolated, half were E. coli (n = 11). Gram-negative compared to Gram-positive bacteria were most likely to be isolated from patients with a hematologic malignancy (P = 0.02) or patients with neutropenia (P = 0.006). Of the isolated Enterobacteriaceae 85% (n = 20) were resistant to three or more classes of antibiotic and 41% (n = 7) had extended spectrum beta-lactamases. Of the 11 Gram-positive bacteria isolated, the S. aureus isolate was methicillin resistant but susceptible to vancomycin. Multidrug resistant Gram-negative bacteria are the main cause of bacteremia in febrile cancer patients at the Uganda Cancer Institute. There is need for ongoing microbial surveillance, infection prevention and control, and antibiotic stewardship programs.


Asunto(s)
Bacteriemia/microbiología , Fiebre/microbiología , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Neoplasias/microbiología , Neutropenia/microbiología , Adulto , Antibacterianos/uso terapéutico , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Bacteriemia/patología , Cultivo de Sangre , Niño , Estudios Transversales , Farmacorresistencia Bacteriana Múltiple/genética , Femenino , Fiebre/complicaciones , Fiebre/tratamiento farmacológico , Fiebre/patología , Expresión Génica , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/enzimología , Bacterias Gramnegativas/genética , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/patología , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/enzimología , Bacterias Grampositivas/genética , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/patología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Neoplasias/patología , Neutropenia/complicaciones , Neutropenia/tratamiento farmacológico , Neutropenia/patología , Uganda , beta-Lactamasas/genética , beta-Lactamasas/metabolismo
19.
Int J Infect Dis ; 89: 84-86, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31465848

RESUMEN

BACKGROUND: The signs and symptoms of Lassa fever are initially indistinguishable from other febrile illnesses common in the tropics and complications of pregnancy. Surviving Lassa fever during pregnancy is rare. Only few cases have been documented. The antiviral drug of choice is ribavirin. CASE DESCRIPTION: A 25-year-old multigravida farmer with fever who was initially thought to have malaria in pregnancy at 29 weeks gestation. Further changes in her clinical state and laboratory tests led to a confirmation of Lassa fever. The Liver enzymes were markedly deranged and the packed cell volume was 27%. She commenced on ribavirin and subsequently was delivered of a live male neonate who was RT PCR negative for Lassa fever virus. Her clinical state improved, repeat RT PCR on day 15 was negative and she made full recovery. DISCUSSION: The case reported had similar clinical features of fever and abdominal pain and resulted in the initial diagnoses of Malaria in pregnancy. When she failed to respond to antimalarial and antibiotics treatments, a strong suspicion of viral hemorrhagic fever was made. At this time the patient was in advanced stage of the disease with bleeding from vagina and puncture sites. On the third day of admission she was delivered of a live male neonate who remained negative after 2 consecutive RT PCR tests for Lassa fever virus. Lassa fever carries a high risk of death to the fetus throughout pregnancy and to the mother in the third trimester. Mothers with Lassa fever improved rapidly after evacuation of the uterus by spontaneous abortion, or normal delivery. She was clinically stable following delivery. Her laboratory investigations were essentially normal. Throughout her management transmission based precautions were observed. None of the six close contacts developed symptoms after been followed up for 21 days. CONCLUSION: This report adds to the body of literature that individuals can survive Lassa fever during pregnancy with good maternal and fetal outcome.


Asunto(s)
Fiebre de Lassa/virología , Complicaciones del Embarazo/virología , Adulto , Antivirales/uso terapéutico , Femenino , Fiebre/diagnóstico , Fiebre/tratamiento farmacológico , Fiebre/fisiopatología , Fiebre/virología , Humanos , Recién Nacido , Fiebre de Lassa/diagnóstico , Fiebre de Lassa/tratamiento farmacológico , Fiebre de Lassa/fisiopatología , Virus Lassa/efectos de los fármacos , Virus Lassa/genética , Virus Lassa/aislamiento & purificación , Masculino , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/tratamiento farmacológico , Complicaciones del Embarazo/fisiopatología , Resultado del Embarazo , Ribavirina/uso terapéutico
20.
J Therm Biol ; 83: 69-79, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31331527

RESUMEN

Endotoxin tolerance is defined as a reduced endotoxin-induced fever following repeated injections of lipopolysaccharide (LPS). Clinical examples of endotoxin tolerance include sepsis or cystic fibrosis. This state is characterized by inhibition of pro-inflammatory cytokines production and decrease in nuclear factor-kappa B (NF-κB) activation. Extract from Coriolus versicolor (CV) fungus is classified as a biological response modifier, which exhibits various biological activities, including immunopotentiating properties. The aim of study was to examine the effect of CV extract injection on body core temperature of Wistar rats during LPS-induced endotoxin tolerance. Body temperature was measured using biotelemetry. CV extract was injected intraperitoneally (100 mg kg-1) 2 h prior to the first LPS peritoneal administration (50 µg/kg). Endotoxin tolerance was induced by three consecutive daily injections of LPS at the same dose. We also investigated the influence of CV extract pre-injection on the properties of peripheral blood mononuclear cells (PBMCs) isolated from LPS-treated rats in response to LPS stimulation ex vivo. PBMCs were isolated 2 h after the first LPS injection. After 24 h pre-incubation, the cells were stimulated with LPS (1 µg ml-1) for 4 h. Our results revealed that CV extract partially prevents endotoxin tolerance through maintaining febrile response in rats following consecutive exposure to LPS. This state was accompanied by the ability of PBMCs isolated from rats injected with CV extract and LPS to release larger amounts of interleukin 6 and greater NF-κB activation in response to LPS stimulation ex vivo compared with the cells derived from rats injected only with LPS. Data also showed that CV extract augmented mitogenic effect of LPS on PBMCs and caused increase in reactive oxygen species generation. We concluded that CV extract, by a modifying effect on body temperature during endotoxin tolerance, can be consider as the immunostimulating agent, which prevents the non-specific refractoriness described in patients with sepsis or ischemia.


Asunto(s)
Antipiréticos/uso terapéutico , Productos Biológicos/uso terapéutico , Temperatura Corporal/efectos de los fármacos , Fiebre/tratamiento farmacológico , Interleucina-6/metabolismo , Trametes/química , Animales , Antipiréticos/administración & dosificación , Antipiréticos/farmacología , Productos Biológicos/administración & dosificación , Productos Biológicos/farmacología , Células Cultivadas , Fiebre/etiología , Lipopolisacáridos/toxicidad , Masculino , Monocitos/efectos de los fármacos , FN-kappa B/metabolismo , Ratas , Ratas Wistar
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