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1.
Acta Otolaryngol ; 142(2): 182-186, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35073502

RESUMO

BACKGROUND: Peritonsillitis (PT) is defined as cellulitis in peritonsillar tissue without pus. The pathogenesis of peritonsillar infections is controversial. OBJECTIVE: To explore whether minor salivary glands are involved in the development of PT and to identify clinical findings that predict the evolution of PT to peritonsillar abscess (PTA). MATERIAL AND METHODS: We included 146 adult patients treated for acute tonsillitis (AT; n = 54), PT (n = 34), or PTA (n = 58) at the Helsinki University Hospital. The treating physician recorded tonsillar, oropharyngeal, and dental findings. We analysed serum C-reactive protein (S-CRP) and amylase (S-Amyl). For PTA, pus samples were analysed; for AT and PT, throat cultures were collected. Patients with PT or PTA (PT/PTA; n = 92) were classified into groups with or without tonsillar exudate or hyperaemia (tonsillar findings). RESULTS: The PT group without tonsillar findings had lower S-CRP than the PT group with tonsillar findings (p=.0275). The PT/PTA group without tonsillar findings had higher S-Amyl than the PT/PTA group with tonsillar findings (p=.0278). Three out of 34 (8.8%) patients with PT returned to the emergency department; 1 (2.9%) developed PTA. CONCLUSIONS: Elevated S-Amyl in the PT/PTA group without tonsillar findings suggests that minor salivary glands are sometimes involved in the development of peritonsillar infections.


Assuntos
Abscesso Peritonsilar , Sialadenite , Adulto , Proteína C-Reativa , Humanos , Tonsila Palatina/patologia , Abscesso Peritonsilar/terapia , Glândulas Salivares Menores/patologia
2.
Arch Dis Child ; 107(3): e3, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34244164

RESUMO

OBJECTIVE: Features of multisystem inflammatory syndrome in children (MIS-C) overlap with other febrile illnesses, hindering prompt and accurate diagnosis. The objectives of this study were to identify clinical and laboratory findings that distinguished MIS-C from febrile illnesses in which MIS-C was considered but ultimately excluded, and to examine the diseases that most often mimicked MIS-C in a tertiary medical centre. STUDY DESIGN: We identified all children hospitalised with fever who were evaluated for MIS-C at our centre and compared clinical signs and symptoms, SARS-CoV-2 status and laboratory studies between those with and without MIS-C. Multivariable logistic LASSO (least absolute shrinkage and selection operator) regression was used to identify the most discriminative presenting features of MIS-C. RESULTS: We identified 50 confirmed MIS-C cases (MIS-C+) and 68 children evaluated for, but ultimately not diagnosed with, MIS-C (MIS-C-). In univariable analysis, conjunctivitis, abdominal pain, fatigue, hypoxaemia, tachypnoea and hypotension at presentation were significantly more common among MIS-C+ patients. MIS-C+ and MIS-C- patients had similar elevations in C-reactive protein (CRP), but were differentiated by thrombocytopenia, lymphopenia, and elevated ferritin, neutrophil/lymphocyte ratio, BNP and troponin. In multivariable analysis, predictors of MIS-C included age, neutrophil/lymphocyte ratio, platelets, conjunctivitis, oral mucosa changes, abdominal pain and hypotension. CONCLUSIONS: Among hospitalised children undergoing evaluation for MIS-C, children with MIS-C were older, more likely to present with conjunctivitis, oral mucosa changes, abdominal pain and hypotension, and had higher neutrophil/lymphocyte ratios and lower platelet counts. These data may be helpful for discrimination of MIS-C from other febrile illnesses, including bacterial lymphadenitis and acute viral infection, with overlapping features.


Assuntos
COVID-19/complicações , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Dor Abdominal/etiologia , Adolescente , Idade de Início , Infecções Bacterianas/diagnóstico , Proteína C-Reativa/metabolismo , COVID-19/sangue , COVID-19/diagnóstico , COVID-19/patologia , Criança , Pré-Escolar , Conjuntivite/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Hipotensão/etiologia , Contagem de Leucócitos , Linfadenite/diagnóstico , Contagem de Linfócitos , Masculino , Mucosa Bucal/patologia , Neutrófilos , Contagem de Plaquetas , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/patologia , Infecções Urinárias/diagnóstico , Viroses/diagnóstico
3.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431479

RESUMO

Here we present the case of a 37-year-old previously healthy man who developed fever, headache and a unilateral, painful neck swelling while working offshore. He had no known contact with anyone with COVID-19; however, due to the ongoing pandemic, a nasopharyngeal swab was performed, which was positive for the virus. After transfer to hospital for assessment his condition rapidly deteriorated, requiring admission to intensive care for COVID-19 myocarditis. One week after discharge he re-presented with unilateral facial nerve palsy. Our case highlights an atypical presentation of COVID-19 and the multifaceted clinical course of this still poorly understood disease.


Assuntos
Alcalose Respiratória/sangue , Paralisia de Bell/fisiopatologia , COVID-19/fisiopatologia , Miocardite/fisiopatologia , Adulto , Alcalose Respiratória/etiologia , Gasometria , Proteína C-Reativa/metabolismo , COVID-19/sangue , COVID-19/terapia , Ecocardiografia , Edema/etiologia , Eletrocardiografia , Humanos , Hipotensão/etiologia , Hipotensão/fisiopatologia , Linfadenite/etiologia , Linfadenite/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Miocardite/sangue , Miocardite/diagnóstico por imagem , Miocardite/terapia , Peptídeo Natriurético Encefálico/sangue , Pescoço , Oxigenoterapia , Fragmentos de Peptídeos/sangue , Pró-Calcitonina/sangue , Recuperação de Função Fisiológica , SARS-CoV-2 , Troponina T/sangue , Vasoconstritores/uso terapêutico
4.
J Pediatr ; 225: 30-36.e2, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32450069

RESUMO

OBJECTIVES: To distinguish early-stage lymph node first presentation of Kawasaki disease from acute cervical lymphadenitis, we developed an algorithm using sequential laboratory marker levels and radiologic findings. STUDY DESIGN: Data were obtained from pediatric inpatients initially presenting with fever and cervical lymphadenopathy. Discriminative factors for the differential diagnosis of acute cervical lymphadenitis and lymph node first presentation of Kawasaki disease were identified from intergroup comparison or univariate logistic regression analysis. A model for differentiating between lymph node first presentation of Kawasaki disease and acute cervical lymphadenitis was constructed using decision-tree analysis. RESULTS: Patients were divided into 2 cohorts: training (206 patients) and validation (103 patients) cohorts. A decision-tree model developed from the data of the training cohort included 3 determinants: neck computed tomography- or ultrasonography-defined abscess, percentage change in C-reactive protein level, and percentage change in neutrophil count. The prediction power of our decision-tree model for the validation cohort was superior to that of previously known laboratory markers (sensitivity of 89.5%, specificity of 88.9%, positive predictive value of 95.8%, negative predictive value of 75.0%, overall accuracy of 89.3%, and a Youden index of 0.784). CONCLUSIONS: A decision-tree model could differentiate lymph node first presentation of Kawasaki disease from acute cervical lymphadenitis with an increased accuracy. External validation based on multicenter data is needed before clinical application.


Assuntos
Árvores de Decisões , Diagnóstico Diferencial , Linfadenite/diagnóstico , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Algoritmos , Antibacterianos/uso terapêutico , Proteína C-Reativa/metabolismo , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Hospitalização , Humanos , Linfonodos/diagnóstico por imagem , Masculino , Neutrófilos/metabolismo , Valor Preditivo dos Testes , Análise de Regressão , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resultado do Tratamento
5.
Eur Radiol ; 30(8): 4475-4485, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32189052

RESUMO

OBJECTIVES: To establish a diagnostic tree analysis (DTA) model based on ultrasonography (US) findings and clinical characteristics for differential diagnosis of common causes of cervical lymphadenopathy in children. METHODS: A total of 242 patients (131 boys, 111 girls; mean age, 11.2 ± 0.3 years; range, 1 month-18 years) with pathologically confirmed Kikuchi disease (n = 127), reactive hyperplasia (n = 64), lymphoma (n = 24), or suppurative lymphadenitis (n = 27) who underwent neck US were included. US images were retrospectively reviewed to assess lymph node (LN) characteristics, and clinical information was collected from patient records. DTA models were created using a classification and regression tree algorithm on the basis of US imaging and clinical findings. The patients were randomly divided into training (70%, 170/242) and validation (30%, 72/242) datasets to assess the diagnostic performance of the DTA models. RESULTS: In the DTA model based on all predictors, perinodal fat hyperechogenicity, LN echogenicity, and short diameter of the largest LN were significant predictors for differential diagnosis of cervical lymphadenopathy (overall accuracy, 85.3% and 83.3% in the training and validation datasets). In the model based on categorical parameters alone, perinodal fat hyperechogenicity, LN echogenicity, and loss of fatty hilum were significant predictors (overall accuracy, 84.7% and 86.1% in the training and validation datasets). CONCLUSIONS: Perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum were significant US findings in the DTA for differential diagnosis of cervical lymphadenopathy in children. KEY POINTS: • Diagnostic tree analysis model based on ultrasonography and clinical findings would be helpful in differential diagnosis of pediatric cervical lymphadenopathy. • Significant predictors were perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum.


Assuntos
Algoritmos , Diagnóstico Diferencial , Linfadenite Histiocítica Necrosante/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Pseudolinfoma/diagnóstico por imagem , Adolescente , Biópsia por Agulha Fina , Biópsia com Agulha de Grande Calibre , Criança , Pré-Escolar , Eritema/fisiopatologia , Feminino , Febre/fisiopatologia , Linfadenite Histiocítica Necrosante/patologia , Linfadenite Histiocítica Necrosante/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador , Lactente , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfadenite/diagnóstico por imagem , Linfadenite/patologia , Linfadenite/fisiopatologia , Linfadenopatia/patologia , Linfadenopatia/fisiopatologia , Linfoma/patologia , Linfoma/fisiopatologia , Masculino , Pescoço , Pseudolinfoma/patologia , Pseudolinfoma/fisiopatologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Ultrassonografia , Ultrassonografia Doppler em Cores
6.
Med. lab ; 24(2): 141-151, 2020.
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1097268

RESUMO

El síndrome PFAPA es la entidad más frecuente dentro de los síndromes de fiebres periódicas que pueden manifestarse desde la infancia. Es un síndrome autoinflamatorio caracterizado por una disfunción en las citoquinas, de carácter autolimitado y de etiología desconocida, aunque se han reportado casos de presentación familiar; lo que sugiere la existencia de una base genética de la enfermedad. Se presenta con episodios febriles que suelen acompañarse de aftas orales, adenopatías cervicales, faringoamigdalitis y síntomas constitucionales. En los exámenes de laboratorio es frecuente encontrar elevación marcada de la proteína C reactiva, leucocitosis y aumento de IgG, IgA e IgM. El diagnóstico se realiza utilizando los criterios modificados de Thomas, que incluyen parámetros clínicos, antecedentes y diagnósticos de exclusión. Se presenta el caso de un paciente de 4 años de edad que consultó a un hospital por un cuadro febril, movimientos tónico-clónicos generalizados, desviación de la mirada, sialorrea y relajación de esfínteres. También presentó cefalea de localización frontal y odinofagia. En la cavidad oral se observaron lesiones tipo aftas, y se evidenciaron adenopatías cervicales. El paciente no respondió al manejo con antibióticos, y se observó que cumplía con los criterios de diagnóstico para síndrome PFAPA, luego de descartarse un proceso infeccioso. Se inició terapia con corticoides con respuesta favorable y se concluyó que el paciente tenía un cuadro compatible con síndrome PFAPA.


PFAPA syndrome is the most frequent illness within the syndromes of periodic fevers manifesting during childhood. It is an auto-inflammatory syndrome characterized by cytokine dysfunction, a self-limiting nature, and unknown etiology; family cases have been reported, suggesting the existence of a genetic basis for the disease. PFAPA syndrome is manifested with febrile episodes that are usually accompanied by oral aphthae, cervical adenopathy, pharyngotonsillitis and constitutional symptoms. In laboratory tests, it is common to find marked elevation of C reactive protein, leukocytosis and increased IgG, IgA and IgM levels. Diagnosis is reached by means of the modified Thomas criteria that include clinical parameters, personal and family history, and exclusion diagnoses. The case of a 4-year-old patient who visited the hospital with fever, generalized tonic-clonic seizures and sphincter relaxation is presented. The patient reported frontal headache and odynophagia. Aphthous stomatitis was observed, and cervical adenopathies were evident. The patient did not respond to antibiotic therapy, and met the diagnostic criteria for PFAPA syndrome after an infectious process was ruled out. Corticosteroid therapy was initiated with a favorable response. It was concluded that the patient had a diagnosis compatible with PFAPA syndrome


Assuntos
Humanos , Animais , Estomatite Aftosa , Faringite , Linfadenopatia , Febre Aftosa , Linfadenite
7.
Reumatol. clín. (Barc.) ; 15(6): 355-359, nov.-dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-189653

RESUMO

INTRODUCCIÓN: El síndrome PFAPA es una enfermedad autoinflamatoria de diagnóstico clínico. Se han propuesto diversos tratamientos; entre ellos, la tonsilectomía podría ser un tratamiento efectivo. MATERIAL Y MÉTODOS: Estudio multicéntrico retrospectivo. Se incluyeron pacientes diagnosticados de síndrome PFAPA, según los criterios de Thomas, en 3 hospitales madrileños, entre 2009-2013. RESULTADOS: Se incluyeron 32 casos. Las medianas de edad de inicio del cuadro y al diagnóstico fueron 32 meses (RIQ 24-44) y 47,5 meses (RIQ 37-60), respectivamente. Se hallaron incrementos en las cifras de leucocitos (13.580/μl [RIQ 8.200-16.600] vs.8.300/μl [RIQ 7.130-9.650], p = 0,005), neutrófilos (9.340/μl [RIQ 5.900-11.620] vs.3.660/μl [RIQ 2.950-4.580], p = 0,002) y proteína C reactiva (11,0mg/dl [RIQ 6,6-12,7] vs.0,2mg/dl [RIQ 0,1-0,6], p = 0,003) durante los episodios febriles, respecto a los periodos libres de síntomas. El 80,8% refería remisión de los síntomas en 24h tras corticoterapia oral. Fueron tonsilectomizados 14 pacientes. En 11 cesaron los episodios febriles, mientras que en 3 se redujo su frecuencia; hubo 2 sangrados posquirúrgicos como complicación. El cuadro se había resuelto en el 56,3% de los pacientes, a una mediana de edad de 60 meses (RIQ 47-95), con una duración similar entre los pacientes que fueron tonsilectomizados y los que no. CONCLUSIONES: Se presenta una cohorte amplia de niños con síndrome de PFAPA en la que se confirma que, en nuestro medio, los niños con este síndrome presentan unas características clínicas y analíticas similares a las descritas en la literatura, con buena respuesta a corticoterapia y elevada resolución de la clínica tras la amigdalectomía


INTRODUCTION: PFAPA syndrome is an autoinflammatory disease whose diagnosis is mainly clinical. Several treatments have been proposed; among them, tonsillectomy could be an effective one. MATERIAL AND METHODS: Retrospective multicenter study. Patients included were diagnosed with PFAPA syndrome, according to the Thomas criteria, in 3 hospitals in Madrid between 2009-2013. RESULTS: Thirty-two cases were included. Median age at onset and at diagnosis were 32 months (IQR 24-44) and 47.5 months (IQR 37-60), respectively. There were increases in leukocytes (13,580/μL [IQR 8,200-16,600] vs.8,300/μL [IQR 7,130-9,650], P=.005), neutrophils (9,340/μL [IQR 5,900-11,620] vs.3,660/μL [IQR 2,950-4,580], P=.002) and C-reactive protein (11.0mg/dL [IQR 6.6-12.7] vs.0.2mg/dL [IQR 0.1-0.6], P=.003) during febrile episodes. In all, 80.8% of patients reported remission of symptoms within 24h after oral corticosteroid therapy. Fourteen patients were tonsillectomized. In 11, the febrile episodes stopped while, in 3, the frequency was reduced; there were 2 cases of postoperative bleeding. The disease was resolved in 56.3% of the patients, at a median age of 60 months (IQR 47-95), with similar duration in patients who were tonsillectomized and those who were not. CONCLUSIONS: We present a large cohort of children with PFAPA syndrome, with clinical and analytical features similar to those described in the literature, and a good response to corticosteroids and a high resolution rate of symptoms after tonsillectomy


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Febre/diagnóstico , Febre/epidemiologia , Linfadenite/diagnóstico , Linfadenite/epidemiologia , Faringite/diagnóstico , Faringite/epidemiologia , Estomatite Aftosa/diagnóstico , Estomatite Aftosa/epidemiologia , Estudos de Coortes , Progressão da Doença , Estudos Retrospectivos , Espanha/epidemiologia , Síndrome , Saúde da População Urbana
8.
Int J Pediatr Otorhinolaryngol ; 121: 55-57, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30870794

RESUMO

OBJECTIVE: The periodic fever, aphthous stomatitis, pharangytis and cervical adenitis (PFAPA) syndrome, is an idiopathic chronic disease of non-hereditary origin, primarily affecting pre-school children and is the most common periodic fever disorder in children. Rapid response to corticosteroid treatment suggest an immune dysregulation. Recently, emerging evidence suggest that vitamin D plays an important role in immunity regulation. The aim of our study was to assess the vitamin D levels in children with PFAPA syndrome. METHODS: This study was conducted prospectively. We have consecutively evaluated 50 patients after having excluded other causes of recurrent fever between May 2017 and May 2018 in addition to age-matched 50 patients as control group. All patients has complete physical examination and laboratory tests. Laboratory tests included complete blood count, C-reactive protein (CRP), and vitamin D levels. Serum 25 (OH) vitamin D levels were measured in all patients twice yearly. RESULTS: Vitamin D levels was 18 ±â€¯10 ng/ml in the patient group and 35 ±â€¯13 ng/ml in the control group. There was statistically significant difference between the groups (p < 0.001). 38 patients from the PFAPA group and 20 patients from the control group had low vitamin D levels. Multivariate logistic regression analysis showed that CRP (odd ratio (OR) = 2.7, 95% confidence interval (CI) = 2.4-4.1) and serum 25 (OH) vitamin D levels <30 ng/ml OR = 2.1, 95% CI = 1.8-2.5) were associated with PFAPA occurrence. CONCLUSION: We found strong correlation between PFAPA and vitamin D insufficiency. Hypovitaminosis D can be a significant risk factor for PFAPA episode recurrence.


Assuntos
Doenças Hereditárias Autoinflamatórias/sangue , Deficiência de Vitamina D/complicações , Vitamina D/sangue , Contagem de Células Sanguíneas , Proteína C-Reativa/análise , Criança , Pré-Escolar , Feminino , Doenças Hereditárias Autoinflamatórias/etiologia , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Síndrome , Deficiência de Vitamina D/sangue
9.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-786529

RESUMO

PURPOSE: Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is a leading cause of periodic fever in children. This study describes the clinical characteristics of PFAPA syndrome in patients from a single center.METHODS: Thirteen children diagnosed with PFAPA syndrome at Seoul National University Children's Hospital were included in this study. Retrospective medical chart reviews were performed.RESULTS: Among the 13 patients, 8 (61.5%) were male. The median follow-up duration was 3.3 years (range, 10 months–8.3 years). The median age of periodic fever onset was 3 years (range, 1–6 years). All patients had at least 5 episodes of periodic fever and pharyngitis, managed with oral antibiotics, before diagnosis. The median occurrence of fever was every 3.9 weeks and lasted for 4.2 days. All patients had pharyngitis and 12 (92.3%) had cervical lymphadenitis. Blood tests were performed for 12 patients, and no patients had neutropenia. Both the C-reactive protein and erythrocyte sedimentation rate were elevated at medians of 4.5 mg/dL (range, 0.4–13.2 mg/dL) and 29 mm/hr (range, 16–49 mm/hr), respectively. Throat swab cultures and rapid streptococcal antigen tests were negative. Nine (69.2%) patients received oral prednisolone at a median dose of 0.8 mg/kg, and in 6 (66.7%) patients, fever resolved within a few hours. Three (23.1%) patients received tonsillectomy and adenoidectomy.CONCLUSIONS: PFAPA syndrome should be considered when a child presents with periodic fever along with aphthous stomatitis, pharyngitis, or cervical lymphadenitis. Glucocorticoid administration is effective for fever resolution and can reduce unnecessary use of antibiotics.


Assuntos
Criança , Humanos , Masculino , Adenoidectomia , Antibacterianos , Sedimentação Sanguínea , Proteína C-Reativa , Diagnóstico , Febre , Seguimentos , Testes Hematológicos , Linfadenite , Neutropenia , Faringite , Faringe , Prednisolona , Estudos Retrospectivos , Seul , Estomatite Aftosa , Tonsilectomia , Iêmen
11.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-758428

RESUMO

PURPOSE: Kawasaki disease (KD) is an acute, self-limited, febrile disease. For cases of KD in which the first symptom is cervical lymphadenopathy (node-first presentations of KD, NFKD), it is frequently misdiagnosed as bacterial cervical lymphadenitis (BCL). Therefore, we evaluated the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) to differentiate between NFKD and BCL. METHODS: This is a retrospective, observational study. Patients were divided into three groups, KD as 1st diagnosis, NFKD, and BCL. The laboratory and demographic data, intravenous immunoglobulin (IVIG) administration time and total febrile duration, length of hospital stay, and number of coronary artery complications were then compared for each group. RESULTS: A total of 451 patients were diagnosed as KD and 45 patients as BCL. Of the 451 KD patients, 417 (92.5%) were KD as 1st diagnosis, and 34 (7.5%) were NFKD. White blood cell count, absolute neutrophil count, C-reactive protein, erythrocyte sedimentation rate, and NT-proBNP differed significantly between NFKD and BCL. Variables that differed significantly were analyzed using a receiver operating characteristic curve, which revealed that NT-proBNP had the largest area under curve (0.944). Additionally, IVIG administration time, total febrile duration and length of hospital stay differed between KD as 1st diagnosis and NFKD. CONCLUSION: It is difficult to differentiate NFKD from BCL, so proper treatment and length of hospital stay were delayed. NT-proBNP is very useful for differentiating NFKD and BCL. Therefore, in cases of BCL with a long febrile period without reacting general treatments, the NT-proBNP test can be considered.


Assuntos
Humanos , Área Sob a Curva , Sedimentação Sanguínea , Proteína C-Reativa , Vasos Coronários , Diagnóstico , Imunoglobulinas , Imunoglobulinas Intravenosas , Tempo de Internação , Contagem de Leucócitos , Linfadenite , Doenças Linfáticas , Síndrome de Linfonodos Mucocutâneos , Neutrófilos , Estudo Observacional , Estudos Retrospectivos , Curva ROC
12.
CCM ; 21(2)2017. tab, graf
Artigo em Espanhol | CUMED | ID: cum-75787

RESUMO

Introducción: la enfermedad de Kawasaki es una arteritis sistémica de origen desconocido y considerada emergente a nivel mundial. Actualmente no existe marcador biológico que permita realizar un diagnóstico seguro, este se fundamenta en una asociación de síntomas y signos agrupados según criterios clínicos.Objetivo: caracterizar clínicamente los pacientes diagnosticados en el Hospital Pediátrico Pedro Soto Alba de Moa.Método: estudio serie de casos, que incluyó los cinco pacientes con enfermedad de Kawasaki diagnosticados en Moa en el periodo comprendido entre enero 2007 diciembre 2012. Para obtener los datos se realizó una revisión exhaustiva de las historias clínicas confeccionadas durante el ingreso. Se emplearon estadígrafos descriptivos.Resultados: el 100 por ciento de los casos eran de sexo masculino y el 80 por ciento tenían tres años de edad. La fiebre de más de cinco días de evolución, el exantema, la adenitis y la inyección conjuntival se presentaron como criterios diagnósticos en todos los casos. La hemoglobina ≤100 g/L, la aceleración de la eritrosedimentación por encima de 90 mm/h y la proteína c reactiva positiva se observaron como alteraciones analíticas en el 100 por ciento de los pacientes.Conclusiones: en Moa se diagnostica aproximadamente un caso con enfermedad de Kawasaki por año, expresándose con mayor frecuencia a los tres años de vida y el sexo masculino. La mayoría de los criterios diagnósticos se manifestaron en todos los pacientes y demoraron más de cuatro días en desaparecer luego de iniciado el tratamiento. Solo un paciente presentó complicaciones cardiovasculares(AU)


Introduction: Kawasaki disease is a systematic arteritis of unknown origin, considered a worldwide emergent disease. There is not a biological indicator allowing a safe diagnosis, this is based in an association of grouped symptoms and signs according to clinical criteria.Objective: to characterize clinically the diagnosed patients at Pedro Sotto Alba Moa Paediatric Hospital of Moa.Method: a series of cases study which included the five patients with Kawasaki disease diagnosed in Moa, in the period from January 2007 to December 2012. There was a deep revision of the clinical histories checked during the admission. Descriptive statistic tables were used.Results: one hundred per cent of cases were males and 80 percent of them were three years old. Fever during more than five days of evolution, exanthema, adenitis and conjunctive injection were presented as diagnosis criteria in 100 percent cases. The haemoglobin ≤100 g/L, the acceleration of eritrosedimentation over 90 mm/h and the protein c reactive positive were observed as analytical alterations in 100 percent cases. Conclusions: there is at least one patient with Kawasaki disease in Moa per year, appearing at the age of three in the male sex. Most of the diagnosis criteria were manifested in all the patients, delaying more than four days in disappearing after the treatment beginning. Only one patient presented cardiovascular complications(AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Síndrome de Linfonodos Mucocutâneos/terapia
13.
CCH, Correo cient. Holguín ; 21(2): 345-356, abr.-jun. 2017. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-839568

RESUMO

Introducción: la enfermedad de Kawasaki es una arteritis sistémica de origen desconocido y considerada emergente a nivel mundial. Actualmente no existe marcador biológico que permita realizar un diagnóstico seguro, este se fundamenta en una asociación de síntomas y signos agrupados según criterios clínicos. Objetivo: caracterizar clínicamente los pacientes diagnosticados en el Hospital Pediátrico Pedro Soto Alba de Moa. Método: estudio serie de casos, que incluyó los cinco pacientes con enfermedad de Kawasaki diagnosticados en Moa en el periodo comprendido entre enero 2007 diciembre 2012. Para obtener los datos se realizó una revisión exhaustiva de las historias clínicas confeccionadas durante el ingreso. Se emplearon estadígrafos descriptivos. Resultados: el 100% de los casos eran de sexo masculino y el 80% tenían tres años de edad. La fiebre de más de cinco días de evolución, el exantema, la adenitis y la inyección conjuntival se presentaron como criterios diagnósticos en todos los casos. La hemoglobina ≤100 g/L, la aceleración de la eritrosedimentación por encima de 90 mm/h y la proteína c reactiva positiva se observaron como alteraciones analíticas en el 100% de los pacientes. Conclusiones: en Moa se diagnostica aproximadamente un caso con enfermedad de Kawasaki por año, expresándose con mayor frecuencia a los tres años de vida y el sexo masculino. La mayoría de los criterios diagnósticos se manifestaron en todos los pacientes y demoraron más de cuatro días en desaparecer luego de iniciado el tratamiento. Solo un paciente presentó complicaciones cardiovasculares.


Introduction: Kawasaki disease is a systematic arteritis of unknown origin, considered a worldwide emergent disease. There is not a biological indicator allowing a safe diagnosis, this is based in an association of grouped symptoms and signs according to clinical criteria. Objective: to characterize clinically the diagnosed patients at Pedro Sotto Alba Moa Paediatric Hospital of Moa. Method: a series of cases study which included the five patients with Kawasaki disease diagnosed in Moa, in the period from January 2007 to December 2012. There was a deep revision of the clinical histories checked during the admission. Descriptive statistic tables were used. Results: one hundred per cent of cases were males and 80% of them were three years old. Fever during more than five days of evolution, exanthema, adenitis and conjunctive injection were presented as diagnosis criteria in 100% cases. The haemoglobin ≤100 g/L, the acceleration of eritrosedimentation over 90 mm/h and the protein c reactive positive were observed as analytical alterations in 100% cases. Conclusions: there is at least one patient with Kawasaki disease in Moa per year, appearing at the age of three in the male sex. Most of the diagnosis criteria were manifested in all the patients, delaying more than four days in disappearing after the treatment beginning. Only one patient presented cardiovascular complications.

15.
Ann R Coll Surg Engl ; 99(3): 242-244, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27917669

RESUMO

OBJECTIVES Lymphoma often presents with a neck mass and while fine-needle aspiration cytology may be suggestive, tissue biopsy is required for reliable diagnosis and classification of a lymphoma that is sufficient to deliver the correct treatment for the patient. Traditionally, excisional biopsy of a lymph node has been the standard method of tissue sampling, providing ample tissue for assessment. However, this requires theatre time, and preceding fine-needle aspiration cytology, which may incur a delay. With careful use of tissue, coupled with advances in immunohistochemical and molecular investigative techniques, core biopsy provides a possible alternative to traditional fine-needle aspiration and excisional biopsy. In this study, we aimed to determine the efficacy of diagnosing neck masses. METHOD A retrospective analysis was performed of patients being investigated for a neck mass who were undergoing ultrasound-guided core biopsies of cervical lymph nodes over a 17-month period. The final histology report was scrutinised to assess whether adequate tissue was obtained to allow for full tissue diagnosis. RESULTS Over the 17-month period analysed, 70 patients with cervical lymphadenopathy underwent core biopsy. Of these, 63 (90%) were diagnostic for either lymphoma or other pathology and did not require further tissue sampling. Overall, 19 patients were diagnosed with lymphoma, of which only 1 required further biopsy due to inconclusive initial core biopsy. CONCLUSIONS Current guidelines for investigating lymphomas require that excisional biopsy be performed to obtain ample tissue to allow full nodal architecture assessment and ancillary investigation to reach an accurate histological classification. Within our head and neck multidisciplinary team, however, it is considered that results from core biopsies can be obtained in a more timely fashion and with histological accuracy equal to those of open biopsy. The results obtained demonstrate that core biopsy is an effective tool for investigation. We believe this should be the first-line investigation of choice, as it reduces the need for patients to undergo surgery, is more cost effective and offers a faster diagnosis.


Assuntos
Biópsia com Agulha de Grande Calibre , Carcinoma de Células Escamosas/patologia , Linfonodos/patologia , Linfadenite/patologia , Linfadenopatia/patologia , Linfoma/patologia , Pseudolinfoma/patologia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/secundário , Humanos , Biópsia Guiada por Imagem , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Linfadenite/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Metástase Linfática , Linfoma/diagnóstico por imagem , Pescoço , Pseudolinfoma/diagnóstico por imagem , Estudos Retrospectivos , Ultrassonografia
16.
Cir. pediátr ; 29(4): 135-141, oct. 2016. graf, tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-162208

RESUMO

Introducción. Los tumores de la región parotídea son raros en Pediatría, y suelen presentar múltiples diagnósticos diferenciales que requieren diferentes métodos diagnósticos y de tratamiento. Material y Métodos. Estudio de cohorte retrospectivo de todos los pacientes pediátricos consecutivos con tumores de la región parotídea en el periodo 2003-2016, que fueron atendidos en el Servicio de Cirugía Pediátrica del Hospital Italiano de Buenos Aires. Resultados. Se incluyeron 22 pacientes con tumores de la región parotídea. El 72% (n=16) fueron pacientes del sexo femenino. La mediana de edad fue de 10 años (rango: prenatal a 19 años). Estudios complementarios: Ecografía, TC y RMN. Confirmación diagnóstica: biopsia por punción o quirúrgica (14), biopsia de adenopatías (3), diagnóstico por imágenes (4), laboratorio (1). Tratamiento: resección quirúrgica (12), tratamiento médico (7), escleroterapia (2). Diagnósticos diferenciales: adenoma pleomorfo (4), hemangioma infantil (4), malformación vascular de bajo flujo (2), PNET (2), enfermedad de Castleman (1), schwannoma (1), neuroblastoma (1), rabdomiosarcoma alveolar (1), carcinoma mucoepidermoide (1), RICH (hemangioma congénito rápidamente involutivo) (1), enfermedad granulomatosa (1), adenitis reactiva (1), quiste parotídeo (1), LLA (leucemina linfoblástica aguda) (1). Seguimiento medio de 42,5 meses: libres de enfermedad (18), realizando tratamiento médico (3), óbito (1). Conclusiones. Nuestra serie demuestra la gran variedad diagnóstica que pueden presentar los tumores de la región parotídea en la población pediátrica y concuerda con la literatura donde se observa mayor incidencia de lesiones benignas. Sin embargo, es difícil predecir el riesgo de malignidad. Es importante realizar un diagnóstico exhaustivo, utilizando métodos complementarios de imágenes y biopsia ante la duda diagnóstica


Introduction. Parotid tumors are rare in children and usually have multiple differential diagnoses that require different diagnostic and treatment methods. Material and Methods. Retrospective cohort study of all consecutive pediatric patients with parotid tumors that were treated in Pediatric Surgery Service of Hospital Italiano de Buenos Aires. Results. Twenty-two patients with parotid tumors were included and 72% (n=16) were female patients. The median age was 10 years (range: prenatal to 19 years). Imaging studies: ultrasound, CT and MRI. Diagnostic methods: needle or open biopsy (14), biopsy of lymph nodes (3), imaging (4), blood test (1). Treatment: surgical resection (12), medical treatment (7), sclerotherapy (2). Diverse histological diagnosis were obtained: pleomorphic adenoma (4), infantile hemangioma (4), PNET (2), low flow vascular malformation (2), Castleman’s disease (1), schwannoma (1), neuroblastoma (1), alveolar rhabdomyosarcoma (1), mucoepidermoid carcinoma (1) RICH (Rapidly Involuting Congenital Hemangioma) (1), granulomatous disease (1), reactive adenitis (1), parotid cyst (1), ALL (Acute Lymphoblastic Leukemia) (1). Follow-up (42,5 months): 18 patients are free of disease, 3 are currently under medical treatment and 1 died. Conclusions. Our series shows the diversity that parotid tumor can present in pediatric population and is consistent with the literature there the incidence of benign lesions are predominant. However, it is difficult to predict risk of malignancy. An exhaustive diagnosis is important, using complementary methods and biopsy whenever that is necessary


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Neoplasias Parotídeas/epidemiologia , Adenoma Pleomorfo/epidemiologia , Diagnóstico Diferencial , Estudos Retrospectivos , Biópsia por Agulha
17.
Clin Dermatol ; 34(4): 482-6, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27343963

RESUMO

Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, the most common periodic disorder of childhood, presents with the cardinal symptoms of periodic fever, aphthous stomatitis, pharyngitis, and adenitis typically before age 5. This review presents the recent literature on PFAPA and summarizes key findings in the pathogenesis, evaluation, and treatment of the disease. Theories surrounding the pathogenesis of PFAPA include a faulty innate immunologic response in conjunction with dysregulated T-cell activation. A potential genetic link is also under consideration. Mediterranean fever (MEFV) gene variants have been implicated and appear to modify disease severity. In individuals with the heterozygous variant, PFAPA episodes are milder and shorter in duration. Diagnostic criteria include the traditional clinical signs, in addition to the following biomarkers: elevated C-reactive protein in the absence of elevated procalcitonin, vitamin D, CD64, mean corpuscular volume, and other nonspecific inflammatory mediators in the absence of an infectious explanation for fever. Treatment of PFAPA includes tonsillectomy, a single dose of corticosteroids, and, most recently, interleukin 1 blockers such as anakinra, rilonacept, and canakinumab. Tonsillectomy remains the only permanent treatment modality.


Assuntos
Febre/diagnóstico , Febre/etiologia , Linfadenite/diagnóstico , Linfadenite/etiologia , Faringite/diagnóstico , Faringite/etiologia , Estomatite Aftosa/diagnóstico , Estomatite Aftosa/etiologia , Proteína C-Reativa/metabolismo , Quimiocina CXCL10/sangue , Febre/terapia , Humanos , Linfadenite/terapia , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Faringite/terapia , Pirina/genética , Receptores de IgG/sangue , Recidiva , Estomatite Aftosa/terapia , Síndrome , Vitamina D/sangue
18.
Bosn J Basic Med Sci ; 16(2): 157-61, 2016 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-27131024

RESUMO

As no specific laboratory test has been identified, PFAPA (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis) remains a diagnosis of exclusion. We searched for a practical use of procalcitonin (PCT) and C-reactive protein (CRP) in distinguishing PFAPA attacks from acute bacterial and viral infections. Levels of PCT and CRP were measured in 38 patients with PFAPA and 81 children diagnosed with an acute bacterial (n=42) or viral (n=39) infection. Statistical analysis with the use of the C4.5 algorithm resulted in the following decision tree: viral infection if CRP≤19.1 mg/L; otherwise for cases with CRP>19.1 mg/L: bacterial infection if PCT>0.65ng/mL, PFAPA if PCT≤0.65 ng/mL. The model was tested using a 10-fold cross validation and in an independent test cohort (n=30), the rule's overall accuracy was 76.4% and 90% respectively. Although limited by a small sample size, the obtained decision tree might present a potential diagnostic tool for distinguishing PFAPA flares from acute infections when interpreted cautiously and with reference to the clinical context.


Assuntos
Proteína C-Reativa/análise , Calcitonina/sangue , Febre/diagnóstico , Infecções/diagnóstico , Linfadenite/diagnóstico , Faringite/diagnóstico , Estomatite Aftosa/diagnóstico , Doença Aguda , Infecções Bacterianas/sangue , Infecções Bacterianas/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Árvores de Decisões , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , Reprodutibilidade dos Testes , Síndrome , Viroses/sangue , Viroses/diagnóstico
19.
Cir Pediatr ; 29(4): 135-141, 2016 Oct 10.
Artigo em Espanhol | MEDLINE | ID: mdl-28481064

RESUMO

INTRODUCTION: Parotid tumors are rare in children and usually have multiple differential diagnoses that require different diagnostic and treatment methods. MATERIAL AND METHODS: Retrospective cohort study of all consecutive pediatric patients with parotid tumors that were treated in Pediatric Surgery Service of Hospital Italiano de Buenos Aires. RESULTS: Twenty-two patients with parotid tumors were included and 72% (n=16) were female patients. The median age was 10 years (range: prenatal to 19 years). Imaging studies: ultrasound, CT and MRI. Diagnostic methods: needle or open biopsy (14), biopsy of lymph nodes (3), imaging (4), blood test (1). Treatment: surgical resection (12), medical treatment (7), sclerotherapy (2). Diverse histological diagnosis were obtained: pleomorphic adenoma (4), infantile hemangioma (4), PNET (2), low flow vascular malformation (2), Castleman's disease (1), schwannoma (1), neuroblastoma (1), alveolar rhabdomyosarcoma (1), mucoepidermoid carcinoma (1) RICH (Rapidly Involuting Congenital Hemangioma) (1), granulomatous disease (1), reactive adenitis (1), parotid cyst (1), ALL (Acute Lymphoblastic Leukemia) (1). Follow-up (42,5 months): 18 patients are free of disease, 3 are currently under medical treatment and 1 died. CONCLUSIONS: Our series shows the diversity that parotid tumor can present in pediatric population and is consistent with the literature there the incidence of benign lesions are predominant. However, it is difficult to predict risk of malignancy. An exhaustive diagnosis is important, using complementary methods and biopsy whenever that is necessary.


INTRODUCCION: Los tumores de la región parotídea son raros en Pediatría, y suelen presentar múltiples diagnósticos diferenciales que requieren diferentes métodos diagnósticos y de tratamiento. MATERIAL Y METODOS: Estudio de cohorte retrospectivo de todos los pacientes pediátricos consecutivos con tumores de la región parotídea en el periodo 2003-2016, que fueron atendidos en el Servicio de Cirugía Pediátrica del Hospital Italiano de Buenos Aires. RESULTADOS: Se incluyeron 22 pacientes con tumores de la región parotídea. El 72% (n=16) fueron pacientes del sexo femenino. La mediana de edad fue de 10 años (rango: prenatal a 19 años). Estudios complementarios: Ecografía, TC y RMN. Confirmación diagnóstica: biopsia por punción o quirúrgica (14), biopsia de adenopatías (3), diagnóstico por imágenes (4), laboratorio (1). Tratamiento: resección quirúrgica (12), tratamiento médico (7), escleroterapia (2). Diagnósticos diferenciales: adenoma pleomorfo (4), hemangioma infantil (4), malformación vascular de bajo flujo (2), PNET (2), enfermedad de Castleman (1), schwannoma (1), neuroblastoma (1), rabdomiosarcoma alveolar (1), carcinoma mucoepidermoide (1), RICH (hemangioma congénito rápidamente involutivo) (1), enfermedad granulomatosa (1), adenitis reactiva (1), quiste parotídeo (1), LLA (leucemina linfoblástica aguda) (1). Seguimiento medio de 42,5 meses: libres de enfermedad (18), realizando tratamiento médico (3), óbito (1). CONCLUSIONES: Nuestra serie demuestra la gran variedad diagnóstica que pueden presentar los tumores de la región parotídea en la población pediátrica y concuerda con la literatura donde se observa mayor incidencia de lesiones benignas. Sin embargo, es difícil predecir el riesgo de malignidad. Es importante realizar un diagnóstico exhaustivo, utilizando métodos complementarios de imágenes y biopsia ante la duda diagnóstica.


Assuntos
Neoplasias Parotídeas/diagnóstico , Neoplasias Parotídeas/terapia , Adenoma Pleomorfo/diagnóstico , Adenoma Pleomorfo/terapia , Adolescente , Carcinoma Mucoepidermoide/diagnóstico , Carcinoma Mucoepidermoide/terapia , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Hemangioma/diagnóstico , Hemangioma/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Região Parotídea , Estudos Retrospectivos , Adulto Jovem
20.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-123228

RESUMO

PURPOSE: This study identified the characteristics differentiating node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD). METHODS: From July 2007 to June 2015, the medical records of patients with BCL, NFKD, and typical KD were retrospectively reviewed. We analyzed and compared the demographic, clinical, laboratory, and imaging characteristics of the cohorts. RESULTS: Twenty-two patients with BCL, 37 with NFKD, and 132 with typical KD were included in this study. Patients with BCL had longer durations of hospitalization than patients with NFKD. Bilateral and multiple enlarged cervical lymph nodes were associated more with NFKD than BCL. Compared with BCL patients, NFKD patients had lower platelet counts, higher percentages of neutrophils, and higher C-reactive protein (CRP) levels. NFKD patients were older and presented with higher white blood cell counts, percentages of neutrophils, absolute neutrophil counts, and CRP levels as well as lower platelet counts and alanine aminotransferase levels than typical KD patients. CONCLUSIONS: In febrile patients with cervical lymphadenopathy, the combination of bilateral and multiple enlarged nodes, low platelet count, high percentage of neutrophils, and high CRP levels should prompt consideration of NFKD for prevention of delayed diagnosis of KD.


Assuntos
Humanos , Alanina Transaminase , Proteína C-Reativa , Estudos de Coortes , Diagnóstico Tardio , Diagnóstico Diferencial , Febre , Hospitalização , Contagem de Leucócitos , Linfonodos , Linfadenite , Doenças Linfáticas , Prontuários Médicos , Síndrome de Linfonodos Mucocutâneos , Neutrófilos , Contagem de Plaquetas , Estudos Retrospectivos
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