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2.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32527752

RESUMO

In this case series, we describe the clinical course and outcomes of 7 febrile infants aged ≤60 days with confirmed severe acute respiratory syndrome coronavirus 2 infection. No infant had severe outcomes, including the need for mechanical ventilation or ICU level of care. Two infants had concurrent urinary tract infections, which were treated with antibiotics. Although a small sample, our data suggest that febrile infants with severe acute respiratory syndrome coronavirus 2 infection often have mild illness.


Assuntos
Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Febre de Causa Desconhecida/etiologia , Pneumonia Viral/diagnóstico , Infecções Respiratórias/diagnóstico , Síndrome Respiratória Aguda Grave/diagnóstico , Infecções Urinárias/diagnóstico , Fatores Etários , Infecções por Coronavirus/epidemiologia , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Febre de Causa Desconhecida/diagnóstico , Seguimentos , Hospitais Pediátricos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Estudos Prospectivos , Infecções Respiratórias/complicações , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Infecções Urinárias/complicações
3.
Am J Case Rep ; 21: e920515, 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32127513

RESUMO

BACKGROUND Fever of unknown origin (FUO) is a diagnosis that requires a demanding workup from physicians before confirming a diagnosis. Thyroid diseases are a rare cause of FUO. Subacute thyroiditis is an inflammatory disease that can lead to a wide spectrum of presentations. CASE REPORT We report a case of a previously healthy male who presented with persistent fever of 4 weeks following an upper respiratory tract infection associated with constitutional symptoms. His laboratory workup included complete blood counts (CBC), complete metabolic panel (blood urea and creatinine, liver function tests, and serum electrolytes), blood cultures, abdominal and pelvic ultrasound, and computed tomography abdomen and pelvis that were inconclusive. His thyroid function tests showed a hyperthyroid state and a thyroid scan confirmed a picture of thyroiditis. The patient was treated with Ibuprofen and then with prednisolone; he showed significant improvement over a few days and was discharged with treatment of tapering doses of prednisolone over 6 weeks. Two weeks after discharge the patient had a follow-up at an outpatient clinic and was found to be in good health with resolution of his symptoms. CONCLUSIONS Thyroid disorders are not a common cause of FUO, and even if the clinical assessment of the patient is not suggestive of thyroid disease, we should consider it a possible cause. and thyroid function test should be performed to exclude thyroid problems.


Assuntos
Febre de Causa Desconhecida/tratamento farmacológico , Febre de Causa Desconhecida/etiologia , Prednisolona/uso terapêutico , Infecções Respiratórias/complicações , Tireoidite Subaguda/tratamento farmacológico , Tireoidite Subaguda/etiologia , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Diagnóstico Diferencial , Glucocorticoides/uso terapêutico , Humanos , Ibuprofeno/uso terapêutico , Masculino
4.
Trop Doct ; 50(3): 275-277, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32098613

RESUMO

Histoplasmosis is usually clinically suspected only in people who reside in, are migrants from or are travelling to endemic areas such as North America. Immunocompetent patients with a low level of exposure typically have either subclinical or mild and self-limiting infection. The most common risk for the development of progressive disseminated form is HIV infection. We recently managed two patients with disseminated histoplasmosis, presenting with prolonged fever, significant weight loss, pallor and hepatosplenomegaly. Both were HIV-negative and lived in Himachal Pradesh (India), a region that was considered "Histoplasma-free" until recently.


Assuntos
Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/etiologia , Histoplasma/isolamento & purificação , Histoplasmose/complicações , Histoplasmose/diagnóstico , Idoso , Antifúngicos/uso terapêutico , Feminino , Febre de Causa Desconhecida/tratamento farmacológico , Histoplasma/efeitos dos fármacos , Histoplasmose/tratamento farmacológico , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
BMC Pediatr ; 20(1): 32, 2020 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-31987031

RESUMO

BACKGROUND: Kawasaki disease (KD) is an acute febrile multisystem vasculitis and has been recognized to be the most common cause of acquired heart disease in children. Owing to its propensity to involve vessels throughout the entire body, KD often mimics other disease processes. The diagnosis might be delayed if other prominent symptoms appear before the characteristic clinical features of KD. Although gastrointestinal symptoms including vomiting, diarrhea, and abdominal pain are not uncommon in KD patients, KD with gastrointestinal bleeding is quite rare. CASE PRESENTATION: A previously healthy 4-year-old boy initially presented with abdominal pain, followed by fever, rash, and gastrointestinal hemorrhage, eventually diagnosed as complete KD. The patient recovered smoothly after appropriate management and no subsequent complications occurred in the following months. CONCLUSION: The diagnosis of KD should be considered in children presenting with abdominal symptoms and fever without definable cause. Pediatricians should be aware of the risk of gastrointestinal bleeding in patients with KD, especially in those with prominent abdominal symptoms.


Assuntos
Hemorragia Gastrointestinal/etiologia , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Anticoagulantes/uso terapêutico , Pré-Escolar , Diagnóstico Tardio , Úlcera Duodenal/diagnóstico , Febre de Causa Desconhecida/etiologia , Hemorragia Gastrointestinal/diagnóstico , Gastroscopia , Humanos , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações
6.
Pediatrics ; 145(1)2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31810997

RESUMO

A 9-year-old African American boy was admitted to hospital with a 12-day history of fevers, diarrhea, abdominal pain and a 1-day history of joint pain. His abdominal pain and diarrhea resolved within the first few days of admission, but he continued with high-grade fevers and intermittent joint pain. The joints affected included the right first interphalangeal joint, right wrist, right elbow, and left knee joint. His initial laboratory tests revealed normal complete blood count, comprehensive metabolic panel, and C-reactive protein. Consequently, he developed fatigue, lower back pain, and bicytopenias. After 19 days of fevers, a multispecialty collaborative evaluation arrived at a final diagnosis and treatment plan. In this article, we discuss the child's hospital course and our clinical thought process. Written consent was obtained from the family.


Assuntos
Artrite Juvenil/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Dor Abdominal/etiologia , Antirreumáticos/uso terapêutico , Artralgia/etiologia , Artrite Juvenil/complicações , Artrite Juvenil/tratamento farmacológico , Criança , Diagnóstico Diferencial , Diarreia/etiologia , Fadiga/etiologia , Febre de Causa Desconhecida/etiologia , Humanos , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Dor Lombar/etiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Linfo-Histiocitose Hemofagocítica/diagnóstico , Masculino , Exame Físico , Sintomas Prodrômicos , Fatores de Tempo , Falha de Tratamento , Vasculite/diagnóstico
7.
Best Pract Res Clin Rheumatol ; 33(4): 101426, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31810543

RESUMO

A significant proportion of patients with pyrexia of unknown origin (PUO) are found to have a rheumatological cause. The mainstay of treatment for rheumatic disease is immunosuppression, and therefore, accurate diagnosis is crucial given the risks associated with these drugs. In this review, we analyse the rheumatological conditions that most commonly present with fever and illustrate clinical cases demonstrating some of the challenges in the workup of these patients. With this in mind, we propose an evidence-based algorithm for investigating PUO from a rheumatological perspective, with the aim that it will aid clinicians when approaching these clinical scenarios.


Assuntos
Febre de Causa Desconhecida , Doenças Reumáticas , Adulto , Febre de Causa Desconhecida/etiologia , Humanos , Doenças Reumáticas/complicações , Doenças Reumáticas/diagnóstico
8.
Indian Pediatr ; 56(12): 1059-1061, 2019 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-31884443

RESUMO

Fever of unknown origin frequently remains a diagnostic challenge. Immunological diseases account for about 20- 30% cases of these fevers. We report the case of a boy who presented with high fever for 2 months and was finally diagnosed as a case of IgG4-related disease at the rectovesical pouch.


Assuntos
Doença Relacionada a Imunoglobulina G4 , Peritônio , Reto , Criança , Diagnóstico Diferencial , Febre de Causa Desconhecida/etiologia , Humanos , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Doença Relacionada a Imunoglobulina G4/cirurgia , Masculino , Peritônio/diagnóstico por imagem , Peritônio/cirurgia , Tomografia por Emissão de Pósitrons , Reto/diagnóstico por imagem , Reto/cirurgia
9.
Rev Assoc Med Bras (1992) ; 65(10): 1308-1313, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721964

RESUMO

Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.


Assuntos
Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/etiologia , Infecção Hospitalar , Feminino , Humanos , Infecções/complicações , Inflamação/complicações , Masculino , Neoplasias/complicações , Neutropenia
10.
BMJ Case Rep ; 12(9)2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31492731

RESUMO

A 72-year-old gentleman with significant cardiac history and a pacemaker in situ initially presented to the emergency department 5 days after he had his pacemaker-unit batteries changed. He had deranged vital signs, productive cough and fever. His chest plain radiograph did not show evidence of infection; however, he had right basal crackles on auscultation, which suggested a lower respiratory tract infection. He was treated with intravenous co-amoxiclav and supportive therapy, which led to his improvement. The patient was discharged but had to be readmitted a total of four times over the span of 4 months due to recurrent fever and associated symptoms. Transthoracic and transoesophageal echocardiograms and CT of the neck/thorax/abdomen/pelvis were done to look for endocarditis, pacemaker-unit infection and other sources of infection. However, these did not show any evidence of infection. He did have persistent raised inflammatory markers and two blood cultures growing Enterobacter cloacae. A fluorodeoxyglucose positron emission tomography scan was done, which showed evidence of pacemaker lead infection. His pacemaker unit was removed, which led to cessation of his symptoms and normalisation of his inflammatory markers. He had no further hospital admissions to date and has been regularly followed up in an outpatient cardiology clinic.


Assuntos
Infecções por Enterobacteriaceae/diagnóstico , Marca-Passo Artificial , Infecções Relacionadas à Prótese/diagnóstico , Idoso , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Hemocultura , Remoção de Dispositivo , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/complicações , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/terapia , Febre de Causa Desconhecida/etiologia , Fluordesoxiglucose F18 , Hospitalização , Humanos , Masculino , Readmissão do Paciente , Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/complicações , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/terapia , Compostos Radiofarmacêuticos
11.
Rev Assoc Med Bras (1992) ; 65(8): 1109-1115, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531611

RESUMO

Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world and can be associated with a myriad of differential diagnoses. It is defined as axillary temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or three outpatient visits. The main etiologies are: infectious, neoplastic, and rheumatic. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12% - 35%, varying according to the underlying etiology. In this sense, the objective of this study is to review the main topics about fever of undetermined origin, bringing historical and scientific aspects, national and international.


Assuntos
Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/etiologia , Diagnóstico Diferencial , Humanos , Exame Físico , Prognóstico
12.
Clin Respir J ; 13(11): 683-692, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31364275

RESUMO

INTRODUCTION: Fever of unknown origin (FUO) with pulmonary lesions is a common syndrome in respiratory diseases, which can be caused by infection, cancer, connective tissue disease and other rare diseases of South China. In patients with FUO associated with pulmonary lesions, pathogeny should be identified and followed by an appropriate treatment strategy. OBJECTIVE: This study aimed to investigate the etiological distribution and clinical features of FUO with pulmonary lesions and to analyze the efficiency of different diagnostic methods for certain disease categories. METHODS: Patients hospitalized at the Guangzhou Institute of Respiratory Health from July 2012 to December 2016 who had fever ≥38.3°C that lasted ≥21 days, in whom the chest X-ray or computed tomography (CT) revealed definite pulmonary infiltration, and for whom, despite being examined for a week, no definitive diagnosis could be made, were considered for this study. RESULTS: A total of 104 patients were identified as having FUO with lung lesions, and 89.4% (93/104) patients were definitively diagnosed. Infectious disease was the most common cause (46.2%, 48/104). Histopathology was instrumental in the diagnosis of the causes of FUO with pulmonary manifestations, 47.3% (44/93) patients were diagnosed through histopathology, 35.4% (17/48) with infectious disease and 55.2% (16/29) with connective tissue diseases as the etiology were definitely diagnosed using histopathology. CONCLUSION: Most FUO with pulmonary lesions are identified during infections and autoimmune diseases. The most important diagnostic measure for FUO with pulmonary lesions is histopathology. Additionally, lung biopsy must be encouraged in multi-level hospitals in the future.


Assuntos
Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/etiologia , Pulmão/patologia , Doenças Respiratórias/complicações , Adulto , Doenças Autoimunes/complicações , Doenças Autoimunes/epidemiologia , Biópsia , China/epidemiologia , Doenças Transmissíveis/complicações , Doenças Transmissíveis/epidemiologia , Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/epidemiologia , Estudos Transversais , Feminino , Febre de Causa Desconhecida/epidemiologia , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/epidemiologia , Radiografia Torácica/métodos , Doenças Respiratórias/diagnóstico por imagem , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
13.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401572

RESUMO

A 58-year-old man presented with a 2-month history of arthralgia and bilateral temporal region pain, and a 1-month history of fever. He had had refractory neck pain since his 20s. Reduced cervical and lumbar mobility was observed. Radiographs of cervical and thoracic vertebrae disclosed syndesmophytes. Pelvic radiographs showed sclerosis in the right sacroiliac joint and ankylosis in the left sacroiliac joint. MRI with contrast enhancement showed enthesitis in the upper extremities and enhancement in the bilateral temporal muscle, which indicated enthesitis of temporal muscle. He was diagnosed with ankylosing spondylitis based on the limitation in mobility of the lumbar spine and radiographic findings. To the best of our knowledge, this is the first report describing enthesitis of the temporal muscle. This case highlights that ankylosing spondylitis can be accompanied with enthesitis at the temporal muscle and fever of unknown origin at the initial presentation.


Assuntos
Entesopatia/etiologia , Febre de Causa Desconhecida/etiologia , Espondilite Anquilosante/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/patologia , Espondilite Anquilosante/diagnóstico , Músculo Temporal/diagnóstico por imagem , Músculo Temporal/fisiopatologia
14.
World Neurosurg ; 132: e430-e433, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470155

RESUMO

BACKGROUND: Craniosynostosis is the premature fusion of ≥1 cranial sutures. Surgical management involves early cranial vault reconstruction. Postoperative management of these patients is often complicated by fever of unknown origin and results in additional laboratory studies, extended hospital intensive care unit stays, and increased cost to the patient. METHODS: A retrospective analysis of 70 consecutive patients who underwent cranial vault reconstruction were included. Postoperative fever (Tmax), length of stay, transfusions, estimated blood loss, and white blood cell counts were obtained, as well as blood, urine, and other culture data. RESULTS: Mean age at surgery was 1.1 years. Sixty (86%) patients had idiopathic postoperative fevers >38°C. Of those, 20% underwent fever workups, none of which returned a positive culture or concern for pneumonia. Length of stay was significantly increased in patients who had fever workups (6.1 days vs. 4.7, P < 0.001). There was no significant difference in age, estimated blood loss, Tmax, white blood cell count, and day of postoperative fever between groups. The average estimated cost of a fever workup at our institution is $1288 (U.S. dollars). CONCLUSIONS: Fever of unknown origin is a common finding after craniosynostosis repair. Workup for fever of unknown did not result in the identification of an infection and added significantly to the cost and patient's length of stay.


Assuntos
Craniossinostoses/cirurgia , Febre de Causa Desconhecida/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos
16.
Pediatr Emerg Med Pract ; 16(7): CD1-CD3, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31294949

RESUMO

The Rochester criteria for febrile infants determine whether or not febrile infants are at low risk for serious bacterial infection.


Assuntos
Infecções Bacterianas/diagnóstico , Regras de Decisão Clínica , Febre de Causa Desconhecida/etiologia , Índice de Gravidade de Doença , Infecções Bacterianas/complicações , Humanos , Lactente , Recém-Nascido , Medição de Risco
20.
Am J Emerg Med ; 37(8): 1601.e1-1601.e2, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31088751

RESUMO

BACKGROUND: Psychogenic fever is a stress-related psychosomatic disease and has been recognized clinically since the early twentieth century. It is common in adolescents or young women with acute or persistent elevation in body temperature. Psychogenic fever can be attenuated by anxiolytic, neuroleptic, or by psychotherapy. CASE SUMMARY: A 22-year-old female was diagnosed with psychogenic fever and suffered from fever, headache and transient visual impairment. She had a history of being hit on the head by a rolling gate 10 days prior to visiting our hospital. All examinations showed no abnormal findings. Antipyretic drugs and antibiotics had no effect on reducing her body temperature. The patient was usually nervous at work and became extremely anxious after the injury. Within a week of psychotherapy, her temperature gradually returned to normal and her sight was restored. CONCLUSION: Psychological stress may present with a range of symptoms, including visual impairment. Physicians should consider the diagnosis of psychogenic fever when patients present with fever of unknown origin and no other abnormal findings.


Assuntos
Febre de Causa Desconhecida/etiologia , Transtornos Psicofisiológicos/complicações , Transtornos Psicofisiológicos/diagnóstico , Transtornos da Visão/etiologia , Regulação da Temperatura Corporal , Traumatismos Craniocerebrais/complicações , Feminino , Cefaleia/etiologia , Humanos , Psicoterapia , Adulto Jovem
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