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2.
Rev. cuba. med ; 58(4): e1318, oct.-dic. 2019. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139031

RESUMO

Introducción: La fiebre de origen desconocido es un síndrome que genera un gran desafío para el pensamiento clínico; el patrón recurrente es el subtipo más retador y de difícil diagnóstico etiológico. Objetivo: Caracterizar los pacientes con fiebre de origen desconocido con patrón recurrente. Método: Se realizó un estudio descriptivo de corte transversal en el periodo de enero de 2008 a diciembre de 2015. La muestra quedó constituida por 48 pacientes, los cuales fueron hospitalizados y se les realizó una evaluación clínica en el Hospital Clínico Quirúrgico Hermanos Amejeiras. Para el análisis de los datos se utilizaron medidas de resumen para las variables cualitativas y para las cuantitativas, media y desviación estándar. Resultados: La edad media fue 41,3 años, predominaron los hombres (62,5 por ciento), la duración media de la fiebre fue de 497 días y las pistas clínicas más importantes fueron los hallazgos de adenopatías (43,8 por ciento) y hepatomegalia (22,9 por ciento). Los casos sin diagnóstico fueron 45,8 por ciento. Conclusiones: La fiebre de origen desconocido con patrón recurrente es de difícil diagnóstico. A pesar de una evaluación clínica minuciosa, la mayoría de los pacientes quedan sin diagnóstico(AU)


Introduction: Fever of unknown origin is a syndrome that generates great challenge for clinical thought; the recurrent pattern is the most challenging subtype and with difficult etiological diagnosis. Objective: To describe patients with fever of unknown origin with recurring pattern. Method: A descriptive cross-sectional study was carried out from January 2008 to December 2015. Forty-eight patients formed the sample. They were hospitalized and underwent clinical evaluation at Hermanos Amejeiras Surgical Clinical Hospital. For data analysis, summary measures were used for qualitative variables and mean and standard deviation variables were used for quantitative. Results: The mean age was 41.3 years, men predominated (62.5 percent), the mean duration of fever was 497 days, and the most important clinical signs were the findings of lymphadenopathy (43.8 percent) and hepatomegaly. (22.9 percent). Undiagnosed cases were 45.8 percent. Conclusions: Fever of unknown origin with recurring pattern is difficult to diagnose. Despite careful clinical evaluation, most patients remain undiagnosed(AU)


Assuntos
Humanos , Masculino , Feminino , Febre Recorrente/etiologia , Febre de Causa Desconhecida/etiologia , Febre de Causa Desconhecida/patologia , Febre de Causa Desconhecida/diagnóstico por imagem , Epidemiologia Descritiva , Estudos Transversais
3.
Curr Med Sci ; 39(4): 589-596, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31346995

RESUMO

The diagnosis and treatment of fever of unknown origin (FUO) are huge challenges to clinicians. Separating the etiologies of FUO into infectious and non-infectious disease is conducive to clinical physicians not only on making decisions rapidly concerning the prescription of suitable antibiotics but also on further analysis of the final diagnosis. In order to develop and validate a diagnostic tool to efficiently distinguish the etiologies of adult FUO patients as infectious or non-infectious disease, FUO patients from the departments of infectious disease and internal medicine in three Chinese tertiary hospitals were enrolled retrospectively and prospectively. By using polynomial logistic regression analysis, the diagnostic formula and the associated scoring system were developed. The variables included in this diagnostic formula were from clinical evaluations and common laboratory examinations. The proposed tool could discriminate infectious and non-infectious causes of FUO with an area under receiver operating characteristic curve (AUC) of 0.83, sensitivity of 0.80 and specificity of 0.75. This diagnosis tool could predict the infectious and non-infectious causes of FUO in the validation cohort with an AUC of 0.79, sensitivity of 0.79 and specificity of 0.70. The results suggested that this diagnostic tool could be a reliable tool to discriminate between infectious and non-infectious causes of FUO.


Assuntos
Doenças Transmissíveis/diagnóstico , Febre de Causa Desconhecida/diagnóstico , Doenças não Transmissíveis/epidemiologia , Adulto , China/epidemiologia , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/patologia , Diagnóstico Diferencial , Febre de Causa Desconhecida/epidemiologia , Febre de Causa Desconhecida/patologia , Humanos , Modelos Logísticos
5.
J Med Case Rep ; 13(1): 24, 2019 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-30684969

RESUMO

BACKGROUND: Fever of unknown origin is often a diagnostic dilemma for clinicians due to its extremely broad differential. One of the rarer categories of disease causing fever of unknown origin is malignancies; of these, soft tissue sarcoma is one of the least common. Soft tissue sarcomas make up < 1% of all adult malignancies and often do not present with any systemic manifestations or neoplastic fevers. CASE PRESENTATION: A 73-year-old Caucasian woman presented with a 2-week history of fever and profound fatigue. The only other symptom she endorsed was a transient history of left knee pain, initially thought to be unrelated. There was no clear cause on initial examination and routine investigations, but her C-reactive protein was significantly elevated at 207 mg/L. Blood cultures and a urine culture were drawn. She was admitted to hospital for further investigation and placed on empiric antibiotics. Her blood cultures were negative, but she had one further fever in hospital. Computed tomography scans did not yield a cause of her fever. No vegetations were seen on echocardiography. Antibiotics were stopped as she did not seem to have an acute infectious cause of her fever. No new symptoms developed. She felt well enough to proceed with out-patient follow up and was discharged after 8 days in hospital. At 1-month post-discharge: no resolution of symptoms, but she endorsed a recurrence of her left knee pain. Ultrasound and magnetic resonance imaging revealed a 4.5 × 6.8 × 11.6 cm soft tissue mass, identified as a sarcoma on biopsy. She subsequently underwent a distal femur resection. Final staging was pT2bN0M0. She underwent adjuvant radiation therapy, but was found to have developed metastatic disease. CONCLUSION: This case revealed an atypical presentation of a rare soft tissue sarcoma as the cause of the illness. The etiology behind a fever of unknown origin can be difficult to elucidate, making the approach to investigation particularly important. Repeated history-taking and serial physical examinations can be crucial in guiding investigations and ultimately arriving at a diagnosis. In addition, we believe this case highlights the adage that no seemingly innocuous symptom should be left out when working up a condition with such an extensive and complex differential.


Assuntos
Neoplasias Ósseas/patologia , Febre de Causa Desconhecida/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Tomografia Computadorizada por Raios X , Idoso , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/terapia , Feminino , Febre de Causa Desconhecida/patologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/terapia , Cuidados Paliativos , Radioterapia Adjuvante , Sarcoma/diagnóstico por imagem , Sarcoma/terapia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/terapia , Fatores de Tempo
6.
Trop Doct ; 49(2): 88-96, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30614411

RESUMO

Five-year clinico-laboratory data from 99 (one HIV seropositive) adults (mean age = 41.3 ± 20.4 years) who underwent bone marrow examination for fever persisting for ≥ 1 week were analysed and correlated with microbiological characteristics. Infections, reactive marrow changes and haematolymphoid malignancies were most commonly associated with fever. A high concordance rate of 71% was noted between aspiration and trephine biopsies. Bone marrow granulomas (BMG) were seen exclusively on sections and were most commonly of tubercular and typhoidal in origin (two Salmonella Typhi, one Salmonella Paratyphi A). The common aetiologies associated with fever and cytopenia(s) were BMG, acute leukaemia and haemophagocytic lymphohistiocytosis (HLH; n = 3). The yield from bone marrow culture was inferior compared to other body fluids. In conclusion, bone marrow histology is superior to smears in the evaluation of prolonged fever. Marrow culture may not be useful in immunocompetent individuals other than if Salmonellosis is suspected.


Assuntos
Exame de Medula Óssea , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/imunologia , Hospedeiro Imunocomprometido , Adulto , Biópsia/métodos , Medula Óssea/microbiologia , Medula Óssea/patologia , Feminino , Febre de Causa Desconhecida/microbiologia , Febre de Causa Desconhecida/patologia , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Atenção Terciária à Saúde , Adulto Jovem
7.
Clin Nucl Med ; 44(3): 251-254, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30562199

RESUMO

Focal myositis is an uncommon inflammatory pseudotumor of the skeletal muscle that may mimic neoplastic and inflammatory diseases. We present one case of focal myositis involving the left proximal vastus lateralis and vastus intermedius, and left soleus showing intense FDG uptake on FDG PET/CT. This case indicates that focal myositis should be considered as a differential diagnosis in patients with focal hypermetabolic muscular lesions, including benign and malignant tumors, necrotizing autoimmune myopathy, nodular fasciitis, myositis ossificans, and muscular sarcoidosis.


Assuntos
Febre de Causa Desconhecida/diagnóstico por imagem , Miosite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Adulto , Diagnóstico Diferencial , Febre de Causa Desconhecida/patologia , Fluordesoxiglucose F18 , Humanos , Masculino , Miosite/patologia , Compostos Radiofarmacêuticos
8.
Intern Med J ; 49(7): 850-854, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30350441

RESUMO

BACKGROUND: Bone marrow biopsy (BMB) is an accepted investigation in fever of unknown origin (FUO) to uncover haematological malignancies, such as lymphoma, and sometimes infections. With the advance in imaging modalities, such as 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) to identify the focus of lymphoma, BMB may not contribute to the diagnosis when there are no other clinical features to suggest an underlying haematological disease. AIM: To investigate the utility of BMB in determining the cause of FUO, when there are no other indications for BMB. METHODS: Medical records of adult patients who had BMB performed for FUO or febrile illness from 1 January 2005 to 31 December 2014 in four metropolitan tertiary hospitals in Melbourne, Australia were reviewed. Patients with other concurrent indications for BMB, known human immunodeficiency virus infection and previously diagnosed connective tissue diseases were excluded. RESULTS: Seventy-three patients were included in the study. Fifty-one patients had a final diagnosis for fever (systemic inflammatory diseases, infective, malignancy or other) while 22 patients had no diagnoses. In only 10 patients (13.7%) did BMB contribute to the diagnosis, finding either malignancy or granulomata. However, all these diagnoses could have been made without BMB. Two patients with diffuse large B-cell lymphoma had normal BMB. FDG-PET was helpful in making a diagnosis in eight (25%) out of 32 patients. CONCLUSION: Performing BMB in patients with FUO and no other haematological abnormalities is of very limited value, and other investigations, such as FDG-PET, may be more likely to help establish a definitive diagnosis.


Assuntos
Medula Óssea/patologia , Febre de Causa Desconhecida/diagnóstico por imagem , Febre de Causa Desconhecida/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Biópsia/métodos , Feminino , Febre de Causa Desconhecida/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Estudos Retrospectivos
9.
Am J Transplant ; 19(3): 933-938, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30091842

RESUMO

"Cepacia syndrome", caused by Burkholderia cepacia complex and often associated with cystic fibrosis, carries a high mortality rate. It is rare for Burkholderia multivorans, a species within the B. cepacia complex, to cause cepacia syndrome even among patients with cystic fibrosis. This is the first reported fatal case of cepacia syndrome caused by B. multivorans occurring in a pediatric liver transplant recipient who does not have cystic fibrosis. We describe the unique characteristics of this pathogen among the non-cystic fibrosis population and the importance of early recognition and treatment.


Assuntos
Infecções por Burkholderia/microbiologia , Complexo Burkholderia cepacia/patogenicidade , Febre de Causa Desconhecida/cirurgia , Transplante de Fígado/efeitos adversos , Sepse/etiologia , Infecções por Burkholderia/complicações , Evolução Fatal , Febre de Causa Desconhecida/patologia , Humanos , Lactente , Masculino , Sepse/patologia
11.
Expert Rev Anti Infect Ther ; 15(11): 1041-1057, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29103336

RESUMO

INTRODUCTION: The management of children with fever without apparent sources (FWAS) is difficult. This study aimed to evaluate the diagnostic accuracy of procalcitonin (PCT) in detecting serious or invasive bacterial infection (SBI or IBI) in children with FWAS. Areas covered: A systematic review of literature from 2007 to 2017 was performed on Medline. Twelve studies were included, involving 7,260 children with FWAS and analyzing the diagnostic performance of PCT. Four meta-analyses were performed to calculate pooled sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve for PCT in detecting SBI and IBI, at two different thresholds. Considering IBI, PCT sensitivity and specificity at a threshold of 0.5 ng/mL were 0.82 and 0.86, respectively; at a threshold of 2 ng/mL sensitivity and specificity were 0.61 and 0.94, respectively. In detecting SBI, PCT performance was lower, with 55% sensitivity and 85% specificity at a threshold of 0.5 ng/mL, and 30% sensitivity and 95% specificity at a threshold of 2 ng/mL. Expert commentary: Considering IBI, results showed high diagnostic accuracy for PCT. Conversely, PCT performance in diagnosis of SBI was poor. These findings suggest that PCT level determination could be helpful in detecting meningitis, bacteremia and sepsis in children with FWAS.


Assuntos
Bacteriemia/diagnóstico , Calcitonina/sangue , Febre de Causa Desconhecida/diagnóstico , Meningites Bacterianas/diagnóstico , Sepse/diagnóstico , Bacteriemia/sangue , Bacteriemia/microbiologia , Bacteriemia/patologia , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Criança , Febre de Causa Desconhecida/sangue , Febre de Causa Desconhecida/microbiologia , Febre de Causa Desconhecida/patologia , Humanos , Meningites Bacterianas/sangue , Meningites Bacterianas/microbiologia , Meningites Bacterianas/patologia , Razão de Chances , Sensibilidade e Especificidade , Sepse/sangue , Sepse/microbiologia , Sepse/patologia , Índice de Gravidade de Doença
12.
Transpl Infect Dis ; 19(6)2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28921746

RESUMO

This case describes a patient being considered for combined liver-kidney transplantation for Caroli's disease with a failed renal transplant. A chronic septic focus could not be located with standard imaging techniques, such as ultrasonography and computed tomography. This case report highlights the observation that a retained non-functioning transplant can be the cause of fever of unknown origin and PET-CT can be useful in diagnosing these challenging cases.


Assuntos
Aloenxertos/diagnóstico por imagem , Doença de Caroli/cirurgia , Febre de Causa Desconhecida/diagnóstico por imagem , Rim/diagnóstico por imagem , Transplante de Fígado/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Adulto , Aloenxertos/microbiologia , Aloenxertos/patologia , Aloenxertos/cirurgia , Febre de Causa Desconhecida/microbiologia , Febre de Causa Desconhecida/patologia , Febre de Causa Desconhecida/cirurgia , Rejeição de Enxerto/microbiologia , Humanos , Rim/microbiologia , Rim/patologia , Rim/cirurgia , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Cirrose Hepática/congênito , Cirrose Hepática/cirurgia , Masculino , Necrose , Nefrectomia , Doenças Renais Policísticas/cirurgia , Cuidados Pré-Operatórios/métodos , Transplantados , Falha de Tratamento , Ultrassonografia
14.
Internist (Berl) ; 58(10): 1090-1096, 2017 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-28555378

RESUMO

A 59-year-old woman suffered from fever and upper abdominal pain. The computed tomography (CT) scan revealed a liver lesion. Conventional imaging techniques (CT, magnetic resonance imaging, contrast-enhanced ultrasonography) did not allow for a consistent diagnosis. Fine needle biopsy of the liver lesion was performed. Histologically, fibrotic inflammation was found and an inflammatory pseudotumor (IPT) diagnosed. Despite treatment with steroids and antibiotics, the size of the IPT increased; thus, surgical resection was necessary. In case of fever of unknown origin, IPT should be considered as a potential diagnosis.


Assuntos
Dor Abdominal/etiologia , Febre de Causa Desconhecida/etiologia , Granuloma de Células Plasmáticas/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Dor Abdominal/diagnóstico por imagem , Antibacterianos/uso terapêutico , Biópsia por Agulha Fina , Budesonida/uso terapêutico , Diagnóstico Diferencial , Feminino , Febre de Causa Desconhecida/diagnóstico por imagem , Febre de Causa Desconhecida/patologia , Febre de Causa Desconhecida/terapia , Granuloma de Células Plasmáticas/patologia , Granuloma de Células Plasmáticas/terapia , Hepatectomia , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Hepatopatias/patologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ultrassonografia
15.
J Microbiol Immunol Infect ; 50(1): 40-45, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25735796

RESUMO

BACKGROUND: Fever of unknown origin (FUO) was first described in 1961 as fever >38.3°C for at least 3 weeks with no apparent source after 1 week of investigations in the hospital. Infectious disease comprises the majority of cases (40-60%). There is no related research on FUO in children in Taiwan. The aim of this study is to determine the etiologies of FUO in children in Taiwan and to evaluate the relationship between the diagnosis and patient's demography and laboratory data. METHODS: Children under 18 years old with fever >38.3°C for >2 weeks without apparent source after preliminary investigations at Taipei Veterans General Hospital during 2002-2012 were included. Fever duration, symptoms and signs, laboratory examinations, and final diagnosis were recorded. The distribution of etiologies and age, fever duration, laboratory examinations, and associated symptoms and signs were analyzed. RESULTS: A total of 126 children were enrolled; 60 were girls and 66 were boys. The mean age was 6.7 years old. Infection accounted for 27.0% of cases, followed by undiagnosed cases (23.8%), miscellaneous etiologies (19.8%), malignancies (16.6%), and autoimmune disorders (12.7%). Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were the most commonly found pathogens for infectious disease, and Kawasaki disease (KD) was the top cause of miscellaneous diagnosis. CONCLUSIONS: Infectious disease remains the most common etiology. Careful history taking and physical examination are most crucial for making the diagnosis. Conservative treatment may be enough for most children with FUO, except for those suffering from malignancies.


Assuntos
Febre de Causa Desconhecida/epidemiologia , Febre de Causa Desconhecida/etiologia , Adolescente , Criança , Pré-Escolar , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/epidemiologia , Feminino , Febre de Causa Desconhecida/patologia , Hospitais Gerais , Hospitais de Veteranos , Humanos , Lactente , Masculino , Taiwan
17.
Indian J Gastroenterol ; 35(1): 55-9, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26923374

RESUMO

AIM: Tuberculosis is a common disease in India with significant morbidity and mortality. Limited data is available on the description of tubercular lymphadenopathy on endoscopic ultrasound. METHODS: Retrospective data of 116 lymph nodes in 113 patients was evaluated at a tertiary care center. Lymphadenopathy in the mediastinum and abdomen were included. The study was aimed at identifying the endoscopic ultrasound (EUS) features of tubercular lymphadenopathy and comparing them with reactive lymphadenopathy in patients with pyrexia of unknown origin. RESULTS: The following features were suggestive of tubercular lymphadenopathy (n = 55) as compared to reactive lymphadenopathy (n = 61): hypoechoic echotexture (94.5% vs. 75.4%, p 0.004), patchy anechoic/hypoechoic areas (30.2% vs. 0%, p = 0.000), calcification (24.5% vs. 0%, p = 0.000), sharply demarcated borders (34.5% vs. 9.8%, p = 0.001), pus like material on aspirate (18.2% vs. 0%, p 0.000), and conglomeration of lymph nodes (10.9% vs. 0%, p = 0.009). The tubercular lymph nodes were significantly larger than reactive nodes at long axis and short axis diameter (2.4 ± 1.1 vs. 1.6 ± 0.6 cm, p < 0.001 and 1.5 ± 0.7 vs. 0.9 ± 0.3 cm, p = 0.001 respectively). On cytopathological examination, presence of necrosis (92.7% vs. 0%, p = 0.000) and granulomas (78.1% vs. 0%, p = 0.000) favored tubercular as compared to reactive lymphadenopathy. CONCLUSION: EUS features like hypoechoic echotexture, patchy anechoic/hypoechoic areas, calcification, sharply demarcated borders, conglomeration, purulent aspirate, larger size, and cytopathological presence of necrosis/granulomas are suggestive of tubercular as compared to reactive lymphadenopathy.


Assuntos
Endossonografia , Linfonodos/diagnóstico por imagem , Doenças Linfáticas/diagnóstico por imagem , Pseudolinfoma/diagnóstico por imagem , Tuberculose/diagnóstico por imagem , Adulto , Idoso , Endossonografia/métodos , Feminino , Febre de Causa Desconhecida/diagnóstico por imagem , Febre de Causa Desconhecida/patologia , Humanos , Linfonodos/patologia , Doenças Linfáticas/patologia , Masculino , Pessoa de Meia-Idade , Pseudolinfoma/patologia , Estudos Retrospectivos , Tuberculose/patologia
18.
J Infect Dev Ctries ; 10(1): 30-42, 2016 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-26829535

RESUMO

INTRODUCTION: Fever of unknown origin (FUO) is one of the most challenging diagnostic dilemmas in the field of infectious diseases and tropical medicine. Clinicians should use the frequency distribution of disorders causing FUO to guide their diagnostic approach in patients with prolonged, unexplained fevers meeting the definition of FUO. METHODOLOGY: The present study was undertaken to examine the etiologies, clinico-epidemiologic profile, and prognosis of classical FUO in patients reporting to the Alexandria Fever Hospital in Egypt. Records of 979 patients admitted to the fever hospital (from January 2009 to January 2010) and diagnosed as having FUO were examined carefully. FUO was defined as three outpatient visits or three days in the hospital without elucidation of cause of fever. RESULTS: A total of 979 cases (57.0% males and 43.0% females), with ages ranging from 0.2 to 90 years, were investigated. The mean duration of fever before hospitalization was 31 ± 10 days. The etiology of FUO was delineated in 97% of cases, and only 3% remained undiagnosed. Diagnoses were grouped into five major categories. Infectious causes of FUO were strongly associated with better outcome (73.7% improved). Smoking, contact with animals or birds, drug addiction, and HIV seropositivity were important risk factors associated with infections. CONCLUSIONS: Infections are the most common cause of FUO, followed by collagen vascular diseases, in our region. A three-step diagnostic work-up approach is recommended to be applied in Egypt in order to improve the quality of medical service provided to FUO patients.


Assuntos
Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/patologia , Febre de Causa Desconhecida/epidemiologia , Febre de Causa Desconhecida/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Egito/epidemiologia , Feminino , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/patologia , Hospitais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
Jpn J Infect Dis ; 69(5): 378-83, 2016 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-26743139

RESUMO

This study was designed to evaluate the diagnostic value of common inflammatory markers with regard to fever of unknown origin (FUO). We investigated 383 patients who were hospitalized with FUO at the Henan Province People's hospital between January 2009 and June 2015. Of all the cases, infectious diseases accounted for 33.9%, neoplasms for 21.1%, collagen vascular diseases for 25.1%, miscellaneous diseases for 4.7%, and no diagnosis for 15.1%. Patients in the neoplasm group were older than those in the infectious disease, collagen vascular disease, and miscellaneous disease groups (p = 0.006, p < 0.0001, and p = 0.001, respectively). The duration of fever before admission of patients in the neoplasm and collagen vascular disease group was longer than that of patients in the infectious disease group (p = 0.002 and p = 0.007, respectively). The diagnostic time after admission of patients from the neoplasm and collagen vascular disease groups was longer than that for patients from the infectious disease group (both p < 0.0001). Serum ferritin levels of patients in the infectious disease group were lower than those of patients in the neoplasm and collagen vascular disease groups (p = 0.029 and p = 0.032, respectively), while serum procalcitonin (PCT) levels in the infectious disease group was higher than that in the neoplasm and collagen vascular disease groups (p = 0.016 and p = 0.007, respectively). Therefore, FUO remains a clinical problem in China and serum ferritin and PCT may be useful in discriminating infectious from non-infectious causes (neoplasms and collagen vascular diseases) in patients with FUO.


Assuntos
Biomarcadores/sangue , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/etiologia , Inflamação/patologia , Adulto , Idoso , Calcitonina/sangue , China , Feminino , Ferritinas/sangue , Febre de Causa Desconhecida/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Soro/química , Adulto Jovem
20.
PLoS Negl Trop Dis ; 9(11): e0004199, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26580074

RESUMO

Local transmission of Chikungunya virus (CHIKV) was first documented in Trinidad and Tobago (T&T) in July 2014 preceding a large epidemic. At initial presentation, it is difficult to distinguish chikungunya fever (CHIKF) from other acute undifferentiated febrile illnesses (AUFIs), including life-threatening dengue disease. We characterised and compared dengue virus (DENV) and CHIKV infections in 158 patients presenting with suspected dengue fever (DF) and CHIKF at a major hospital in T&T, and performed phylogenetic analyses on CHIKV genomic sequences recovered from 8 individuals. The characteristics of patients with and without PCR-confirmed CHIKV were compared using Pearson's χ2 and student's t-tests, and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were determined using logistic regression. We then compared signs and symptoms of people with RT-qPCR-confirmed CHIKV and DENV infections using the Mann-Whitney U, Pearson's χ2 and Fisher's exact tests. Among the 158 persons there were 8 (6%) RT-qPCR-confirmed DENV and 30 (22%) RT-qPCR-confirmed CHIKV infections. Phylogenetic analyses showed that the CHIKV strains belonged to the Asian genotype and were most closely related to a British Virgin Islands strain isolated at the beginning of the 2013/14 outbreak in the Americas. Compared to persons who were RT-qPCR-negative for CHIKV, RT-qPCR-positive individuals were significantly more likely to have joint pain (aOR: 4.52 [95% CI: 1.28-16.00]), less likely to be interviewed at a later stage of illness (days post onset of fever--aOR: 0.56 [0.40-0.78]) and had a lower white blood cell count (aOR: 0.83 [0.71-0.96]). Among the 38 patients with RT-qPCR-confirmed CHIKV or DENV, there were no significant differences in symptomatic presentation. However when individuals with serological evidence of recent DENV or CHIKV infection were included in the analyses, there were key differences in clinical presentation between CHIKF and other AUFIs including DF, which can be used to triage patients for appropriate care in the clinical setting.


Assuntos
Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , Vírus Chikungunya/isolamento & purificação , Dengue/diagnóstico , Dengue/epidemiologia , Técnicas de Diagnóstico Molecular/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Febre de Chikungunya/patologia , Vírus Chikungunya/classificação , Vírus Chikungunya/genética , Dengue/patologia , Diagnóstico Diferencial , Feminino , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/epidemiologia , Febre de Causa Desconhecida/patologia , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Filogenia , RNA Viral/genética , Análise de Sequência de DNA , Homologia de Sequência , Trinidad e Tobago/epidemiologia , Adulto Jovem
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