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1.
BMJ Case Rep ; 14(5)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059537

RESUMO

A 35-year-old woman presented with a constellation of systemic symptoms: rashes, weight loss, arthralgia and mouth ulcers. Six months afterwards, she experienced bilateral and sequential reduction in vision, and was found to have bilateral vaso-occlusive retinopathy, with critical macular ischaemia in the left eye. Her serological markers were consistent with a diagnosis of lupus. A lymph node biopsy confirmed Kikuchi-Fujimoto disease, a benign condition of unknown cause characterised by fever, cervical and axillary lymphadenopathy. Given that this overlap syndrome was associated with a number of systemic features and had affected the eyes, an immunosuppressive regime with rituximab was considered prudent. This rendered her vasculitis stable and non-progressive, and there were signs of partial retinal microvasculature recovery on optical coherence tomography angiography. There is increasing evidence of an overlap between Kikuchi-Fujimoto disease and systemic lupus erythematosus, which is associated with vaso-occlusive retinopathy. In these instances, a multidisciplinary approach is warranted, with consideration of appropriate treatment in order to prevent harmful sequelae of vasculitis. Our treatment with rituximab abated the disease process, although close follow-up is paramount to monitor results and side-effects of treatment.


Assuntos
Linfadenite Histiocítica Necrosante , Lúpus Eritematoso Sistêmico , Doenças Retinianas , Adulto , Biópsia , Feminino , Febre , Linfadenite Histiocítica Necrosante/complicações , Linfadenite Histiocítica Necrosante/diagnóstico , Linfadenite Histiocítica Necrosante/tratamento farmacológico , Humanos , Lúpus Eritematoso Sistêmico/complicações
2.
BMC Infect Dis ; 21(1): 539, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098893

RESUMO

BACKGROUND: In sub-Saharan Africa, acute respiratory infections (ARI), acute gastrointestinal infections (GI) and acute febrile disease of unknown cause (AFDUC) have a large disease burden, especially among children, while respective aetiologies often remain unresolved. The need for robust infectious disease surveillance to detect emerging pathogens along with common human pathogens has been highlighted by the ongoing novel coronavirus disease 2019 (COVID-19) pandemic. The African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA) is a sentinel surveillance study on the aetiology and clinical characteristics of ARI, GI and AFDUC in sub-Saharan Africa. METHODS: ANDEMIA includes 12 urban and rural health care facilities in four African countries (Côte d'Ivoire, Burkina Faso, Democratic Republic of the Congo and Republic of South Africa). It was piloted in 2018 in Côte d'Ivoire and the initial phase will run from 2019 to 2021. Case definitions for ARI, GI and AFDUC were established, as well as syndrome-specific sampling algorithms including the collection of blood, naso- and oropharyngeal swabs and stool. Samples are tested using comprehensive diagnostic protocols, ranging from classic bacteriology and antimicrobial resistance screening to multiplex real-time polymerase chain reaction (PCR) systems and High Throughput Sequencing. In March 2020, PCR testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and analysis of full genomic information was included in the study. Standardised questionnaires collect relevant clinical, demographic, socio-economic and behavioural data for epidemiologic analyses. Controls are enrolled over a 12-month period for a nested case-control study. Data will be assessed descriptively and aetiologies will be evaluated using a latent class analysis among cases. Among cases and controls, an integrated analytic approach using logistic regression and Bayesian estimation will be employed to improve the assessment of aetiology and associated risk factors. DISCUSSION: ANDEMIA aims to expand our understanding of ARI, GI and AFDUC aetiologies in sub-Saharan Africa using a comprehensive laboratory diagnostics strategy. It will foster early detection of emerging threats and continued monitoring of important common pathogens. The network collaboration will be strengthened and site diagnostic capacities will be reinforced to improve quality management and patient care.


Assuntos
Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/epidemiologia , Programas de Rastreamento , Vigilância de Evento Sentinela , Teorema de Bayes , Burkina Faso , Estudos de Casos e Controles , Costa do Marfim , República Democrática do Congo , Febre/epidemiologia , Febre/microbiologia , Gastroenteropatias/epidemiologia , Gastroenteropatias/microbiologia , Humanos , Reação em Cadeia da Polimerase em Tempo Real , Infecções Respiratórias/epidemiologia , África do Sul
3.
Medicina (Kaunas) ; 57(5)2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-34062973

RESUMO

We present a case of tularemia complicated by rhabdomyolysis in a 43-year-old male who presented with fever, swelling, and pain of the right groin and a history of a week-old tick bite. Empirical parenteral amoxicillin/clavulanic acid treatment was initiated. Suspecting tularemia, parenteral gentamycin was added. Later, the patient started to complain of muscle pain, weakness, and difficulties in breathing and walking. Heightened levels of creatine kinase and myoglobin concentration (42,670 IU/L and >12,000 µg/L, respectively) were found. Due to rhabdomyolysis, large amounts of intravenous fluid therapy were initiated to prevent kidney damage, continuing intravenous antibiotic therapy. Francisella tularensis IgG in serum was found to be positive only on the sixteenth day of hospitalization. Upon discharge, the laboratory analyses returned to normal levels, and the patient was in good condition. The successful outcome could be associated with the early appropriate therapy of tularemia and its rare complication of rhabdomyolysis.


Assuntos
Francisella tularensis , Rabdomiólise , Tularemia , Adulto , Anticorpos Antibacterianos , Febre , Humanos , Masculino , Rabdomiólise/complicações , Tularemia/complicações , Tularemia/diagnóstico , Tularemia/tratamento farmacológico
4.
J Enzyme Inhib Med Chem ; 36(1): 1230-1235, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34074197

RESUMO

The ongoing Covid-19 is a contagious disease, and it is characterised by different symptoms such as fever, cough, and shortness of breath. Rising concerns about Covid-19 have severely affected the healthcare system in all countries as the Covid-19 outbreak has developed at a rapid rate all around the globe. Intriguing, a clinically used drug, acetazolamide (a specific inhibitor of carbonic anhydrase, CA, EC 4.2.1.1), is used to treat high-altitude pulmonary oedema (HAPE), showing a high degree of clinical similarities with the pulmonary disease caused by Covid-19. In this context, this preliminary study aims to provide insights into some factors affecting the Covid-19 patients, such as hypoxaemia, hypoxia as well as the blood CA activity. We hypothesise that patients with Covid-19 problems could show a dysregulated acid-base status influenced by CA activity. These preliminary results suggest that the use of CA inhibitors as a pharmacological treatment for Covid-19 may be beneficial.


Assuntos
Acetazolamida/uso terapêutico , Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , Inibidores da Anidrase Carbônica/uso terapêutico , Anidrases Carbônicas/sangue , Equilíbrio Ácido-Base/efeitos dos fármacos , Doença da Altitude/sangue , Doença da Altitude/tratamento farmacológico , Anticonvulsivantes/uso terapêutico , Bicarbonatos/sangue , COVID-19/sangue , COVID-19/diagnóstico por imagem , COVID-19/virologia , Dióxido de Carbono/sangue , Tosse/sangue , Tosse/tratamento farmacológico , Tosse/patologia , Tosse/virologia , Reposicionamento de Medicamentos , Dispneia/sangue , Dispneia/tratamento farmacológico , Dispneia/patologia , Dispneia/virologia , Febre/sangue , Febre/tratamento farmacológico , Febre/patologia , Febre/virologia , Humanos , Concentração de Íons de Hidrogênio , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/tratamento farmacológico , Hipóxia/sangue , Hipóxia/tratamento farmacológico , Hipóxia/patologia , Hipóxia/virologia , Oximetria , Projetos de Pesquisa , SARS-CoV-2/patogenicidade , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
5.
Pan Afr Med J ; 38: 259, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104307

RESUMO

Introduction: acute diarrhea in children under five years is a public health problem in developing countries and particularly in malaria-endemic areas where both diseases co-exist. The present study examined the etiology of childhood diarrhea and its comorbidity with malaria in a rural area of Burkina Faso. Methods: conventional culture techniques, direct stools examination, and viruses´ detection by rapid tests were performed on the fresh stools and microscopy was used to diagnose malaria. Some risk factors were also assessed. Results: on a total of 191 samples collected, at least one pathogen was identified in 89 cases (46.6%). The proportions of pathogens found on the 89 positive stool samples were parasites 51.69% (46 cases), viruses 39.33% (35 cases), and bacteria 14.61% (13 cases), respectively. The relationship between malaria and infectious diarrhea was significant in viral and parasites causes (p=0.005 and 0.043 respectively). Fever, vomiting and abdominal pain were the major symptoms associated with diarrhea, with 71.51%, 31.72% and 23.66% respectively. The highest viral diarrhea prevalence was reported during the dry season (OR=5.29, 95% CI: 1.74 - 16.07, p=0.001) while parasite diarrhea was more encountered during the rainy season (OR=0.41, 95% CI: 0.33 - 0.87, p=0.011). Conclusion: Giardia spp and rotavirus were the leading cause of acute diarrhea in Nanoro, Burkina Faso with a predominance of rotavirus in children less than 2 years. Parasite and viral diarrhea were the most pathogens associated with malaria. However, the high rate of negative stool samples suggests the need to determine other enteric microorganisms.


Assuntos
Diarreia/epidemiologia , Malária/epidemiologia , População Rural , Dor Abdominal/epidemiologia , Doença Aguda , Burkina Faso/epidemiologia , Pré-Escolar , Comorbidade , Diarreia/microbiologia , Feminino , Febre/epidemiologia , Giardíase/epidemiologia , Humanos , Lactente , Masculino , Prevalência , Fatores de Risco , Infecções por Rotavirus/epidemiologia , Estações do Ano , Vômito/epidemiologia
6.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 50(1): 74-80, 2021 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-34117848

RESUMO

To develop a quality control checklist for the prevention and control of coronavirus disease 2019 (COVID-19) in fever clinic and isolation ward of the general hospital and to assess its application. Based on the relevant prevention and control plans and technical guidelines for COVID-19,Delphi method was used to identity items for evaluation,and a quality control checklist for the prevention and control of COVID-19 in the fever clinic and isolation ward was developed in Sir Run Run Shaw Hospital. The checklists included 8 dimensions and 32 items for fever clinic,7 dimensions and 27 items for the isolation ward. The appointed inspectors conducted daily quality control for each shift with this checklist. The expert authority coefficient was 0.88,the mean of the importance of each index in the quality control table was not less than 4.8,and the coefficient of variation was not more than 0.07. During the entire February 2020,8 problems were found and rectified on-the-spot with the application of the checklist. Quality inspection rate was 100% in both isolation wards and fever clinic. The compliance rate and accuracy rate of hand hygiene were 100%; the correct rate of wearing and removing protective equipment increased from 96% to 100%. During the same period,a total of 1915 patients were admitted to the fever clinic,including 191 suspected patients (all were isolated in the hospital,3 were confirmed). There were no medical staff infected with COVID-19,no cross infection of patients and their families in the hospital. A quality control checklist for the prevention and control of COVID-19 has been developed and applied in the isolation wards and fever clinic,which plays an important role in preventing nosocomial infection.


Assuntos
COVID-19 , Lista de Checagem , Febre , Hospitais Gerais , Humanos , SARS-CoV-2
7.
Brain Nerve ; 73(6): 737-740, 2021 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-34127570

RESUMO

A 73-year-old woman with untreated diabetes mellitus visited our emergency department with a 4-day history of progressive headache, fever, and chills. She received trigger point injections (TPI) into the right sternocleidomastoid for exercise-induced ipsilateral shoulder pain, 13 days before admission and into the right trapezius, 6 days before admission. Cerebrospinal fluid (CSF) evaluation revealed pleocytosis with a predominance of neutrophils, as well as elevated protein and reduced glucose levels. Magnetic resonance imaging of the cervical spine revealed inflammatory changes of the right-sided posterior cervical muscles and the right vertebral arch of the C5-C6 vertebrae without contrast enhancement of the right posterior cervical veins. She was diagnosed with bacterial meningitis and suppurative thrombophlebitis, and empiric broad-spectrum antibiotic therapy was administered intravenously. The initial blood culture yielded Streptococcus intermedius; however, CSF culture showed no growth. She recovered completely after a 4-week course of intravenously administered ampicillin and was discharged with oral clindamycin to complete a total 6-week antibiotic course. TPI are widely used as a safe therapeutic strategy associated with few complications, and serious infections are rare. However, clinicians must remain mindful of the possibility of these complications in immunocompromised patients, such as those with diabetes mellitus who undergo TPI. (Received September 18, 2020; Accepted December 21, 2020; Published June 1, 2021).


Assuntos
Meningites Bacterianas , Tromboflebite , Idoso , Feminino , Febre , Humanos , Imageamento por Ressonância Magnética , Meningites Bacterianas/tratamento farmacológico , Tromboflebite/diagnóstico por imagem , Tromboflebite/tratamento farmacológico , Pontos-Gatilho
8.
Sci Rep ; 11(1): 11832, 2021 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-34088919

RESUMO

Among the myriad of challenges healthcare institutions face in dealing with coronavirus disease 2019 (COVID-19), screening for the detection of febrile persons entering facilities remains problematic, particularly when paired with CDC and WHO spatial distancing guidance. Aggressive source control measures during the outbreak of COVID-19 has led to re-purposed use of noncontact infrared thermometry (NCIT) for temperature screening. This study was commissioned to establish the efficacy of this technology for temperature screening by healthcare facilities. We conducted a prospective, observational, single-center study in a level II trauma center at the onset of the COVID-19 outbreak to assess (i) method agreement between NCIT and temporal artery reference temperature, (ii) diagnostic accuracy of NCIT in detecting referent temperature [Formula: see text] and ensuing test sensitivity and specificity and (iii) technical limitations of this technology. Of 51 healthy, non-febrile, healthcare workers surveyed, the mean temporal artery temperature was [Formula: see text] ([Formula: see text] confidence interval (CI) = [Formula: see text]). Mean NCIT temperatures measured from [Formula: see text], [Formula: see text], and [Formula: see text] distances were [Formula: see text] [Formula: see text], [Formula: see text] [Formula: see text], and [Formula: see text] [Formula: see text], respectively. From statistical analysis, the only method in sufficient agreement with the reference standard was NCIT at [Formula: see text]. This demonstrated that the device offset (mean temperature difference) between these methods was [Formula: see text] ([Formula: see text]) with 95% of measurement differences within [Formula: see text] ([Formula: see text]) and [Formula: see text] ([Formula: see text]). By setting the NCIT screening threshold to [Formula: see text] at [Formula: see text], we achieve diagnostic accuracy with [Formula: see text] test sensitivity and specificity for temperature detection [Formula: see text] by reference standard. In comparison, reducing this screening criterion to the lower limit of the device-specific offset, such as [Formula: see text], produces a highly sensitive screening test at [Formula: see text], which may be favorable in high-risk pandemic disease. For future consideration, an infrared device with a higher distance-to-spot size ratio approaching 50:1 would theoretically produce similar results at [Formula: see text], in accordance with CDC and WHO spatial distancing guidelines.


Assuntos
COVID-19/diagnóstico , Febre/diagnóstico , Termometria/instrumentação , Adulto , Idoso , Temperatura Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto Jovem
9.
BMC Public Health ; 21(1): 1075, 2021 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090402

RESUMO

BACKGROUND: Febrile diseases in Sub-Saharan Africa cause acute and chronic illness. Co-infections are common and these diseases have a complex etiology that includes zoonoses. For the implementation of appropriate treatment and control strategies, determinants of lay treatment-seeking behavior by the affected communities need to be understood. The objective of this study was to explore, using the socio-ecological model, the determinants of treatment-seeking actions among self-identified febrile illness cases in the Kilombero District of Tanzania. METHODS: Thirty-nine in-depth interviews were conducted with 28 men and 11 women in three villages in Kilombero district. These villages were purposively selected due to malaria endemicity in the area, animal husbandry practices, and proximity to livestock-wildlife interaction, all risk factors for contracting febrile zoonotic infections. Thematic analysis was conducted on the interviews to identify the key determinants of treatment-seeking actions. RESULTS: Study participants attributed febrile illnesses to malaria, typhoid and urinary tract infections. Treatment-seeking behavior was an iterative process, influenced by individual, socio-cultural, ecological and policy factors. Age, expendable income, previous history with a febrile illness, perceptions on disease severity, seasonal livelihood activities and access to timely healthcare were some of the determinants. Self-treatment with pharmaceutical drugs and herbs was usually the initial course of action. Formal healthcare was sought only when self-treatment failed and traditional healers were consulted after the perceived failure of conventional treatment. Delays in seeking appropriate health care and the consultation of medically unqualified individuals was very common. CONCLUSION: The results imply that treatment-seeking behavior is shaped by multiple factors across all levels of the socio-ecological model. Public policy efforts need to focus on facilitating prompt health care seeking through community education on the complicated etiology of febrile illnesses. Improved access to timely treatment and better differential diagnostics by health professionals are essential to ensure correct and appropriate treatment and to reduce reliance of patients on unqualified persons.


Assuntos
Malária , Animais , Feminino , Febre/epidemiologia , Febre/etiologia , Febre/terapia , Humanos , Malária/tratamento farmacológico , Malária/epidemiologia , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Autorrelato , Tanzânia/epidemiologia
10.
BMJ Case Rep ; 14(5)2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980565

RESUMO

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but often severe complication of SARS-CoV-2 infection. While several case reports about MIS-A in the setting of COVID-19 have been published since the term was first coined in June 2020, a clear description of the underlying pathophysiology and guideline-based recommendations on the diagnostic and therapeutic approach are lacking. What has been reported is that in the absence of severe respiratory illness, MIS-A can present with hypotension or shock, high-grade fever, abdominal pain, diarrhoea and severe weakness days to weeks after SARS-CoV-2 infection. Here, we present a case of a 28-year-old man who presented with a rarely described initial symptom: unilateral neck swelling. His presentation, disease progression and treatment course provide further information about MIS-A as a complication and in formulating diagnostic guidelines.


Assuntos
COVID-19 , SARS-CoV-2 , Dor Abdominal , Adulto , Diarreia , Febre/etiologia , Humanos , Masculino , Síndrome de Resposta Inflamatória Sistêmica
11.
BMJ Case Rep ; 14(4)2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33931425

RESUMO

A 9-day-old girl presented during the 2020 SARS-CoV-2 pandemic in wide-complex tachycardia with acute, symptomatic COVID-19 infection. Because the potential cardiac complications of COVID-19 were unknown at the time of her presentation, we chose to avoid the potential risks of haemodynamic collapse associated with afterload reduction from adenosine. Instead, a transoesophageal pacing catheter was placed. Supraventricular tachycardia (SVT) with an aberrated QRS morphology was diagnosed and the catheter was used to pace-terminate tachycardia. This presentation illustrates that the haemodynamic consequences of a concurrent infection with largely unknown neonatal sequelae present a potentially high-risk situation for pharmacologic conversion. Oesophageal cannulation can be used to diagnose and terminate infantile SVT.


Assuntos
COVID-19 , Febre , Taquicardia Supraventricular , COVID-19/complicações , COVID-19/diagnóstico , Feminino , Febre/virologia , Humanos , Recém-Nascido , Taquicardia Supraventricular/virologia
12.
BMC Infect Dis ; 21(1): 415, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947336

RESUMO

BACKGROUND: Kawasaki disease (KD) is the most common cause of acquired heart disease among children in developed countries, in which the resulting coronary artery (CA) abnormalities cause myocardial ischemia, infarction, and death. Prompt diagnosis was essential, and supplemental information should be used to assist the diagnosis when classical clinical criteria are incomplete. The elevated levels of serum transaminases in most KD patients are mild. Herein, a case of atypical KD child with severely elevated transaminase was reported. CASE PRESENTATION: A child with clinical manifestations of fever, high C-reactive protein (CRP) and severely elevated transaminases was reported. The treatment effect of antibiotic and liver-protecting drugs was not satisfactory. A bilateral diffuse dilation of the CA was detected on echocardiography on day 5 of the illness; thus, atypical KD was diagnosed. Elevated transaminases declined rapidly to normal after the treatment of intravenous immunoglobulin (IVIG). A 1-month follow-up revealed that CA returned to normal, and 2-month, 6-months, and 1-year follow-up revealed the child was in good general health. CONCLUSIONS: This case highlighted that atypical KD clinical symptoms were diverse, and severely elevated transaminases might provide a clue to healthcare providers for the diagnosis and management of atypical KD.


Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Síndrome de Linfonodos Mucocutâneos/etiologia , Transaminases/sangue , Proteína C-Reativa/análise , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Ecocardiografia , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Lactente , Masculino
13.
BMC Infect Dis ; 21(1): 442, 2021 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-33992076

RESUMO

BACKGROUND: In resource-limited settings, where rubella is endemic, it is difficult to determine which sporadic case should be tested for rubella. The study aimed to provide useful evidence to help screen rubella cases for real-time reverse transcriptase-polymerase chain reaction (RT-PCR) examination for rubella in resource-limited settings. METHOD: Suspected rubella patients identified by a physician and brought to the notice of the Ryugasaki public health center or the Tsuchiura public health center were enrolled from April 2018 through December 2019. The inclusion criterion was a confirmed rubella diagnosis based on laboratory tests. We studied the distribution of the time from the onset of fever until the onset of rash. RESULTS: The study included 86 cases with simultaneous presentation of fever and rash. Twenty-nine cases had confirmed rubella based on the laboratory diagnosis. Among these, the time from the onset of fever until the onset of rash was limited to - 1 day to 2 days. The number of rubella cases was the highest when the onset of rash was on the following day of the onset of fever. Of the 78 patients who underwent the RT-PCR test, 48% tested positive for rubella among those with a time from the onset of fever to the onset of rash between - 1 day and 2 days (22 out of 46, 95% confidence interval 34-62%); no positive results (0 out of 30, 95% confidence interval - 14%) were seen in patients with a time from fever to rash onset ≥3 days. CONCLUSION: The period from the onset of fever to the onset of rash was limited to - 1 day to 2 days among confirmed rubella patients. If the period from onset of fever to the onset of rash was ≥3 days for a patient, the likelihood of rubella was low.


Assuntos
Exantema/complicações , Febre/complicações , Rubéola (Sarampo Alemão)/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , RNA Viral/análise , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rubéola (Sarampo Alemão)/complicações , Vírus da Rubéola/genética , Vírus da Rubéola/isolamento & purificação , Fatores de Tempo , Adulto Jovem
14.
PLoS One ; 16(5): e0251250, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34003850

RESUMO

OBJECTIVES: Clinical characterisation studies have been essential in helping inform research, diagnosis and clinical management efforts, particularly early in a pandemic. This systematic review summarises the early literature on clinical characteristics of patients admitted to hospital, and evaluates the quality of evidence produced during the initial stages of the pandemic. METHODS: MEDLINE, EMBASE and Global Health databases were searched for studies published from January 1st 2020 to April 28th 2020. Studies which reported on at least 100 hospitalised patients with Covid-19 of any age were included. Data on clinical characteristics were independently extracted by two review authors. Study design specific critical appraisal tools were used to evaluate included studies: the Newcastle Ottawa scale for cohort and cross sectional studies, Joanna Briggs Institute checklist for case series and the Cochrane collaboration tool for assessing risk of bias in randomised trials. RESULTS: The search yielded 78 studies presenting data on 77,443 people. Most studies (82%) were conducted in China. No studies included patients from low- and middle-income countries. The overall quality of included studies was low to moderate, and the majority of studies did not include a control group. Fever and cough were the most commonly reported symptoms early in the pandemic. Laboratory and imaging findings were diverse with lymphocytopenia and ground glass opacities the most common findings respectively. Clinical data in children and vulnerable populations were limited. CONCLUSIONS: The early Covid-19 literature had moderate to high risk of bias and presented several methodological issues. Early clinical characterisation studies should aim to include different at-risk populations, including patients in non-hospital settings. Pandemic preparedness requires collection tools to ensure observational studies are methodologically robust and will help produce high-quality data early on in the pandemic to guide clinical practice and public health policy. REVIEW REGISTRATION: Available at https://osf.io/mpafn.


Assuntos
COVID-19/patologia , Proteína C-Reativa/análise , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/virologia , Tosse/epidemiologia , Tosse/etiologia , Bases de Dados Factuais , Febre/epidemiologia , Febre/etiologia , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Linfopenia/etiologia , Pandemias , SARS-CoV-2/isolamento & purificação
15.
BMJ Case Rep ; 14(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011642

RESUMO

A 50-year-old woman, with a background of autoimmune haemolytic anaemia, presented to the emergency department with lethargy and shortness of breath. Investigations revealed a haemoglobin level of 50 g/L. High dose steroids were administered and blood transfusion prescribed. However, the blood transfusion was delayed due to a positive antibody screen and concerns regarding administering blood when the patient was pyrexic. The delay resulted in a significant deterioration in the patient's clinical state with her haemoglobin level falling to 26 g/L 24 hours later. She was urgently transfused with blood and made a full recovery. This report analyses the delays for transfusion and how these could have been minimised. First, guidelines advise that emergency blood should be considered in life-threatening circumstances. Second, fever is not always a contraindication for transfusion, particularly in an emergency setting.


Assuntos
Anemia Hemolítica Autoimune , Anemia Hemolítica Autoimune/complicações , Anemia Hemolítica Autoimune/diagnóstico , Anemia Hemolítica Autoimune/terapia , Transfusão de Sangue , Dispneia , Serviço Hospitalar de Emergência , Feminino , Febre , Humanos , Pessoa de Meia-Idade
16.
BMJ Case Rep ; 14(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011672

RESUMO

Familial Mediterranean fever (FMF) is an autoinflammatory disease caused by a pyrin dysfunction, leading to uncontrolled interleukin-1 production that triggers the attacks. Here we report a case of a 36-year-old female patient repeatedly admitted to the cardiology ward with recurrent episodes of pericarditis, with intervals of 1 and 2 months between the episodes. During the attacks, chest pain and fever were the only symptoms. Following the administration of steroids and non-steroidal anti-inflammatory drugs, the patient became afebrile. She also had lymphoma and thyroid carcinoma in anamnesis essential for differential diagnosis. Laboratory tests for infection and autoimmune disease were all negative, and the positron emission tomography-CT scan did not reveal lymphoma relapse. Genetic testing revealed a mutation in the MEFV gene. It is very rare for pericarditis to be the first and only manifestation of FMF.


Assuntos
Febre Familiar do Mediterrâneo , Pericardite , Adulto , Febre Familiar do Mediterrâneo/complicações , Febre Familiar do Mediterrâneo/tratamento farmacológico , Febre Familiar do Mediterrâneo/genética , Feminino , Febre , Humanos , Mutação , Recidiva Local de Neoplasia , Pericardite/etiologia , Pirina/genética
17.
Rev Gaucha Enferm ; 42(spe): e20200205, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34037180

RESUMO

OBJECTIVE: To identify symptoms of COVID-19 in adults in the scientific literature. METHOD: Systematic review of studies published from December 1, 2019 to April 21, 2020 from the Scopus, Web of Science and PubMed databases, in order to answer the following research question: "What are the symptoms caused by COVID-19 in adults?" using the keywords "Symptoms", "Clinical Manifestations", "Coronavirus", "COVID-19". RESULTS: Of the total 105 references, 13 references that addressed the symptoms of COVID-19 were selected. Fever and normal or dry cough were symptoms present in all studies. CONCLUSION: The symptoms identified in adult patients were fever, normal or dry cough, headache, pharyngalgia, dyspnea, diarrhea, myalgia, vomiting, sputum or expectoration, anxiety or chest pain, fatigue, nausea, anorexia, abdominal pain, rhinorrhea, runny nose or nasal congestion, dizziness, chills, systemic pain, mental confusion, hemoptysis, asthma, taste disorder, smell disorder, belching and tachycardia.


Assuntos
COVID-19/diagnóstico , Avaliação de Sintomas , Adulto , COVID-19/complicações , Tosse/diagnóstico , Tosse/etiologia , Estudos Transversais , Diarreia/diagnóstico , Diarreia/etiologia , Dispneia/diagnóstico , Dispneia/etiologia , Fadiga/diagnóstico , Fadiga/etiologia , Febre/diagnóstico , Febre/etiologia , Humanos , Pessoa de Meia-Idade
18.
BMC Res Notes ; 14(1): 209, 2021 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-34051849

RESUMO

OBJECTIVE: This study was carried out to determine the prevalence of leptospirosis among febrile patients with a suspicious clinical diagnosis of dengue fever in northern Peru. RESULTS: A total of 276 serum samples from patients with acute febrile illness (AFI) and suspected diagnosis for dengue virus (DENV) were analyzed. We identified an etiological agent in 121 (47.5%) patients, DENV was detected in 30.4% of the cases, leptospirosis in 11.2% and co-infection by both pathogens was observed in 5.9% of the patients. In this study the most common clinical symptoms reported by the patients were: headache 89.1%, myalgias 86.9% and arthralgias 82.9%. No differences in symptomatology was observed among the different study groups.


Assuntos
Coinfecção , Dengue , Leptospirose , Dengue/complicações , Dengue/diagnóstico , Febre/diagnóstico , Humanos , Leptospirose/complicações , Leptospirose/diagnóstico , Peru/epidemiologia
19.
Lancet Haematol ; 8(6): e433-e445, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34048682

RESUMO

BACKGROUND: Novel approaches are required to improve outcomes in relapsed or refractory classical Hodgkin lymphoma and non-Hodgkin lymphoma. We aimed to evaluate camidanlumab tesirine, an anti-CD25 antibody-drug conjugate, in this patient population. METHODS: This was a phase 1, dose-escalation (part 1), dose-expansion (part 2), multicentre trial done in 12 hospital sites (seven in the USA and five in the UK). Adults (≥18 years old) with pathologically confirmed relapsed or refractory classical Hodgkin lymphoma or non-Hodgkin lymphoma, an Eastern Cooperative Oncology Group performance status 0-2, who had no therapies available to them with established clinical benefit for their disease stage were enrolled. Camidanlumab tesirine was administered intravenously (3-150 µg/kg) once every 3 weeks. Primary objectives were to assess dose-limiting toxicity, determine maximum tolerated dose and recommended expansion dose(s), and assess safety of camidanlumab tesirine. Safety was assessed in all treated patients; antitumour activity was assessed in patients with one or more valid baseline and post-baseline disease assessment and in those who had disease progression or died after first study-drug dose. This trial was registered with ClinicalTrials.gov, NCT02432235. FINDINGS: Between Oct 5, 2015, and Jun 30, 2019, 133 patients were enrolled (77 [58%] had classical Hodgkin lymphoma and 56 (42%) had non-Hodgkin lymphoma). Median follow-up was 9·2 months (IQR 4·2-14·3). Eight dose-limiting toxicities were reported in five (6%) of 86 patients who were evaluable; the maximum tolerated dose was not reached. The recommended doses for expansion were 30 µg/kg and 45 µg/kg for patients with classical Hodgkin lymphoma and 80 µg/kg for patients with T-cell non-Hodgkin lymphomas. No recommended doses for expansion were defined for B-cell non-Hodgkin lymphomas. Grade 3 or worse treatment-emergent adverse events (reported by ≥10% of the 133 patients) included increased γ-glutamyltransferase (20 [15%] patients), maculopapular rash (16 [12%]), and anaemia (15 [11%]); 74 (56%) patients had serious treatment-emergent adverse events, most commonly pyrexia (16 [12%]). One (1%) fatal treatment-emergent adverse event and two (2%) deaths outside the reporting period were considered at least possibly study-drug related. Antitumoural activity was seen in classical Hodgkin and non-Hodgkin lymphomas; notably in all patients with classical Hodgkin lymphoma, the overall response was 71% (95% CI 60-81). INTERPRETATION: These results warrant evaluation of camidanlumab tesirine as a potential treatment option for relapsed or refractory lymphoma, particularly in patients with classical Hodgkin lymphoma. FUNDING: ADC Therapeutics.


Assuntos
Imunoconjugados/uso terapêutico , Linfoma/tratamento farmacológico , Administração Intravenosa , Adulto , Idoso , Esquema de Medicação , Exantema/etiologia , Exantema/patologia , Feminino , Febre/etiologia , Febre/patologia , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/patologia , Humanos , Imunoconjugados/efeitos adversos , Subunidade alfa de Receptor de Interleucina-2/imunologia , Estimativa de Kaplan-Meier , Linfoma/mortalidade , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva , Índice de Gravidade de Doença , Resultado do Tratamento
20.
Sci Rep ; 11(1): 10902, 2021 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-34035353

RESUMO

The objective of this study was to detect the Epstein-Barr virus (EBV) coinfection in coronavirus disease 2019 (COVID-19). In this retrospective single-center study, we included 67 COVID-19 patients with onset time within 2 weeks in Renmin Hospital of Wuhan University from January 9 to February 29, 2020. Patients were divided into EBV/SARS-CoV-2 coinfection group and SARS-CoV-2 infection alone group according to the serological results of EBV, and the characteristics differences between the two groups were compared. The median age was 37 years, with 35 (52.2%) females. Among these COVID-19 patients, thirty-seven (55.2%) patients were seropositive for EBV viral capsid antigen (VCA) IgM antibody. EBV/SARS-CoV-2 coinfection patients had a 3.09-fold risk of having a fever symptom than SARS-CoV-2 infection alone patients (95% CI 1.11-8.56; P = 0.03). C-reactive protein (CRP) (P = 0.02) and the aspartate aminotransferase (AST) (P = 0.04) in EBV/SARS-CoV-2 coinfection patients were higher than that in SARS-CoV-2 infection alone patients. EBV/SARS-CoV-2 coinfection patients had a higher portion of corticosteroid use than the SARS-CoV-2 infection alone patients (P = 0.03). We find a high incidence of EBV coinfection in COVID-19 patients. EBV/SARS-CoV-2 coinfection was associated with fever and increased inflammation. EBV reactivation may associated with the severity of COVID-19.


Assuntos
Anticorpos Antivirais/sangue , COVID-19/patologia , Infecções por Vírus Epstein-Barr/patologia , Herpesvirus Humano 4/isolamento & purificação , Corticosteroides/uso terapêutico , Adulto , Aspartato Aminotransferases/sangue , Proteína C-Reativa/análise , COVID-19/complicações , COVID-19/virologia , Proteínas do Capsídeo/imunologia , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Infecções por Vírus Epstein-Barr/virologia , Feminino , Febre/etiologia , Herpesvirus Humano 4/imunologia , Herpesvirus Humano 4/metabolismo , Humanos , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença
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