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1.
Pediatr Ann ; 53(6): e202-e207, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38852083

RESUMO

For more than 4 decades, pediatricians have sought the best practices for effectively managing well-appearing young febrile infants. In 2021, the American Academy of Pediatrics released a clinical practice guideline for the management of well-appearing febrile infants aged 8 to 60 days. The guideline incorporates advancements in testing, such as biomarkers and diagnostic testing in the setting of changing epidemiology, to help risk stratify infants in the newly formed group age 22 to 28 days as well as the group age 29 to 60 days. The new guideline uses inflammatory markers (procalcitonin, C-reactive protein, absolute neutrophil count, and a temperature >38.4°C) to identify infants at low risk for invasive bacterial infection who can potentially avoid the invasive procedures of lumbar puncture, hospitalization, and broad-spectrum antimicrobials. Because of continued ambiguity, incorporating shared decision-making with families in the care of these infants will be important, as will ongoing clinical research to better inform future practice. [Pediatr Ann. 2024;53(6):e202-e207.].


Assuntos
Febre , Pediatria , Guias de Prática Clínica como Assunto , Humanos , Lactente , Febre/etiologia , Febre/diagnóstico , Recém-Nascido , Pediatria/métodos , Pediatria/normas , Estados Unidos , Antibacterianos/uso terapêutico , Sociedades Médicas , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Biomarcadores/sangue
2.
Medicine (Baltimore) ; 103(24): e38615, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38875366

RESUMO

RATIONALE: Urachal anomalies are rare and can present with various clinical manifestations. Urachal remnants, in particular, can be difficult to diagnose because of atypical symptoms at presentation. This study reports a case of intestinal obstruction in an infant secondary to an infected urachal cyst. PATIENTS CONCERNS: A 3-month-old boy with a known febrile urinary tract infection developed acute abdominal distension. DIAGNOSES: Abdominal ultrasound (US) and computed tomography (CT) revealed a nonspecific, ill-defined soft tissue density at the mid-abdomen, associated with intestinal obstruction. INTERVENTIONS: Emergency exploratory laparotomy was performed. The site of the obstruction was found to be at the mid-small bowel; the proximal small bowel was markedly distended, and the small bowel and sigmoid colon were adherent to urachal remnant. The urachal remnant was excised, and the peritoneal adhesions were lysed. OUTCOMES: The day after surgery, the patient was discharged without any complications. LESSONS: Intestinal obstruction is an exceedingly rare presentation of urachal remnants. This case highlights that urachal anomalies should be considered in the differential diagnosis in patients with intestinal obstruction and a concurrent febrile urinary tract infection.


Assuntos
Obstrução Intestinal , Cisto do Úraco , Infecções Urinárias , Humanos , Masculino , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Cisto do Úraco/complicações , Cisto do Úraco/diagnóstico , Cisto do Úraco/cirurgia , Lactente , Obstrução Intestinal/etiologia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Febre/etiologia , Diagnóstico Diferencial , Ultrassonografia/métodos
5.
Pediatr Rheumatol Online J ; 22(1): 61, 2024 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-38862943

RESUMO

OBJECTIVES: To characterize the clinical features and to identify the predictors of recurrence of histiocytic necrotizing lymphadenitis (HNL) in Chinese children. STUDY DESIGN: This study retrospectively analyzed the clinical characteristics, laboratory and pathological findings, and recurrence status of children diagnosed with HNL at a single center in China from January 2018 to May 2023. Logistic regression analysis was employed to identify predictors of HNL recurrence. RESULTS: 181 Chinese children with histopathologically confirmed HNL were enrolled (121 males and 60 females). The mean age was 9.3 ± 2.9 years. The most prominent clinical features were fever (98.9%) and cervical lymphadenopathy (98.3%). Aseptic meningitis was the most frequent complication (38.5%), while hemophagocytic lymphohistiocytosis and autoimmune disease were rare (1.7% and 1.2%, respectively). Recurrence occurred in 12.7% of patients. Erythrocyte sedimentation rate (> 30 mm/h) was the significant predictors of HNL recurrence, with odds ratios of 6.107, respectively. CONCLUSION: Our study demonstrates that fever and cervical lymphadenopathy are the most frequent clinical manifestations of HNL in Chinese children, which often coexist with aseptic meningitis. HNL patients with risk factors require follow-up for recurrence.


Assuntos
Linfadenite Histiocítica Necrosante , Recidiva , Humanos , Linfadenite Histiocítica Necrosante/diagnóstico , Linfadenite Histiocítica Necrosante/epidemiologia , Linfadenite Histiocítica Necrosante/patologia , Masculino , Feminino , Criança , Estudos Retrospectivos , China/epidemiologia , Linfadenopatia/etiologia , Febre/etiologia , Fatores de Risco , Pré-Escolar , Adolescente , Meningite Asséptica/epidemiologia , Meningite Asséptica/diagnóstico , População do Leste Asiático
6.
Beijing Da Xue Xue Bao Yi Xue Ban ; 56(3): 533-540, 2024 Jun 18.
Artigo em Chinês | MEDLINE | ID: mdl-38864141

RESUMO

OBJECTIVE: To analyze the clinical data of histiocytic necrotizing lymphadenitis(HNL), comparing the similarities and differences between children and adults, to deepen the understanding of the disease by clinical physicians, and to improve diagnostic rate and reduce misdiagnosis and mistreatment. METHODS: The clinical data of hospitalized patients with histiocytic necrotizing lymphadenitis diagnosed by biopsy from January 2010 to August 2023 in Peking University First Hospital were collec-ted, and the clinical features, laboratory examinations, pathological features, treatments with antibiotics and glucocorticoids, and prognosis of histiocytic necrotic lymphadenitis were analyzed. Grouped based on age, the differences of clinical characteristics, laboratory tests, treatment, and prognosis between the children group (< 16 years old) and the adult group (≥16 years old) were compared. RESULTS: Among the 81 enrolled patients, there were 42 males and 39 females. The median age was 21(14, 29) years, the median duration of disease was 20.0(13.0, 30.0) days, and the median length of hospital stay was 13.0 (10.0, 15.0) days. The first symptoms were fever, lymphadenopathy, and both. All the patients had enlarged lymph nodes with different parts and sizes, 96.3% (78 of 81) of the patients had cervical lymphadenopathy, 50.6% (41 of 81) had bilateral cervical lymphadenopathy, 55.6% (45 of 81) had supraclavicular, axillary or inguinal lymphadenopathy, and the median lymph node diameter was 20.0(20.0, 30.0) mm. Only one patient had no fever, the other 80 patients had fever, the median peak body temperature was 39.0(38.0, 39.8) ℃. Accompanying symptoms: rash (8.6%, 7/81), fatigue (34.6%, 28/81), night sweating (8.6%, 7/81), chills (25.3%, 25/81), muscle soreness (13.6%, 11/81), and joint pain (6.2%, 5/81). There were 17 cases (21.0%, 17/81) of hepatosplenomegaly, of which 12 cases (70.6%, 12/17) were splenomegaly. 68.8%(55/80) of patients had a decrease in white blood cell (WBC) count, with 47.5%(38/80)increased in lymphocyte(LY)proportion, 53.4%(39/73) increased in high-sensitivity C-reactive protein(CRP), 79.2%(57/72) increased in erythrocyte sedimentation rate(ESR), 22.2%(18/81) increased in alanine transaminase(ALT), 27.2%(22/81) elevated in aspartate transaminase(AST), and 81.6%(62/76) elevated in lactate dehydrogenase(LDH). All the 81 patients underwent lymph node biopsy, and 77.8%(63/81) of the patients showed that most of the structures in the lymph nodes were destroyed or disappeared, and 16.0%(13/81) of the lymph nodes were still in existence, hyperplasia and normal lymph node were 1.2%(1/81) respectively, and 3.7%(3/81) had normal lymph node structures. Immunohistochemical staining was performed in 67 cases. The percentages of CD3+ and CD68(KP1)+ were respectively 97.0%(65/67), and MPO+ were 94.0%(63/67). In the study, 51 patients (63.0%, 51/81) were treated with glucocorticoid therapy after diagnosis. The median time for temperature to return to normal was 1.0(1.0, 4.0) days after glucocorticoid therapy. when the glucocorticoid treatment worked best, the body temperature could drop to normal on the same day. There were significant differences in length of stay, predisposing factors, chills, the rate of increase in high-sensitivity CRP, antibiotic and glucocorticoid treatment between the adults and children groups (P < 0.05). CONCLUSION: In clinical practice, if there are cases with unexplained fever, superficial lymph node enlargement, and reduced white blood cells as clinical characteristics, and general antibiotics treatment is ineffective, histiocytic necrotic lymphadenitis should be considered. Lymph node biopsy should be performed as early as possible to clarify the diagnosis, reduce misdiagnosis and mistreatment, and symptomatic treatment should be the main treatment. Glucocorticoids therapy has a definite therapeutic effect.


Assuntos
Linfadenite Histiocítica Necrosante , Humanos , Masculino , Linfadenite Histiocítica Necrosante/diagnóstico , Linfadenite Histiocítica Necrosante/tratamento farmacológico , Linfadenite Histiocítica Necrosante/patologia , Feminino , Adolescente , Adulto , Adulto Jovem , Criança , Antibacterianos/uso terapêutico , Glucocorticoides/uso terapêutico , Prognóstico , Febre/etiologia , Linfonodos/patologia , Linfadenopatia/patologia
8.
J Med Case Rep ; 18(1): 258, 2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38783354

RESUMO

BACKGROUND: Angiosarcoma of the adrenal gland is a very rare malignant vascular neoplasm. The clinical symptoms are atypical or completely absent. Angiosarcomas of the adrenal gland are therefore often discovered incidentally, and the diagnosis is made histologically after resection. CASE PRESENTATION: A 46-year-old white Spanish male who was a previous smoker and nondrinker and was slightly overweight (92 kg, 176 cm, body mass index 29.7 kg/m2) with no relevant medical history presented to the internal medicine emergency department of our hospital with an unclear 12 cm tumor of the right adrenal gland. Prior to the computed tomography scan, he had had persistent evening fevers for 4 months and unintentional weight loss of 5 kg. The laboratory results showed anemia and an elevated C-reactive protein, but no hormone production. We performed an open adrenalectomy of the right adrenal gland. Finally, the histologic findings revealed an angiosarcoma of the adrenal gland. CONCLUSION: Even though angiosarcomas of the adrenal gland are rare, the differential diagnosis of an angiosarcoma should be considered if a malignant tumor of the adrenal gland is suspected. Treatment decisions should be made on an interdisciplinary basis and preferably in a specialized center. Owing to the rarity of angiosarcomas of the adrenal gland, it is necessary to continue to share clinical experience to gain a better understanding of this particular tumor entity.


Assuntos
Neoplasias das Glândulas Suprarrenais , Adrenalectomia , Febre , Hemangiossarcoma , Humanos , Masculino , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/cirurgia , Hemangiossarcoma/patologia , Pessoa de Meia-Idade , Neoplasias das Glândulas Suprarrenais/cirurgia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/patologia , Febre/etiologia , Diagnóstico Diferencial , Tomografia Computadorizada por Raios X , Recidiva
9.
World J Urol ; 42(1): 323, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38748255

RESUMO

PURPOSE: This study aimed to assess the effect of the modified 5-item frailty index on perioperative complications and surgical outcomes in patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones. METHODS: Patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones between 2019 and 2022 were reviewed retrospectively. Assessment was performed using the modified 5-item frailty index based on medical history (hypertension, diabetes, heart failure, chronic obstructive pulmonary disease) and functional status. Patients were categorized into the high (≥ 2) and low (≤ 1) modified 5-item frailty index groups based on the frailty score. We compared the perioperative complications and surgical outcomes between the two groups. RESULTS: Seventy-one (15.8%) and 393 (84.1%) of the 467 patients were classified into the high and low modified 5-item frailty index groups, respectively. The high modified 5-item frailty index group exhibited a significant association with increased febrile urinary tract infections compared to the low modified 5-item frailty index group [≥ 37.8 °C: 15 (20.3%) vs 13 (3.3%), p < 0.001; ≥ 38 °C: 9 (12.2%) vs 7 (1.8%), p < 0.001]. Surgical outcomes, including operative time and stone-free rate, did not differ significantly between the two groups. CONCLUSION: The modified 5-item frailty index is valuable for predicting postoperative complications, particularly febrile urinary tract infections, after ureteroscopy with laser lithotripsy for upper urinary tract stones. This index allows for practical preoperative risk assessment in patients who underwent ureteroscopy with laser lithotripsy.


Assuntos
Febre , Fragilidade , Cálculos Renais , Litotripsia a Laser , Complicações Pós-Operatórias , Cálculos Ureterais , Ureteroscopia , Infecções Urinárias , Humanos , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Litotripsia a Laser/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico , Infecções Urinárias/etiologia , Infecções Urinárias/epidemiologia , Idoso , Fragilidade/diagnóstico , Febre/etiologia , Cálculos Renais/cirurgia , Cálculos Ureterais/cirurgia , Valor Preditivo dos Testes , Adulto
10.
J Pak Med Assoc ; 74(5): 998-999, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38783456

RESUMO

Fever is usually thought to be of an infectious or inflammatory etiology. In this brief communication, we explore the multifaceted connections between fever and endocrine dysfunction. Impaired resistance to infection often leads to fever in conditions like diabetes and Cushing's syndrome. Additionally, several endocrine disorders, including hyperthyroidism, subacute thyroiditis, carcinoid syndrome, and pheochromocytoma, can manifest as fever. Furthermore, fever can be an adverse effect of various endocrine treatments, such as bisphosphonates and antithyroid drugs. We refer to these scenarios as 'endocrine fever.' Increased awareness of these clinical associations can aid in prompt diagnosis and management of these conditions.


Assuntos
Doenças do Sistema Endócrino , Febre , Humanos , Febre/etiologia , Doenças do Sistema Endócrino/terapia , Doenças do Sistema Endócrino/diagnóstico , Hipertireoidismo/terapia , Hipertireoidismo/diagnóstico , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/terapia , Feocromocitoma/terapia , Feocromocitoma/diagnóstico , Feocromocitoma/complicações , Neoplasias das Glândulas Suprarrenais/terapia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/complicações , Antitireóideos/uso terapêutico , Antitireóideos/efeitos adversos , Difosfonatos/uso terapêutico , Difosfonatos/efeitos adversos
12.
J Nippon Med Sch ; 91(2): 190-197, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38777782

RESUMO

BACKGROUND: The appropriate duration of antimicrobial therapy for febrile urinary tract infection (fUTI) in children has not been established. This study examined the optimal duration of treatment for fUTI in children. METHODS: We created a protocol that used fever duration to determine the duration of antibiotic administration. Transvenous antibiotics were administered until 3 days after resolution of fever, followed by oral antibiotics for 1 week. Diagnosis of fUTI was based on a fever of 37.5°C or higher and a quantitative culture of catheterized urine yielded a bacteria count of ≥5 × 104. Acute focal bacterial nephritis (AFBN) and pyelonephritis (PN) were diagnosed on the basis of contrast-enhanced computed tomography (eCT) findings. We retrospectively reviewed treatment outcomes. RESULTS: Of the 78 patients treated according to our protocol, data from 58 were analyzed-49 children (30 boys) had PN and nine (three boys) had AFBN. Blood test results showed that patients with AFBN had significantly higher white blood cell counts and C-reactive protein levels than did those with PN; however, urinary findings and causative bacteria did not differ between groups. Time to resolution of fever and duration of intravenous antibiotic administration were significantly longer in patients with AFBN than in those with PN. However, average duration of AFBN treatment was 14.2 days, which was shorter than the previously reported administration period of 3 weeks. No recurrence was observed in AFBN patients. CONCLUSIONS: A protocol that used fever duration to determine the duration of antimicrobial treatment was useful. Invasive examinations, such as eCT, were not required.


Assuntos
Antibacterianos , Febre , Pielonefrite , Infecções Urinárias , Humanos , Infecções Urinárias/microbiologia , Infecções Urinárias/terapia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/diagnóstico , Masculino , Feminino , Febre/etiologia , Febre/terapia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Estudos Retrospectivos , Pré-Escolar , Fatores de Tempo , Pielonefrite/terapia , Pielonefrite/microbiologia , Pielonefrite/tratamento farmacológico , Lactente , Criança , Resultado do Tratamento , Tomografia Computadorizada por Raios X , Proteína C-Reativa/análise , Nefrite/microbiologia , Nefrite/terapia , Administração Oral , Doença Aguda , Duração da Terapia , Contagem de Leucócitos , Administração Intravenosa , Protocolos Clínicos
13.
Urolithiasis ; 52(1): 80, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38819457

RESUMO

Infectious complications are among the most common and potentially life-threatening morbidities of retrograde intrarenal surgery (RIRS). Few predictive tools on these complications include radiological signs. The Mayo adhesive probability (MAP) score is an image-based scoring system that incorporates two radiological signs: perinephric fat stranding and perinephric fat thickness. Previous studies have suggested an association between these signs and febrile urinary tract infection (UTI) following lithotripsy. This study aimed to evaluate the predictive factors, including the MAP score, for post-RIRS fever and sepsis. A total of 260 patients who underwent 306 RIRS between October 2019 to December 2023 due to renal or upper ureteral stones were included in this retrospective study. Patient demographics, perioperative characteristics, stone factors, radiological signs, and MAP scores were recorded. Multivariate logistic regression analysis was used to evaluate the risk factors associated with postoperative fever and sepsis. Postoperative fever and sepsis occurred in 20.8% and 8.5% of the patients, respectively. On multivariate analysis, female gender, history of recurrent UTI, larger maximal stone diameter, and higher MAP score were independent risk factors for postoperative fever and sepsis. Identifying the risk factors for post-RIRS infectious complications is imperative to providing the proper perioperative management. The MAP score is a promising, easily calculated, image-based scoring system that predicts post-RIRS fever and sepsis.


Assuntos
Febre , Cálculos Renais , Complicações Pós-Operatórias , Sepse , Humanos , Masculino , Feminino , Febre/etiologia , Febre/epidemiologia , Sepse/etiologia , Estudos Retrospectivos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Cálculos Renais/cirurgia , Adulto , Idoso , Fatores de Risco , Cálculos Ureterais/cirurgia , Infecções Urinárias/etiologia , Infecções Urinárias/epidemiologia , Valor Preditivo dos Testes
14.
J Clin Anesth ; 96: 111497, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38728932

RESUMO

Periodic fever syndromes are autoinflammatory disorders associated with recurrent fevers unrelated to infection. Little is known about the perioperative management of patients with these syndromes, and existing literature consists primarily of case reports and occasional case series. This narrative review discusses background information and diagnostic criteria for the three most common periodic fever syndromes: periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA), familial Mediterranean fever (FMF), and TNF receptor-associated periodic syndrome (TRAPS), and describes perioperative considerations for anesthesia providers when caring for the patient with a periodic fever syndrome. We include a systems-based framework in which to organize these considerations.


Assuntos
Assistência Perioperatória , Humanos , Assistência Perioperatória/métodos , Doenças Hereditárias Autoinflamatórias/diagnóstico , Doenças Hereditárias Autoinflamatórias/complicações , Doenças Hereditárias Autoinflamatórias/terapia , Anestesia/métodos , Febre/etiologia , Febre Familiar do Mediterrâneo/complicações , Febre Familiar do Mediterrâneo/diagnóstico , Faringite/etiologia , Faringite/diagnóstico
15.
Arch Gynecol Obstet ; 310(1): 195-202, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38797768

RESUMO

PURPOSE: To assess the prevalence, microbial profile, and clinical risk factors of maternal bacteremia associated with intrapartum fever (IPF). METHODS: A retrospective cohort study, in a single tertiary university-affiliated medical center between 2012 and 2018. Demographic and labor characteristics of women, who delivered at term (37+0/7-41+6/7) and developed bacteremia following IPF were compared to a control group of women with IPF but without bacteremia. RESULTS: During the study period there were 86,590 deliveries in our center. Of them, 2074 women (2.4%) were diagnosed with IPF, of them, for 2052 women (98.93%) the blood maternal cultures were available. In 26 patients (1.25%) maternal bacteremia was diagnosed. A lower rate of epidural anesthesia (84.6% vs 95.9%, p = 0.02) and a higher rate of antibiotics prophylaxis treatment prior to the onset of fever (30.8%.vs 12.1%, p = 0.006) were observed in patients who developed maternal bacteremia in comparison to those who have not. Maternal hyperpyrexia developed after initiation of antibiotics or without epidural anesthesia remained significantly associated with maternal bacteremia after applying a multivariate analysis, (Odds Ratio 3.14 95% CI 1.27-7.14, p = 0.009; 4.76 95% CI 1.35-12.5, p = 0.006; respectively). CONCLUSION: Maternal fever developing after initiation of antibiotics or without epidural is associated with maternal bacteremia.


Assuntos
Bacteriemia , Febre , Humanos , Feminino , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Gravidez , Estudos Retrospectivos , Adulto , Fatores de Risco , Febre/epidemiologia , Febre/microbiologia , Febre/etiologia , Prevalência , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Anestesia Epidural/efeitos adversos , Antibioticoprofilaxia , Antibacterianos/uso terapêutico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/microbiologia
16.
Ann Hematol ; 103(6): 2089-2102, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38691145

RESUMO

Infection post-hematopoietic stem cell transplantation (HSCT) is one of the main causes of patient mortality. Fever is the most crucial clinical symptom indicating infection. However, current microbial detection methods are limited. Therefore, timely diagnosis of infectious fever and administration of antimicrobial drugs can effectively reduce patient mortality. In this study, serum samples were collected from 181 patients with HSCT with or without infection, as well as the clinical information. And more than 80 infectious-related microRNAs in the serum were selected according to the bulk RNA-seq result and detected in the 345 time-pointed serum samples by Q-PCR. Unsupervised clustering result indicates a close association between these microRNAs expression and infection occurrence. Compared to the uninfected cohort, more than 10 serum microRNAs were identified as the combined diagnostic markers in one formula constructed by the Random Forest (RF) algorithms, with a diagnostic accuracy more than 0.90. Furthermore, correlations of serum microRNAs to immune cells, inflammatory factors, pathgens, infection tissue, and prognosis were analyzed in the infection cohort. Overall, this study demonstrates that the combination of serum microRNAs detection and machine learning algorithms holds promising potential in diagnosing infectious fever after HSCT.


Assuntos
Febre , Transplante de Células-Tronco Hematopoéticas , Aprendizado de Máquina , Humanos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Febre/etiologia , Febre/diagnóstico , Febre/sangue , Algoritmos , MicroRNAs/sangue , Biomarcadores/sangue , Adolescente , Adulto Jovem
17.
Tidsskr Nor Laegeforen ; 144(6)2024 May 14.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-38747663

RESUMO

Background: Chagas encephalitis is a rare but severe manifestation of reactivation in patients with chronic Chagas disease. Case presentation: A woman in her seventies who was immunosuppressed after a heart transplant due to Chagas disease was admitted with convulsions, headache and visual disturbances. She developed fever, confusion and repeated convulsions. Pleocytosis was found in spinal fluid. Wet-mount microscopy of spinal fluid revealed motile Trypanosoma cruzi trypomastigotes, and multiple trypomastigotes were seen on a Giemsa-stained smear, confirming reactivation of Chagas disease with meningoencephalitis. Despite benznidazole treatment, she deteriorated, exhibiting pharyngeal paralysis, aphasia and increasing somnolence. Brain CT showed pathology consistent with Chagas encephalitis. Nifurtimox was given as an adjunctive treatment. After a week of treatment, the patient began to improve. She completed 60 days of benznidazole and had regained normal cognitive and neurological function on subsequent follow-up. She had no signs of myocarditis reactivation. Interpretation: Chronic Chagas disease is common among Latin American immigrants in Europe. Reactivation with myocarditis after a heart transplant is well known, while encephalitis is a rare manifestation. We report on a case of Chagas encephalitis in an immunosuppressed patient. Microscopy of parasites in spinal fluid revealed the diagnosis. The WHO provided antiparasitic medications, and despite a severe prognosis, the patient made a full recovery.


Assuntos
Convulsões , Humanos , Feminino , Convulsões/etiologia , Convulsões/tratamento farmacológico , Idoso , Febre/etiologia , Doença de Chagas/tratamento farmacológico , Tripanossomicidas/uso terapêutico , Hospedeiro Imunocomprometido
19.
Medicine (Baltimore) ; 103(18): e38060, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38701281

RESUMO

Neutropenic fever in adults undergoing chemotherapy for cancer treatment is a medical emergency and has been the focus of numerous studies. However, there is a paucity of data about non-chemotherapy induced neutropenic fever (non-CINF). We retrospectively reviewed 383 adults with neutropenic fever hospitalized at one academic medical center between October 2015 and September 2020 to characterize the frequency, causes, and outcomes of non-CINF. Twenty-six percent of cases of neutropenic fever were non-chemotherapy induced. Among these, the major causes of neutropenia were hematologic malignancy, infection, and rheumatologic disease, and the major causes of fever were infections. Patients with non-CINF had a higher 30-day mortality than those with chemotherapy induced neutropenic fever (25% vs 13%, P = .01). Non-CINF constituted > 25% of neutropenic fever events in hospitalized adults and was associated with a high mortality rate.


Assuntos
Febre , Hospitalização , Neutropenia , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Febre/induzido quimicamente , Febre/etiologia , Neutropenia/induzido quimicamente , Neutropenia/epidemiologia , Hospitalização/estatística & dados numéricos , Adulto , Idoso , Neoplasias/tratamento farmacológico , Antineoplásicos/efeitos adversos , Neoplasias Hematológicas/tratamento farmacológico
20.
Pediatr Rheumatol Online J ; 22(1): 55, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38760816

RESUMO

BACKGROUND: Systemic autoinflammatory disorders (SAIDs) represent a growing spectrum of diseases characterized by dysregulation of the innate immune system. The most common pediatric autoinflammatory fever syndrome, Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis (PFAPA), has well defined clinical diagnostic criteria, but there is a subset of patients who do not meet these criteria and are classified as undefined autoinflammatory diseases (uAID). This project, endorsed by PRES, supported by the EMERGE fellowship program, aimed to analyze the evolution of symptoms in recurrent fevers without molecular diagnosis in the context of undifferentiated AIDs, focusing on PFAPA and syndrome of undifferentiated recurrent fever (SURF), using data from European AID registries. METHODS: Data of patients with PFAPA, SURF and uSAID were collected from 3 registries including detailed epidemiological, demographic and clinical data, results of the genetic testing and additional laboratory investigations with retrospective application of the modified Marshall and PRINTO/Eurofever classification criteria on the cohort of PFAPA patients and preliminary SURF criteria on uSAID/SURF patients. RESULTS: Clinical presentation of PFAPA is variable and some patients did not fit the conventional PFAPA criteria and exhibit different symptoms. Some patients did not meet the criteria for either PFAPA or SURF, highlighting the heterogeneity within these groups. The study also explored potential overlaps between PFAPA and SURF/uAID, revealing that some patients exhibited symptoms characteristic of both conditions, emphasizing the need for more precise classification criteria. CONCLUSIONS: Patients with recurrent fevers without molecular diagnoses represent a clinically heterogeneous group. Improved classification criteria are needed for both PFAPA and SURF/uAID to accurately identify and manage these patients, ultimately improving clinical outcomes.


Assuntos
Doenças Hereditárias Autoinflamatórias , Linfadenite , Faringite , Sistema de Registros , Estomatite Aftosa , Humanos , Criança , Europa (Continente)/epidemiologia , Feminino , Masculino , Estomatite Aftosa/diagnóstico , Estomatite Aftosa/epidemiologia , Pré-Escolar , Doenças Hereditárias Autoinflamatórias/diagnóstico , Linfadenite/diagnóstico , Linfadenite/epidemiologia , Faringite/diagnóstico , Adolescente , Lactente , Estudos Retrospectivos , Febre/etiologia , Febre/diagnóstico , Recidiva
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