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1.
Cochrane Database Syst Rev ; 1: CD014884, 2023 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-36695415

RESUMO

BACKGROUND: Kawasaki disease (KD) is an acute systemic vasculitis (inflammation of the blood vessels) that mainly affects children. Symptoms include fever, chapped lips, strawberry tongue, red eyes (bulbar conjunctival injection), rash, redness, swollen hands and feet or skin peeling; and enlarged cervical lymph nodes. High fevers and systemic inflammation characterise the acute phase. Inflammation of the coronary arteries causes the most serious complication of the disease, coronary artery abnormalities (CAAs). The primary treatment is intravenous immunoglobulin (IVIG) and acetylsalicylic acid (ASA/aspirin), with doses and regimens differing between institutions. It is important to know which regimens are the safest and most effective in preventing complications. OBJECTIVES: To evaluate the efficacy and safety of IVIG in treating and preventing cardiac consequences of Kawasaki disease. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 26 April 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) investigating the use of IVIG for the treatment of KD. We included studies involving treatment for initial or refractory KD, or both. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were incidence of CAAs and incidence of any adverse effects after treatment. Our secondary outcomes were acute coronary syndromes, duration of fever, need for additional treatment, length of hospital stay, and mortality. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We identified 31 RCTs involving a total of 4609 participants with KD. Studies compared IVIG with ASA, another dose or regimen of IVIG, prednisolone, or infliximab. The majority of studies reported on primary treatment, so those results are reported below. A limited number of studies investigated secondary or tertiary treatment in IVIG-resistant patients. Doses and regimens of IVIG infusion varied between studies, and all studies had some concerns related to risk of bias. Primary treatment with IVIG compared to ASA for people with KD Compared to ASA treatment, IVIG probably reduces the incidence of CAAs in people with KD up to 30 days (odds ratio (OR) 0.60, 95% confidence interval (CI) 0.41 to 0.87; 11 studies, 1437 participants; moderate-certainty evidence). The individual studies reported a range of adverse effects, but there was little to no difference in numbers of adverse effects between treatment groups (OR 0.57, 95% CI 0.17 to 1.89; 10 studies, 1376 participants; very low-certainty evidence). There was limited evidence for the incidence of acute coronary syndromes, so we are uncertain of any effects. Duration of fever days from treatment onset was probably shorter in the IVIG group (mean difference (MD) -4.00 days, 95% CI -5.06 to -2.93; 3 studies, 307 participants; moderate-certainty evidence). There was little or no difference between groups in need for additional treatment (OR 0.27, 95% CI 0.05 to 1.57; 3 studies, 272 participants; low-certainty evidence). No study reported length of hospital stay, and no deaths were reported in either group. Primary treatment with IVIG compared to different infusion regimens of IVIG for people with KD Higher-dose regimens of IVIG probably reduce the incidence of CAAs compared to medium- or lower-dose regimens of IVIG up to 30 days (OR 0.60, 95% CI 0.40 to 0.89; 8 studies, 1824 participants; moderate-certainty evidence). There was little to no difference in the number of adverse effects between groups (OR 1.11, 95% CI 0.52 to 2.37; 6 studies, 1659 participants; low-certainty evidence). No study reported on acute coronary syndromes. Higher-dose IVIG may reduce the duration of fever compared to medium- or lower-dose regimens (MD -0.71 days, 95% CI -1.36 to -0.06; 4 studies, 992 participants; low-certainty evidence). Higher-dose regimens may reduce the need for additional treatment (OR 0.29, 95% CI 0.10 to 0.88; 4 studies, 1125 participants; low-certainty evidence). We did not detect a clear difference in length of hospital stay between infusion regimens (MD -0.24, 95% CI -0.78 to 0.30; 3 studies, 752 participants; low-certainty evidence). One study reported mortality, and there was little to no difference detected between regimens (moderate-certainty evidence). Primary treatment with IVIG compared to prednisolone for people with KD The evidence comparing IVIG with prednisolone on incidence of CAA is very uncertain (OR 0.60, 95% CI 0.24 to 1.48; 2 studies, 140 participants; very low-certainty evidence), and there was little to no difference between groups in adverse effects (OR 4.18, 95% CI 0.19 to 89.48; 1 study; 90 participants; low-certainty evidence). We are very uncertain of the impact on duration of fever, as two studies reported this outcome differently and showed conflicting results. One study reported on acute coronary syndromes and mortality, finding little or no difference between groups (low-certainty evidence). No study reported the need for additional treatment or length of hospital stay. AUTHORS' CONCLUSIONS: The included RCTs investigated a variety of comparisons, and the small number of events observed during the study periods limited detection of effects. The certainty of the evidence ranged from moderate to very low due to concerns related to risk of bias, imprecision, and inconsistency. The available evidence indicated that high-dose IVIG regimens are probably associated with a reduced risk of CAA formation compared to ASA or medium- or low-dose IVIG regimens. There were no clinically significant differences in incidence of adverse effects, which suggests there is little concern about the safety of IVIG. Compared to ASA, high-dose IVIG probably reduced the duration of fever, but there was little or no difference detected in the need for additional treatment. Compared to medium- or low-dose IVIG, there may be reduced duration of fever and reduced need for additional treatment. We were unable to draw any conclusions regarding acute coronary syndromes, mortality, or length of hospital stay, or for the comparison IVIG versus prednisolone. Our findings are in keeping with current guideline recommendations and evidence from long-term epidemiology studies.


Assuntos
Síndrome Coronariana Aguda , Síndrome de Linfonodos Mucocutâneos , Criança , Humanos , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Imunoglobulinas Intravenosas/efeitos adversos , Prednisolona/uso terapêutico , Aspirina/efeitos adversos , Inflamação , Febre/etiologia , Febre/tratamento farmacológico
3.
Support Care Cancer ; 31(2): 102, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36622445

RESUMO

INTRODUCTION: Positive urine sample is a frequent finding in post-chemotherapy febrile neutropenia (FN) and can lead to prolonged antibiotic therapy. The aim of this study was to assess the outcome of bacteriuria episodes in FN patients receiving targeted antibiotic therapy. MATERIALS AND METHODS: A multi-centric retrospective study was conducted over a four-year period (2014-2019) on systematic urinalysis. All consecutive first bacteriuria episodes (≤ 2 bacteria with at least ≥ 103 CFU/mL) during FN in hospitalized adult patients for hematological malignancies were included. Relapse and recurrence were defined by fever or urinary tract symptoms (UTS) with the same bacterial subspecies in urine occurring ≤ 7 days and ≤ 30 days, respectively, after antibiotic discontinuation. Mortality rate was determined at 30 days. Targeted antibiotic therapy ≤ 10 days for women and ≤ 14 for men was considered as short course. RESULTS: Among 97 patients, 105 bacteriuria episodes on systematic urinalysis were analyzed; 67.6% occurred in women, 41.9% in AML patients, 17.1% were bacteremic, 14.2% presented with UTS, and 61.9% were treated with short-course antibiotic treatment. One death was reported. In men, no relapse/recurrence was noted, even in the short-course antibiotic group. In women, 2.8% of episodes treated with short-course antibiotic led to relapse or recurrence. CONCLUSIONS: Relapse, recurrence, and mortality were uncommon events in FN patients experiencing bacteriuria episode, whatever the antibiotic duration. To distinguish asymptomatic bacteriuria from infection remained challenging in women. In men, systematic urinalysis at onset of FN could be useful.


Assuntos
Bacteriúria , Neutropenia Febril , Hematologia , Infecções Urinárias , Adulto , Masculino , Humanos , Feminino , Bacteriúria/tratamento farmacológico , Bacteriúria/etiologia , Bacteriúria/diagnóstico , Estudos Retrospectivos , Recidiva Local de Neoplasia/tratamento farmacológico , Antibacterianos/uso terapêutico , Febre/tratamento farmacológico , Febre/etiologia , Neutropenia Febril/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologia
5.
Mymensingh Med J ; 32(1): 177-184, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36594318

RESUMO

To assess the role of the Glasgow Comma Score (GCS) for predicting the outcome of the patient with fever and altered sensorium was the objective of the study. This prospective observational study was conducted for six months following ethical approval. Informed consent was obtained prior enrollment. A total of 50 patients with complaints of fever for <2 weeks duration with altered sensorium with or without seizure were included in the study. GCS was calculated for all patients just after admission and before starting interventions. All patients were investigated and managed according to the hospital protocol. The outcome of the patients (living or dead within the hospital) was evaluated against the admission GCS score. The study was performed in accordance with the current Declaration of Helsinki. Of all, 42.0% (n=21) of the patients had bacterial meningitis, followed by viral encephalitis, cerebral malaria and coma vigil. Complete recovery occurred in 60.0% of cases, while recovery with disability occurred in 28.0% of cases. Death occurred in 12.0% of cases (n=6) due to cerebral malaria, viral encephalitis and bacterial meningitis (n=2 each cause). A higher number of deaths occurred in the lower GCS group (n=5 in GCS group 3-5) and this difference was statistically significant (p<0.05). Moreover, considering death as an outcome, multivariate logistic regression showed that GCS (OR 70.598, 95% CI-1.243-4009.41; p=0.039) was an independent predictor of the outcome. GCS seemed to be a predictor of the short-term outcome of the patient presenting with fever and altered sensorium in our setting. However, further exploration in larger setting with appropriate study design is recommended.


Assuntos
Encefalite Viral , Malária Cerebral , Meningites Bacterianas , Humanos , Coma/etiologia , Malária Cerebral/complicações , Febre/etiologia , Encefalite Viral/complicações , Meningites Bacterianas/complicações , Prognóstico
6.
PLoS One ; 18(1): e0281018, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36716321

RESUMO

BACKGROUND: A host-protein score (BV score) that combines the circulating levels of TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10) and C-reactive protein (CRP) was developed for distinguishing bacterial from viral infection. This study assessed the potential of the BV score to impact decision making and antibiotic stewardship at the emergency department (ED), by comparing BV score's performance to physician's etiological suspicion at patient presentation. METHODS: Rosetta study participants, aged 3 months to 18 years with febrile respiratory tract infection or fever without source, were prospectively recruited in a tertiary care pediatric ED. 465 patients were recruited, 298 met eligibility criteria and 287 were enrolled. ED physician's etiological suspicion was recorded in a questionnaire. BV score was measured retrospectively with results interpreted as viral, bacterial or equivocal and compared to reference standard etiology, which was adjudicated by three independent experts based on all available data. Experts were blinded to BV scores. RESULTS: Median age was 1.3 years (interquartile range 1.7), 39.7% females. 196 cases were reference standard viral and 18 cases were reference standard bacterial. BV score attained sensitivity of 88.9% (95% confidence interval: 74.4-100), specificity 92.1% (88.1-96.0), positive predictive value 53.3% (35.5-71.2) and negative predictive value 98.8% (97.1-100). Positive likelihood ratio was 11.18 (6.59-18.97) and negative likelihood ratio was 0.12 (0.03-0.45). The rate of BV equivocal scores was 9.4%. Comparing physician's suspicion to BV score and to the reference standard, and assuming full adoption, BV score could potentially correct the physician's diagnosis and reduce error ~2-fold, from 15.9% to 8.2%. CONCLUSIONS: BV score has potential to aid the diagnostic process. Future studies are warranted to assess the impact of real-time BV results on ED practice.


Assuntos
Infecções Bacterianas , Criança , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Infecções Bacterianas/diagnóstico , Febre/etiologia , Febre/microbiologia , Serviço Hospitalar de Emergência
7.
Taiwan J Obstet Gynecol ; 62(1): 171-174, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36720535

RESUMO

OBJECTIVE: To report a case of pyomyoma, a serious complication of the uterine leiomyoma, in a postpartum woman. As the occurrence of pyomyoma in association with pregnancy is rather rare, a brief literature review of the condition in pregnant women is provided. CASE REPORT: A 41-year-old woman was found to have pyomyoma following persistent fever during the postpartum period of a first-time vaginal delivery. Her pregnancy course was complicated by preterm labor, for which the patient had received tocolysis since 30-week gestation. The pyomyoma was promptly removed by myomectomy on day-6 postpartum. CONCLUSION: Pyomyoma can occur in both pre- and post-menopausal women, and may even complicate pregnancies. Therefore, obstetricians and gynecologists should be wary of pyomyoma in postpartum women with histories of leiomyoma that present with sepsis of unknown focus that is refractory to standard antibiotics. Fertility may be preserved through timely diagnosis, followed by a prompt intervention.


Assuntos
Bacteriemia , Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Humanos , Recém-Nascido , Feminino , Gravidez , Adulto , Neoplasias Uterinas/complicações , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/diagnóstico , Leiomioma/complicações , Leiomioma/cirurgia , Leiomioma/diagnóstico , Miomectomia Uterina/efeitos adversos , Bacteriemia/complicações , Bacteriemia/diagnóstico , Febre/etiologia
8.
Ann Afr Med ; 22(1): 1-4, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36695215

RESUMO

Objectives: Fever in pregnancy is a common clinical problem that increases the risk of morbidity for the mother and fetus. We studied variable medical complications of pregnant women suffering from fever and possible fetal complications. Materials and Methods: A prospective observational study of pyrexia with pregnancy in 50 patients admitted to our hospital irrespective of age, parity, reproductive characteristics, and socioeconomical conditions. Results: First, the majority group of the patients were of urinary tract infections and upper respiratory tract infections. The second majority group of the patients were of malaria, dengue, enteric fever, and pyrexia of unknown origin. Most of the etiologies of pyrexia were preventable. The majority of the patients had a low and moderate grade of pyrexia. Small for gestational age was the most common adverse pregnancy outcome and there were six perinatal deaths. Conclusion: Our study depicts that a wide range of maternal medical complications, as well as fetal and neonatal complications, occur due to pyrexia in pregnancy from various etiology.


Résumé Objectifs: La fièvre pendant la grossesse est un problème clinique courant qui augmente le risque de morbidité pour la mère et le fœtus. Nous avons étudié les complications médicales variables des femmes enceintes souffrant de fièvre et d'éventuelles complications fœtales. Matériaux et Méthodes: Une étude observationnelle prospective de la pyrexie avec une grossesse chez 50 patients admis dans notre hôpital, quel que soit l'âge, la parité, les caractéristiques reproductives et les conditions socioéconomiques. Résultats: Premièrement, le groupe majoritaire des patients était des infections des voies urinaires et des infections des voies respiratoires supérieures. Le deuxième groupe majoritaire des patients était de paludisme, de dengue, de fièvre entérique et de pyrexie d'origine inconnue. La plupart des étiologies de la pyrexie étaient évitables. La majorité des patients avaient un grade de pyrexie faible et modéré. Petit pour l'âge gestationnel était le résultat de la grossesse défavorable le plus courant et il y a eu six décès périnataux. Conclusion: Notre étude montre qu'un large éventail de Les complications médicales, ainsi que les complications fœtales et néonatales, se produisent en raison de la pyrexie pendant la grossesse de diverses étiologies. Mots-clés: Grossesse, résultats de la grossesse, pyrexie, petite pour l'âge gestationnel.


Assuntos
Malária , Complicações Infecciosas na Gravidez , Recém-Nascido , Gravidez , Feminino , Humanos , Estudos Prospectivos , Resultado da Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Febre/etiologia
10.
Pediatrics ; 151(2)2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36601710

RESUMO

A 7-year-old boy presented to the emergency department with fever, cough, congestion, abdominal pain, myalgias, and morbilliform rash. Several aspects of the patient's history, including recent travel, living on a farm, exposure to sick contacts, and new medications, resulted in a wide differential diagnosis. Initial laboratory testing revealed leukocytosis with neutrophilia and elevated atypical lymphocytes, but did not reveal any infectious causes of illness. He was discharged from the hospital, but then represented to the emergency department a day later with worsening rash, continued fever, abdominal pain, and poor intake. He was then admitted. A more comprehensive laboratory evaluation was initiated. During this hospital course, the patient's physical examination changed when he developed head and neck edema, and certain laboratory trends became clearer. With the assistance of several specialists, the team was able to reach a more definitive diagnosis and initiate treatment to appropriately manage his condition.


Assuntos
Tosse , Exantema , Masculino , Humanos , Criança , Tosse/etiologia , Febre/etiologia , Dor Abdominal/etiologia , Leucocitose , Diagnóstico Diferencial , Exantema/etiologia
11.
Dtsch Med Wochenschr ; 148(3): 112-115, 2023 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-36690007

RESUMO

HISTORY: The 37 year old patient was admitted to hospital with persisting fever for 4 weeks. He had a history of weight loss, night sweat and cough. Antipyretic treatment with Paracetamol and up to ineffectiveness therapy with Ibuprofen was taken by the patient. FINDINGS AND DIAGNOSIS: Fever and poor general condition were obvious on time of admission. The ECG showed tachycardia. Liver values were increased. X-ray of the chest showed a central mass on the right site. On computed tomography there was a finding of a possibly necrotic tumour close to central vessels. The patient developed a prolonged thrombocytopenia and bleeding on several sites. Further diagnostic approaches were difficult to perform. After puncture of the central mediastinal mass and bone marrow we diagnosed an extensive extrapulmonary tuberculosis. Toxic hepatitis was getting worse under medical treatment of tuberculosis. In addition, with thrombocytopenia patient condition reached a critical state. THERAPY AND COURSE: After initiation of prednisolone-treatment up to suspicion of drug- induced thrombocytopenia (D-ITP) and switch of the anti- Tb-regimen the general condition improved. There was repetitive need for transfusion of thrombocytes. CONCLUSIONS: Toxic hepatitis is a possible severe complication of anti-Tb-treatment. A critical evaluation of patients' medication and soon initiation of anti -Tb-treatment is necessary. Especially in patients coming from high tb-incidence regions with history of poor general condition and persisting fever the diagnosis of extrapulmonary tuberculosis and bone marrow infiltration should be taken into account.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas , Febre , Trombocitopenia , Adulto , Humanos , Masculino , Doença Hepática Induzida por Substâncias e Drogas/complicações , Febre/etiologia , Prednisolona , Trombocitopenia/complicações , /diagnóstico
12.
J Med Case Rep ; 17(1): 10, 2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36627702

RESUMO

BACKGROUND: Kawasaki disease is an acute febrile condition in children. It affects mainly children under 5 years old, and is known to cause coronary artery abnormalities if treatment is delayed. The diagnosis rests mainly on clinical criteria. However, it is also known that some infants do not have diagnostic criteria sufficient enough for the diagnosis of Kawasaki disease. Further, children may rarely present with unusual features, and this entity is recognized as "Atypical Kawasaki disease." CASE PRESENTATION: We present the case of a 9-month-old Tamil boy who presented with sterile gross hematuria in association with prolonged fever, lymphadenopathy, and generalized maculopapular rash. He had high inflammatory markers and echocardiogram disclosed left coronary artery dilatation. The diagnosis of incomplete Kawasaki disease was confirmed based on clinical grounds supported by investigations and exclusion of differential diagnosis. The child showed a good response to intravenous immunoglobulin and aspirin. CONCLUSION: Kawasaki disease is one of the important differential diagnoses of protracted fever of unknown origin in very young children. Since delayed treatment is associated with a high risk of complications, atypical Kawasaki disease needs to be suspected in children presenting with unusual features such as macroscopic hematuria that occurs in association with unexplained prolonged fever.


Assuntos
Síndrome de Linfonodos Mucocutâneos , Masculino , Criança , Humanos , Lactente , Pré-Escolar , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Índia , Hematúria/etiologia , Febre/etiologia , Febre/tratamento farmacológico , Aspirina/uso terapêutico , Imunoglobulinas Intravenosas/uso terapêutico
15.
Pediatr Infect Dis J ; 42(1): 85-86, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36476535
16.
Rheumatology (Oxford) ; 61(7): 3082-3092, 2022 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34559193

RESUMO

OBJECTIVES: Differential diagnosis in children with prolonged fever is challenging. In particular, differentiating systemic-onset JIA (SJIA) from infectious diseases is difficult. Biomarkers are needed that support the diagnostic work-up. The aim of this study was to validate the usefulness of Myeloid-related protein 8/14 (MRP8/14) measurements in the diagnostic work-up of febrile children and to transfer it to clinical practice. METHODS: Data for 1110 paediatric patients were included and divided into two cohorts: (cohort A) for validation of MRP8/14 test performance with three different testing systems: the experimental ELISA, commercial ELISA and an innovative (point-of-care test) lateral flow immunoassay (LFIA); (cohort B) to validate the diagnostic accuracy with the two latter assays. RESULTS: In cohort A (n = 940), MRP8/14 was elevated in SJIA (12 110 ± 2650 ng/ml mean ± 95% CI) compared with other diagnoses (including infections and autoinflammatory diseases; 2980 ± 510 ng/ml) irrespective of fever and anti-inflammatory treatment (P < 0.001). In untreated patients with fever (n = 195) MRP8/14 levels in SJIA (19 740 ± 5080 ng/ml) were even higher compared with other diagnoses (4590 ± 1160 ng/ml) (P < 0.001, sensitivity 73%, specificity 90%). In group B1, the performance of the tests was confirmed in untreated patients with fever (n = 170): commercial ELISA (sensitivity 79%, specificity 89%) and LFIA (sensitivity 84%, specificity 81%). Compared with ferritin, IL-18, ESR, soluble IL-2 receptor and procalcitonin, MRP8/14 showed the best accuracy. CONCLUSION: MRP8/14 serum analyses have been validated as a helpful tool supporting the diagnosis of SJIA in febrile children. The results could be confirmed with commercial ELISA and LFIA enabling a rapid diagnostic point-of-care screening test.


Assuntos
Artrite Juvenil , Anti-Inflamatórios/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Biomarcadores , Calgranulina A/metabolismo , Criança , Estudos de Coortes , Febre/tratamento farmacológico , Febre/etiologia , Humanos
17.
Wiad Lek ; 75(10): 2544-2548, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36472296

RESUMO

Kawasaki disease is an acute systemic disease characterized by the predominant lesions of middle and small arteries, alongside destructive and proliferative vasculitis development. The aetiology is currently being discussed. Infectious factors are mostly preferred, in addition, autoimmune mechanisms and genetic heredity are considered. The diagnosis of Kawasaki disease is established by clinical signs; laboratory changes are usually taken into account as are ancillary criteria. The article discusses the clinical case of Kawasaki disease in an 8-year-old boy. Given the variety and inconsistency of the clinical symptoms (the child had four of the five mandatory criteria together with prolonged fever), there was a late diagnosis, namely on day 10 of the disease. Due to the high risk of cardiovascular complications in the differential diagnosis of children with fever lasting more than 3 days should be considered Kawasaki disease, followed by mandatory heart echocardiography during the first 10 days of the disease, especially if the fever is accompanied by the increase of acute phase reactants. When treating children with chronic fever without a specific source, the doctor should be wary of Kawasaki disease, as it can clinically simulate acute respiratory viral disease, the onset of diffuse connective tissue disease, and infectious endocarditis, and can have common features and require differential diagnostics with coronavirus associated multisystem inflammatory syndrome.


Assuntos
Infecções por Coronavirus , Cardiopatias , Síndrome de Linfonodos Mucocutâneos , Vasculite , Criança , Masculino , Humanos , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Febre/etiologia , Cardiopatias/etiologia , Vasculite/complicações
18.
BMC Infect Dis ; 22(1): 902, 2022 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-36461006

RESUMO

BACKGROUND: Sotrovimab neutralizing SARS-CoV-2 remained effective at the advent of B.1 lineage of the Omicron variant in outpatients. Primarily for hospitalized patients, however, the Japanese government regulated to administer this antibody agent. As this regulation enabled close monitoring in inpatients to investigate post-infusion adverse events (AEs) and efficacy, we attempted a retrospective study while the Omicron BA.1 lineage was dominant regionally. METHODS: Subjects were inpatients with COVID-19 who received infusion of sotrovimab in our institute. In line with previous clinical trials, we included patients at risk of COVID-19 worsening and SARS-CoV-2 vaccinees, who were hospitalized as directed by the government. For statistical analyses, we reviewed background factors of demographics, imaging, and laboratory findings for the outcome infusion-related reactions including post-infusion pyrexia over 38 degrees Celsius and/or pulse oximetry below 94%. RESULTS: In a total of 139 patients, the follow-up period had a median of 200 days (range, 154-248 days). Among 119 patients (85.6%) fully vaccinated for SARS-CoV-2, 86 (61.9% of all) underwent 2 doses while 33 (23.7% of all) received 3 doses. For the outcome of pyrexia and/or dyspnea (N = 40, 28.8%), multivariate analysis showed that significant risk factors were pre-infusion lowered oximetry below 96.5% (Odds Ratio [OR] 0.344, 95% Confidence Interval [CI] 0.139-0.851, P = 0.021) and pre-infusion temperature more than 36.7 degrees Celsius (OR 4.056, 95% CI 1.696-9.701, P = 0.002). Infusion-related reactions included vomiting immediately after infusion, chill/shivering, dizziness, rash, pruritus, pyrexia, and dyspnea. The number of patients with any of these events was 44 (31.6%). Three patients (2.2%) showed worsening of COVID-19; one developed hypoxia and two died. Limitations for this study included no genome typing whether BA.1 or BA.2 lineage of the Omicron variant but the local epidemiology indicated the prevalence of BA.1. Another was sotrovimab administration for inpatients that allow precise detection of post-infusion events, confounding previous exacerbation definition including hospitalization. CONCLUSIONS: For 24 h after infusion of sotrovimab, COVID-19 patients showing pre-infusion lowered oximetry below 96.5% and/or temperature more than 36.7 degrees Celsius may have temperature elevation or dyspnea, warranting close monitoring for these risk factors.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , SARS-CoV-2 , Pacientes Internados , Estudos Retrospectivos , Japão/epidemiologia , Anticorpos Monoclonais Humanizados/efeitos adversos , Febre/etiologia , Dispneia
20.
Ital J Pediatr ; 48(1): 199, 2022 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-36527084

RESUMO

FIRES is defined as a disorder that requires a prior febrile infection starting between 2 weeks and 24 h before the onset of the refractory status epilepticus with or without fever at the onset of status epilepticus. The patients, previously normal, present in the acute phase recurrent seizures and status epilepticus followed by a severe course with usually persistent seizures and residual cognitive impairment. Boundary with "new onset refractory status epilepticus (NORSE) has not clearly established. Pathogenetic hypothesis includes inflammatory or autoimmune mechanism with a possible genetic predisposition for an immune response dysfunction.Various types of treatment have been proposed for the treatment of the acute phase of the disorder to block the rapid seizures evolution to status epilepticus and to treat status epilepticus itself. Prognosis is usually severe both for control of the seizures and for cognitive involvement.FIRES is an uncommon but severe disorder which must be carefully considered in the differential diagnosis with other epileptic encephalopathy.


Assuntos
Epilepsia Resistente a Medicamentos , Encefalite , Síndromes Epilépticas , Estado Epiléptico , Humanos , Epilepsia Resistente a Medicamentos/diagnóstico , Síndromes Epilépticas/complicações , Síndromes Epilépticas/diagnóstico , Síndromes Epilépticas/terapia , Febre/diagnóstico , Febre/etiologia , Convulsões , Estado Epiléptico/diagnóstico , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/etiologia , Masculino , Criança
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