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1.
Medicine (Baltimore) ; 99(22): e20121, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481378

RESUMO

INTRODUCTION: The aim of this study was to evaluate the efficacy and safety of azithromycin (AZI) combined with glucocorticoid (GC) in the treatment of children with refractory Mycoplasma pneumoniae. METHODS: Computer search for PubMed, EMbase, Cochrane Library, China Biomedical Literature Database (CBMdisc), China Knowledge Network (CNKI), Wanfang, VIP (VIP), and a randomized controlled trial (RCT) of AZI combined with GC in the treatment of children with refractory Mycoplasma pneumoniae pneumonia test (RCT), the search time limit is built until March 20, 2019. Two researchers independently performed literature screening, data extraction, and literature risk bias, and meta-analysis was performed using RevMan 5.3 software. RESULTS: A total of 12 RCTs were included, including 1130 patients. Meta-analysis showed that AZI combined with GC therapy significantly improved the total effective rate of the disease compared with the conventional treatment group (odds ratio [OR] = 6.37; 95% confidence interval [CI] 4.03, 10.07; P < .00001; I = 0%), effectively shortened the antipyretic time (SMD = -2.29; 95% CI -2.70, -1.88; P < .0001); promoted lung inflammation absorption (SMD = -1.89; 95% CI -2.38, -1.40; P < .0001), reduced cough time (SMD = -2.39; 95% CI -2.80, -1.99; P < .0001); shortened hospital stay (SMD = -2.19; 95% CI -3.21, -1.17; P < .0001); improved imaging findings (OR = 5.38; 95% CI 1.09, 26.51, P = .04); reduced inflammation index (SMD = -3.15; 95% CI -4.93, -1.36; P = .004); improved immune function (SMD = 1.29; 95% CI -0.02, 2.60; P < .0001); had no significant adverse reactions (OR = 1.18; 95% CI 0.71, 1.98; P = .53). CONCLUSIONS: According to the current limited research evidence, the addition of GCs to the conventional treatment of refractory Mycoplasma pneumoniae in children can improve the clinical efficacy to a certain extent, and the safety is better. However, due to the quality and quantity of the included literature, the conclusions of this study need to be confirmed by more high-quality studies.


Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Glucocorticoides/uso terapêutico , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/tratamento farmacológico , Antibacterianos/efeitos adversos , Azitromicina/efeitos adversos , Criança , Tosse/tratamento farmacológico , Tosse/microbiologia , Quimioterapia Combinada , Febre/tratamento farmacológico , Febre/microbiologia , Glucocorticoides/efeitos adversos , Humanos , Tempo de Internação , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/diagnóstico por imagem
2.
BMC Infect Dis ; 20(1): 421, 2020 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-32552663

RESUMO

BACKGROUND: The number of human Q fever cases in South Korea has been rapidly increasing since 2015. We report the first isolation of Coxiella burnetii in Korea in two patients who initially presented with non-specific febrile illness and were finally diagnosed with acute Q fever in South Korea. CASE PRESENTATION: Two adult patients with fever had serologic tests against C. burnetii initially negative, and polymerase chain reaction against 16S rRNA using whole blood was also negative. After bacterial amplification of C. burnetii in immune-depressed mice, we isolated C. burnetii from patients with acute Q fever. The isolates KZQ2 and KZQ3 were confirmed by polymerase chain reaction, nucleotide sequence analysis, and morphologic observation using a transmission electron microscope. CONCLUSIONS: These results can help us understand the clinical and epidemiologic features of Q fever in South Korea.


Assuntos
Coxiella burnetii/isolamento & purificação , Febre/microbiologia , Febre Q/diagnóstico , Febre Q/epidemiologia , Adulto , Idoso , Animais , Chlorocebus aethiops , Coxiella burnetii/genética , Coxiella burnetii/imunologia , Humanos , Incidência , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Reação em Cadeia da Polimerase , Febre Q/microbiologia , RNA Ribossômico 16S/genética , República da Coreia/epidemiologia , Testes Sorológicos , Células Vero
3.
BMC Infect Dis ; 20(1): 364, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448167

RESUMO

BACKGROUND: Reports of human rickettsial infection in Indonesia are limited. This study sought to characterize the epidemiology of human rickettsioses amongst patients hospitalized with fever at 8 tertiary hospitals in Indonesia. METHODS: Acute and convalescent blood from 975 hospitalized non-dengue patients was tested for Rickettsia IgM and IgG by ELISA. Specimens from cases with seroconversion or increasing IgM and/or IgG titers were tested for Rickettsia IgM and IgG by IFA and Rickettsia genomes using primers for Rickettsia (R.) sp, R. typhi, and Orientia tsutsugamushi. Testing was performed retrospectively on stored specimens; results did not inform patient management. RESULTS: R. typhi, R. rickettsii, and O. tsutsugamushi IgG antibodies were identified in 269/872 (30.8%), 36/634 (5.7%), and 19/504 (3.8%) of samples, respectively. For the 103/975 (10.6%) non-dengue patients diagnosed with acute rickettsial infection, presenting symptoms included nausea (72%), headache (69%), vomiting (43%), lethargy (33%), anorexia (32%), arthralgia (30%), myalgia (28%), chills (28%), epigastric pain (28%), and rash (17%). No acute rickettsioses cases were suspected during hospitalization. Discharge diagnoses included typhoid fever (44), dengue fever (20), respiratory infections (7), leptospirosis (6), unknown fever (6), sepsis (5), hepatobiliary infections (3), UTI (3), and others (9). Fatalities occurred in 7 (6.8%) patients, mostly with co-morbidities. CONCLUSIONS: Rickettsial infections are consistently misdiagnosed, often as leptospirosis, dengue, or Salmonella typhi infection. Clinicians should include rickettsioses in their differential diagnosis of fever to guide empiric management; laboratories should support evaluation for rickettsial etiologies; and public policy should be implemented to reduce burden of disease.


Assuntos
Febre/diagnóstico , Hospitalização , Infecções por Rickettsia/diagnóstico , Infecções por Rickettsia/epidemiologia , Rickettsia rickettsii/imunologia , Rickettsia typhi/imunologia , Doença Aguda , Adolescente , Adulto , Idoso , Anticorpos Antibacterianos/sangue , Criança , Pré-Escolar , Dengue/diagnóstico , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Feminino , Febre/microbiologia , Humanos , Imunoglobulina G/sangue , Indonésia/epidemiologia , Lactente , Leptospirose/diagnóstico , Masculino , Pessoa de Meia-Idade , Orientia tsutsugamushi/imunologia , Estudos Retrospectivos , Infecções por Rickettsia/microbiologia , Tifo por Ácaros/diagnóstico , Febre Tifoide/diagnóstico , Adulto Jovem
4.
BMC Infect Dis ; 20(1): 327, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380974

RESUMO

BACKGROUND: Tularemia, a re-emerging, potential life threatening infectious disease, can present itself with nonspecific clinical symptoms including fever, chills and malaise. Taking a detailed history of exposure and a highly raised index of clinical suspicion are necessary to take the appropriate diagnostic and therapeutic steps in this setting. Here, a case report of typhoid tularaemia is presented. CASE PRESENTATION: A 53-year old male forester and farmer with protracted fever, abdominal pain, diarrhoea and loss of weight, who experienced productive cough and a pulmonary infiltrate later in the course of disease, was admitted for further investigation. Tularaemia was suspected only owing to history and confirmed by serologic testing more than three weeks after the beginning of the symptoms. The initial antibiotic therapy with ceftriaxone/doxycycline was switched to ciprofloxacin, resulting in the resolution of fever and symptoms. CONCLUSION: Tularaemia has to be considered as a differential diagnosis in febrile patients, even more in cases with protracted fever. Since tularaemia is expanding geographically, involving more animal hosts and causing larger outbreaks, clinicians have to be aware of this potentially fatal disease.


Assuntos
Febre/microbiologia , Tularemia/diagnóstico , Tularemia/etiologia , Dor Abdominal/diagnóstico , Dor Abdominal/tratamento farmacológico , Antibacterianos/uso terapêutico , Peso Corporal , Ceftriaxona/uso terapêutico , Ciprofloxacino/uso terapêutico , Tosse/tratamento farmacológico , Tosse/microbiologia , Diagnóstico Diferencial , Diarreia/tratamento farmacológico , Diarreia/microbiologia , Doxiciclina/uso terapêutico , Fazendeiros , Francisella tularensis/patogenicidade , Humanos , Masculino , Pessoa de Meia-Idade , Testes Sorológicos , Tularemia/tratamento farmacológico
5.
Int J Infect Dis ; 96: 334-342, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32437937

RESUMO

OBJECTIVES: This study investigated causes of fever in the primary levels of care in Southeast Asia, and evaluated whether C-reactive protein (CRP) could distinguish bacterial from viral pathogens. METHODS: Blood and nasopharyngeal swab specimens were taken from children and adults with fever (>37.5 °C) or history of fever (<14 days) in Thailand and Myanmar. RESULTS: Of 773 patients with at least one blood or nasopharyngeal swab specimen collected, 227 (29.4%) had a target organism detected. Influenza virus type A was detected in 85/227 cases (37.5%), followed by dengue virus (30 cases, 13.2%), respiratory syncytial virus (24 cases, 10.6%) and Leptospira spp. (nine cases, 4.0%). Clinical outcomes were similar between patients with a bacterial or a viral organism, regardless of antibiotic prescription. CRP was higher among patients with a bacterial organism compared with those with a viral organism (median 18 mg/L, interquartile range [10-49] versus 10 mg/L [≤8-22], p = 0.003), with an area under the curve of 0.65 (95% CI 0.55-0.75). CONCLUSIONS: Serious bacterial infections requiring antibiotics are an exception rather than the rule in the first line of care. CRP testing could assist in ruling out such cases in settings where diagnostic uncertainty is high and routine antibiotic prescription is common. The original CRP randomised controlled trial was registered with ClinicalTrials.gov, number NCT02758821.


Assuntos
Infecções Bacterianas/complicações , Proteína C-Reativa/metabolismo , Febre/etiologia , Atenção Primária à Saúde , Adulto , Antibacterianos/uso terapêutico , Ásia Sudeste , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Febre/diagnóstico , Febre/microbiologia , Febre/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar , Tailândia
6.
Int J Infect Dis ; 96: 408-415, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32360942

RESUMO

OBJECTIVES: Children aged <5 years are the group most affected by infectious diseases, more specifically in underdeveloped countries. A study was performed to assess the effects of daily soap use on the incidence of diarrhoea, fever, respiratory infection, and the prevalence of pathogenic bacteria on the skin. METHODS: Soap was distributed to the population of the village of Ndiop (test) for use in their daily hygiene but not to the population of the village of Dielmo (control). Fieldworkers daily recorded the clinical events in the two villages and encouraged the use of soap in Ndiop. RESULTS: A total of 638 people participated in the study. The incidence rates of cough, runny nose and fever significantly decreased in 2016 compared with 2015, unlike that of diarrhoea. In 2016, significant reductions in the incidence rates of cough, runny nose and fever were observed in children aged <15 years in Ndiop. The prevalence of Streptococcus pneumoniae, Staphylococcus aureus and Streptococcus pyogenes in the palms of the hands significantly dropped in Ndiop. CONCLUSION: Using soap reduces the incidence of respiratory infections, fevers and the prevalence of pathogenic bacteria on the skin. However, for diarrhoea, additional strategies are needed to improve outcomes.


Assuntos
Febre/prevenção & controle , Microbiota , Infecções Respiratórias/prevenção & controle , Pele/microbiologia , Sabões/uso terapêutico , Adolescente , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/prevenção & controle , Feminino , Febre/epidemiologia , Febre/microbiologia , Humanos , Incidência , Lactente , Masculino , Prevalência , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , População Rural/estatística & dados numéricos , Senegal/epidemiologia
7.
Parasit Vectors ; 13(1): 199, 2020 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-32303256

RESUMO

BACKGROUND: Borrelia miyamotoi is a relapsing fever Borrelia species transmitted by ticks of the Ixodes ricinus complex. Human disease caused by B. miyamotoi was first described in Russia and later in the USA and Japan. Additionally, five cases of meningoencephalitis in immunocompromised patients and one case in an apparently immunocompetent patient were described. METHODS: We investigated the presence of B. miyamotoi in I. ricinus nymphs and in patients suspected of human granulocytic anaplasmosis, in Alsace (France), an endemic area for I. ricinus ticks and Lyme borreliosis, using direct (PCR) and indirect diagnosis (glycerophosphoryldiester-phosphodiesterase (GlpQ) serology). RESULTS: Borrelia miyamotoi was found in 2.2% of 4354 ticks collected between 2013 and 2016. None of the 575 blood samples, collected from the patients suspected of HGA, was found positive for B. miyamotoi by PCR. Acute and late sera from 138 of these 575 patients were available. These paired sera were tested for IgM and IgG antibodies against the B. miyamotoi GlpQ antigen. A total of 14 out of 138 patients had at least one positive parameter (i.e. anti-GlpQ IgG and/or IgM). One patient seroconverted for IgG, and three had isolated IgM in the acute serum. These three patients were treated with doxycycline which could have prevented seroconversion. After reviewing clinical data and other biological tests performed, co-exposure among different microorganisms vectored by ticks or serological cross-reactivity could not be ruled out in these different cases. One patient had persistent IgG, which strongly suggests previous exposure to B. miyamotoi. CONCLUSIONS: Humans can be exposed to B. miyamotoi through tick bites in Alsace. We present serological data for possible B. miyamotoi exposure or infection of patients with fever after tick bite. Future studies should determine the incidence, clinical course and burden of this emerging tick-borne disease in other parts of Western Europe.


Assuntos
Borrelia/isolamento & purificação , Ixodes/microbiologia , Doença de Lyme/epidemiologia , Animais , Vetores Aracnídeos/microbiologia , DNA Bacteriano , Reservatórios de Doenças/microbiologia , Febre/microbiologia , França/epidemiologia , Humanos , Masculino , Ninfa/microbiologia , Reação em Cadeia da Polimerase , Testes Sorológicos , Picadas de Carrapatos/microbiologia , Doenças Transmitidas por Carrapatos/epidemiologia
8.
J Water Health ; 18(2): 239-243, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32300096

RESUMO

This case report discusses a rare presentation of salmonella bacteremia after an oral exposure to a sand dollar in a pediatric patient. A 2-year-old Hispanic male presented to the emergency department with a chief complaint of diarrhea and fever for 8 days after a family trip to Destin beach, Florida, during the sea turtle nesting season. The symptoms began a day after the patient took a bite on a sand dollar found on the beach that caused a small wound inside his cheek. The laboratory testing done in the emergency department was remarkable for blood and stool culture testing positive for non-typhoid salmonella. The sand dollar is a type of a sea urchin commonly found on sandy beaches and consists of an anatomical filtration system to consume sandy water. It could be inferred that the increased presence of sea turtles during the time of the patient's visit to Destin beach could have led to higher levels of salmonella in the seawater and consequently in the sand dollar, possibly leading to the inoculation of salmonella in this patient. To the best of our knowledge, this is a first case report that links oral exposure of the sand dollar to invasive salmonellosis.


Assuntos
Bacteriemia/diagnóstico , Praias , Febre/microbiologia , Infecções por Salmonella/diagnóstico , Ouriços-do-Mar/microbiologia , Animais , Pré-Escolar , Florida , Humanos , Masculino , Salmonella
9.
Infection ; 48(3): 471-475, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32128685

RESUMO

BACKGROUND: While Campylobacter jejuni represents the most common cause of bacterial gastroenteritis, Yersinia pseudotuberculosis infections are very rarely diagnosed in adults. CASE: We report on a previously healthy patient who presented several times at our hospital with fever, Guillain-Barré syndrome, recurrent abdominal symptoms and distinct mesenteric lymphadenopathy, respectively. This complicated and diagnostically challenging course of disease was caused by a C. jejuni and Y. pseudotuberculosis coinfection. Antibiotic treatment with doxycycline was effective. CONCLUSION: Broad serology testing was crucial to discover that two concomitant infections were causing the symptoms. This case demonstrates that when a clinical picture is not fully explained by one known infection, another infection with the same underlying risk factor has to be considered, hence "a horse and a zebra".


Assuntos
Infecções por Campylobacter/diagnóstico , Coinfecção/diagnóstico , Gastroenteropatias/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Infecções por Yersinia pseudotuberculosis/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Infecções por Campylobacter/diagnóstico por imagem , Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/microbiologia , Campylobacter jejuni/isolamento & purificação , Coinfecção/diagnóstico por imagem , Coinfecção/tratamento farmacológico , Coinfecção/microbiologia , Doxiciclina/uso terapêutico , Febre/microbiologia , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/microbiologia , Alemanha , Síndrome de Guillain-Barré/diagnóstico por imagem , Síndrome de Guillain-Barré/microbiologia , Humanos , Linfadenopatia/diagnóstico , Linfadenopatia/microbiologia , Masculino , Recidiva , Resultado do Tratamento , Yersinia pseudotuberculosis/isolamento & purificação , Infecções por Yersinia pseudotuberculosis/diagnóstico por imagem , Infecções por Yersinia pseudotuberculosis/tratamento farmacológico , Infecções por Yersinia pseudotuberculosis/microbiologia
10.
BMC Infect Dis ; 20(1): 117, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041536

RESUMO

BACKGROUND: Severe febrile illness without a known source (SFWS) is a challenge for clinicians when deciding how to manage a patient, particularly given the wide spectrum of potential aetiologies that contribute to fever. These infections are difficult to distinguish clinically, and accurate diagnosis requires a plethora of diagnostics including blood cultures, imaging techniques, molecular or serological tests, and more. When laboratory services are available, a limited test menu hinders clinical decision-making and antimicrobial stewardship, leading to empiric treatment and suboptimal patient outcomes. To specifically address SFWS, this work aimed to identify priority pathogens for a globally applicable panel for fever causing pathogens. METHOD: A pragmatic two-pronged approach combining currently available scientific data in an analytical hierarchy process and systematically gathered expert input, was designed to address the lack of comprehensive global aetiology data. The expert re-ranked list was then further adapted for a specific use case to focus on community acquired infections in whole blood specimens. The resulting list was further analysed to address different geographical regions (Asia, Africa, and Latin America), and Cohen kappa scores of agreement were calculated. RESULTS: The expert ranked prioritized pathogen list generated as part of this two-pronged approach included typhoidal Salmonella, Plasmodium species and Mycobacterium tuberculosis as the top 3 pathogens. This pathogen list was then further adapted for the SFWS use case to develop a final pathogen list to inform product development. Subsequent analysis comparing the relevance of the SFWS pathogen list to multiple populations and geographical regions showed that the SFWS prioritized list had considerable utility across Africa and Asia, but less so for Latin America. In addition, the list showed high levels of agreement across different patient sub-populations, but lower relevance for neonates and symptomatic HIV patients. CONCLUSION: This work highlighted once again the challenges of prioritising in global health, but it also shows that taking a two-pronged approach, combining available prevalence data with expert input, can result in a broadly applicable priority list. This comprehensive utility is particularly important in the context of product development, where a sufficient market size is essential to achieve a sustainable commercialized diagnostic product to address SFWS.


Assuntos
Testes Diagnósticos de Rotina/normas , Febre/diagnóstico , África/epidemiologia , Ásia/epidemiologia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/parasitologia , Infecções Comunitárias Adquiridas/virologia , Países em Desenvolvimento , Febre/microbiologia , Febre/parasitologia , Febre/virologia , Saúde Global/normas , Humanos , América Latina/epidemiologia , Prevalência
11.
J Vasc Interv Radiol ; 31(3): 464-472, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32007416

RESUMO

PURPOSE: To assess diagnostic performance of CT-guided percutaneous needle bone biopsy (CTNBB) in patients with suspected osteomyelitis and analyze whether certain clinical or technical factors were associated with positive microbiology results. MATERIALS AND METHODS: All CTNBBs performed in a single center for suspected osteomyelitis of the appendicular and axial skeleton during 2003-2018 were retrospectively reviewed. Specific inclusion criteria were clinical and radiologic suspicion of osteomyelitis. Standard of reference was defined using outcome of surgical histopathology and microbiology culture and clinical and imaging follow-up. Technical and clinical data (needle size, comorbidities, clinical factors, laboratory values, blood cultures) were collected. Logistic regression was performed to assess associations between technical and clinical data and microbiology biopsy outcome. RESULTS: A total of 142 CTNBBs were included (46.5% female patients; age ± SD 46.10 y ± 22.8), 72 (50.7%) from the appendicular skeleton and 70 (49.3%) from the axial skeleton. CTNBB showed a sensitivity of 42.5% (95% confidence interval [CI], 32.0%-53.6%) in isolating the causative pathogen. A higher rate of positive microbiology results was found in patients with intravenous drug use (odds ratio [OR] = 5.15; 95% CI, 1.2-21.0; P = .022) and elevated white blood cell count ≥ 10 × 109/L (OR = 3.9; 95% CI, 1.62-9.53; P = .002). Fever (≥ 38°C) was another clinical factor associated with positive microbiology results (OR = 3.6; 95% CI, 1.3-9.6; P = .011). CONCLUSIONS: CTNBB had a low sensitivity of 42.5% for isolating the causative pathogen. Rate of positive microbiology samples was significantly higher in patients with IV drug use, elevated white blood cell count, and fever.


Assuntos
Bactérias/isolamento & purificação , Técnicas Bacteriológicas , Osso e Ossos/microbiologia , Biópsia Guiada por Imagem/métodos , Osteomielite/diagnóstico , Radiografia Intervencionista , Adolescente , Adulto , Idoso , Criança , Bases de Dados Factuais , Feminino , Febre/complicações , Febre/microbiologia , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Osteomielite/microbiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/microbiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
12.
Infect Dis Poverty ; 9(1): 6, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31948465

RESUMO

BACKGROUND: Human brucellosis is a neglected public health issue in China and reports of HIV-infected individuals complicated with brucellosis are rare. This report describes the case of an HIV-infected patient complicated with brucellosis. We want to raise awareness of clinical diagnosis of brucellosis among clinicians. Furthermore, we should be more concerned about cases with pyrexia of unknown origin, especially in non-epidemic areas of brucellosis in China. CASE PRESENTATION: We encountered the case of a 31-year-old HIV-infected male with a CD4+ T lymphocyte count of approximately 300. On May 1, 2019, the patient had onset of non-specific caustic irregular fever with body temperature reaching 41.0 °C. He was admitted to two medical institutions in Yunnan with pyrexia of unknown origin. Finally, on day 7 of hospitalization in the Public Health Clinical Medical Center in Chengdu City, he was diagnosed as having brucellosis infection based on blood culture results. CONCLUSIONS: This is the first reported case of brucellosis concomitant with HIV infection in China. Laboratories in infectious disease hospitals and category A level III hospitals in the southern provinces of China should be equipped with reagents for clinical diagnosis of brucellosis and to strengthen the awareness of brucellosis diagnosis in China. Secondly, in provinces with a high incidence of AIDS and brucellosis such as Xinjiang and Henan, it is recommended to implement a joint examination strategy to ensure the early detection, diagnosis, and treatment of this infection.


Assuntos
Brucelose/diagnóstico , Febre/diagnóstico , Infecções por HIV/virologia , Adulto , Brucelose/tratamento farmacológico , Brucelose/microbiologia , China , Comorbidade , Febre/tratamento farmacológico , Febre/microbiologia , Humanos , Masculino , Resultado do Tratamento
13.
BMC Infect Dis ; 20(1): 22, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914937

RESUMO

BACKGROUND: Brucellosis is one of the most widespread zoonosis in the world. In China, 90% of human brucellosis occurs in six northern agricultural provinces. However, there is a recent increase in the trend of human brucellosis in southern provinces with limited cases reported in the literature. Our study aims to describe the clinical features and epidemiology of brucellosis in a tertiary hospital in southern China. METHODS: A retrospective case series of brucellosis was conducted between January 1, 2014 and October 31. 2018. Cases were identified based on positive Brucella serology by tube agglutination test, or positive culture from clinical specimen identified by Vitek 2 and MALDL-TOF MS. Clinical details of brucellosis including patients' occupation, risk factors, and complications were analyzed. Clinical characteristics between patients from Guangdong and other provinces were also compared. RESULTS: A total of 13 cases of laboratory-confirmed brucellosis were identified. 7 (53.8%) of the patients were male, 6 (46.2%) were female, with age ranging from 29 to 73 years old (median age: 51 years). 5 patients (38.5%) were from Guangdong province, while the remaining patients (61.5%) were from other provinces. The commonest risk factors of acquisition were consumption of undercooked meat and goat placenta. Patients from Guangdong province were found to be more likely to have prior placenta consumption. The commonest clinical presentations were fever, osteoarticular pain, urinary symptoms, splenomegaly, and lymphadenopathy. Spondylodiscitis/ peripheral joint arthritis (5 patients, 38.5%) was the most prevalent complication, while extra-osteoarticular complications including abdominal aortitis, hepatosplenic abscess, chest wall abscess, and epididymo-orchitis were observed in 4 other patients. Furthermore, it was demonstrated that MALDI-TOF MS is reliable in Brucella identification after additional of reference spectra with standard Brucella strain. CONCLUSIONS: Brucellosis, previously thought to be only found in northern China, is now increasingly seen in highly cosmopolitan part of southern China. MALDI-TOF MS in hospitals in China should include reference spectra with standard Brucella strain to aid bacterial identification in routine clinical practice. In addition to tuberculosis, typhoid fever and typhus, brucellosis should be considered in patients with fever of unknown origin in this locality.


Assuntos
Brucelose/epidemiologia , Adulto , Idoso , Brucella/isolamento & purificação , Brucelose/diagnóstico , China/epidemiologia , Diagnóstico Diferencial , Feminino , Febre/complicações , Febre/diagnóstico , Febre/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Urbanização
14.
PLoS Negl Trop Dis ; 14(1): e0007927, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31923174

RESUMO

BACKGROUND: The epidemiology of acute febrile illness, a common cause of hospitalization in Indonesia, has not been systematically studied. METHODOLOGY/PRINCIPAL FINDINGS: This prospective observational study enrolled febrile patients (temperature ≥38°C) aged ≥1 year from July 2013 until June 2016 at eight government referral teaching hospitals in seven provincial capitals in Indonesia. Patients were managed according to the hospital standard-of-care (SOC), and blood samples were drawn for molecular and serological assays. Clinical data, laboratory results, and specimens for additional tests were collected at enrollment, days 14-28, and at three months. Regular follow-up visits were then scheduled for every three months either until symptoms resolved or until one year. In total, this study included 1,486 adult and pediatric patients presenting with multi-organ (768, 51.7%), gastrointestinal (497, 33.0%), respiratory (114, 7.7%), constitutional (62, 4.2%), skin and soft-tissue (24, 1.6%), central nervous system (17, 1.1%), or genitourinary (4, 0.3%) manifestations. Microbiological diagnoses were found in 1,003/1,486 (67.5%) participants, of which 351/1,003 (35.0%) were not diagnosed during hospitalization using SOC diagnostic tests. Missed diagnoses included all cases caused by Rickettsia spp., chikungunya, influenza, and Seoul virus. The most common etiologic agents identified were dengue virus (467, 46.6%), Salmonella spp. (103, 10.3%), and Rickettsia spp. (103, 10.3%). The overall mortality was 89 (5.9%). CONCLUSIONS/SIGNIFICANCE: Febrile illness in Indonesia has various microbiologic etiologies and substantial overall mortality. Diagnostic limitations and lack of epidemiologic data resulted in potentially treatable, and at times fatal, diseases being missed.


Assuntos
Febre/diagnóstico , Febre/epidemiologia , Pacientes Internados/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Febre/microbiologia , Febre/mortalidade , Seguimentos , Hospitais de Ensino , Humanos , Indonésia/epidemiologia , Lactente , Masculino , Pessoa de Meia-Idade , Diagnóstico Ausente/estatística & dados numéricos , Estudos Prospectivos
15.
Int J Infect Dis ; 90: 1-4, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31648003

RESUMO

BACKGROUND: Scrub typhus is caused by Orientia tsutsugamushi. Clinical manifestations include fever, rash, eschar at the bite site, and other non-specific flu-like symptoms. The eschar is a dark, scab-like area at the bite site, and is the typical lesions that prompts a diagnosis of O. tsutsugamushi. Without eschar lesions, it is difficult to identify scrub typhus. However, metagenomic next-generation sequencing (mNGS) can be used to identify infections, and this novel method may help improve clinical diagnosis. CASE PRESENTATION: Here, we report a case of scrub typhus in a 51-year-old woman who presented to the emergency department with a week-long fever from an unknown cause. We used mNGS to search for an infectious etiology, and the mNGS suggested O. tsutsugamushi, which was unexpectedly detected. DISCUSSION AND CONCLUSION: This study suggests that mNGS may be a useful diagnostic tool to identify clinical, causative pathogens in fever, particular ones with atypical features.


Assuntos
Orientia tsutsugamushi/isolamento & purificação , Tifo por Ácaros/diagnóstico , Feminino , Febre/diagnóstico , Febre/microbiologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Metagenômica , Pessoa de Meia-Idade , Orientia tsutsugamushi/genética , Tifo por Ácaros/microbiologia
17.
Int J Infect Dis ; 92: 78-80, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887457

RESUMO

We report the case of an 18-year-old immunocompetent man who presented to the hospital with fever, headaches, and arthromyalgia, which progressed to include an erythematous rash. He had a history of a tick bite 72 h earlier. The diagnosis of rickettsial infection was suspected and a course of doxycycline was initiated for a total of 5 days. His evolution was rapidly favorable under treatment, with resolution of the symptoms within 24 h. Blood cultures came back positive for Neisseria meningitidis serotype B, indicating an authentic purpura fulminans. Purpura fulminans is a medical emergency, a syndrome of intravascular thrombosis characterized by a very rapid evolution that requires early recognition and specific treatment. It is commonly described in the young and healthy patient and has high mortality and morbidity. Common bacteria mainly associated with purpura fulminans are Meningococcus spp., Pneumococcus spp., and Staphylococcus spp.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Doxiciclina/uso terapêutico , Infecções Meningocócicas/tratamento farmacológico , Púrpura Fulminante/tratamento farmacológico , Adolescente , Febre/microbiologia , Humanos , Masculino , Neisseria meningitidis , Púrpura Fulminante/microbiologia , Resultado do Tratamento
18.
BMC Infect Dis ; 19(1): 1038, 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31818269

RESUMO

BACKGROUND: To investigate the risk factors for brucellosis in suspected cases of the disease. METHODS: A self-designed questionnaire was developed to collect data from 3557 people whose initial visit site was the Songyuan Center for Disease Control and Prevention (CDC) from January 1st, 2009 to December 31st, 2012. After collecting blood samples, a plate agglutination test (PAT) and serum agglutination test (SAT) were used to distinguish the patients with brucellosis from the suspected cases. RESULTS: Sex, occupation (farmers and herdsmen), contact with abortion products, and contact with feces were the main risk factors for brucellosis in the suspected cases (all P < 0.05). No difference existed between the confirmed cases and suspected cases in the demographic characteristics, contact with animals (except swine), contact with substances, or clinical symptoms (except fever). However, the confirmed cases showed significant differences from people without brucellosis in demographic characteristics, contact with animals (except cattle and swine), contact with substances, and clinical symptoms. Suspected cases exhibited significant differences from people without brucellosis in the demographic characteristics (except education), contact with animals (except swine), contact with substances (except dust), and clinical symptoms (except chills and acratia). Brucella was cultured from the blood samples of three of 30 suspected cases with fever. Using AMOS-PCR and agarose electrophoresis, the detailed species of Brucella strain was identified as Brucella melitensis. CONCLUSIONS: Abortion products and feces are the main risk factors for brucellosis in suspected cases of the disease. Pyrexia in suspected cases with a history of contact with abortion products or feces should raise suspicion for the disease.


Assuntos
Brucelose/diagnóstico , Brucelose/transmissão , Aborto Animal/microbiologia , Adolescente , Adulto , Testes de Aglutinação/métodos , Animais , Brucella melitensis/genética , Brucella melitensis/isolamento & purificação , Brucella melitensis/patogenicidade , Brucelose/etiologia , Bovinos , China , Fazendeiros , Fezes/microbiologia , Feminino , Febre/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Gravidez , Fatores de Risco , Suínos , Adulto Jovem
19.
Clin Lab ; 65(12)2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31850719

RESUMO

BACKGROUND: Bacteroides caccae is a ubiquitous, anaerobic bacteria, but it is not a common cause of pathologic bloodstream infection. Diabetic patients are at increased risk of developing anaerobic bacteria infection. Here, we report a repeated fever case caused by Bacteroides caccae in a diabetic patient. The aim of this study was to describe the clinical characteristics and manifestations of Bacteroides caccae. METHODS: The pathogenic bacteria isolated from patient blood was identified as Bacteroides caccae. Identification of the Bacteroides caccae was done by 16s rDNA sequencing and matrix-assisted laser desorption/ionization-time of light spectrometry. The infection was cured by one-week combined therapy of intravenous Piperacillin tazobactam and oral Ornidazole tablet. RESULTS: After treatment had been completed, no episodes of fever occurred during the follow-up to date. CONCLUSIONS: Bacteroides caccae is regarded as an intestinal, opportunistic pathogenic bacteria. It can invade the mucosa of the intestine and cause various abdominal suppurative infections. Sequencing and matrix-assisted laser desorption/ionization-time of flight spectrometry could have a role for Bacteroides caccae diagnosis. The curative effect of using first generation cephalosporines therapy was unsatisfactory. Using intravenous Piperacillin tazobactam and ornidazole tablet might obtain certain curative effect. Early diagnosis and appropriate anti-infection therapy were necessary to improve the outcome of patients with Bacteroides caccae bloodstream infection.


Assuntos
Infecções por Bacteroides/microbiologia , Bacteroides/fisiologia , Complicações do Diabetes/microbiologia , Diabetes Mellitus/microbiologia , Febre/microbiologia , Bacteroides/efeitos dos fármacos , Bacteroides/isolamento & purificação , Infecções por Bacteroides/sangue , Infecções por Bacteroides/tratamento farmacológico , Complicações do Diabetes/sangue , Complicações do Diabetes/tratamento farmacológico , Quimioterapia Combinada , Feminino , Febre/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Ornidazol/uso terapêutico , Combinação Piperacilina e Tazobactam/uso terapêutico
20.
PLoS Negl Trop Dis ; 13(11): e0007792, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31730635

RESUMO

BACKGROUND: Acute febrile illness (AFI), a common reason for people seeking medical care globally, represents a spectrum of infectious disease etiologies with important variations geographically and by population. There is no standardized approach to conducting AFI etiologic investigations, limiting interpretation of data in a global context. We conducted a scoping review to characterize current AFI research methodologies, identify global research gaps, and provide methodological research standardization recommendations. METHODOLOGY/FINDINGS: Using pre-defined terms, we searched Medline, Embase, and Global Health, for publications from January 1, 2005-December 31, 2017. Publications cited in previously published systematic reviews and an online study repository of non-malarial febrile illness etiologies were also included. We screened abstracts for publications reporting on human infectious disease, aimed at determining AFI etiology using laboratory diagnostics. One-hundred ninety publications underwent full-text review, using a standardized tool to collect data on study characteristics, methodology, and laboratory diagnostics. AFI case definitions between publications varied: use of self-reported fever as part of case definitions (28%, 53/190), fever cut-off value (38·0°C most commonly used: 45%, 85/190), and fever measurement site (axillary most commonly used: 19%, 36/190). Eighty-nine publications (47%) did not include exclusion criteria, and inclusion criteria in 13% (24/190) of publications did not include age group. No publications included study settings in Southern Africa, Micronesia & Polynesia, or Central Asia. We summarized standardized reporting practices, specific to AFI etiologic investigations that would increase inter-study comparability. CONCLUSIONS: Wider implementation of standardized AFI reporting methods, with multi-pathogen disease detection, could improve comparability of study findings, knowledge of the range of AFI etiologies, and their contributions to the global AFI burden. These steps can guide resource allocation, strengthen outbreak detection and response, target prevention efforts, and improve clinical care, especially in resource-limited settings where disease control often relies on empiric treatment. PROSPERO: CRD42016035666.


Assuntos
Doenças Transmissíveis/epidemiologia , Febre/epidemiologia , Febre/etiologia , Conhecimento , África Austral , Bases de Dados Factuais , Surtos de Doenças , Febre/microbiologia , Febre/virologia , Humanos , Ilhas do Pacífico
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