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1.
J Infect Dev Ctries ; 15(8): 1104-1106, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34516417

RESUMO

Brucellosis is a common zoonotic infection. Brucellosis typically presents with fever, weakness, night sweats, and arthralgias. Symptoms associated with Coronavirus Disease 2019 (COVID-19) and infection with Brucella spp. are similar to one another, which may lead to delayed diagnosis of the latter condition. There are no previous reports of brucellosis in a patient previously diagnosed with COVID-19. We present here the case of a 20-year-old male who we diagnosed with brucellosis after joint pains and fever that persisted after resolution of COVID-19.


Assuntos
Brucelose/diagnóstico , COVID-19/complicações , Coinfecção/diagnóstico , Zoonoses/diagnóstico , Animais , Artralgia/microbiologia , Brucelose/fisiopatologia , COVID-19/diagnóstico por imagem , Coinfecção/microbiologia , Coinfecção/virologia , Diagnóstico Diferencial , Febre/microbiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Adulto Jovem , Zoonoses/microbiologia
2.
Lancet Digit Health ; 3(8): e507-e516, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34325854

RESUMO

BACKGROUND: Acute febrile illness is one of the main reasons for outpatient hospital visits worldwide. However, differential diagnosis between bacterial and viral causes is challenging and misdiagnosis can result in antimicrobial overuse and hinder prompt treatment. We aimed to build and validate a diagnostic model to discriminate bacterial from viral infection in acute febrile illness by evaluating the expression of potential classifier host genes. METHODS: In this multicentre discovery and validation study, we included patients aged 14-85 years with acute febrile illness (fever for ≤14 days, axillary temperature of ≥38°C, and confirmed bacterial infection, viral infection, or non-infectious inflammatory disease), and healthy control participants (no significant medical history and no fever within the past 90 days) from four hospitals in Shandong province, China. Patients from the first hospital were divided into the screening, discovery, and internal validation groups, and patients from the three other hospitals comprised the external validation group. We measured expression of candidate genes in peripheral blood by RT-PCR, and patients for whom a successful RT-PCT result was recorded were included in the next-step analysis. For patients from the first hospital, those enrolled during the early phase of the study were assigned to the screening group, which was used to identify the optimal transcripts (IFI44L and PI3) for discrimination between bacterial and viral infections by screening four candidate genes (FAM89A, IFI44L, PI3, and ITGB2) by RT-PCR. The remaining patients were then randomly assigned (1:1) to discovery and internal validation groups by time of admission and blood drawing via the equidistant random sampling method. A logistic regression model integrating the mRNA levels of IFI44L and PI3 was built by use of the discovery group, and the diagnostic performance of the model was evaluated in the internal and external validation groups using area under the receiver operating curve (AUC), sensitivity, and specificity. FINDINGS: Between March 1, 2018, and Aug 31, 2019, we assessed 1658 individuals for inclusion in the study. After exclusion of ineligible participants, 458 participants were enrolled (178 patients with acute febrile illness caused by bacterial infection, 212 with acute febrile illness caused by viral infection, 38 with non-infectious inflammatory diseases, and 30 healthy controls). The 390 patients with bacterial or viral infections were assigned to one of four groups: screening (n=64, 33 with bacterial infections and 31 with viral infections), discovery (n=124, 55 with bacterial infections and 69 with viral infections), internal validation (n=124, 55 with bacterial infections and 69 with viral infections), and external validation (n=78, 35 with bacterial infections and 43 with viral infections). Of the four candidate host genes (FAM89A, IFI44L, PI3, and ITGB2), IFI44L and PI3 showed the most discriminative expression pattern and were used to build the logistic regression model. We established the optimal cutoff of the bacterial infection likelihood score to be 0·547598. With the diagnostic result from the gold standard tests (culture and PCR) as the reference, the two-transcript classifier model had an AUC of 0·969 (95% CI 0·937-1·000), sensitivity of 0·891 (0·782-0·949), and specificity of 0·971 (0·900-0·992) to discriminate bacterial and viral infections in the internal validation group. The model showed similar results in the external validation group (AUC 0·986, 95% CI 0·968-1·000; sensitivity 0·857, 0·706-0·937; and specificity 0·954, 0·845-0·987). INTERPRETATION: IFI44L and PI3 transcripts, measured by RT-PCR, are robust classifiers to discriminate bacterial from viral infection in acute febrile illness. This two-transcript biomarker has the potential to be transformed into a commercial panel and applied universally. FUNDING: None.


Assuntos
Bactérias , Infecções Bacterianas/diagnóstico , Febre/diagnóstico , Programas de Rastreamento/métodos , Modelos Biológicos , Viroses/diagnóstico , Vírus , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Bactérias/crescimento & desenvolvimento , Infecções Bacterianas/metabolismo , Infecções Bacterianas/microbiologia , Biomarcadores/metabolismo , China , Diagnóstico Diferencial , Feminino , Febre/metabolismo , Febre/microbiologia , Febre/virologia , Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Viroses/metabolismo , Viroses/virologia , Vírus/crescimento & desenvolvimento , Adulto Jovem
3.
Pediatrics ; 148(4)2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34193619

RESUMO

OBJECTIVES: To determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in infants hospitalized for a serious bacterial infection (SBI) evaluation and clinically characterize young infants with SARS-CoV-2 infection. METHODS: A retrospective chart review was conducted on infants <90 days of age hospitalized for an SBI evaluation. The study was conducted at 4 inpatient facilities in New York City from March 15, 2020, to December 15, 2020. RESULTS: We identified 148 SBI evaluation infants who met inclusion criteria. A total of 22 infants (15%) tested positive for SARS-CoV-2 by nasopharyngeal reverse transcription polymerase chain reaction; 31% of infants admitted during periods of high community SARS-CoV-2 circulation tested positive for SARS-CoV-2, compared with 3% when community SARS-CoV-2 circulation was low (P < .001). The mean age of infants with SARS-CoV-2 was higher than that of SARS-CoV-2-negative infants (33 [SD: 17] days vs 23 [SD: 23] days, respectively; P = .03), although no age difference was observed when analysis was limited only to febrile infants. An isolated fever was the most common presentation of SARS-CoV-2 (n = 13; 59%). Admitted infants with SARS-CoV-2 were less likely to have positive urine culture results (n = 1 [5%] versus n = 25 [20%], respectively; P = .002), positive cerebrospinal culture results (n = 0 [0%] versus n = 5 [4%], respectively; P = .02), or be admitted to intensive care (n = 2 [9%] versus n = 47 [37%]; P < .001), compared with infants without SARS-CoV-2. CONCLUSIONS: SARS-CoV-2 was common among young infants hospitalized for an SBI evaluation during periods of high but not low community SARS-CoV-2 circulation in New York City, although most infants did not require intensive care admission.


Assuntos
Infecções Bacterianas/diagnóstico , COVID-19/diagnóstico , COVID-19/epidemiologia , Idade de Início , Infecções Bacterianas/complicações , Infecções Bacterianas/epidemiologia , COVID-19/complicações , Teste de Ácido Nucleico para COVID-19 , Comorbidade , Feminino , Febre/microbiologia , Febre/virologia , Humanos , Lactente , Recém-Nascido , Masculino , Cidade de Nova Iorque/epidemiologia , Prevalência , Estudos Retrospectivos , SARS-CoV-2
5.
Front Immunol ; 12: 631308, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34079538

RESUMO

Febrile patients, suffering from an infection, inflammatory disease or autoimmunity may present with similar or overlapping clinical symptoms, which makes early diagnosis difficult. Therefore, biomarkers are needed to help physicians form a correct diagnosis and initiate the right treatment to improve patient outcomes following first presentation or admittance to hospital. Here, we review the landscape of novel biomarkers and approaches of biomarker discovery. We first discuss the use of current plasma parameters and whole blood biomarkers, including results obtained by RNA profiling and mass spectrometry, to discriminate between bacterial and viral infections. Next we expand upon the use of biomarkers to distinguish between infectious and non-infectious disease. Finally, we discuss the strengths as well as the potential pitfalls of current developments. We conclude that the use of combination tests, using either protein markers or transcriptomic analysis, have advanced considerably and should be further explored to improve current diagnostics regarding febrile infections and inflammation. If proven effective when combined, these biomarker signatures will greatly accelerate early and tailored treatment decisions.


Assuntos
Infecções Bacterianas/diagnóstico , Febre/etiologia , Inflamação/diagnóstico , Viroses/diagnóstico , Infecções Bacterianas/sangue , Infecções Bacterianas/complicações , Biomarcadores/sangue , Diagnóstico Diferencial , Febre/sangue , Febre/microbiologia , Febre/virologia , Perfilação da Expressão Gênica , Humanos , Inflamação/sangue , Inflamação/complicações , Índice de Gravidade de Doença , Viroses/sangue , Viroses/complicações
6.
BMC Infect Dis ; 21(1): 539, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098893

RESUMO

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


Assuntos
Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/epidemiologia , Programas de Rastreamento , Vigilância de Evento Sentinela , Teorema de Bayes , Burkina Faso , Estudos de Casos e Controles , Costa do Marfim , República Democrática do Congo , Febre/epidemiologia , Febre/microbiologia , Gastroenteropatias/epidemiologia , Gastroenteropatias/microbiologia , Humanos , Reação em Cadeia da Polimerase em Tempo Real , Infecções Respiratórias/epidemiologia , África do Sul
7.
BMC Infect Dis ; 21(1): 437, 2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980167

RESUMO

BACKGROUND: Many studies have shown that vancomycin is inferior to ß-lactam antibiotics in terms of effectiveness in the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. However, limited data are available regarding the comparison of clinical outcomes between patients receiving initial teicoplanin and those receiving ß-lactam antibiotics for MSSA bacteremia. METHODS: Eighty-four adults with MSSA bacteremia were included: initial teicoplanin treatment group (n = 28) and ß-lactam treatment group (n = 56). The two groups were further stratified based on propensity score matching according to the outcome analysis using a logistic regression model. We investigated the clinical outcomes between the groups before and after propensity score matching after treatment completion. RESULTS: Pittsburgh bacteremia score ≥ 4 (odds ratio, 60.6; 95%CI, 7.4-496.8) was an independent risk factor for unfavorable outcome. After propensity score matching, the initial teicoplanin treatment group and the ß-lactam treatment group consisted of 28 patients each. No statistically significant differences were observed in the proportions of patients with favorable outcomes and 30-day overall mortality rates between the groups before and after propensity score matching after the completion of teicoplanin or ß-lactam treatment. The Kaplan-Meier 30-day survival curve also showed no significant difference between the patients receiving initial teicoplanin treatment and those receiving ß-lactam treatment before and after matching (hazard ratio, 1.84, 95%CI, 0.60-5.64; and 3.12, 95%CI, 0.98-9.99, respectively). CONCLUSIONS: There were no significant difference in clinical outcomes between initial teicoplanin treatment and ß-lactam treatment among patients with MSSA bacteremia. Pittsburgh bacteremia score ≥ 4 was a significant risk factor for mortality.


Assuntos
Bacteriemia/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Teicoplanina/uso terapêutico , beta-Lactamas/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Feminino , Febre/tratamento farmacológico , Febre/microbiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Infecções Estafilocócicas/microbiologia , Resultado do Tratamento
8.
BMC Infect Dis ; 21(1): 501, 2021 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-34051756

RESUMO

BACKGROUND: Tick-borne pathogens other than Borrelia burgdorferi sensu lato - the causative agent of Lyme borreliosis - are common in Ixodes ricinus ticks. How often these pathogens cause human disease is unknown. In addition, diagnostic tools to identify such diseases are lacking or reserved to research laboratories. To elucidate their prevalence and disease burden, the study 'Ticking on Pandora's Box' has been initiated, a collaborative effort between Amsterdam University Medical Center and the National Institute for Public Health and the Environment. METHODS: The study investigates how often the tick-borne pathogens Anaplasma phagocytophilum, Babesia species, Borrelia miyamotoi, Neoehrlichia mikurensis, spotted fever group Rickettsia species and/or tick-borne encephalitis virus cause an acute febrile illness after tick-bite. We aim to determine the impact and severity of these tick-borne diseases in the Netherlands by measuring their prevalence and describing their clinical picture and course of disease. The study is designed as a prospective case-control study. We aim to include 150 cases - individuals clinically suspected of a tick-borne disease - and 3 matched healthy control groups of 200 persons each. The controls consist respectively of a group of individuals with either a tick-bite without complaints, the general population and of healthy blood donors. During a one-year follow-up we will acquire blood, urine and skin biopsy samples and ticks at baseline, 4 and 12 weeks. Additionally, participants answer modified versions of validated questionnaires to assess self-reported symptoms, among which the SF-36, on a 3 monthly basis. DISCUSSION: This article describes the background and design of the study protocol of 'Ticking on Pandora's Box'. With our study we hope to provide insight into the prevalence, clinical presentation and disease burden of the tick-borne diseases anaplasmosis, babesiosis, B. miyamotoi disease, neoehrlichiosis, rickettsiosis and tick-borne encephalitis and to assist in test development as well as provide recommendations for national guidelines. TRIAL REGISTRATION: NL9258 (retrospectively registered at Netherlands Trial Register, trialregister.nl in in February 2021).


Assuntos
Ixodes/microbiologia , Doenças Transmitidas por Carrapatos/epidemiologia , Doenças Transmitidas por Carrapatos/microbiologia , Adulto , Animais , Sangue/microbiologia , Sangue/virologia , Estudos de Casos e Controles , DNA Bacteriano , Febre/epidemiologia , Febre/microbiologia , Febre/virologia , Seguimentos , Humanos , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prevalência , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Índice de Gravidade de Doença , Pele/microbiologia , Pele/virologia , Inquéritos e Questionários , Picadas de Carrapatos/epidemiologia , Picadas de Carrapatos/microbiologia , Picadas de Carrapatos/virologia , Urina/microbiologia , Urina/virologia
9.
Medicine (Baltimore) ; 100(11): e24894, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725960

RESUMO

OBJECTIVES: Refractory mycoplasma pneumoniae pneumonia (RMPP) in children has been increasing worldwide. In this study, we conducted a meta-analysis to generate large-scale evidence on the risk factors of RMPP to provide suggestions on prevention and controlling for children. METHODS: Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang (Chinese) were searched to identify relevant articles. All analyses were performed using Stata 14.0. RESULTS: We conducted a meta-analysis of 15 separate studies. Fever for more than 10 days (odds ratio [OR] 3.965, 95% confidence interval [CI] 2.109-7.456), pleural effusion (OR 6.922, 95% CI 2.058-23.282), extra-pulmonary complications (OR 17.762, 95% CI 11.146-28.305), pulmonary X-ray consolidation ≥2/3 (OR 8.245, 95% CI 1.990-34.153), CRP >40 mg/L (OR 4.975, 95% CI 2.116-11.697) were significantly related to the risk of RMPP. We did not find an association between male sex (OR 0.808, 95% CI 0.548-1.189), LDH >410IU/L (OR 1.033, 95% CI 0.979-1.091) and the risk of RMPP. CONCLUSIONS: Fever for more than 10 days, pleural effusion, extra-pulmonary complications, pulmonary X-ray consolidation≥ 2/3 and CRP >40 mg/L are risk factors for early evaluation of RMPP.


Assuntos
Mycoplasma pneumoniae , Pneumonia por Mycoplasma/etiologia , Proteína C-Reativa/análise , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/microbiologia , Farmacorresistência Bacteriana , Feminino , Febre/microbiologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Masculino , Derrame Pleural/microbiologia , Pneumonia por Mycoplasma/microbiologia , Radiografia , Medição de Risco , Fatores de Risco
10.
Am J Emerg Med ; 45: 1-6, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33639293

RESUMO

CONTEXT: Febrile neutropenic immunocompromised children are at a high risk of Serious Bacterial Infections (SBI). OBJECTIVE: This systematic review and meta-analysis report the prevalence of SBI in healthy children with febrile neutropenia. DATA SOURCE: PubMed, EMBASE, and Web of Science from their inception to August 2020. STUDY SELECTION: Patients with an Absolute Neutrophil Count (ANC) <1000 cells/mm3 up to 18 years of age presenting to the ED with a chief complaint of fever (temperature > 38°C) and who had a workup for SBI as defined by each study. DATA ABSTRACTION: Data from individual studies was abstracted by a subset of the authors and checked independently by the senior author. Any discrepancies were adjudicated by the joint agreement of all the authors. We calculated the prevalence of SBI by using the number of SBI's as the numerator and the total number of febrile events in patients as the denominator. Bias in our studies was quantified by the Newcastle Ottawa Scale. RESULTS: We identified 2066 citations of which five studies (1693 patients) our inclusion criteria. None of our reviewed studies consistently tested every included patient for SBI. Spectrum bias in every study resulted in a wide range of the SBI prevalence of 1.9% (<0.01% - 11%) similar to non-neutropenic children. LIMITATIONS: All of our studies were retrospective and many did not consistently screen all subjects for SBI. CONCLUSION: If the clinical suspicion is low, the risk for SBI is similar between febrile healthy neutropenic and non-neutropenic children.


Assuntos
Infecções Bacterianas/epidemiologia , Febre/microbiologia , Neutropenia/microbiologia , Criança , Humanos , Prevalência
11.
Pediatrics ; 147(3)2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33563770

RESUMO

A previously healthy 15-year-old boy from a rural county in the southeastern United States was evaluated in the emergency department with fever and worsening toe pain in the absence of trauma. He initially presented to his primary care physician 4 weeks before with upper respiratory symptoms and was treated with corticosteroids for presumed reactive airway disease. His respiratory symptoms resolved. One week after this presentation, he developed fever and right great toe pain and presented to an outside hospital. Inflammatory markers were elevated. MRI confirmed a diagnosis of osteomyelitis with associated periosteal abscess. He was treated with intravenous antibiotics and drainage of the abscess. Ten days after his discharge from the outside hospital, he developed fever and had increasing drainage of the toe and pain refractory to oral pain medications. He presented to our facility for further evaluation. Repeat MRI and inflammatory markers corroborated his worsening disease, and he was admitted to the hospital for intravenous antibiotics and underwent serial surgical debridement. He developed painful subcutaneous nodules on his lower extremities and was found to have lung abnormalities on chest radiograph. A multispecialty team collaborated in the management of this patient and unveiled a surprising diagnosis.


Assuntos
Abscesso/microbiologia , Blastomicose/diagnóstico , Febre/microbiologia , Hallux , Osteomielite/microbiologia , Dor Intratável/etiologia , Doenças dos Trabalhadores Agrícolas/microbiologia , Amputação , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Blastomyces/isolamento & purificação , Blastomicose/complicações , Daptomicina/uso terapêutico , Progressão da Doença , Hallux/cirurgia , Humanos , Itraconazol/uso terapêutico , Masculino
12.
J Pediatr ; 232: 192-199.e2, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33421424

RESUMO

OBJECTIVE: To develop a novel predictive model using primarily clinical history factors and compare performance to the widely used Rochester Low Risk (RLR) model. STUDY DESIGN: In this cross-sectional study, we identified infants brought to one pediatric emergency department from January 2014 to December 2016. We included infants age 0-90 days, with temperature ≥38°C, and documented gestational age and illness duration. The primary outcome was bacterial infection. We used 10 predictors to develop regression and ensemble machine learning models, which we trained and tested using 10-fold cross-validation. We compared areas under the curve (AUCs), sensitivities, and specificities of the RLR, regression, and ensemble models. RESULTS: Of 877 infants, 67 had a bacterial infection (7.6%). The AUCs of the RLR, regression, and ensemble models were 0.776 (95% CI 0.746, 0.807), 0.945 (0.913, 0.977), and 0.956 (0.935, 0.975), respectively. Using a bacterial infection risk threshold of .01, the sensitivity and specificity of the regression model was 94.6% (87.4%, 100%) and 74.5% (62.4%, 85.4%), compared with 95.5% (87.5%, 99.1%) and 59.6% (56.2%, 63.0%) using the RLR model. CONCLUSIONS: Compared with the RLR model, sensitivities of the novel predictive models were similar whereas AUCs and specificities were significantly greater. If externally validated, these models, by producing an individualized bacterial infection risk estimate, may offer a targeted approach to young febrile infants that is noninvasive and inexpensive.


Assuntos
Infecções Bacterianas/diagnóstico , Regras de Decisão Clínica , Febre/microbiologia , Anamnese/métodos , Infecções Bacterianas/complicações , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Lineares , Modelos Logísticos , Aprendizado de Máquina , Masculino , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade
13.
Internist (Berl) ; 62(1): 95-99, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33030562

RESUMO

A 19-year-old female patient was admitted to hospital for further diagnostics and treatment of a febrile infection. The cause was found to be a bronchopulmonary infection due to methicillin-sensitive Staphylococcus aureus (MSSA), which led to an infective endocarditis with mitral valve infestation and two splenic abscesses. Under treatment according to the antibiogram and laparoscopic excision of the splenic abscesses, the infection-related complications could be successfully resolved. Even during the physical examination there was a suspicion of Cushing's syndrome, which was confirmed by laboratory and radiological investigations and is associated with a general immune deficiency. Remarkable was that the initially difficult to adjust high blood pressure became normalized after transsphenoidal resection of the pituitary adenoma.


Assuntos
Abscesso/complicações , Síndrome de Cushing/diagnóstico , Febre/complicações , Hipertensão/complicações , Valva Mitral/microbiologia , Hipersecreção Hipofisária de ACTH/cirurgia , Esplenopatias/complicações , Infecções Estafilocócicas/complicações , Abscesso/microbiologia , Abscesso/cirurgia , Hormônio Adrenocorticotrópico/sangue , Antibacterianos/uso terapêutico , Síndrome de Cushing/cirurgia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Febre/diagnóstico , Febre/microbiologia , Humanos , Laparoscopia , Hipófise/cirurgia , Esplenopatias/tratamento farmacológico , Esplenopatias/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
15.
J Pediatr Hematol Oncol ; 43(2): 47-51, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32604334

RESUMO

Children with cancer and non-neutropenic fever (NNF) episodes are often treated as outpatients if they appear well. However, a small subset have bloodstream infections (BSIs) and must return for further evaluation. These patients may be directly admitted to inpatient units, whereas others are first evaluated in outpatient settings before admission. The best practice for securing care for patients discovered to have outpatient bacteremia are unclear. To determine outcomes and compare time to antibiotics between the 2 disposition, we retrospectively reviewed all NNF initially treated as outpatients and later had positive blood cultures from 2012 to 2016. Of 845 NNF cases initially treated in outpatient settings, 48 episodes (n=43 patients) had BSIs. Of those, 77.1% (n=37) were re-evaluated as outpatients and admitted; 14.6% (n=7) were direct admissions. The median time to antibiotic did not significantly differ between outpatient re-evaluations (119 min) and direct admissions (191 min), P=0.11. One patient met sepsis criteria upon return and required intensive care unit admission for vasopressor support. No patient died within 1 week of the febrile episode. Most patients with NNF and BSIs initially discharged are stable upon return. Institutions should evaluate their patient flows to ensure that patients receive timely care.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Febre/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Neoplasias/terapia , Sepse/tratamento farmacológico , Adolescente , Adulto , Bacteriemia/sangue , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Feminino , Febre/sangue , Febre/epidemiologia , Febre/microbiologia , Seguimentos , Humanos , Lactente , Masculino , Neoplasias/patologia , Prognóstico , Estudos Retrospectivos , Sepse/sangue , Sepse/epidemiologia , Sepse/microbiologia , Estados Unidos/epidemiologia , Adulto Jovem
16.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318244

RESUMO

Hepatic brucelloma (HB), a rare manifestation of brucellosis, refers to liver involvement in the form of abscess. A 35-year-old woman stockbreeder was admitted due to 1-month history of evening fever, sweating and weight loss, while she was on 3-week course of rifampicin/doxycycline for suspected brucellosis. On admission, she had hepatosplenomegaly and a systolic murmur, while cholestasis, increased inflammation markers and a strong-positive Wright-Coombs test were the main laboratory findings. As blood and bone marrow cultures were unrevealing, further investigation with CT imaging showed a central liver calcification surrounded by heterogeneous hypodense area being compatible with HB. Material from CT-guided drainage tested negative for Brucella spp. After failure to improve on a 10-week triple regiment, surgical excision was decided and Brucella spp were identified by PCR. Our case highlights challenges in establishing HB diagnosis, which should be considered on the right epidemiological context and when serological and radiological evidence favour its diagnosis.


Assuntos
Brucelose/diagnóstico , Febre/microbiologia , Fígado/microbiologia , Adulto , Animais , Antibacterianos/uso terapêutico , Brucella melitensis/isolamento & purificação , Brucelose/tratamento farmacológico , Feminino , Febre/tratamento farmacológico , Humanos , Fígado/patologia , Tomografia Computadorizada por Raios X , Zoonoses
17.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334767

RESUMO

An 83-year-old man with a history of chronic myelogenous leukaemia in remission maintained with bosutinib presented with new-onset fevers. He denied pain and had no other focal symptoms. Ultrasound imaging revealed mild gallbladder wall thickening. Non-contrasted CT revealed right upper quadrant inflammation of indeterminate source. The diagnosis of acalculous cholecystitis was made on the third day when a CT with oral contrast demonstrated a remarkably inflamed biliary tree. The gallbladder was surgically removed and found to be necrotic. The case highlights an unusual presentation for a well-known condition. Both ultrasound and CT have limited diagnostic sensitivity for acalculous cystitis. This case adds to existing literature to support development of acalculous cholecystitis in non-critically ill patients. Clinicians should maintain awareness of this condition among patients presenting to the hospital or clinic with abdominal pain. Careful discussion with radiology and surgery is indicated to guide diagnostic testing when initial imaging results are indeterminate.


Assuntos
Colecistite Acalculosa/diagnóstico , Escherichia coli/isolamento & purificação , Febre/microbiologia , Vesícula Biliar/patologia , Colecistite Acalculosa/complicações , Colecistite Acalculosa/microbiologia , Colecistite Acalculosa/terapia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Colecistectomia , Quimioterapia Combinada , Febre/sangue , Febre/imunologia , Febre/terapia , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/microbiologia , Vesícula Biliar/cirurgia , Humanos , Masculino , Necrose/complicações , Necrose/diagnóstico , Necrose/microbiologia , Necrose/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
18.
PLoS One ; 15(11): e0242138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33211730

RESUMO

Fungi have been associated with various diseases of the eye like keratitis, uveitis and endophthalmitis. Despite this fact, fungal microbiome (mycobiome) studies compared to the bacterial microbiome studies have remained neglected. In the present study, using metagenomic sequencing, the mycobiomes of the vitreous of healthy control individuals (VC, n = 15) and individuals with post fever retinitis + non-PFR uveitis (PFR+, n = 9) were analysed and compared. The results indicated that Ascomycota was the most predominant phylum in both VC and PFR+ groups. Further, at the genera level it was observed that the abundance of 17 fungal genera were significantly different in post fever retinitis (PFR, n = 6) group compared to control group. Of these 17 genera, it was observed that 14 genera were relatively more abundant in PFR group and the remaining 3 genera in the VC group. Genus Saccharomyces, a commensal of the gut and skin, was predominantly present in the vitreous of both the cohorts, however it was significantly less abundant in PFR group. Further, significant increase in the genera that have a pathogenic interaction with the host were observed in PFR group. On the whole the mycobiome in both the groups differed significantly and formed two distinct clusters in the heatmap and Principal co-ordinate analysis. These results demonstrate significant changes in the mycobiome from the vitreous of post fever retinitis patients compared to healthy controls thus implying that dysbiotic changes in the fungal vitreous microbiome are associated with PFR.


Assuntos
Ascomicetos/fisiologia , Febre/microbiologia , Micobioma , Retinite/microbiologia , Saccharomyces/fisiologia , Corpo Vítreo/microbiologia , Análise por Conglomerados , Disbiose/microbiologia , Febre/complicações , Humanos , Metagenoma , Retinite/complicações , Uveíte/microbiologia
19.
PLoS One ; 15(11): e0242856, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33237968

RESUMO

Autonomic nervous function evaluated by heart rate variability (HRV) and blood characteristics were compared between Holstein Friesian cows that developed postpartum fever (PF; n = 5) and clinically healthy (CH; n = 6) puerperal cows in this case-control study. A cow was defined as having PF when its rectal temperature rose to ≥39.5°C between 1 and 3 days postpartum. We recorded electrocardiograms during this period using a Holter-type electrocardiograph and applied power spectral analysis of HRV. Comparisons between the groups were analyzed by t test or Mann-Whitney U test, and the relationship between rectal temperature and each parameter was analyzed using multiple regression analysis. Heart rate was higher in PF cows than in CH cows (Mean ± SE, 103.3 ± 2.7 vs. 91.5 ± 1.7 bpm). This result suggested that PF cows had a relatively dominant sympathetic nervous function. Total (44,472 ± 2,301 vs. 55,373 ± 1,997 ms) and low frequency power (24.5 ± 3.8 vs. 39.9 ± 5.3 ms) were lower in PF cows than in CH cows. These findings were possibly caused by a reduction in autonomic nervous function. The total white blood cell count (54.3 ± 5.1 vs. 84.5 ± 6.4 ×102/µL) and the serum magnesium (2.1 ± 0.1 vs. 2.4 ± 0.1 mg/dL) and iron (81.5 ± 8.0 vs. 134.4 ± 9.1 µg/dL) concentrations were lower and the serum amyloid A concentration (277 ± 33 vs. 149 ± 21 µg/mL) was higher in PF cows than in CH cows. These results imply that more inflammation was present in PF cows than in CH cows. Multiple regression analysis showed that both of low frequency power and concentration of serum iron were associated with rectal temperature. We found differences in changes in hematologic results, biochemical findings, and HRV patterns between PF cows and CH cows.


Assuntos
Febre/fisiopatologia , Período Pós-Parto/fisiologia , Infecção Puerperal/microbiologia , Animais , Estudos de Casos e Controles , Bovinos , Feminino , Febre/genética , Febre/microbiologia , Frequência Cardíaca/genética , Frequência Cardíaca/fisiologia , Humanos , Lactação/fisiologia , Fotoperíodo , Período Pós-Parto/genética , Gravidez , Infecção Puerperal/patologia
20.
PLoS One ; 15(10): e0236460, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33112882

RESUMO

The intestinal bacterial flora of febrile neutropenic patients has been found to be significantly diverse. However, there are few reports of alterations of in adult acute myeloid leukemia (AML) patients. Stool samples of each treatment-naïve AML patient were collected the day before initiation of induction chemotherapy (pretreatment), on the first date of neutropenic fever and first date of bone marrow recovery. Bacterial DNA was extracted from stool samples and bacterial 16s ribosomal RNA genes were sequenced by next-generation sequencing. Relative abundance, overall richness, Shannon's diversity index and Simpson's diversity index were calculated. No antimicrobial prophylaxis was in placed in all participants. Ten cases of AML patients (4 male and 6 female) were included with a median age of 39 years (range: 19-49) and all of patients developed febrile neutropenia. Firmicutes dominated during the period of neutropenic fever, subsequently declining after bone marrow recovery a pattern in contrast to that shown by Bacteroidetes and Proteobacteria. Enterococcus was more abundant in the febrile neutropenia period compared to pretreatment (mean difference +20.2; p < 0.0001) while Escherichia notably declined during the same period (mean difference -11.2; p = 0.0064). At the operational taxonomic unit (OTU) level, there was a significantly higher level of overall richness in the pretreatment period than in the febrile neutropenic episode (mean OTU of 203.1 vs. 131.7; p = 0.012). Both of the diversity indexes of Shannon and Simpson showed a significant decrease during the febrile neutropenic period. Adult AML patients with a first episode of febrile neutropenia after initial intensive chemotherapy demonstrated a significant decrease in gut microbiota diversity and the level of diversity remained constant despite recovery of bone marrow.


Assuntos
Bactérias/classificação , Biodiversidade , Febre/microbiologia , Microbioma Gastrointestinal , Quimioterapia de Indução/efeitos adversos , Leucemia Mieloide Aguda/tratamento farmacológico , Neutropenia/microbiologia , Adolescente , Adulto , Idoso , Bactérias/isolamento & purificação , Feminino , Febre/induzido quimicamente , Humanos , Leucemia Mieloide Aguda/patologia , Masculino , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente , Adulto Jovem
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