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1.
Ethiop J Health Sci ; 31(3): 653-662, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34483623

RESUMO

Background: Tuberculosis and human immunodeficiency virus (HIV) are among the major health problems in Ethiopia. This study assessed the proportion of tuberculosis lymphadenitis (TBLN), HIV infection and their co-infection among TBLN presumptive individuals at the selected hospitals in Northwest Ethiopia. Methods: Institution based cross sectional study was carried out. Data on demographic and clinical variables were collected with standardized questionnaire. Microbiological culture was done on specimen obtained by fine needle aspirates. The HIV status was determined by rapid anti-HIV antibody test. Data was entered and scrutinized using SPSS version 20 statistical packages. A stepwise logistic regression model was used. The result was considered as statistically significant at P<0. 05. Results: A total of 381 lymphadenitis patients were included in the study. The overall prevalence of TBLN and HIV were at 250(65.6%) and 9(2.4%), respectively and their co-infection was at 6(2.4%). Based on the cytological examination, 301(79.0%) of them were diagnosed as TBLN. The age group, (P=0.01) and residency, (P=0.01) were found significantly associated with TBLN. Similarly, unsafe sex was also statistically significant for HIV infection (P=0.007). Conclusion: Tuberculosis lymphadenitis is the leading cause of TB and lymphadenitis in the region. However, TBLN-HIV coinfection was promisingly low. High rate of discrepancy was noticed between cytological and culture results. Hence, the TBLN diagnostic criteria shall pursue revision.


Assuntos
Coinfecção , Infecções por HIV , Linfadenite , Mycobacterium tuberculosis , Tuberculose dos Linfonodos , Coinfecção/epidemiologia , Estudos Transversais , Etiópia/epidemiologia , HIV , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Linfadenite/epidemiologia , Linfadenite/etiologia , Tuberculose dos Linfonodos/epidemiologia
2.
Turk J Pediatr ; 63(4): 666-672, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34449149

RESUMO

BACKGROUND: Periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome is the most common cause of periodic fever in childhood. This study aimed to investigate sleep patterns and possible factors that are associated with sleep disturbances among children with PFAPA syndrome. METHODS: Sixty-two patients with PFAPA and 68 age and sex matched healthy controls were enrolled in the study. Patients who had an attack during the former 2 weeks were not included. Demographic and anthropometric data, duration of fever episodes, laboratory results, and clinical manifestations of patients were recorded. The Children`s Sleep Habits Questionnaire was administered. RESULTS: The total sleep scores of patients with PFAPA were significantly higher than the control group (49.6 ± 10.7 vs. 38.3 ± 7.5, p = 0.002 ). Children with PFAPA had significantly higher scores regarding sleep-onset delay, sleep anxiety and night wakening (p=0.003, p=0.007, and p=0.014, respectively). Total sleep durations were similar between children with PFAPA and the control group. There was a significant positive correlation between the total sleep score and disease duration (r=0.425, p=0.002). Also there was a significant positive correlation between disease duration and sleep onset delay (r=0.561, p < 0.001) and night wakening (r=0.327, p=0.003). CONCLUSION: This study showed for the first time that patients with PFAPA have significantly disturbed sleep when compared to otherwise normal children. This study emphasized the need to assess sleep problems in children with PFAPA.


Assuntos
Linfadenite , Faringite , Estomatite Aftosa , Criança , Febre/etiologia , Humanos , Linfadenite/complicações , Linfadenite/diagnóstico , Faringite/complicações , Faringite/diagnóstico , Sono , Estomatite Aftosa/complicações , Estomatite Aftosa/diagnóstico
3.
BMC Infect Dis ; 21(1): 801, 2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380453

RESUMO

BACKGROUND: The management strategy of Bacille Calmette-Guérin (BCG) vaccine-induced regional suppurative lymphadenitis in children is still controversial and more clinical studies are needed. We therefore present a surgical case series to explore the role of surgical management for this dilemma. METHODS: From January 2013 to June 2020, data from 65 patients diagnosed with BCG vaccine-induced regional suppurative lymphadenitis were retrospectively reviewed. Clinical characteristics, ultrasonographic findings, surgical procedures, perioperative management, and outcome were analyzed. The association between postoperative seroma and symptom duration, skin involvement, and postoperative hospital stay were compared using Yates's corrected Chi-square test and Student's t-test for statistical analysis. The follow-up period ranged from three to six months. RESULTS: Of the 65 cases, the median age at presentation was 3.4 months. All patients were full-term with normal range of birth weight and received a BCG vaccination in the first 24 h of life. All patients underwent surgical excision of the abscess with the involved lymph node(s). Postoperative seroma formation was found in 20 patients and fine needle aspiration was needed. There was no significant association between postoperative seroma formation with symptom duration, skin involvement, and postoperative hospital stay. No oral anti-tubercular agents were given postoperatively. The mean length of postoperative hospital stay was 6.02 ± 1.62 days. Sixty-four cases (98.46%) received only one procedure and recovered. One patient required a second procedure due to postoperative sinus. CONCLUSIONS: The present study showed that surgical excision of the abscess with involved lymph node(s) is one of the choices for BCG vaccine-induced suppurative lymphadenitis, but special attention should be paid to controlling the surgical indications. Intraoperative meticulous manipulation and postoperative care are crucial to achieve a good outcome.


Assuntos
Vacina BCG , Linfadenite , Vacina BCG/efeitos adversos , Criança , Humanos , Lactente , Linfonodos , Linfadenite/induzido quimicamente , Estudos Retrospectivos , Vacinação/efeitos adversos
4.
Am J Surg Pathol ; 45(9): 1235-1244, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34232607

RESUMO

Routine tissue handling exposes lymph node specimens to microbial contamination that can confound microbiological culture results and interfere with diagnosis. The scope and impact of this problem remain poorly understood. We combined over 13 years of lymph node pathology, culture data, and patient records to define the prevalence, predisposing factors, microbiology, and clinical management of false-positive lymph node cultures at a large academic medical center. Nearly one third (31.9%) of 216 cultured lymph nodes yielded bacterial growth. Approximately 90% of positive bacterial cultures grew 1 of 2 common skin-resident taxa-coagulase-negative Staphylococcus and Cutibacterium acnes-with well-documented predispositions for contamination in other clinical settings. Lymph nodes excised from axillary, cervical, and inguinal regions yielded higher positive culture rates than nodes excised from the mediastinum, suggesting proximity to the skin surface may increase contamination risk. Accordingly, cultures from thoracoscopic pulmonary resections displayed contamination rates over 5-fold lower than those from percutaneously accessed lymph nodes. Lymph nodal tissue allocated for culture in the operating room yielded unexpectedly high contamination rates, significantly higher than cultures sent from the frozen section processing area. A significant minority of contamination events were noted in the clinical record and prompted antibiotic therapy on multiple occasions. Collectively, our results illuminate the risk factors contributing to bacterial contamination and argue that routine lymph node bacterial cultures provide minimal clinical benefit for adult patients. This widespread bacterial contamination also warrants cautious implementation of increasingly sensitive molecular microbiology tools for excised tissues.


Assuntos
Bactérias , Infecções/diagnóstico , Linfonodos/microbiologia , Linfadenite/diagnóstico , Adulto , Idoso , Biópsia , Reações Falso-Positivas , Feminino , Humanos , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Prevalência
5.
Rev. cuba. pediatr ; 93(2): e887, tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1280371

RESUMO

Introducción: El síndrome de fiebre periódica, estomatitis aftosa, faringitis y adenitis es un cuadro relativamente frecuente de curso autolimitado y buen pronóstico. Es la más común de las enfermedades autoinflamatorias que presentan fiebre recurrente y su etiología y fisiopatogenia permanecen inciertas. Objetivo: Describir el caso clínico de un niño que consultó por fiebre recurrente y faringitis y se arribó al diagnóstico de síndrome de fiebre periódica, estomatitis aftosa, faringitis y adenitis. Presentación del caso: Se trata de un paciente de 5 años que consultó por un episodio febril acompañado de faringitis y adenitis, con antecedente de múltiples episodios previos. Conclusiones: El síndrome fiebre periódica, estomatitis aftosa, faringitis y adenitis, es una entidad de curso benigno y autolimitado que constituye la causa más común de fiebre recurrente con un gran impacto en la vida de los pacientes. La fisiopatogenia permanece incierta. Es destacable la sospecha clínica para arribar al diagnóstico ya que no existen en la actualidad exámenes complementarios específicos(AU)


Introduction: Periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome is a relatively common picture of self-limiting course and good prognosis. It is the most common of self-inflammatory diseases with recurrent fever and its etiology and physiopathology remain uncertain. Objective: Describe the clinical case of a boy who was checked due recurrent fever and pharyngitis and being diagnosed with Periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome. Case presentation: This is a 5-year-old patient who was consulted due to a febrile episode accompanied by pharyngitis and adenitis, with a history of multiple previous episodes. Conclusions: Periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome is a benign, self-limiting course entity that is the most common cause of recurrent fever with a large impact on patients' lives. Its physiopathology remains uncertain. Clinical suspicion for diagnosis is noteworthy as there are currently no specific complementary test for it(AU)


Assuntos
Humanos , Masculino , Pré-Escolar , Febre Recorrente , Estomatite Aftosa , Faringite , Febre , Linfadenite
6.
BMJ Case Rep ; 14(5)2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952565

RESUMO

Cervical acute lymphadenitis is rarely described in neonates. We present the case of a 12-day-old preterm, fed by nasogastric tube, who presented a tender erythematous submandibular swelling. Laboratory data showed neutrophilia and an elevation of C reactive protein and procalcitonin. Ultrasound findings suggested cellulitis and adenitis with abscess. The culture of the drainage material identified methicillin-sensitive Staphylococcus aureus With the administration of the right antibiotic treatment, a good clinical outcome was observed.


Assuntos
Linfadenite , Infecções Estafilocócicas , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Humanos , Recém-Nascido , Linfadenite/diagnóstico , Linfadenite/tratamento farmacológico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus
7.
J Clin Exp Hematop ; 61(2): 85-92, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-33994431

RESUMO

Necrotizing lymphadenitis (NEL) is a self-limited systemic disease exhibiting characteristic clinical features. The pathogenesis of the disease remains unclear, but it may be associated with viral infection. In lymph nodes affected by this disease, innumerable plasmacytoid dendritic cells produce interferon-α when triggered by certain viral stimuli. IFN-α presents antigens causing the transformation of CD8+ cells into immunoblasts and apoptosis of CD4+ cells. From the perspective of innate immunity, UNC93B1, an endoplasmic reticulum (ER)-resident protein, associates more strongly with TLR9 than TLR7. Homeostasis is maintained under normal conditions. However, in NEL, TLR 7 was observed more than TLR 9, possibly because mutant type UNC93B1 associates more tightly with TLR7. The inhibitory effects against TLR7 by TLR9 were reported to disappear. It is likely that more TLR7 than TLR9 is transported from the ER to endolysosomes. In conclusion, overexpression of TLR7, an innate immune sensor of microbial single-stranded RNA, is inferred. Consequently, NEL may be induced.


Assuntos
Células Dendríticas/patologia , Linfadenite/patologia , Receptor 7 Toll-Like/metabolismo , Receptor Toll-Like 9/metabolismo , Adolescente , Adulto , Criança , Pré-Escolar , Células Dendríticas/metabolismo , Feminino , Humanos , Linfadenite/metabolismo , Masculino , Pessoa de Meia-Idade , Transporte Proteico , Receptor 7 Toll-Like/análise , Receptor Toll-Like 9/análise , Adulto Jovem
9.
Int J Pediatr Otorhinolaryngol ; 144: 110674, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33725589

RESUMO

INTRODUCTION: Tonsillar microenvironment is thought to contribute to innate immune dysregulation responsible for the periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) because of beneficial effects of tonsillectomy on treatment of the syndrome. Accordingly previous studies reported altered lymphocyte frequency, cytokine level and microbial composition in PFAPA tonsils. The aim of our study is to monitor expression levels of pro-inflammatory cell surface Toll-like receptors (TLRs) which have important role in induction of inflammation and maintaining tissue haemostasis. MATERIALS AND METHODS: Seven patients with PFAPA syndrome, and eight patients with group A beta-hemolytic streptococcal (GAßHS) recurrent tonsillitis were included in our study. Tonsillar expression levels of TLR-1, -2, -4, -5, and -6 were monitored by immunohistochemistry (IHC). Expression levels were scored using semi-quantitative analysis method and were statistically analyzed by Two-Way Repeated Measures Analysis of Variance test. RESULTS: IHC analysis demonstrated expression of all TLRs in tonsillar surface epithelium (SE) and lymphoid interior (LI) except for TLR-6 which was not present in the former. There has not been any statistically significant difference in TLR expression levels between PFAPA and GAßHS tonsils, except for TLR-1 and TLR-2 which were higher on LI and lower on SE of PFAPA tonsils, respectively, than that of the GAßHS samples. CONCLUSIONS: Altered TLR expression levels may be involved in PFAPA pathogenesis. Future studies with higher patient number, uninflamed tonsils and cellular markers are required to further enlighten the role of TLRs in the development of syndrome.


Assuntos
Linfadenite , Faringite , Estomatite Aftosa , Receptor 1 Toll-Like/metabolismo , Receptor 2 Toll-Like/metabolismo , Tonsilite , Humanos , Tonsila Palatina/cirurgia , Tonsilite/cirurgia
10.
Front Immunol ; 12: 625320, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33717137

RESUMO

Background: Chronic granulomatous disease (CGD) is an inherited defect in phagocytic respiratory burst that results in severe and life-threatening infections in affected children. Single center studies from India have shown that proportion of autosomal recessive (AR) CGD is more than that reported from the West. Further, affected patients have high mortality rates due to late referrals and difficulties in accessing appropriate treatment. However, there is lack of multicentric collaborative data on CGD from India. Objective: To describe infection patterns, immunological, and molecular features of CGD from multiple centers in India. Methods: A detailed proforma that included clinical and laboratory details was prepared and sent to multiple centers in India that are involved in the care and management of patients with inborn errors of immunity. Twelve centers have provided data which were later pooled together and analyzed. Results: Of the 236 patients analyzed in our study, X-linked and AR-CGD was seen in 77 and 97, respectively. Male female ratio was 172:64. Median age at onset of symptoms and diagnosis was 8 and 24 months, respectively. Common infections documented include pneumonia (71.6%), lymphadenitis (31.6%), skin and subcutaneous abscess (23.7%), blood-stream infection (13.6%), osteomyelitis (8.6%), liver abscess (7.2%), lung abscess (2.9%), meningoencephalitis (2.5%), splenic abscess (1.7%), and brain abscess (0.9%). Forty-four patients (18.6%) had evidence of mycobacterial infection. Results of molecular assay were available for 141 patients (59.7%)-CYBB (44.7%) gene defect was most common, followed by NCF1 (31.9%), NCF2 (14.9%), and CYBA (8.5%). While CYBA variants were documented only in Southern and Western parts of India, a common dinucleotide deletion in NCF2 (c.835_836delAC) was noted only in North Indian population. Of the 174 patients with available outcome data, 67 (38.5%) had expired. Hematopoietic stem cell transplantation was carried out in 23 patients, and 12 are doing well on follow-up. Conclusions: In India, proportion of patients with AR-CGD is higher as compared to Western cohorts, though regional differences in types of AR-CGD exist. Clinical profile and mortality rates are similar in both X-linked and AR-CGD. However, this may be a reflection of the fact that milder forms of AR-CGD are probably being missed.


Assuntos
Doença Granulomatosa Crônica/imunologia , Transplante de Células-Tronco Hematopoéticas , Pele/patologia , Pré-Escolar , Feminino , Doença Granulomatosa Crônica/genética , Doença Granulomatosa Crônica/mortalidade , Humanos , Índia , Lactente , Linfadenite , Masculino , Mutação/genética , NADPH Oxidase 2/genética , NADPH Oxidases/genética , Fagocitose/genética , Pneumonia , Análise de Sobrevida
11.
J Coll Physicians Surg Pak ; 31(2): 193-196, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33645188

RESUMO

OBJECTIVE:  To determine the factors associated with cervical lymph node suppuration in oropharyngeal tularemia. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY:  Departments of Infectious Diseases and Clinical Microbiology, Faculties of Medicine, Duzce University and Bolu Abant Izzet Baysal University Turkey, between January 2016 and August 2019. METHODOLOGY: Tularemia was diagnosed in clinically compatible cases by micro-agglutination test (≥1/160 titres). Positive cases were divided into two groups according to development of suppurated and discharging lymph nodes. If the cases did not develop suppuration and discharge lymph nodes, they were defined as completely healed. If they did, they were defined as "suppurated and drained lymph node group." Demographic and clinical characteristics and acute phase reactants of these groups were compared as to investigate any significant difference between the groups. RESULTS: There were 88 tularemia cases in the current study. Of these, 60 cases were completely healed (68.2%) and 28 cases had suppurated and drained lymph nodes (31.8%). Tonsillopharyngitis was found significantly lower in suppurated and drained lymph node group compared to the completely healed group (p= 0.016). However, late presentation (>14 days) was found significantly more frequent in suppurated and drained lymph node group compared to the completely healed group (p=0.033). CONCLUSION: In order to prevent suppurative lymphadenitis in oropharyngeal tularemia, it is advisable to start appropriate antimicrobials within 14 days after the appearance of symptoms. Key Words: Oropharyngeal tularemia, Cervical lymph node suppuration, Antibiotic initiation time.


Assuntos
Linfadenite , Tularemia , Humanos , Linfonodos , Supuração , Tularemia/diagnóstico , Tularemia/tratamento farmacológico , Turquia/epidemiologia
12.
Appl Microbiol Biotechnol ; 105(6): 2287-2296, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33651132

RESUMO

Caseous lymphadenitis (CLA) is an infectious chronic disease responsible for economic losses in sheep and goat breeding worldwide. CLA has no effective treatment, evidencing the vaccination schedule as the best control strategy. Although some commercial vaccines have been available, none of them provides total protection, which is sometimes insufficient and does not reach the same efficiency when compared in sheep and goats. They also have questionable safety levels and side effects. In light of this, several experimental vaccines are in development in order to improve safety, reproducibility, and protective immune response against the etiologic agent of CLA, Corynebacterium pseudotuberculosis. In this review, we discussed aspects as antigen, adjuvant, routes of administration, protection level, and animal models used in CLA vaccine development, as well the challenges and future perspectives. KEY POINTS: Caseous lymphadenitis (CLA) does not have an appropriate commercial vaccine. Different experimental vaccines are in development aiming to protect against Corynebacterium pseudotuberculosis. An ideal vaccine for CLA is necessary for the disease control.


Assuntos
Infecções por Corynebacterium , Corynebacterium pseudotuberculosis , Linfadenite , Doenças dos Ovinos , Animais , Vacinas Bacterianas , Infecções por Corynebacterium/prevenção & controle , Infecções por Corynebacterium/veterinária , Cabras , Linfadenite/prevenção & controle , Linfadenite/veterinária , Reprodutibilidade dos Testes , Ovinos
14.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(2): 143-147, 2021 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-33627208

RESUMO

OBJECTIVE: To study the clinical features of children with periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, a polygenic and multifactorial autoinflammatory disease with unknown pathogenesis. METHODS: A retrospective analysis was performed on the medical data of 13 children with PFAPA syndrome. RESULTS: All 13 children had disease onset within the age of 3 years, with a mean age of onset of (14±10) months. They all had periodic fever, with 8-18 attacks each year. The mean interictal period of fever was (30±5) days. Pharyngitis, cervical adenitis, and aphthous stomatitis were the three cardinal symptoms, with incidence rates of 100% (13/13), 85% (11/13), and 38% (5/13) respectively. There were increases in white blood cells, C-reactive protein, and erythrocyte sedimentation rate during fever. Of all the 13 children, 6 underwent whole exome sequencing and 7 underwent panel gene detection for autoinflammatory disease, and the results showed single heterozygous mutations in the MEFV gene in 6 children (46%). Recurrent fever in all children gradually returned to normal without antibiotics. Ten children were treated with a single dose of glucocorticoids, and fever was relieved after treatment. Of all the children, 4 were treated with cimetidine, among whom 2 had response; 4 children were treated with colchicine, among whom 2 had response and 2 were withdrawn from the drug due to adverse reactions. Tonsillectomy was performed for 2 children, among whom 1 was followed up for 3 years without recurrence and 1 still had recurrence. CONCLUSIONS: For children with unexplained periodic fever with early onset accompanied by pharyngitis, cervical adenitis, aphthous stomatitis, elevated inflammatory indices, and good response to glucocorticoids, PFAPA syndrome should be considered. This disorder has good prognosis, and early diagnosis can avoid the long-term repeated use of antibiotics.


Assuntos
Linfadenite , Faringite , Estomatite Aftosa , Criança , Pré-Escolar , Febre/etiologia , Humanos , Lactente , Linfadenite/diagnóstico , Faringite/diagnóstico , Faringite/tratamento farmacológico , Pirina , Estudos Retrospectivos , Estomatite Aftosa/diagnóstico , Estomatite Aftosa/tratamento farmacológico , Estomatite Aftosa/genética
15.
Clin Immunol ; 226: 108697, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33636366

RESUMO

Autoinflammatory disorders of the innate immune system present with recurrent episodes of inflammation often beginning in early childhood. While there are now more than 30 genetically-defined hereditary fever disorders, many patients lack a clear diagnosis. Many pediatric patients are often grouped with patients with periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome despite failing to meet diagnostic criteria. Here, we categorize these patients as syndrome of undifferentiated recurrent fever (SURF), and identify the unique features which distinguish them from the PFAPA syndrome. SURF patients were more likely to report gastrointestinal symptoms of nausea, vomiting and abdominal pain, and experienced inconsistent responses to on-demand steroid therapy compared to PFAPA patients. For this previously undefined cohort, an optimal course of therapy remains uncertain, with medical and surgical therapies largely driven by parental preference. A subset of patients with SURF underwent tonsillectomy with complete resolution. Flow cytometric evaluation demonstrates leukocytic populations distinct from PFAPA patients, with reduced CD3+ T cell numbers. SURF patient tonsils were predominantly characterized by an IL-1 signature compared to PFAPA, even during the afebrile period. Peripheral blood signatures were similar between groups suggesting that PFAPA and SURF patient tonsils have localized, persistent inflammation, without clinical symptoms. These data suggest that SURF is a heterogenous syndrome on the autoinflammatory disease spectrum.


Assuntos
Febre/diagnóstico , Doenças Hereditárias Autoinflamatórias/diagnóstico , Inflamação/diagnóstico , Interleucina-1/metabolismo , Linfadenite/diagnóstico , Faringite/diagnóstico , Estomatite Aftosa/diagnóstico , Complexo CD3/metabolismo , Pré-Escolar , Feminino , Febre/metabolismo , Gastroenteropatias/diagnóstico , Gastroenteropatias/metabolismo , Doenças Hereditárias Autoinflamatórias/metabolismo , Humanos , Inflamação/metabolismo , Linfadenite/metabolismo , Masculino , Tonsila Palatina/metabolismo , Pediatria , Faringite/metabolismo , Estomatite Aftosa/metabolismo , Síndrome , Linfócitos T/metabolismo , Tonsilectomia/métodos
16.
Laryngoscope ; 131(7): E2149-E2152, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33630321

RESUMO

OBJECTIVES/HYPOTHESIS: Tonsillectomy is an effective treatment for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome, but the role of adenoidectomy, as well as later tonsillar regrowth, is unclear. To find out if the volume of lymphoid tissue is pivotal to the efficacy, we analyzed the association between the relapse of the symptoms of PFAPA syndrome and regrowth of tonsillar tissue after tonsillectomy or adenotonsillectomy. STUDY DESIGN: Prospective cohort study of operated PFAPA pateints. METHODS: We invited all patients that had undergone tonsillectomy or adenotonsillectomy due to PFAPA syndrome at the Oulu University Hospital, Oulu, Finland, between the years 1990 and 2007, at the age of ≤12 years, to a follow-up visit, after an average period of 9.8 years after their diagnoses. Out of the 132 invited, 94 (71%) participated in the follow-up study. RESULTS: At the follow-up study visit, 5 (5%) of the 94 PFAPA syndrome cases experienced recurrent fevers. The regrowth of palatine tonsillar tissue was seen in four of them (80%) as compared to 19/89 (21%) of symptom-free patients (P = .006). Two of the patients with clear PFAPA relapse at the time of the study visit were reoperated with clear effect on the symptoms. At the time of the study visit, 59/63 (94%) of the patients who had undergone adenotonsillectomy and 30/31 of the patients (97%) who had undergone tonsillectomy earlier were free of fever flares (P = .99). CONCLUSION: Palatine tonsil regrowth was associated with PFAPA syndrome relapse after tonsillectomy. Reoperation might be a treatment option in these patients. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2149-E2152, 2021.


Assuntos
Doenças Hereditárias Autoinflamatórias/cirurgia , Linfadenite/cirurgia , Faringite/cirurgia , Estomatite Aftosa/cirurgia , Tonsilectomia/efeitos adversos , Adenoidectomia/efeitos adversos , Criança , Feminino , Finlândia/epidemiologia , Seguimentos , Doenças Hereditárias Autoinflamatórias/patologia , Humanos , Linfadenite/patologia , Masculino , Pescoço/patologia , Tonsila Palatina/crescimento & desenvolvimento , Tonsila Palatina/patologia , Tonsila Palatina/cirurgia , Faringite/patologia , Período Pós-Operatório , Estudos Prospectivos , Recidiva , Estomatite Aftosa/patologia , Síndrome , Resultado do Tratamento
18.
J Trop Pediatr ; 67(1)2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33411886

RESUMO

BACKGROUND: We investigated the practical use of procalcitonin (PCT), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and complete blood count (CBC) parameters in distinguishing periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA) attacks from exudative tonsillitis associated with group A streptococcus (GAS) and Epstein-Barre virus (EBV). METHODS: The study population consisted of cases with exudative tonsillitis who had been subsequently diagnosed as PFAPA, EBV, and GAS tonsillitis through a period of 6 years. We retrieved the CBC, ESR, CRP and PCT data from patients' medical records. RESULTS: Of the patients, 47 (35.6%) had PFAPA, 36 (27.3%) had GAS and 49 (37.1%) had EBV tonsillitis. Median CRP, ESR and PCT values of patients with PFAPA were 78 (17-92) mg/dl, 44 (11-83) mm/h, 0.16 (0.01-1.45) ng/ml, respectively. The CRP and ESR levels were significantly higher in PFAPA and GAS groups compared with the EBV group (p = 0.001). There was no significant difference between the groups regarding the PCT levels. CONCLUSION: The study indicated no benefit of PCT in distinguishing PFAPA from the others. However, we found that CRP, ESR, and CBC parameters could be useful in identifying PFAPA and GAS than EBV tonsillitis.


Assuntos
Linfadenite , Faringite , Estomatite Aftosa , Tonsilite , Reação de Fase Aguda , Diagnóstico Diferencial , Febre , Humanos , Faringite/diagnóstico , Estomatite Aftosa/diagnóstico , Tonsilite/diagnóstico
19.
Microb Pathog ; 151: 104746, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33485993

RESUMO

Corynebacterium pseudotuberculosis is the causative agent of caseous lymphadenitis (CLA) in small ruminants. There is still needed an immunoprophylaxis model, which induces a protective and sustained immune response against the bacteria. In this study, we evaluated a recombinant Escherichia coli bacterin expressing the recombinant phospholipase D (rPLD) protein, the most relevant virulence factor of C. pseudotuberculosis, as a potential vaccine formulation. E. coli BL21 (DE3) Star strain was used for rPLD protein expression and was then inactivated by formaldehyde. Four groups with 10 Balb/c mice each were immunized twice within a 21 days interval: G1-control - 0.9% saline solution; G2- E. coli bacterin/pAE (naked plasmid); G3- E. coli bacterin/pAE/pld; G4-purified recombinant rPLD. Subsequently, the animals were challenged with a C. pseudotuberculosis virulent strain and evaluated for 40 days. The highest survival rate was observed for G3 with 40% protection, followed by 30% in the purified rPLD group (G4). These two groups also showed considerable IgG production when compared with the control group (G1). Also, a higher significant expression of interferon-γ was observed for the experimental groups G2, G3, and G4 when compared with a control group (G1) (p < 0.05). These results represent that a recombinant bacterin can be seen as a promising approach for vaccinal antigens against CLA, being possible to be used in association of different vaccine strategies.


Assuntos
Infecções por Corynebacterium , Corynebacterium pseudotuberculosis , Linfadenite , Fosfolipase D , Animais , Vacinas Bacterianas/genética , Infecções por Corynebacterium/prevenção & controle , Infecções por Corynebacterium/veterinária , Corynebacterium pseudotuberculosis/genética , Escherichia coli/genética , Camundongos , Fosfolipase D/genética
20.
Intern Med ; 60(11): 1779-1784, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33431735

RESUMO

We herein report a 31-year-old man with recurrent aseptic meningitis associated with Kikuchi's disease. Although aseptic meningitis is the most common neurological complication of Kikuchi's disease, its characteristics remain unclear, especially in recurrent cases. A literature review revealed that aseptic meningitis associated with Kikuchi's disease was more likely to occur in men and was associated with a low cerebrospinal fluid (CSF)/serum glucose ratio. Lymphadenopathy tended to occur simultaneously or after the onset of meningitis. When encountering a patient with aseptic meningitis of unknown etiology, it may be worthwhile to focus on the CSF/serum glucose ratio and lymphadenopathy with a careful examination.


Assuntos
Infecções do Sistema Nervoso Central , Linfadenite Histiocítica Necrosante , Linfadenite , Linfadenopatia , Meningite Asséptica , Adulto , Linfadenite Histiocítica Necrosante/complicações , Linfadenite Histiocítica Necrosante/diagnóstico , Humanos , Masculino , Meningite Asséptica/diagnóstico
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