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1.
Am J Vet Res ; 80(6): 586-594, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31140853

RESUMO

OBJECTIVE: To determine oxytetracycline concentrations in plasma and in fluid from Corynebacterium pseudotuberculosis (CPT)-inoculated tissue chambers (used as experimental abscess models) and uninoculated (control) tissue chambers in sheep after IM or local administration of the drug and to investigate whether CPT growth was reduced or eliminated by these treatments. ANIMALS: 10 clinically normal female sheep. PROCEDURES: Sterile tissue chambers were surgically implanted in both paralumbar fossae of each sheep; ≥ 2 weeks later (day -6), 1 randomly selected chamber was inoculated with CPT, and the opposite chamber was injected with sterile growth medium. Sheep received oxytetracycline IM (n = 5) or by percutaneous injection into CPT-inoculated (4) or uninoculated (1) chambers on day 0. Tissue fluid from each chamber and venous blood samples for plasma collection were obtained at predetermined times over 6 days for bacterial counts (tissue chambers) and analysis of oxytetracycline concentrations (tissue chambers and plasma). Sheep were euthanized on day 6. Regional lymph nodes were collected bilaterally from each sheep for culture. RESULTS: Measurable concentrations of oxytetracycline were present in each chamber throughout the study, regardless of administration route or presence of CPT. No CPT growth was detected after the 48-hour time point in inoculated chambers injected with oxytetracycline; however, CPT was isolated from all inoculated chambers throughout the study after IM drug administration. One regional lymph node (ipsilateral to a CPT-inoculated, oxytetracycline-injected chamber with no CPT growth after 48 hours) was culture positive for CPT. CONCLUSIONS AND CLINICAL RELEVANCE: Intralesional administration of oxytetracycline may eliminate growth of CPT locally, but complete elimination of the organism remains difficult.


Assuntos
Antibacterianos/administração & dosagem , Infecções por Corynebacterium/veterinária , Corynebacterium pseudotuberculosis , Injeções Intralesionais/veterinária , Injeções Intramusculares/veterinária , Oxitetraciclina/administração & dosagem , Doenças dos Ovinos/tratamento farmacológico , Abscesso/tratamento farmacológico , Abscesso/prevenção & controle , Abscesso/veterinária , Animais , Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Infecções por Corynebacterium/metabolismo , Infecções por Corynebacterium/prevenção & controle , Modelos Animais de Doenças , Líquido Extracelular/metabolismo , Feminino , Linfadenite/tratamento farmacológico , Linfadenite/veterinária , Oxitetraciclina/farmacocinética , Oxitetraciclina/uso terapêutico , Distribuição Aleatória , Ovinos , Doenças dos Ovinos/prevenção & controle
2.
Int J Pediatr Otorhinolaryngol ; 122: 196-202, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31039497

RESUMO

OBJECTIVES: Nontuberculous mycobacterial (NTM) lymphadenitis is a rare disease of children under 5 years. Its treatment is not standardized, even a "wait-and-see" approach is shown to be effective in the literature. Here, we discuss the diagnostic and therapeutic strategies employed in our departments. METHODS: Records of pediatric patients treated for NTM cervical lymphadenitis from 2010 to 2015 in our tertiary center were retrospectively reviewed. Patients underwent cervical echotomography and/or CT scan. Every patient but one had microbiological explorations (NTM polymerase chain reaction [PCR] and culture) on fine needle aspiration of pus and/or adenitis biopsy. Differential diagnoses (tuberculosis, cat scratch disease) were excluded with serologies, chest X-Ray, and PCR on adenitis samples. Patients were classified as "proven diagnosis" (NTM detected), "highly probable" (suggestive clinical and anatomopathological aspect) or "possible" infection (suggestive adenitis alone). Treatments, follow-up and adverse events were reviewed. RESULTS: Thirty-one patients were treated for NTM, median age 2.40 years (Interquartile Range IQR = [1.85-3.16]). Twenty-nine patients (96.77%) had an isolated cervico-facial localization. Median follow-up was 8.00 months (IQR = [4.20-13.43]). We found 17 "proven diagnosis" (58.62%), 5 "highly probable" (17.24%) and 7 "possible" infections (24.14%). "Proven" infections were due to: Mycobacterium avium (n = 12, 66.67%) and M. intracellulare (n = 5, 27.78%). All 29 patients received antibiotics, which were effective for 10 (34.48%, group 1); 10 underwent surgical excision for a poor outcome with antibiotics (34.48%, group 2); spontaneous or surgical drainage occurred in 9 on antibiotics (31.03%, group 3). The median times to resolution for group 1, 2 and 3 were respectively 6.33 months, 6.22 months and 9.53 months. Antibiotics treatment was mostly clarithromycin (n = 27, 93.10%) and/or rifampicin (n = 19, 65.52%); 18 patients (62.07%) received both. Median antibiotics duration was 6.23 months (IQR = [5.17-7.46]), with good compliance (79.31%). The observed adverse effects were 3 (13.04%) isolated transient transaminase elevations, 1 case (4.35%) of minor creatinine elevation, and 1 case (4.35%) of transient diarrhea. Surgical drainage caused 1 transient marginal mandibular nerve palsy, resolutive after 1 month. CONCLUSION: Antibiotics in NTM adenitis lead to resolution in 7 months, with good tolerance and compliance. The efficacy of "wait-and-see" attitude in the literature make excision surgery a second line treatment.


Assuntos
Antibacterianos/uso terapêutico , Linfadenite/tratamento farmacológico , Linfadenite/microbiologia , Infecções por Micobactéria não Tuberculosa/diagnóstico , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Antibacterianos/efeitos adversos , Antibióticos Antituberculose/uso terapêutico , Pré-Escolar , Claritromicina/uso terapêutico , Drenagem/efeitos adversos , Quimioterapia Combinada , Feminino , Humanos , Lactente , Linfadenite/cirurgia , Masculino , Infecções por Micobactéria não Tuberculosa/complicações , Infecções por Micobactéria não Tuberculosa/microbiologia , Mycobacterium avium , Complexo Mycobacterium avium , Pescoço , Estudos Retrospectivos , Rifampina/uso terapêutico
3.
Comp Immunol Microbiol Infect Dis ; 63: 112-116, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30961805

RESUMO

Morel's disease is a form of abscessing lymphadenitis of sheep and goats caused by Staphylococcus aureus subspecies anaerobius. In Europe and Africa, the disease is linked to S. aureus of multilocus sequence type 1464. In an outbreak recorded in 2015 in a flock of 530 animals in the district of Nymburk, Czech Republic, Europe, the causative agent was cultured and subsequently confirmed by Maldi-TOF. Neither antibiotic therapy nor surgical interventions met any success, although the strain isolated was found to be sensitive to antibiotics used. Vaccination and revaccination with inactivated autogenous vaccine administered subcutaneously was relatively successful. Subsequent multilocus sequence typing revealed the presence of new S. aureus sequence type 3756, different from 1464 in three out of seven genes typed. The isolate thus represents a new sequence type of Staphylococcus aureus ssp. anaerobius which should be considered as a causative agent of Morel's disease.


Assuntos
Antibacterianos/uso terapêutico , Linfadenite/tratamento farmacológico , Linfadenite/microbiologia , Doenças dos Ovinos/tratamento farmacológico , Infecções Estafilocócicas/veterinária , Vacinas Antiestafilocócicas/imunologia , Staphylococcus aureus/classificação , Animais , República Tcheca , Linfadenite/veterinária , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Ovinos , Doenças dos Ovinos/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/imunologia , Staphylococcus aureus/isolamento & purificação , Vacinação
4.
Autops. Case Rep ; 9(2): e2018079, Abr.-Jun. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-994654

RESUMO

Reports of histopathological findings in a patient infected with H1N1 influenza virus are limited in the literature, although many deaths have occurred because of this viral infection. In an otherwise healthy individual with no underlying co-morbid conditions, this virus passes off as a very mild disease. However, it can be fatal in the presence of underlying risk factors. Here, we present the autopsy findings of a patient who died of H1N1 infection, but who was apparently healthy with no predisposing ailments. The autopsy revealed chronic kidney disease and caseating granulomatous lymphadenitis in addition to the known classical diffuse alveolar damage picture seen in this condition. These underlying co-morbidities may provide greater insight and a better understanding of this infection.


Assuntos
Humanos , Masculino , Adulto , Influenza Humana/patologia , Vírus da Influenza A Subtipo H1N1 , Autopsia , Evolução Fatal , Insuficiência Renal , Granuloma , Linfadenite
6.
Vet Microbiol ; 230: 86-89, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30827410

RESUMO

For a long time, the scientific community has described the need for a continued update in practices that ensure the welfare of animals undergoing experimentation. In addition to approaches on principles of care and use of animals, there is a more current emerging concern: defining an appropriate end point in experiments that use animals for research, teaching and testing. The term "endpoint" is defined as the point at which an experimental animal's pain and/or distress is terminated, minimized, or reduced humanely. In the present study, we established an endpoint in Balb/C mice for caseous lymphadenitis vaccine trials, which can be considered as a highly important parameter since several studies are being developed to control the disease efficiently. Mice were monitored daily until the 30th day after infection with pathogenic strain of C. pseudotuberculosis MIC-6 using the most relevant parameters for the appearance of clinical signs of caseous lymphadenitis (CLA), such as abscesses, lethargy, and loss of weight and hair. The endpoint was found to be a weight loss of 0.2167 g after five days or 10% weight loss in less than five days. In conclusion, the findings reported here will help improve animal's well-being during vaccine trials for CLA and consequently represent significant contribution to animal's welfare.


Assuntos
Vacinas Bacterianas/imunologia , Infecções por Corynebacterium/prevenção & controle , Modelos Animais de Doenças , Determinação de Ponto Final/métodos , Linfadenite/prevenção & controle , Perda de Peso , Bem-Estar do Animal , Animais , Infecções por Corynebacterium/imunologia , Corynebacterium pseudotuberculosis/imunologia , Linfadenite/microbiologia , Camundongos , Camundongos Endogâmicos BALB C
7.
Eur J Clin Microbiol Infect Dis ; 38(6): 1113-1122, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30834995

RESUMO

Nontuberculous mycobacteria are the most frequent cause of chronic cervical lymphadenitis in childhood. The aim of the study was to evaluate the performance of IL-2, IL-17, and INF-γ in-house enzyme-linked immunospot assays using a Mycobacterium avium lysate, in order to identify a noninvasive diagnostic method of nontuberculous mycobacteria infection. Children with subacute and chronic lymphadenopathies or with a previous diagnosis of nontuberculous mycobacteria lymphadenitis were prospectively enrolled in the study. Sixty children with lymphadenitis were included in our study: 16 with confirmed infection (group 1), 30 probable infected (group 2) and 14 uninfected (group 3). Significantly higher median cytokine values were found in group 1 vs group 2, in group 1 vs group 3, and in group 2 vs group 3 considering IL-2-based enzyme-linked immunospot assay (p = 0.015, p < 0.001, p = 0.004, respectively). INF-γ-based enzyme-linked immunospot assay results were significantly higher in group 2 vs group 3 (p = 0.010). Differences between infected and uninfected children were not significant considering IL-17 assays (p = 0.431). Mycobacterium avium lysate IL-2 and INF-γ-based enzyme-linked immunospot assays seem to be promising noninvasive diagnostic techniques for discriminating children with nontuberculous mycobacteria lymphadenitis and noninfected subjects.


Assuntos
Citocinas/sangue , ELISPOT/normas , Linfadenite/diagnóstico , Complexo Mycobacterium avium/imunologia , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Testes Diagnósticos de Rotina , Feminino , Humanos , Lactente , Recém-Nascido , Interferon gama/sangue , Interleucina-17/sangue , Interleucina-2/sangue , Linfadenite/sangue , Masculino , Infecção por Mycobacterium avium-intracellulare/sangue , Estudos Prospectivos , Curva ROC
8.
Rev. bras. med. fam. comunidade ; 14(41): e1815, 02/2019. ilus, tab
Artigo em Português | LILACS, Coleciona SUS | ID: biblio-986445

RESUMO

Objetivo: Apresentar informações sobre o diagnóstico e tratamento da síndrome PFAPA na Atenção Primária à Saúde. Métodos: Revisão sistemática de literatura baseada na recomendação PRISMA e realizada nas bases de dados Scielo, Lilacs, Medline, IBECS e PubMed, incluindo estudos publicados no período de 2004 a 2018, além da consulta a outros documentos específicos da síndrome PFAPA. Resultados: Após busca e seleção, foram incluídos 31 artigos. Avaliação e Diagnóstico: A síndrome PFAPA acomete principalmente crianças, sendo caracterizada por febre periódica acompanhada por faringite, estomatite aftosa e/ou adenite cervical. Seu diagnóstico é clínico e por exclusão, baseado em critérios estabelecidos. Recomendações: Os episódios costumam responder a prednisona e, em graus variáveis, a cimetidina e colchicina. Casos refratários e acompanhados de hipertrofia tonsilar são candidatos a tonsilectomia, devendo ser encaminhados à avaliação otorrinolaringológica.


Objective: To present information about the diagnosis and treatment of PFAPA syndrome in Primary Health Care. Methods: Systematic review of literature based on the PRISMA recommendation and carried out in the Scielo, Lilacs, Medline, IBECS and PubMed databases, including studies published from 2004 to 2018, in addition to consulting other PFAPA syndrome specific documents. Results: After search and selection, 31 articles were included. Assessment and Diagnosis: PFAPA syndrome affects mainly children and is characterized by periodic fever accompanied by pharyngitis, aphthous stomatitis and/or cervical adenitis. Its diagnosis is clinical and by exclusion, based on established criteria. Recommendations: The episodes usually respond to prednisone and, in varying levels, cimetidine and colchicine. Refractory cases and accompanied by tonsillar hypertrophy are candidates for tonsillectomy, and should be referred to otorhinolaryngological evaluation.


Objetivo: Presentar informaciones sobre el diagnóstico y tratamiento del síndrome PFAPA en la Atención Primaria a la Salud. Métodos: Revisión sistemática de literatura basada en la recomendación PRISMA y realizada en las bases de datos Scielo, Lilacs, Medline, IBECS y PubMed, incluyendo estudios publicados en el período 2004 a 2018, además de la consulta a otros documentos específicos del síndrome PFAPA. Resultados: Después de la búsqueda y selección, se incluyeron 31 artículos. Evaluación y Diagnóstico: El síndrome PFAPA acomete principalmente niños, siendo caracterizada por fiebre periódica acompañada por faringitis, estomatitis aftosa y/o adenitis cervical. Su diagnóstico es clínico y por exclusión, basado en criterios establecidos. Recomendaciones: Los episodios suelen responder a la prednisona y, en grados variables, a la cimetidina y colchicina. Los casos refractarios y acompañados de hipertrofia tonsilar son candidatos a tonsilectomía, debiendo ser encaminados a la evaluación otorrinolaringológica.


Assuntos
Atenção Primária à Saúde , Febre Recorrente , Estomatite Aftosa , Faringite , Linfadenite
10.
BMJ Case Rep ; 12(2)2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709892

RESUMO

A 8-year-old Irish ethnicity girl presented with 3 days of fever with right-sided neck swelling which was first thought as acute tonsillitis with right-sided lymphadenitis. She was started on intravenous antibiotics. At day 7 of illness, she was diagnosed to have Kawasaki disease with clinical and biochemical evidence. Echocardiogram at day 9 of illness and subsequently CT cardiac angiogram performed revealed giant aneurysm at the right coronary artery with non-obstructing thrombus seen. The patient then commenced on clopidogrel and continued with a regular dose of aspirin. Due to the evidence of thrombus with a giant coronary aneurysm, she was also put on long-term warfarin therapy with regular monitoring of her international normalised ratio to be kept at the range of 2.0-3.0.


Assuntos
Aneurisma Coronário/etiologia , Linfadenite/etiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Trombose/etiologia , Criança , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/patologia , Vasos Coronários/patologia , Diagnóstico Diferencial , Feminino , Humanos , Linfonodos/patologia , Linfadenite/diagnóstico , Linfadenite/patologia , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Síndrome de Linfonodos Mucocutâneos/patologia , Pescoço/patologia , Trombose/diagnóstico , Trombose/patologia , Tonsilite/diagnóstico
11.
Presse Med ; 48(1 Pt 2): e77-e87, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30683466

RESUMO

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is a complex autoinflammatory disease with a clinical phenotype characterised by recurrent episodes of fever, systemic inflammation and symptoms and signs depicted in disease acronym. Although PFAPA is the most common autoinflammatory disease among children in many parts of the world, the condition is still an enigma, which include the regular episodes, the prompt responses to corticosteroids, the genetic bases for the familial clustering and therapeutic effects of tonsillectomy. This review explores PFAPA syndrome with the aim of describing the current clinical and scientific understanding of the condition.


Assuntos
Doenças Hereditárias Autoinflamatórias , Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Terapia Combinada , Diagnóstico Diferencial , Febre/etiologia , Predisposição Genética para Doença , Doenças Hereditárias Autoinflamatórias/classificação , Doenças Hereditárias Autoinflamatórias/diagnóstico , Doenças Hereditárias Autoinflamatórias/genética , Doenças Hereditárias Autoinflamatórias/fisiopatologia , Humanos , Inflamação , Linfadenite/genética , Deficiência de Mevalonato Quinase/diagnóstico , Faringite/genética , Faringite/cirurgia , Prognóstico , Recidiva , Estomatite Aftosa/genética , Síndrome , Tonsilectomia
13.
Medicine (Baltimore) ; 97(41): e12744, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30313080

RESUMO

RATIONALE: Lymphatic embolization is a minimally invasive treatment option for managing chyle leakage after nodal dissection in the neck. After the procedure, the embolic material may cause foreign body granulomatous lymphadenitis and can be a diagnostic challenge for radiologists because of sonographic similarity to metastatic lymph node. Herein, we describe a clinical case of granulomatous lymphadenitis due to embolic material mimicking nodal metastasis detected on ultrasonography (US) with cytologic findings in a patient with thyroid cancer who underwent lymphatic embolization to treat chyle leakage after total thyroidectomy and neck dissection. We also review the relevant literature regarding this disease with technical background of the procedure and suggest the importance of clinical suspicion in diagnosing the granulomatous lymphadenitis in patients with a history of lymphatic embolization. PATIENT CONCERNS: A 40-year-old man who underwent total thyroidectomy and bilateral modified radical neck dissection due to papillary thyroid carcinoma had suspicious cervical lymph node on US after lymphatic embolization of chyle leakage. DIAGNOSES: The suspicious cervical lymph node proved to be foreign body granulomatous lymphadenitis due to embolic material by US-guided fine-needle aspiration. INTERVENTIONS: The patient did not undergone additional surgery because the pathologic cervical lymph node was confirmed to be foreign body granulomatous lymphadenitis. OUTCOMES: The patient is being followed up regularly at the outpatient department. LESSONS: Clinical awareness of the technical background of lymphatic embolization and possible sonographic features of granulomatous lymphadenitis is important for an accurate diagnosis and the appropriate management in patients who underwent lymphatic embolization.


Assuntos
Embolização Terapêutica/efeitos adversos , Doença Granulomatosa Crônica/diagnóstico , Linfadenite/diagnóstico , Linfadenopatia/diagnóstico , Doenças Linfáticas/terapia , Complicações Pós-Operatórias/terapia , Adulto , Carcinoma Papilar/complicações , Carcinoma Papilar/cirurgia , Quilo , Diagnóstico Diferencial , Doença Granulomatosa Crônica/etiologia , Humanos , Linfonodos/diagnóstico por imagem , Linfadenite/etiologia , Linfadenopatia/etiologia , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/etiologia , Masculino , Esvaziamento Cervical/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos
14.
Cir. pediátr ; 31(4): 171-175, oct. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-172930

RESUMO

Objetivos: Describir nuestra experiencia en el manejo de la linfadenitis por micobacterias no tuberculosas (LMNT). Material y métodos: Análisis retrospectivo de 65 pacientes (26 varones/ 39 mujeres) intervenidos en nuestro centro de LMNT durante los años 2010-2017. Se analizaron datos demográficos, pruebas complementarias realizadas y datos de seguimiento. Resultados: La edad media fue de 31 meses (rango 7 meses-12 años). Para el diagnóstico la radiografía de tórax se realizó al 92,3% de pacientes, siendo en todos normal. El Mantoux fue positivo en 20,3%, dudoso en 12,5% y negativo en 67,1%. La PAAF preoperatoria fue diagnóstica (linfadenitis granulomatosa necrotizante) en 93,7% mientras que el cultivo para micobacterias fue positivo solo en 23,4%, siendo el Mycobacterium lentiflavum el patógeno más frecuentemente encontrado. El tiempo de espera preoperatorio fue de 2,5 meses con un porcentaje de fistulización previo a la cirugía de 7,7%. La estancia hospitalaria media fue 1,1 días y no hubo complicaciones perioperatorias. El tiempo medio de seguimiento fue 5,5 meses (rango 1-24 meses) observándose 19 casos de parálisis facial temporal, de los cuales 2 persistieron al cabo de 1 año. Conclusiones: La LMNT es una enfermedad cada vez más frecuente en nuestro medio. Es importante realizar un diagnóstico y tratamiento precoz, puesto que el tratamiento quirúrgico ha demostrado ser seguro y eficaz asociando baja tasa de complicaciones. Creemos que los protocolos actuales se deben revisar, debido a la escasa rentabilidad de algunas pruebas complementarias


Aim of study: to describe our experience in the management of non-tuberculosis mycobacterial lymphadenitits (NTML). Methods: Retrospective analysis of patients who underwent surgery for NTML in our centre during the period between 2010-2017. Demographic data, diagnostic tests, treatment and follow up information were recovered from medical records. Results: 65 patients (26 male/39 female) with a mean age of 31 months (range 7 months-12 years) were intervened during the period of study. As diagnostic tests, chest X-ray was performed in 92.3% of patients with normal result in all cases, Mantoux test was positive in 20.3%, inconclusive in 12.5% and negative in 67.1%. Preoperative fine needle aspiration was positive for NTML (granulomatous necrotizing lymphadenitis) in 93.7% whereas culture for mycobacteria was only positive in 23.4% of cases, being Mycobacterium lentiflavum the most frequent agent found. Mean preoperative waiting time was 2.5 months with 7.7% of fistulization previous to surgery. Mean hospital stay was 1,1 days and there were no intraoperative complications. Mean follow up time was 5.5 months (range 1-24 months) during which 19 cases of temporal facial paralysis were noted, among which only 2 persisted after one year. Conclusions: NTML is a disease with a growing incidence in our country. It is important to make an early diagnosis and surgical treatment in order to avoid complications, as surgery has demonstrated to be safe and effective, with a low rate of complications. We believe the actual protocols should be revised/checked due to low effectiveness of diagnostic tests


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Linfadenite/complicações , Linfadenite/diagnóstico , Linfadenite/cirurgia , Micobactérias não Tuberculosas/isolamento & purificação , Micobactérias não Tuberculosas/patogenicidade , Linfadenite/etiologia , Infecções por Micobactéria não Tuberculosa/microbiologia , Radiografia Torácica/métodos , Estudos Retrospectivos , Espanha/epidemiologia , Biópsia por Agulha Fina/métodos
15.
Tuberk Toraks ; 66(2): 109-114, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30246653

RESUMO

Introduction: Endobronchial ultrasonography (EBUS) is an endoscopic method that aids needle aspiration to see the bronchial wall and adjacent tissues with an ultrasound probe. Pulmonary arteries are rarely present between the bronchus wall and the tissue. In this case, it was necessary to make a selection between invasive processes and transbronchial needle aspiration (TBNA) through the pulmonary artery. There are few case reports about the safety of TBNA through the pulmonary artery. We aimed to present the results of EBUS guided TBNA through the pulmonary arteries. Materials and Methods: The data on four cases (three men) in whom EBUS guided TBNA was performed through the pulmonary artery between August 2010 and December 2015 were reviewed retrospectively. Procedures were conducted under local anesthesia and conscious sedation. For TBNA, 22-gauge needles were used. Cases were monitored for 24 hour after the procedures. Antibiotic prophylaxis and onsite cytopathology were not used. Result: All lesions existed were on the left hilar localization. Two of the diagnosed cases were carcinoma and one was the granulomatous lymphadenitis. We were not able to diagnose the last case. No complication was observed in any cases during the procedure. Conclusions: EBUS guided TBNA through the pulmonary arteries at left hilar lesions is safe. The rate of diagnoses from the tissues obtained is high. No special preparation is needed for the cases have no the pulmonary hypertension.


Assuntos
Brônquios/diagnóstico por imagem , Broncoscopia/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Linfonodos/patologia , Linfadenite/patologia , Artéria Pulmonar/diagnóstico por imagem , Adulto , Idoso , Brônquios/irrigação sanguínea , Feminino , Humanos , Masculino , Mediastino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Pediatr Rheumatol Online J ; 16(1): 60, 2018 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-30241480

RESUMO

BACKGROUND: Diagnosis of Periodic Fever, Aphthous stomatitis, Pharyngitis and Cervical Adenitis (PFAPA) syndrome is currently based on the modified Marshall's criteria, but no validated evidence based classification criteria for PFAPA has been established so far. METHODS: A multistep process, based on the Delphi and Nominal Group Technique was conducted. After 2 rounds of e-mail Delphi survey involving 21 experts in autoinflammation we obtained a list of variables that were discussed in an International Consensus Conference. Variables reaching the 80% of consensus between participants were included in the new classification criteria. In the second phase the new classification criteria and the modified Marshall's criteria were applied on a cohort of 80 pediatric PFAPA patients to compare their performance. RESULTS: The Delphi Survey was sent to 22 participants, 21 accepted to participate. Thirty variables were obtained from the survey and have been discussed at the Consensus Conference. Through the Nominal Group Technique we obtained a new set of classification criteria. These criteria were more restrictive in respect to the modified Marshall's criteria when applied on our cohort of patients. CONCLUSION: Our work led us to identify a new set of classification criteria for PFAPA syndrome, but they resulted to be too restrictive to be applied in daily clinical practice for the diagnosis of PFAPA.


Assuntos
Doenças Hereditárias Autoinflamatórias/diagnóstico , Consenso , Técnica Delfos , Diagnóstico Diferencial , Febre/complicações , Doenças Hereditárias Autoinflamatórias/classificação , Humanos , Linfadenite/complicações , Faringite/complicações , Estomatite Aftosa/complicações , Síndrome
17.
J Laryngol Otol ; 132(9): 827-831, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30180912

RESUMO

BACKGROUND: Although melioidosis in the head and neck region is uncommon, it is a potentially life-threatening infection. Thus, early diagnosis and proper management are very important. OBJECTIVES: To report the clinical presentation and management of melioidosis in the head and neck. METHOD: A retrospective study was conducted from 1 January 2013 to 31 October 2016 in Mukdahan Hospital, Thailand. Case records of patients who had presented with culture-positive melioidosis were analysed. RESULTS: Medical records of 49 patients (23 males and 26 females) were analysed. Patients ranged in age from 1 to 75 years. Clinical presentations included 22 parotid abscesses, 16 neck abscesses and 11 suppurative lymphadenitis cases. Only 35 patients (71 per cent) had high indirect haemagglutination assay titres of ≥ 1:160 (95 per cent confidence interval = 45.35-88.28). Almost half of the patients received intravenous ceftazidime and subsequently oral co-trimoxazole. Oral antibiotic regimens were prescribed for mild localised melioidosis. Overall, 95.65 per cent of patients were in remission and no relapses were observed (95 per cent confidence interval = 85.47-98.80). CONCLUSION: Careful clinical correlation and proper investigation are required to establish an early diagnosis of melioidosis and to initiate appropriate treatment.


Assuntos
Abscesso/microbiologia , Cabeça/microbiologia , Linfadenite/microbiologia , Melioidose/microbiologia , Pescoço/microbiologia , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Abscesso/patologia , Administração Intravenosa , Administração Oral , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Burkholderia pseudomallei/isolamento & purificação , Ceftazidima/administração & dosagem , Ceftazidima/uso terapêutico , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , Cabeça/patologia , Humanos , Lactente , Linfadenite/diagnóstico , Linfadenite/tratamento farmacológico , Linfadenite/patologia , Masculino , Melioidose/diagnóstico , Melioidose/tratamento farmacológico , Melioidose/patologia , Pessoa de Meia-Idade , Pescoço/patologia , Estudos Retrospectivos , Tailândia/epidemiologia , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto Jovem
18.
Int J Pediatr Otorhinolaryngol ; 112: 48-54, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30055739

RESUMO

OBJECTIVES: Widespread controversy exists regarding correct diagnosing nontuberculous mycobacterial cervicofacial (NTM) lymphadenitis. This study intends to gather the available evidence with respect to diagnosing NTM cervicofacial lymphadenitis. METHODS: A review protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-statement (www.prisma-statement.org). A comprehensive search was performed in the bibliographic databases PubMed, Embase.com and Wiley/Cochrane Library. 10 Articles fulfilled the inclusion criteria and were included in the review. Assessing risk of bias of the articles was done using the revised Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool. RESULTS: This systematic review shows that diagnostic studies of high methodological quality are scarce. Diagnostic accuracy of polymerase chain reaction (PCR), culture, skin testing, auramine staining, Ziehl-Neelsen staining, and immunodiagnostic assays was studied. Culture sensitivity proved to be 41,8%, while polymerase chain reaction has a sensitivity of 71,6%. Both methods showed a specificity of 100%. Sensitivity of Immunodiagnostic assays ranged between 87,5% and 100% and specificity between 81% and 100%. Overall sensitivity of skin tests containing purified protein derivative (PPD-S) was 70% (95% CI [62%-78%]) with an overall specificity of 94% (95% CI [88%-100%]). CONCLUSIONS: In patients with a high clinical suspicion for NTM cervicofacial lymphadenitis, a positive PPD-S skin is indicative for the diagnosis of NTM cervicofacial lymphadenitis. Either PCR or culture is necessary to confirm the diagnosis. Interferon-γ release assays with purified protein derivative stimulation appear to provide good sensitivity and specificity as a non-invasive pre-operative test, but the evidence is weak. More studies of high methodological quality are needed to validate the results of this systematic review.


Assuntos
Linfadenite/diagnóstico , Infecções por Micobactéria não Tuberculosa/diagnóstico , Criança , Humanos , Linfadenite/microbiologia , Sensibilidade e Especificidade
19.
Ann Otol Rhinol Laryngol ; 127(10): 687-693, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30032669

RESUMO

OBJECTIVE(S): The objective was to describe the characteristics of hearing losses documented in patients treated with clarithromycin alone for nontuberculous mycobacterial NTM lymphadenitis in a pediatric tertiary care center over a 12-year period. METHODS: An institutional review board (IRB) approval was obtained. A database search was performed using the ICD-10 diagnosis codes 31.0, 31.1, and 31.8 between January 2004 and January 2017. A REDCap database was created to record variables. Patients were included if they received clarithromycin alone and had, at the minimum, a baseline audiology assessment, and 1 further evaluation during treatment. Fisher's exact test was used to analyze categorical variables, and Wilcoxon rank sum test was used to analyze continuous variables. RESULTS: A total of 167 patients with cervicofacial NTM were identified. Of them, 42 patients fulfilled inclusion criteria. Three children (7%) developed a hearing loss (HL) between 25 and 63 days after starting treatment. HL was unilateral in 2 children. HL persisted in 1 child following cessation of treatment. However, this patient had Rubinstein Taybi syndrome, limiting our ability to attribute the HL solely to clarithromycin. CONCLUSION: We noted a 7% hearing loss rate in our series. Confounding issues, such as 1 patient with a syndrome potentially contributing to HL, and limitations to this study, including retrospective design and loss to follow-up, temper our ability to conclude that clarithromycin was the sole cause of these HL. However, enough supporting data for a role in clarithromycin causing HL exist that testing should be considered for patients undergoing long-term clarithromycin treatment.


Assuntos
Claritromicina/efeitos adversos , Previsões , Perda Auditiva/induzido quimicamente , Audição/efeitos dos fármacos , Linfadenite/tratamento farmacológico , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Micobactérias não Tuberculosas/isolamento & purificação , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Audiometria de Tons Puros , Criança , Pré-Escolar , Claritromicina/uso terapêutico , Feminino , Seguimentos , Perda Auditiva/diagnóstico , Perda Auditiva/epidemiologia , Humanos , Incidência , Lactente , Linfadenite/microbiologia , Masculino , Infecções por Micobactéria não Tuberculosa/microbiologia , Pescoço , Estudos Retrospectivos , Estados Unidos/epidemiologia
20.
BMJ Case Rep ; 20182018 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-29982178

RESUMO

A 28-year-old man presented to our clinic over the course of 3 weeks with symptoms that progressed from mild headaches to fever, fatigue, myalgia and an enlarged right preauricular lymph node with ipsilateral conjunctivitis and upper eyelid weakness. Our differential included Epstein Barr Virus/Cytomegalovirus mononucleosis, bacterial conjunctivitis and lymphoma. We evaluated with CBC, EBV IgM Ab, lactate dehydrogenase level and a CMV IgG Ab which were all within normal limits. During his third visit, we discovered our patient had been scratched by two stray kittens he had adopted 2 months prior. We confirmed the diagnosis with a positive Bartonella henselae IgG level and diagnosed him with cat scratch disease presenting as Parinaud's oculoglandular syndrome. He was treated with a 5-day course of Azithromycin 250 mg with definitive improvement.


Assuntos
Doença da Arranhadura de Gato/diagnóstico , Linfadenite/etiologia , Adulto , Animais , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Bartonella henselae/isolamento & purificação , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/tratamento farmacológico , Gatos , Conjuntivite Bacteriana/etiologia , Doenças do Nervo Facial/etiologia , Humanos , Linfadenite/diagnóstico por imagem , Masculino , Transtornos da Motilidade Ocular/etiologia , Tomografia Computadorizada por Raios X
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