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1.
Acta Med Indones ; 53(3): 326-330, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34611073

RESUMO

SARS CoV-2 virus has infected more than 200 million people worldwide and more than 4.4 million in Indonesia. The vaccination program has become one of the solutions launched by many countries globally, including Indonesia, to reduce the transmission rate of COVID-19. Various vaccination platforms are produced, such as inactivated, viral vector, mRNA, and protein subunit. The vaccination booster program with mRNA platform (Moderna) was launched by the Indonesian government to give better protection for health care workers, particularly from delta variant. In this case report, we discuss one of the typical side effects of Moderna vaccine, which is referred to as the COVID arm.


Assuntos
Acetaminofen/administração & dosagem , Vacinas contra COVID-19 , COVID-19/prevenção & controle , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hipersensibilidade Tardia , Pele/patologia , Analgésicos não Narcóticos/administração & dosagem , Biópsia/métodos , COVID-19/epidemiologia , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Feminino , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Tardia/fisiopatologia , Hipersensibilidade Tardia/terapia , Reação no Local da Injeção/diagnóstico , Reação no Local da Injeção/etiologia , Reação no Local da Injeção/fisiopatologia , Pessoa de Meia-Idade , Médicos , SARS-CoV-2 , Resultado do Tratamento , Vacinação/métodos
3.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(5): 921-927, 2021 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-34650295

RESUMO

OBJECTIVE: To investigate the relationship between marked hyperferritinemia (MHF) and hemophagocytic lymphohistiocytosis(HLH). METHODS: The clinical data of 123 patients with MHF admitted to Peking University People's Hospital from January 2017 to September 2018 were collected, including demographics, baseline characteristics, signs and symptoms, blood routine, blood biochemistry, coagulation function parameters, such as prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), d-dimer (D-D), fibrin degradation product (FDP), blood ferritin, natural killer (NK) cell activity, soluble interleukin (IL)-2 receptor and bone marrow examination. According to the diagnosis of HLH, the patients were divided into HLH group and non HLH group. The patients were divided into death group and survival group according to the 3-month follow-up results. The groups were compared and statistically analyzed. RESULTS: In the 123 patients with MHF, the average age was (44.2±17.4) years with a male/female ratio of 1.3 ∶1. The most common causes were hematolo-gic malignancies, rheumatologic and inflammatory disorders, iron overload, and HLH. HLH was enriched as the ferritin increased, and the HLH ratios were 28.8%, 40.0%, 54.5%, 50.0%, 50.0% in ferritin value of 10 000-19 999, 20 000-29 999, 30 000-39 999, 40 000-49 999 µg/L, more than 50 000 µg/L respectively. There were 46 cases of HLH, among which 15 cases were secondary to malignancies, 14 cases secondary to rheumatologic disorders, 2 cases secondary to infection, and 15 cases with no clear precipitating cause. There were significant differences between the HLH group and non-HLH group in hepatomegaly, splenomegaly, lymphadenectasis, albumin (ALB), fibrinogen(Fib), P < 0.05, and no significant differences in age, gender, fever, disturbance of consciousness, ferritin level on presentation, maximum ferritin level, cytopenia in 2 or more cell lines, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), triglyceride (TG), coagulation parameters (PT, APTT, D-D, FDP, exception of Fib), and mortality rate (P > 0.05). There were significant differences between the death group and survival group in disturbance of consciousness, platelet count, PT, TBIL, and DBIL (P < 0.05), but no significant differences in age, gender, fever, hepatomegaly, splenomegaly, lymphadenectasis, ferritin level on presentation, maximum ferritin level, neutrophils, hemoglobin, ALT, AST, ALB, TG, coagulation parameters (Fib, APTT, D-D, FDP, exception of PT) and the HLH ratio (P > 0.05). CONCLUSION: HLH was enriched as the ferritin increased, but marked hyperferritinemia was not specific for HLH in adults.


Assuntos
Hiperferritinemia , Linfo-Histiocitose Hemofagocítica , Neoplasias , Adulto , Feminino , Febre , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
BMJ Case Rep ; 14(10)2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598963

RESUMO

This case describes the first documented clinical presentation of Sweet's syndrome with unilateral swelling of the neck, severe pain and fever. The clinical and radiological manifestation resembled necrotising fasciitis and the patient underwent acute neck dissection. The patient was ultimately diagnosed with a new subtype of Sweet's syndrome called necrotising Sweet's syndrome, and quickly recovered after treatment with intravenous administration of prednisolone.


Assuntos
Síndrome de Sweet , Dor no Peito , Edema/etiologia , Feminino , Febre/etiologia , Humanos , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/tratamento farmacológico
5.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(5): 1649-1653, 2021 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-34627455

RESUMO

OBJECTIVE: To investigate the clinical characteristics of infection in children with acute myeloid leukemia (AML) after high intensive chemotherapy, so as to provide reference for prevention and control of infection. METHODS: 56 children diagnosed as acute myeloid leukemia in our hospital from January 2016 to August 2019 were enrolled and retrospectively analyzed, the infection rate, pathogens of disease and common location of infection during the induction and consolidation period were analyzed. RESULTS: The total infection rate of the patients was 93.4%-96.4%, the average of serious infection rate was 16.0%(11.3%-19.6%), and the infection related mortality was 10.7%. Fever of unknown cause was the main reason of infection, while blood flow infections were the most common in severe infection, which were mainly caused by Gramnegative bacteria. The rate of fungal infection was 35.7% during chemotherapy. CONCLUSION: Children with AML shows a high incidence of infection in each stage of chemotherapy. The serious illness caused by blood flow infection and take antifungal drugs to reduce the occurrence of fungal infection in AML patients should be paid attention.


Assuntos
Leucemia Mieloide Aguda , Micoses , Antifúngicos/uso terapêutico , Criança , Febre/tratamento farmacológico , Humanos , Leucemia Mieloide Aguda/tratamento farmacológico , Micoses/tratamento farmacológico , Estudos Retrospectivos
6.
Sci Rep ; 11(1): 19713, 2021 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-34611200

RESUMO

The novel coronavirus disease 2019 (COVID-19) presents with non-specific clinical features. This may result in misdiagnosis or delayed diagnosis, and lead to further transmission in the community. We aimed to derive early predictors to differentiate COVID-19 from influenza and dengue. The study comprised 126 patients with COVID-19, 171 with influenza and 180 with dengue, who presented within 5 days of symptom onset. All cases were confirmed by reverse transcriptase polymerase chain reaction tests. We used logistic regression models to identify demographics, clinical characteristics and laboratory markers in classifying COVID-19 versus influenza, and COVID-19 versus dengue. The performance of each model was evaluated using receiver operating characteristic (ROC) curves. Shortness of breath was the strongest predictor in the models for differentiating between COVID-19 and influenza, followed by diarrhoea. Higher lymphocyte count was predictive of COVID-19 versus influenza and versus dengue. In the model for differentiating between COVID-19 and dengue, patients with cough and higher platelet count were at increased odds of COVID-19, while headache, joint pain, skin rash and vomiting/nausea were indicative of dengue. The cross-validated area under the ROC curve for all four models was above 0.85. Clinical features and simple laboratory markers for differentiating COVID-19 from influenza and dengue are identified in this study which can be used by primary care physicians in resource limited settings to determine if further investigations or referrals would be required.


Assuntos
COVID-19/patologia , Dengue/patologia , Influenza Humana/patologia , Adulto , Área Sob a Curva , COVID-19/complicações , COVID-19/virologia , Estudos de Coortes , Dengue/complicações , Dengue/virologia , Diagnóstico Diferencial , Diarreia/etiologia , Feminino , Febre/etiologia , Humanos , Influenza Humana/complicações , Influenza Humana/virologia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , RNA Viral/análise , RNA Viral/metabolismo , Curva ROC , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Vômito/etiologia , Adulto Jovem
7.
Mymensingh Med J ; 30(4): 936-942, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34605459

RESUMO

Brucellosis is a zoonotic disease that is one of the important infectious causes of Pyrexia of Unknown Origin (PUO). The objective of the present study was to determine the seropositivity and molecular detection of human brucellosis among the patients with pyrexia of unknown origin on both risk and non-risk group of individuals in greater Mymensingh. A total of 400 blood samples were randomly collected from pyretic patients started from September 2018 to August 2019. Questionnaires were used to collect data on both risk and non-risk group of individuals. All samples were initially screened for anti-Brucella antibodies using the Brucella-specific latex agglutination test. For accurate investigation, seropositive as well as seronegative serum samples were tested by BCSP31 Brucella genus-specific TaqMan real-time PCR. Overall 32(8%) cases were positive out of 400 samples by Brucella-specific latex agglutination test and/or BCSP31 Brucella genus-specific real-time PCR. Brucella-specific latex agglutination test documented 7% (28/400) positivity for brucellosis. 22(5.5%) samples found Brucella genus-specific real-time PCR positive out of 400 samples. Most real-time PCR positive cases were found from sero-positive samples of risk group population (15/32). Sero-negative but real-time PCR positive cases also found only from risk group population (4/32). There were 10 seropositive cases where real-time PCR was negative. In addition to Brucella-specific latex agglutination test as a screening test, Brucella genus-specific real-time PCR was performed for confirmation and also to avoid unjustified costs, drug toxicity, and masking of other potentially dangerous diseases.


Assuntos
Brucelose , Brucelose/diagnóstico , Brucelose/epidemiologia , Febre , Humanos , Reação em Cadeia da Polimerase em Tempo Real , Testes de Função Tireóidea
9.
Am J Case Rep ; 22: e932765, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34588412

RESUMO

BACKGROUND Constant stimulation of lymphocytes and histiocytes can result in hemophagocytic lymphohistiocytosis (HLH), which can be primary or secondary (sHLH). The main causes of sHLH are infections and hematological malignancies, especially non-Hodgkin lymphoma. Despite new insights into the pathogenesis of HLH, the diagnosis and treatment of this immune disorder remain a great challenge. CASE REPORT We present a case of a young adult without comorbidities whose clinical course was nonspecific for several months and resulted in late diagnosis of HLH secondary to peripheral T cell lymphoma (PTCL). The etiological factor of recurring fever, hepatosplenomegaly, and deteriorating condition was unidentified for a long time before fatal sHLH was finally diagnosed. The patient was treated according to the HLH-2004 protocol; however, he did not achieve any response. Unfortunately, due to nonspecific symptoms, lack of lymphadenopathy for a long time, and negative positron emission tomography results, the diagnosis of PTCL was established only after the patient's death. CONCLUSIONS It should be emphasized that early diagnosis is crucial for better prognosis of patients with sHLH. Bone marrow biopsy is worth considering in patients with prolonged fever of unknown origin, hyperferritinemia, splenomegaly, and unexplained cytopenia of 2 or more lineages. Despite the existence of diagnostic and therapeutic protocols available in the literature, the prompt diagnosis and treatment of HLH remains a great challenge. More precise and specific diagnostic tools for HLH are needed.


Assuntos
Linfo-Histiocitose Hemofagocítica , Linfoma de Células T Periférico , Medula Óssea , Febre , Humanos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/etiologia , Linfoma de Células T Periférico/complicações , Linfoma de Células T Periférico/diagnóstico , Masculino , Recidiva Local de Neoplasia , Adulto Jovem
10.
Pol J Microbiol ; 70(3): 401-404, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34584534

RESUMO

SARS-CoV-2 was found in a recovered patient's stool specimen by combining quantitative reverse transcription PCR (qRT-PCR) and genome sequencing. The patient was virus positive in stool specimens for at least an additional 15 days after he was recovered, whereas respiratory tract specimens were negative. The discovery of the complete genome of SARS-CoV-2 in the stool sample of the recovered patient demonstrates a cautionary warning that the potential mode of the virus transmission cannot be excluded through the fecal-oral route after viral clearance in the respiratory tract.


Assuntos
COVID-19/virologia , Convalescença , Fezes/virologia , Genoma Viral , SARS-CoV-2/genética , Sequenciamento Completo do Genoma , Adulto , COVID-19/diagnóstico por imagem , COVID-19/transmissão , China , Tosse/virologia , Febre/virologia , Humanos , Masculino , SARS-CoV-2/isolamento & purificação , Tomografia Computadorizada por Raios X
11.
Medicina (Kaunas) ; 57(9)2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34577814

RESUMO

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and its related disease (COVID-19) continue to represent a challenge for humans. To date, vaccination programs have represented an opportunity to navigate the pandemic. However, the advent of new genetic COVID-19 variants has increased more attention representing a worrying threat not only for not vaccinated but also for vaccinated people as virus infections have been shown also in the last ones. Herein, we report different clinical cases and radiological findings of COVID-19 pneumonia in six fully vaccinated patients. Two patients had a history of Rituximab therapy for follicular lymphoma and with persistent positivity for SARS-CoV-2 on nasopharyngeal/oropharyngeal (NP/OP) swabs and with moderate pneumonia on the chest computed tomography (CT). One patient who resulted to be positive to delta variant 8 days after the second vaccination dose, died shortly after. Two patients were hospitalized due to the worsening of fever and dyspnea in presence of mild pneumonia on CT. In one patient mild pneumonia was found on the chest-CT performed after a lipothymic episode associated with chest pain and positive NP/OP swab tested for SARS-CoV-2. These data suggested that in fully vaccinated people, caution should be preserved, and the use of masks and social distancing should be continued in all closed environments. However, further clinical trials should be done to better understand how various factors can influence vaccine immunogenicity as the presence of virus mutations, age factors, and the presence of an immunocompromised state.


Assuntos
COVID-19 , Febre , Humanos , Pandemias , SARS-CoV-2
12.
BMJ Case Rep ; 14(9)2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521745

RESUMO

Most reports of COVID-19 in neonates suggest that they are infected postnatally and present with gastrointestinal or respiratory symptoms. We describe a neonate who had community-acquired COVID-19, and presented with late-onset sepsis and developed dyselectrolytemia. The 26-day-old male baby had fever, feed refusal and shock. Rapid antigen test for SARS-CoV-2 by nasopharyngeal swab was positive and levels of circulating inflammatory markers were high. The baby was supported with antibiotics, and inotropic and vasopressor drugs. He had seizures and bradycardia due to dyselectrolytemia on day 2 of admission. On day 3, he had respiratory distress, with non-specific chest radiographic findings, and was managed with non-invasive support for 24 hours. The baby was discharged after 8 days. On serial follow-up, he was breastfeeding well and gaining weight appropriately with no morbidity. Our report highlights a unique presentation of COVID-19, with late-onset infection and shock-like features along with dyselectrolytemia and seizures.


Assuntos
COVID-19 , Choque , Febre , Hospitalização , Humanos , Recém-Nascido , Masculino , SARS-CoV-2 , Choque/etiologia
13.
J Assoc Physicians India ; 69(9): 11-12, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34585890

RESUMO

BACKGROUND: Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. It is known from various parts of India. However Central India was naive to any epidemics of scrub typhus with occasional and sporadic occurrence now and then. This part of India witnessed an outbreak of scrub typhus in the months of August and September 2018. Therefore present research was carried out with an objective to study the clinical profile and treatment outcome in scrub typhus patients in central India. METHOD: In this study, total 140 patients with an acute febrile illness diagnosed as scrub typhus by positive IgM antibodies against O. tsutsugamushi were enrolled, over a period of two months (August to October 2018). All relevant data were recorded and analyzed. RESULTS: Among 140 cases, 52.14% patients reported from urban area and 47.85% patients from rural area. The mean age of patients was 43.75±16.82 years, ranged from 12-83 years with female predominance (male: female-1:1.37). Fever (100%), cough (38.57%) breathlessness (27.85%), altered sensorium (9.28%) and headache (7.85%) were the predominant clinical features. Eschar was seen in 33 patients (23.57 %). Renal (73; 52.14%) and hepatic dysfunction (68; 48.57%) was the commonest followed by respiratory dysfunction (59; 42.14%). All patients (except pregnant patients) were treated with oral or inj doxycycline. Seventeen patients needed mechanical ventilation and five patients required dialysis. Total 24 (17.14%) patients died during the study period. CONCLUSION: Scrub typhus has become a leading infectious disease in central India and an important cause of infectious fever. An increasing awareness of this disease coupled with prompt management will go a long way in reducing both morbidity and mortality from this disease.


Assuntos
Orientia tsutsugamushi , Tifo por Ácaros , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Doxiciclina , Feminino , Febre/epidemiologia , Febre/etiologia , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Tifo por Ácaros/diagnóstico , Tifo por Ácaros/tratamento farmacológico , Tifo por Ácaros/epidemiologia , Resultado do Tratamento , Adulto Jovem
14.
J Assoc Physicians India ; 69(9): 11-12, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34585893

RESUMO

Acute undifferentiated febrile illnesses (AUFIs) are associated with specific characterizations like fever of less than two weeks' duration with no organ-specific symptoms at onset. These range from mild and self-limiting disease to progressive, life-threatening illness. Acute undifferentiated febrile illnesses are classified into malaria and non-malarial illnesses on the basis of microscopy or malariadiagnostic tests. Various challenges, such as comorbidities, geriatrics, pregnancy, and immune-compromised profile of the patient, impede the treatment regimen. Identifying the root cause of undifferentiated fever becomes critical and involves correct diagnostic tests along with empirical treatment initiation. Doxycycline, being a broad-spectrum antibiotic, confers activity against many Gram-positive, Gram-negative, and "atypical" bacteria. Apart from antimicrobial activity, Doxycycline demonstrates the potential to inhibit dengue virus replication and exhibits anti-inflammatory activity by down-regulating proinflammatory cytokine levels. As coronavirus disease 2019 (COVID-19) spreads, the clinical management of associated cytokine storm remains unanswered. Considering the probable beneficial effect of doxycycline, it has been recommended by the national and international experts for the empirical management of COVID-19.


Assuntos
COVID-19 , Malária , Testes Diagnósticos de Rotina , Febre/etiologia , Humanos , Malária/diagnóstico , Malária/tratamento farmacológico , SARS-CoV-2
15.
BMJ Case Rep ; 14(9)2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34531238

RESUMO

Xanthogranulomatous pyelonephritis is a rare condition characterised by destructive granulomatous inflammation of renal parenchyma. Primary renal Aspergillosis has been reported in patients with immunocompromised states such as diabetes, retroviral disease, organ transplant recipients, etc. We present a unique case of an older adult in his early 60s, presenting with fever and left flank pain with renal angle tenderness, diagnosed with primary renal aspergillosis with xanthogranulomatous pyelonephritis. These symptoms resolved with a long duration of antifungal (itraconazole) therapy and nephrectomy. The unique features are the development of fungal pyelonephritis in the absence of any immunocompromising conditions and the development of xanthogranulomatous changes with no risk factors.


Assuntos
Pielonefrite Xantogranulomatosa , Idoso , Aspergillus , Febre , Humanos , Rim , Nefrectomia , Pielonefrite Xantogranulomatosa/diagnóstico por imagem , Pielonefrite Xantogranulomatosa/cirurgia
17.
J Int Med Res ; 49(9): 3000605211041507, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34496644

RESUMO

Kawasaki disease (KD) is a common systemic vasculitis in childhood that can result in damage to multiple body systems. However, prominent gallbladder (GB) enlargement in the acute stage is especially rare. A 5-year-old boy was admitted to the hospital with an 8-day history of a cervical mass, 7-day history of fever, and 5-day history of abdominal pain and rash. The child was diagnosed with KD. After treatment with high-dose intravenous immunoglobulin therapy (2 g/kg), all clinical manifestations were relieved except the abdominal pain. Enhanced computed tomography showed distinct enlargement of the GB, and a congenital choledochal cyst was strongly suspected. After high-dose glucocorticoid treatment, his obviously enlarged GB returned to normal size in the subacute phase. No abnormality was found during 2 years of follow-up. Prominent GB enlargement may emerge in the acute stage of KD. The enlarged GB can return to normal size within the subacute stage by standard treatment for KD. Proper diagnosis, thorough differential diagnosis, and active anti-inflammatory treatment of KD are crucial to avoid surgery.


Assuntos
Doenças da Vesícula Biliar , Síndrome de Linfonodos Mucocutâneos , Pré-Escolar , Febre , Doenças da Vesícula Biliar/diagnóstico por imagem , Doenças da Vesícula Biliar/tratamento farmacológico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico
19.
Int J Public Health ; 66: 634000, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34526874

RESUMO

Objectives: Understanding treatment seeking for severe febrile illness (SFI) is methodologically challenging. In this scoping review, we investigate definitions of severe febrile illness in treatment seeking studies on children under 5 years of age in low and middle income countries. We analyze the association of SFI definitions with different concepts of treatment seeking and identify related research gaps. Methods: We searched Pubmed, Scopus and WHOLIS, and screened references of included publications for eligibility. Results: Definitions of SFI had either a biomedical perspective (predominantly in quantitative studies) or a caregiver perspective (predominantly in qualitative studies). In quantitative analyses of treatment seeking, severity was more often conceptualized as a determinant rather than an outcome of a treatment seeking process. The majority of quantitative analyses only included surviving children or did not explicitly mention dead children. Conclusion: Different research questions lead to diverse definitions and concepts of severity and treatment seeking outcomes, which limits the comparability of the available evidence. Systematic exclusion of dead children is likely to bias inferences on the association of treatment seeking and health outcomes of children with SFI in low and middle income countries.


Assuntos
Países em Desenvolvimento , Febre , Aceitação pelo Paciente de Cuidados de Saúde , Índice de Gravidade de Doença , Pré-Escolar , Febre/terapia , Humanos , Lactente , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
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