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Bulbin A, Shen J, Liotta-Bono C, Ahmad T. Unexpected severe malaria in a postoperative patient, New York, USA. BMC Infect Dis 2024; 24:404. [PMID: 38622499 PMCID: PMC11017529 DOI: 10.1186/s12879-024-09272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
Severe malaria is not routinely considered when evaluating a febrile patient in the postoperative setting. Common bacterial infections, along with adverse drug reactions, are the usual differential concerns. We present a case of severe malaria emerging unexpectedly eight days after routine craniotomy.
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Affiliation(s)
- Alan Bulbin
- St. Francis Hospital and Heart Center, 100 Port Washington Blvd, 11576, Roslyn, NY, USA
| | - Julia Shen
- St. Francis Hospital and Heart Center, 100 Port Washington Blvd, 11576, Roslyn, NY, USA
| | - Carol Liotta-Bono
- St. Francis Hospital and Heart Center, 100 Port Washington Blvd, 11576, Roslyn, NY, USA.
| | - Tahir Ahmad
- St. Francis Hospital and Heart Center, 100 Port Washington Blvd, 11576, Roslyn, NY, USA
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Eshel YD, Sharaha U, Beck G, Cohen-Logasi G, Lapidot I, Huleihel M, Mordechai S, Kapelushnik J, Salman A. Monitoring the efficacy of antibiotic therapy in febrile pediatric oncology patients with bacteremia using infrared spectroscopy of white blood cells-based machine learning. Talanta 2024; 270:125619. [PMID: 38199122 DOI: 10.1016/j.talanta.2023.125619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024]
Abstract
Bacteremia refers to the presence of bacteria in the bloodstream, which can lead to a serious and potentially life-threatening condition. In oncology patients, individuals undergoing cancer treatment have a higher risk of developing bacteremia due to a weakened immune system resulting from the disease itself or the treatments they receive. Prompt and accurate detection of bacterial infections and monitoring the effectiveness of antibiotic therapy are essential for enhancing patient outcomes and preventing the development and dissemination of multidrug-resistant bacteria. Traditional methods of infection monitoring, such as blood cultures and clinical observations, are time-consuming, labor-intensive, and often subject to limitations. This manuscript presents an innovative application of infrared spectroscopy of leucocytes of pediatric oncology patients with bacteremia combined with machine learning to diagnose the etiology of infection as bacterial and simultaneously monitor the efficacy of the antibiotic therapy in febrile pediatric oncology patients with bacteremia infections. Through the implementation of effective monitoring, it becomes possible to promptly identify any indications of treatment failure. This, in turn, indirectly serves to limit the progression of antibiotic resistance. The logistic regression (LR) classifier was able to differentiate the samples as bacterial or control within an hour, after receiving the blood samples with a success rate of over 95 %. Additionally, initial findings indicate that employing infrared spectroscopy of white blood cells (WBCs) along with machine learning is viable for monitoring the success of antibiotic therapy. Our follow up results demonstrate an accuracy of 87.5 % in assessing the effectiveness of the antibiotic treatment.
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Affiliation(s)
- Yotam D Eshel
- Department of Hematology and Oncology, Saban Pediatric Medical Center Soroka University Medical Center and Faculty of Health Sciences, Beer-Sheva, 84105, Israel
| | - Uraib Sharaha
- Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, 84105, Israel; Department of Biology, Science and Technology College, Hebron University, Hebron, P760, Palestine
| | - Guy Beck
- Department of Hematology and Oncology, Saban Pediatric Medical Center Soroka University Medical Center and Faculty of Health Sciences, Beer-Sheva, 84105, Israel
| | - Gal Cohen-Logasi
- Department of Green Engineering, SCE-Sami Shamoon College of Engineering, Beer-Sheva, 84100, Israel
| | - Itshak Lapidot
- Department of Electrical and Electronics Engineering, ACLP-Afeka Center for Language Processing, Afeka Tel-Aviv Academic College of Engineering, Tel-Aviv, 69107, Israel; LIA Avignon Université, 339 Chemin des Meinajaries, Avignon, 84000, France
| | - Mahmoud Huleihel
- Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, 84105, Israel
| | - Shaul Mordechai
- Department of Physics, Ben-Gurion University, Beer-Sheva, 84105, Israel
| | - Joseph Kapelushnik
- Department of Hematology and Oncology, Saban Pediatric Medical Center Soroka University Medical Center and Faculty of Health Sciences, Beer-Sheva, 84105, Israel
| | - Ahmad Salman
- Department of Physics, SCE-Sami Shamoon College of Engineering, Beer-Sheva, 84100, Israel.
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Cohen N, Regev A, Mordel I, Berliner S, Rimon A. Estimated C-reactive protein (CRP) velocity for rapidly distinguishing bacterial from other etiologies in children presenting to emergency department with remarkably elevated CRP levels. Eur J Pediatr 2024; 183:1925-1933. [PMID: 38347263 DOI: 10.1007/s00431-024-05463-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/21/2024] [Accepted: 01/31/2024] [Indexed: 04/09/2024]
Abstract
The use of a single C-reactive protein (CRP) value to differentiate between bacterial and non-bacterial causes is limited. Estimated CRP velocity (eCRPv) has shown promise in enhancing such discrimination in adults. This study aims to investigate the association between eCRPv and bacterial etiologies among pediatric patients with very elevated CRP levels. We conducted a retrospective analysis of patients under 18 years of age who had been admitted to our Pediatric Emergency Department from 2018 to 2020 with a fever and CRP levels ≥ 150 mg/L. Bacterial and non-bacterial etiologies were determined from hospital discharge diagnoses, which were monitored independently by three physicians from the research team. The records of 495 suitable patients (51.2% males, median age 3.2 years) were retrieved of whom 444 (89.7%) were eventually diagnosed with bacterial infections. The mean CRP levels were significantly higher for bacterial etiologies compared with other causes (209.2 ± 59.8 mg/L vs. 185.6 ± 35.8 mg/L, respectively, p < .001), while the mean eCRPv values did not differ significantly (p = .15). In a time course analysis, we found that specifically in patients presenting ≥ 72 h after symptom onset, only a eCRPv1 level > 1.08 mg/L/h was an independent predictor of bacterial infection (aOR = 5.5 [95% CI 1.7-17.8], p = .004). Conclusion: Pediatric patients with very high CRP levels and fever mostly have bacterial infections. eCRPv levels, unlike CRP values alone, can serve as the sole independent predictor of bacterial infection > 72 h from symptom onset, warranting further prospective investigations into CRP kinetics in pediatric patients. What is Known: • The use of a single C-reactive protein (CRP) value to differentiate between bacterial and non-bacterial causes is limited. • Estimated CRP velocity (eCRPv) has shown promise in enhancing such discrimination in adults, but data on CRP kinetics in pediatric patients is sparse. What is New: • eCRPv levels, unlike CRP values alone, can serve as the sole independent predictor of bacterial infection > 72 h from symptom onset in pediatric patients with remarkably elevated CRP levels.
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Affiliation(s)
- Neta Cohen
- Pediatric Emergency Medicine Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Regev
- Pediatric Infectious Disease Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Mordel
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Berliner
- Departments of Internal Medicine "C", "D", and "E", Tel Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Rimon
- Pediatric Emergency Medicine Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pérez-Porra S, Granda E, Benito H, Roland D, Gomez B, Velasco R. Prevalence of invasive bacterial infection in febrile infants ≤90 days with a COVID-19 positive test: a systematic review and meta-analysis. Emerg Med J 2024; 41:228-235. [PMID: 38071527 DOI: 10.1136/emermed-2023-213483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/15/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Febrile infants with an infection by influenza or enterovirus are at low risk of invasive bacterial infection (IBI). OBJECTIVE To determine the prevalence of IBI among febrile infants ≤90 days old with a positive COVID-19 test. METHODS MEDLINE, Embase, Cochrane Central Register databases, Web of Science, ClinicalTrials.gov and grey literature were searched for articles published from February 2020 to May 2023. INCLUSION CRITERIA researches reporting on infants ≤90 days of age with fever and a positive test for SARS-CoV-2 (antigen test/PCR). Case reports with <3 patients, articles written in a language other than English, French or Spanish, editorials and other narrative studies were excluded. Preferred Reposting Items for Systematic Reviews and Meta-analysis guidelines were followed, and the National Institutes of Health Quality Assessment Tool was used to assess study quality. The main outcome was the prevalence of IBI (a pathogen bacterium identified in blood and/or cerebrospinal fluid (CSF)). Forest plots of prevalence estimates were constructed for each study. Heterogeneity was assessed and data were pooled by meta-analysis using a random effects model. A fixed continuity correction of 0.01 was added when a study had zero events. RESULTS From the 1023 studies and 3 databases provided by the literature search, 33 were included in the meta-analysis, reporting 3943 febrile infants with a COVID-19 positive test and blood or CSF culture obtained. The pooled prevalence of IBI was 0.14% (95% CI, 0.02% to 0.27%). By age, the prevalence of IBI was 0.56% (95% CI, 0.0% to 1.27%) in those 0-21 days old, 0.53% (95% CI, 0.0% to 1.22%) in those 22-28 days old and 0.11% (95% CI, 0.0% to 0.24%) in those 29-60 days old. CONCLUSION COVID-19-positive febrile infants ≤90 days old are at low risk of IBI, especially infants >28 days old, suggesting this subgroup of patients can be managed without blood tests. PROSPERO REGISTRATION NUMBER CRD42022356507.
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Affiliation(s)
- Silvia Pérez-Porra
- Pediatrics Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Elena Granda
- Pediatrics Department, Hospital Universitario Rio Hortega, Valladolid, Spain
- Pediatrics Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Helvia Benito
- Gerencia de Atención Primaria de Segovia, Segovia, Spain
- CAP Concòrdia. Consorci Corporació Sanitària Parc Tauli, Sabadell, Barcelona, Spain
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Borja Gomez
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario de Cruces. University of the Basque Country, UPV/EHU, Barakaldo, Bilbao, Basque Country, Spain
| | - Roberto Velasco
- Pediatric Emergency Unit, Department of Pediatrics, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
- Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
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Sutiman N, Yao SHW, Goh SSM, Sultana R, Chong SL. Protocol for the diagnostic performance of C reactive protein, procalcitonin and interleukin-6 for serious bacterial infections among children ≤36 months old presenting with fever without source: a systematic review and meta-analysis. BMJ Paediatr Open 2024; 8:e002237. [PMID: 38499348 PMCID: PMC10952928 DOI: 10.1136/bmjpo-2023-002237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/01/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION The management of fever without source in children ≤36 months old remains a diagnostic challenge as the underlying aetiologies can vary from self-limiting viral infections to serious bacterial infections (SBIs). Biomarkers such as C reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6) have varying thresholds in the prediction of SBIs due to differences in SBI definitions, SBI prevalence, patient characteristics and timing of presentation. This protocol describes a systematic review and meta-analysis that aims to determine the thresholds at which CRP, PCT and IL-6 can perform optimally in distinguishing the presence of SBIs in children ≤36 months old, as well as to determine their performances in early detection of bacterial infections within 48 hours of fever onset. METHODS AND ANALYSIS We will systematically search electronic databases including MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane CENTRAL, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Science Citation Index from 1 July 2023 to 31 July 2023. We will include studies that report the diagnostic accuracy of CRP, PCT and IL-6 in detecting SBIs in children aged ≤36 months presenting with fever without apparent source. Randomised controlled trials (RCTs) and non-randomised studies including non-RCTs and controlled before-and-after studies will be included. A meta-analysis will be performed and diagnostic performances of these biomarkers will be reported. ETHICS AND DISSEMINATION The results of this study will provide guidance on clinical decision-making in young children presenting with fever without source. Ethics approval will not be required for this study. The authors aim to publish the findings in a peer-reviewed journal as well as present at international conferences. PROSPERO REGISTRATION NUMBER CRD42023439093.
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Affiliation(s)
- Natalia Sutiman
- Department of Emergency Medicine, Kandang Kerbau Women's and Children's Hospital, Singapore
| | | | | | - Rehena Sultana
- Center of Quantitative Medicine, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Shu-Ling Chong
- Department of Emergency Medicine, Kandang Kerbau Women's and Children's Hospital, Singapore
- Pediatric Academic Clinical Programme, Emergency Medicine Academic Clinical Programme, SingHealth Duke-NUS, Singapore
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Hernández-Bou S, Trenchs V, Diego P, Seguí A, Luaces C. Bacterial coinfection in young febrile infants with SARS-CoV-2 infection. Eur J Pediatr 2024; 183:281-288. [PMID: 37872349 DOI: 10.1007/s00431-023-05212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/25/2023]
Abstract
We aimed to assess the prevalence of serious bacterial infections (SBIs) in febrile infants < 90 days of age with SARS-CoV-2 infection versus SARS-CoV-2-negative febrile infants. A retrospective cohort study was conducted in a tertiary pediatric emergency department between March 2020 and October 2022. Febrile infants < 90 days of age who underwent SARS-CoV-2 testing were included. SBIs were defined as urinary tract infection (UTI), bacteremia, and/or bacterial meningitis; bacteremia and bacterial meningitis were considered invasive bacterial infections (IBIs). SBIs rates were compared between SARS-CoV-2-positive and negative infants and stratified by age. We included 779 infants: 221 (28.4%) SARS-CoV-2-positive and 558 (71.6%) SARS-CoV-2-negative. The SBI rate in the SARS-CoV-2-positive group was 5.9% vs 22.9% in the SARS-CoV-2-negative group (p < 0.001; relative risk (RR) 0.26; [95% CI 0.15-0.44]); the most common infections were UTI (5.4% vs 22.0%; p < 0.001). The IBI rate was 0.5% in the SARS-CoV-2-positive group vs. 3.2% in the negative group (p = 0.024; RR 0.14 [95% CI 0.02-1.04]). There were no cases of bacterial meningitis in the positive infants. SARS-CoV-2-positive infants > 28 days of age had a decreased likelihood of SBI (RR 0.22 [95% CI 0.11-0.43]), with no cases of IBI identified. Conclusions: Febrile infants < 90 days of age with SARS-CoV-2 infection are at significantly lower risk of SBIs than those who are SARS-CoV-2-negative. Nevertheless, the rate of UTI remains considerable in SARS-CoV-2-positive infants. SARS-CoV-2 detection may be relevant in considering IBI risk for well-appearing febrile infants 29-89 days of age. What is Known: • Febrile infants with laboratory-confirmed viral infections have a significantly lower risk of serious bacterial infections when compared to those without them. Data focusing on very young febrile infants with a SARS-CoV-2 infection is still limited. What is New: • Young febrile infants with SARS-CoV-2 infection are at significantly lower risk of serious bacterial infections than those who are SARS-CoV-2-negative. Nevertheless, the rate of urinary tract infection remains considerable. SARS-CoV-2 detection may be relevant in considering invasive bacterial infection risk for well-appearing febrile infants 29-89 days of age.
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Affiliation(s)
- Susanna Hernández-Bou
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
- Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
| | - Victoria Trenchs
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain.
- University of Barcelona, Barcelona, Spain.
- Environment Effects on Child/Adolescent Well-being, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain.
| | - Patricia Diego
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
| | - Aina Seguí
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
| | - Carles Luaces
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Environment Effects on Child/Adolescent Well-being, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
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Martin AJ, van der Velden FJS, von Both U, Tsolia MN, Zenz W, Sagmeister M, Vermont C, de Vries G, Kolberg L, Lim E, Pokorn M, Zavadska D, Martinón-Torres F, Rivero-Calle I, Hagedoorn NN, Usuf E, Schlapbach L, Kuijpers TW, Pollard AJ, Yeung S, Fink C, Voice M, Carrol E, Agyeman PKA, Khanijau A, Paulus S, De T, Herberg JA, Levin M, van der Flier M, de Groot R, Nijman R, Emonts M. External validation of a multivariable prediction model for identification of pneumonia and other serious bacterial infections in febrile immunocompromised children. Arch Dis Child 2023; 109:58-66. [PMID: 37640431 DOI: 10.1136/archdischild-2023-325869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To externally validate and update the Feverkids tool clinical prediction model for differentiating bacterial pneumonia and other serious bacterial infections (SBIs) from non-SBI causes of fever in immunocompromised children. DESIGN International, multicentre, prospective observational study embedded in PErsonalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union (PERFORM). SETTING Fifteen teaching hospitals in nine European countries. PARTICIPANTS Febrile immunocompromised children aged 0-18 years. METHODS The Feverkids clinical prediction model predicted the probability of bacterial pneumonia, other SBI or no SBI. Model discrimination, calibration and diagnostic performance at different risk thresholds were assessed. The model was then re-fitted and updated. RESULTS Of 558 episodes, 21 had bacterial pneumonia, 104 other SBI and 433 no SBI. Discrimination was 0.83 (95% CI 0.71 to 0.90) for bacterial pneumonia, with moderate calibration and 0.67 (0.61 to 0.72) for other SBIs, with poor calibration. After model re-fitting, discrimination improved to 0.88 (0.79 to 0.96) and 0.71 (0.65 to 0.76) and calibration improved. Predicted risk <1% ruled out bacterial pneumonia with sensitivity 0.95 (0.86 to 1.00) and negative likelihood ratio (LR) 0.09 (0.00 to 0.32). Predicted risk >10% ruled in bacterial pneumonia with specificity 0.91 (0.88 to 0.94) and positive LR 6.51 (3.71 to 10.3). Predicted risk <10% ruled out other SBIs with sensitivity 0.92 (0.87 to 0.97) and negative LR 0.32 (0.13 to 0.57). Predicted risk >30% ruled in other SBIs with specificity 0.89 (0.86 to 0.92) and positive LR 2.86 (1.91 to 4.25). CONCLUSION Discrimination and calibration were good for bacterial pneumonia but poorer for other SBIs. The rule-out thresholds have the potential to reduce unnecessary investigations and antibiotics in this high-risk group.
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Affiliation(s)
- Alexander James Martin
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Fabian Johannes Stanislaus van der Velden
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ulrich von Both
- Department of Pediatrics, Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Maria N Tsolia
- 2nd Department of Pediatrics, 'P. and A. Kyriakou' Chlidren's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Werner Zenz
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Manfred Sagmeister
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Clementien Vermont
- Department of Paediatrics, Division of Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Gabriella de Vries
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatrics, Division of Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Laura Kolberg
- Department of Pediatrics, Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Emma Lim
- Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marko Pokorn
- Department of Infectious Diseases, University Medical Centre Ljubljana, Univerzitetni, Klinični, Ljubljana, Slovenia
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Dace Zavadska
- Department of Pediatrics, Rīgas Universitāte, Children's Clinical University Hospital, Riga, Latvia
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Irene Rivero-Calle
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Nienke N Hagedoorn
- Department of Paediatrics, Division of Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Effua Usuf
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, London, UK
| | - Luregn Schlapbach
- Neonatal and Pediatric Intensive Care Unit, Children's Research Center, University Children's Hospital Zürich, Zürich, Switzerland
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Shunmay Yeung
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Colin Fink
- Micropathology Ltd, University of Warwick Science Park, Warwick, UK
| | - Marie Voice
- Micropathology Ltd, University of Warwick Science Park, Warwick, UK
| | - Enitan Carrol
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aakash Khanijau
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Stephane Paulus
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Tisham De
- Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Jethro Adam Herberg
- Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Michael Levin
- Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Michiel van der Flier
- Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald de Groot
- Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruud Nijman
- Department of Paediatric Emergency Medicine, St. Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK
- Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Marieke Emonts
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
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8
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Jacob R, Padeh G, Kaplan O, Koppel JH, Porat D, Weiser G, Levy N, Cohen N, Capua T, Schnapp Z, Friedman N. Bacterial Infections and Clinical Outcomes Among Febrile Infants up to 90 Days Old With SARS-CoV-2 Infection: A Multicenter Cohort Study. Pediatr Infect Dis J 2023; 42:905-907. [PMID: 37406214 DOI: 10.1097/inf.0000000000004019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
We present a large, multicenter, cohort study that aimed to assess bacterial infection rates among febrile infants up to 90 days old presenting to the pediatric emergency department with severe acute respiratory syndrome coronavirus 2 infection during 2021-2022 throughout successive variant waves. Overall, 417 febrile infants were included. Twenty-six infants (6.2%) had bacterial infections. All bacterial infections consisted of urinary tract infections, and there were no invasive bacterial infections. There was no mortality.
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Affiliation(s)
- Ron Jacob
- From the Pediatric Emergency Department, Ha'Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Gabi Padeh
- Emergency Department, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Kaplan
- Pediatric Emergency Department, Soroka Medical Center, Beer Sheva, Israel
| | - Jordanna H Koppel
- Pediatric Emergency Department, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danit Porat
- Pediatric Emergency Department, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giora Weiser
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nitai Levy
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Noy Cohen
- Pediatric Emergency Department, Samson Assuta University Hospital, Ashdod, Israel
| | - Tali Capua
- Pediatric Emergency Department, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zeev Schnapp
- Pediatric Emergency Department, Carmel Medical Center, Haifa, Israel
| | - Nir Friedman
- Pediatric Emergency Department, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Greenhow TL, Nguyen THP, Young BR, Somers MJ, Huang J, Alabaster A, Vinson DR, Mark DG, Van Winkle PJ, Sharp AL, Reed ME, Shan J, Zhang JY, Rauchwerger AS, Ballard DW. CA FIRST (California Febrile Infant Risk Stratification Tool) Algorithm Development in a Learning Health System. Perm J 2023; 27:92-98. [PMID: 37559485 PMCID: PMC10502387 DOI: 10.7812/tpp/23.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Introduction There is considerable variation in the approach to infants presenting to the emergency department (ED) with fever. The authors' primary aim was to develop a robust set of algorithms using community ED data to inform modifications of broader clinical guidance. Methods The authors report the development of California Febrile Infant Risk Stratification Tool (CA FIRST) using key components of the Roseville Protocol (ROS) and American Academy of Pediatrics (AAP) Clinical Practice Guideline (CPG). Expanded guidance was derived using a retrospective analysis of a cohort of 3527 febrile infants aged 7-90 days presenting to any Kaiser Permanente Northern California ED between 2010 and 2019 who underwent a core febrile infant evaluation. Results Melding ROS and AAP CPG algorithms in infants 7-60 days old, CA FIRST Algorithms had comparable performance characteristics to ROS and AAP CPG. CA FIRST enhancements included guidance on febrile infants 61-90 days old, high-risk infants, infants with bronchiolitis, and infants who received immunizations within the prior 48 hours. This retrospective analysis revealed that of 235 febrile infants 22-90 days old with respiratory syncytial virus and 221 who had fever in the 48 hours following vaccination, there were no cases of invasive bacterial infection. Discussion CA FIRST is a set of 13 algorithms providing a thoughtful and flexible approach to the febrile infant while minimizing unnecessary interventions. Conclusions CA FIRST Algorithms empower clinicians to manage most febrile infants. Algorithms are being modified as new data become available, imparting useful and ever-current educational information within a learning health care system.
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Affiliation(s)
- Tara L Greenhow
- Division of Infectious Diseases, Department of Pediatrics, Kaiser Permanente Northern California, San Francisco, CA, USA
- The Permanente Medical Group, Oakland, CA, USA
| | - Tran HP Nguyen
- The Permanente Medical Group, Oakland, CA, USA
- Department of Hospital Pediatrics, Kaiser Permanente Northern California, Roseville, CA, USA
| | - Beverly R Young
- The Permanente Medical Group, Oakland, CA, USA
- Department of Hospital Pediatrics, Kaiser Permanente Northern California, Roseville, CA, USA
| | - Madeline J Somers
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jie Huang
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Amy Alabaster
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - David R Vinson
- The Permanente Medical Group, Oakland, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Dustin G Mark
- The Permanente Medical Group, Oakland, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Patrick J Van Winkle
- Department of Pediatrics, Kaiser Permanente Southern California, Anaheim, CA, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Health Systems Science Department, Pasadena, CA, USA
| | - Adam L Sharp
- Kaiser Permanente Bernard J. Tyson School of Medicine, Health Systems Science Department, Pasadena, CA, USA
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Mary E Reed
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Judy Shan
- School of Medicine, University of California, San Francisco, CA, USA
| | - Jennifer Y Zhang
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Adina S Rauchwerger
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Dustin W Ballard
- The Permanente Medical Group, Oakland, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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10
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Al Yazidi LS, Elsidig N, Wali Y, Nazir H. Chronic Disseminated Candidiasis in Children and the Role of Corticosteroids Therapy. Pediatr Infect Dis J 2023; 42:e146-e151. [PMID: 36795580 DOI: 10.1097/inf.0000000000003859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Little is known about chronic disseminated candidiasis (CDC) in children. This study was done to describe the epidemiology, risk factors and outcome of CDC in children managed at Sultan Qaboos University Hospital (SQUH), Oman, and to describe the role of corticosteroids in the management of immune reconstitution inflammatory syndrome (IRIS) complicating CDC. METHODS We retrospectively reported demographic, clinical and laboratory data of all children managed in our center for CDC between January 2013 and December 2021. In addition, we discuss the available literature on the role of corticosteroids for management of CDC-related IRIS in children since 2005. RESULTS Between January 2013 and December 2021, 36 immunocompromised children were diagnosed with invasive fungal infection at our center, of whom 6 had CDC (all with acute leukemia). Their median age was 5.75 years. Prolonged fever despite broad-spectrum antibiotics (6/6) followed by skin rash (4/6) were the most common clinical features of CDC. Four children grew Candida tropicalis from blood or skin. CDC-related IRIS was documented in 5 children (83%) and 2 received corticosteroids. Our literature review revealed that 28 children were managed with corticosteroids for CDC-related IRIS since 2005. The majority of these children had defervescence of fever within 48 hours. Prednisolone of 1-2 mg/kg/day for 2-6 weeks was the most common regimen used. No major side effects reported in these patients. CONCLUSION CDC is more common in children with acute leukemia and CDC-related IRIS is not uncommon. Corticosteroid therapy looks effective and safe as adjunctive therapy for CDC-related IRIS.
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Affiliation(s)
- Laila S Al Yazidi
- From the Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Nagi Elsidig
- From the Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Yasser Wali
- From the Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hanan Nazir
- Department of Pediatrics, Alexandria Faculty of Medicine, Alexandria, Egypt
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11
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Mor M, Paz M, Amir L, Levy I, Scheuerman O, Livni G, Guetta-Oz C, Yochpaz S, Berant R, Schwartz R, Niv O, Singer D, Ashkenazi S, Waisman Y. Bacterial vs viral etiology of fever: A prospective study of a host score for supporting etiologic accuracy of emergency department physicians. PLoS One 2023; 18:e0281018. [PMID: 36716321 PMCID: PMC9886241 DOI: 10.1371/journal.pone.0281018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/12/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A host-protein score (BV score) that combines the circulating levels of TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10) and C-reactive protein (CRP) was developed for distinguishing bacterial from viral infection. This study assessed the potential of the BV score to impact decision making and antibiotic stewardship at the emergency department (ED), by comparing BV score's performance to physician's etiological suspicion at patient presentation. METHODS Rosetta study participants, aged 3 months to 18 years with febrile respiratory tract infection or fever without source, were prospectively recruited in a tertiary care pediatric ED. 465 patients were recruited, 298 met eligibility criteria and 287 were enrolled. ED physician's etiological suspicion was recorded in a questionnaire. BV score was measured retrospectively with results interpreted as viral, bacterial or equivocal and compared to reference standard etiology, which was adjudicated by three independent experts based on all available data. Experts were blinded to BV scores. RESULTS Median age was 1.3 years (interquartile range 1.7), 39.7% females. 196 cases were reference standard viral and 18 cases were reference standard bacterial. BV score attained sensitivity of 88.9% (95% confidence interval: 74.4-100), specificity 92.1% (88.1-96.0), positive predictive value 53.3% (35.5-71.2) and negative predictive value 98.8% (97.1-100). Positive likelihood ratio was 11.18 (6.59-18.97) and negative likelihood ratio was 0.12 (0.03-0.45). The rate of BV equivocal scores was 9.4%. Comparing physician's suspicion to BV score and to the reference standard, and assuming full adoption, BV score could potentially correct the physician's diagnosis and reduce error ~2-fold, from 15.9% to 8.2%. CONCLUSIONS BV score has potential to aid the diagnostic process. Future studies are warranted to assess the impact of real-time BV results on ED practice.
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Affiliation(s)
- Meirav Mor
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Meital Paz
- Carmel Medical Center, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Lisa Amir
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Levy
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Gilat Livni
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | | | - Sivan Yochpaz
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
- Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ron Berant
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Rama Schwartz
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Omer Niv
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Dana Singer
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Yehezkel Waisman
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
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12
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Méndez-Espinola BM, Gallardo-Aravena E. Diagnosis of urinary tract infection in infants under 3 months with fever without a source: reliability of urinalysis and urine culture. Bol Med Hosp Infant Mex 2023; 80:288-295. [PMID: 37963294 DOI: 10.24875/bmhim.23000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/20/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is infants' most common serious bacterial infection. This study aimed to investigate the reliability of urianalysis (UA) to predict UTI, to specify the colony forming units (CFU)/ml threshold for diagnosis, and to identify variables that help suspect bacteremia in infants under 3 months with UTI. METHODS We reviewed clinical records of children under 3 months hospitalized for a fever without source and recorded age, sex, days of fever pre-consultation, temperature and severity at admission, discharge diagnoses, laboratory tests, and treatments. According to the discharge diagnosis, we divided them into UTIs (-) and (+) with or without bacteremia. RESULTS A total of 467 infants were admitted: 334 with UTI and 133 without UTI. In UTIs (+), the pyuria had a sensitivity of 95.8% and bacteria (+) 88.3%; specificity was high, especially for nitrites (96.2%) and bacteria (+) (92.5%). Positive predictive value (PPV) for nitrites was 95.9%, for bacteria 96.7%, and oyuria 92.5%. Escherichia coli was present in 83.8% of urine and 87% of blood cultures. UTIs with bacteremia had inflammatory urinalysis, urine culture > 100,000 CFU/ml, and higher percentage of C reactive protein (CRP) > 50 mg (p= 0.002); 94.6% of the urine culture had > 50,000 CFU. CONCLUSIONS The pyuria and bacteria (+) in urine obtained by catheterization predict UTI. The cut-off point for diagnosis was ≥ 50,000 CFU/ml. No variables to suspect bacteremia were identified in this study.
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13
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Badri N, Friedman L. Fever in children aged 3 to 36 Months: management in the emergency department. Pediatr Emerg Med Pract 2022; 19:1-28. [PMID: 36121775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
The advent of pneumococcal and Haemophilus influenzae vaccines has substantially reduced the risk for occult (unsuspected) serious bacterial infection or invasive bacterial infection in the febrile child. The challenge for emergency clinicians is to identify and treat children with serious illness while avoiding overtreatment. This issue reviews the epidemiology and management of fever in children aged 3 to 36 months, focusing primarily on previously healthy, well-appearing children without a source of fever whose evaluation and management are more ambiguous.
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Affiliation(s)
| | - Lucas Friedman
- Associate Professor, University of California Riverside School of Medicine, Riverside, CA
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14
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Rybak A, Aupiais C, Cotillon M, Basmaci R, de Pontual L, Bonacorsi S, Mariani P, Landraud L, Brichler S, Poilane I, Ouldali N, Titomanlio L. Reassessing the Performance of the "Step-By-Step" Approach to Febrile Infants 90 Days of Age and Younger in the Context of the COVID-19 Pandemic: A Multicentric Retrospective Study. Pediatr Infect Dis J 2022; 41:e365-e368. [PMID: 35703301 PMCID: PMC9359674 DOI: 10.1097/inf.0000000000003614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Infants with COVID-19 can often present with fever without source, which is a challenging situation in infants <90 days old. The "step-by-step" algorithm has been proposed to identify children at high risk of bacterial infection. In the context of the COVID-19 pandemic, we aimed to reassess the diagnostic performance of this algorithm. METHODS We performed a multicentric retrospective study in 3 French pediatric emergency departments between 2018 and 2020. We applied the "step-by-step" algorithm to 4 clinical entities: COVID-19, febrile urinary tract infections (FUTI), invasive bacterial infection (IBI), and enterovirus infections. The main outcome was the proportion of infants classified at high risk (ill-appearing, ≤21 days old, with leukocyturia or procalcitonin level ≥0.5 ng/mL). RESULTS Among the 199 infants included, 40 had isolated COVID-19, 25 had IBI, 60 had FUTI, and 74 had enterovirus infection. All but 1 infant with bacterial infection were classified at high risk (96% for IBI and 100% for FUTI) as well as 95% with enterovirus and 82% with COVID-19. Infants with COVID-19 were classified at high risk because an ill-appearance (72%), an age ≤21 days (27%), or leukocyturia (19%). All these infants had procalcitonin values <0.5 ng/mL and only 1 had C-reactive protein level >20 mg/L. CONCLUSIONS The "step-by-step" algorithm remains effective to identify infants with bacterial infection but misclassifies most infants with COVID-19 as at high risk of bacterial infection leading to unnecessary cares. An updated algorithm based adding viral testing may be needed to discriminate fever related to isolated COVID-19 in infants <90 days old.
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Affiliation(s)
- Alexis Rybak
- From the Pediatric Emergency Department, Robert Debré University Hospital, Université de Paris, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Camille Aupiais
- INSERM, Unité Mixte de Recherche 1123 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Université de Paris, Paris, France
| | - Marie Cotillon
- Department of Pediatrics, Louis Mourier University Hospital, Université de Paris, Assistance Publique—Hôpitaux de Paris, Colombes, France
| | - Romain Basmaci
- Department of Pediatrics, Louis Mourier University Hospital, Université de Paris, Assistance Publique—Hôpitaux de Paris, Colombes, France
| | - Loïc de Pontual
- Department of Pediatrics, Jean Verdier University Hospital, Assistance Publique—Hôpitaux de Paris, Université Sorbonne Paris Nord, Bondy, France
| | - Stéphane Bonacorsi
- INSERM, Unité Mixte de Recherche 1137 Infection-Antimicrobials-Modelling-Evolution (IAME), Université de Paris, Paris, France
| | - Patricia Mariani
- Department of Microbiology, Robert Debré University Hospital, Université de Paris, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Luce Landraud
- Department of Microbiology, Louis Mourier University Hospital, Université de Paris, Assistance Publique—Hôpitaux de Paris, Colombes, France
| | - Ségolène Brichler
- Department of Clinical Microbiology, Paris-Seine-Saint-Denis University Hospitals, Université Sorbonne Paris Nord, Assistance Publique—Hôpitaux de Paris, Bobigny, France
| | - Isabelle Poilane
- Department of Clinical Microbiology, Paris-Seine-Saint-Denis University Hospitals, Université Sorbonne Paris Nord, Assistance Publique—Hôpitaux de Paris, Bobigny, France
| | - Naïm Ouldali
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Créteil, France
| | - Luigi Titomanlio
- From the Pediatric Emergency Department, Robert Debré University Hospital, Université de Paris, Assistance Publique—Hôpitaux de Paris, Paris, France
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15
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Kelly E, Whelan SO, Harriss E, Murphy S, Pollard AJ, O' Connor D. Systematic review of host genomic biomarkers of invasive bacterial disease: Distinguishing bacterial from non-bacterial causes of acute febrile illness. EBioMedicine 2022; 81:104110. [PMID: 35792524 PMCID: PMC9256842 DOI: 10.1016/j.ebiom.2022.104110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Infectious diseases play a significant role in the global burden of disease. The gold standard for the diagnosis of bacterial infection, bacterial culture, can lead to diagnostic delays and inappropriate antibiotic use. The advent of high- throughput technologies has led to the discovery of host-based genomic biomarkers of infection, capable of differentiating bacterial from other causes of infection, but few have achieved validation for use in a clinical setting. Methods A systematic review was performed. PubMed/Ovid Medline, Ovid Embase and Scopus databases were searched for relevant studies from inception up to 30/03/2022 with forward and backward citation searching of key references. Studies assessing the diagnostic performance of human host genomic biomarkers of bacterial infection were included. Study selection and assessment of quality were conducted by two independent reviewers. A meta-analysis was undertaken using a diagnostic random-effects model. The review was registered with PROSPERO (ID: CRD42021208462). Findings Seventy-two studies evaluating the performance of 116 biomarkers in 16,216 patients were included. Forty-six studies examined TB-specific biomarker performance and twenty-four studies assessed biomarker performance in a paediatric population. The results of pooled sensitivity, specificity, negative and positive likelihood ratio, and diagnostic odds ratio of genomic biomarkers of bacterial infection were 0.80 (95% CI 0.78 to 0.82), 0.86 (95% CI 0.84 to 0.88), 0.18 (95% CI 0.16 to 0.21), 5.5 (95% CI 4.9 to 6.3), 30.1 (95% CI 24 to 37), respectively. Significant between-study heterogeneity (I2 77%) was present. Interpretation Host derived genomic biomarkers show significant potential for clinical use as diagnostic tests of bacterial infection however, further validation and attention to test platform is warranted before clinical implementation can be achieved. Funding No funding received.
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Affiliation(s)
- Eimear Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford. UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Seán Olann Whelan
- Department of Clinical Microbiology, Galway University Hospital, Galway, Ireland
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford
| | - Sarah Murphy
- Department of Paediatrics, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford. UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Daniel O' Connor
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford. UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
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16
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Burcham MD, Cochrane AR, Wood JB, Mueller EL. Impact of Paired Central and Peripheral Blood Cultures in Children With Cancer. J Pediatr Hematol Oncol 2022; 44:e138-e143. [PMID: 34486540 DOI: 10.1097/mph.0000000000002307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 08/09/2021] [Indexed: 11/26/2022]
Abstract
Children with cancer require central venous access which carries risk for line-related infections. The necessity of peripheral and central blood cultures is debated for those with fevers. We evaluated and described results for first episode of paired blood cultures from children with cancer who have a central venous line using retrospective database. Blood culture results, laboratory data, and medical outcomes were included. Descriptive analyses of blood culture results and clinical data were performed. There were 190 episodes of paired positive blood cultures with 167 true positive episodes. Of the true positive episodes, 104 (62.3%) were positive in both central and peripheral cultures, 42 (25.1%) were positive in central only cultures, and 21 (12.6%) were positive in peripheral cultures only. Intensive care unit admission within 48 hours after blood cultures (n=33) differed significantly: 28.7% for both central and peripheral, 10% for central only, and 0% for peripheral only (P=0.009). Central line removal (n=34) differed by type of positivity but was not significant: 22.1% for both central and peripheral, 23.8% for central only, and 4.8% for peripheral only (P=0.15). Peripheral blood cultures provided important medical information yet had differences in short-term clinical outcomes. Further evaluation of medical decision making is warranted.
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Affiliation(s)
| | - Anneli R Cochrane
- Section of Pediatric Hematology Oncology, Department of Pediatrics
- Center for Pediatric and Adolescent Comparative Effectiveness Research
| | - James B Wood
- Center for Pediatric and Adolescent Comparative Effectiveness Research
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University, Indianapolis, IN
| | - Emily L Mueller
- Section of Pediatric Hematology Oncology, Department of Pediatrics
- Center for Pediatric and Adolescent Comparative Effectiveness Research
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17
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Kakita T, Okano S, Kyan H, Miyahira M, Taira K, Kitashoji E, Koizumi N. Laboratory diagnostic, epidemiological, and clinical characteristics of human leptospirosis in Okinawa Prefecture, Japan, 2003-2020. PLoS Negl Trop Dis 2021; 15:e0009993. [PMID: 34905535 PMCID: PMC8670671 DOI: 10.1371/journal.pntd.0009993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leptospirosis is considered an endemic disease among agricultural workers in Okinawa Prefecture, which is the southernmost part of Japan and has a subtropical climate, but data on the current status and trend of this disease are scarce. METHODOLOGY/PRINCIPAL FINDINGS We conducted a retrospective study of clinically suspected leptospirosis patients whose sample and information were sent to the Okinawa Prefectural Institute of Health and Environment from November 2003 to December 2020. Laboratory diagnosis was established using culture, nested polymerase chain reaction (PCR), and/or microscopic agglutination test (MAT) with blood, cerebrospinal fluid, and/or urine samples. Statistical analyses were performed to compare the epidemiological information, clinical features, and sensitivities of diagnostic methods among laboratory-confirmed cases. Serogroups and the species of Leptospira isolates were determined by MAT using 13 antisera and flaB sequencing. A total of 531 clinically suspected patients were recruited, among whom 246 (46.3%) were laboratory confirmed to have leptospirosis. Among the confirmed cases, patients aged 20-29 years (22.4%) and male patients (85.7%) were the most common. The most common estimated sources of infection were recreation (44.5%) and labor (27.8%) in rivers. Approximately half of the isolates were of the L. interrogans serogroup Hebdomadis. The main clinical symptoms were fever (97.1%), myalgia (56.3%), and conjunctival hyperemia (52.2%). Headache occurred significantly more often in patients with Hebdomadis serogroup infections than those with other serogroup infections. The sensitivities of culture and PCR exceeded 65% during the first 6 days, while the sensitivity of MAT surpassed that of culture and PCR in the second week after onset. PCR using blood samples was a preferable method for the early diagnosis of leptospirosis. CONCLUSIONS/SIGNIFICANCE The results of this study will support clinicians in the diagnosis and treatment of undifferentiated febrile patients in Okinawa Prefecture as well as patients returning from Okinawa Prefecture.
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Affiliation(s)
- Tetsuya Kakita
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Sho Okano
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Hisako Kyan
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Masato Miyahira
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Katsuya Taira
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Emi Kitashoji
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Nagasaki, Japan
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Disease, Shinjuku, Tokyo, Japan
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18
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Abstract
Rat bite fever is a systemic illness most commonly caused by Streptobacillus moniliformis that is classically characterized by fever, rash and migratory polyarthritis. Here, we highlight the highly variable clinical presentations of rat bite fever in children and the importance of maintaining a high degree of suspicion so appropriate treatment can be promptly initiated.
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Affiliation(s)
- Teena Hadvani
- From the Section of Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Jesus G Vallejo
- Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Ankhi Dutta
- Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
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Gococo-Benore DA, McKenna AL, Harris DM. 44-Year-Old Woman With Fever, Sore Throat, and Polyarthralgia. Mayo Clin Proc 2021; 96:2708-2712. [PMID: 34531063 DOI: 10.1016/j.mayocp.2021.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/07/2021] [Accepted: 01/27/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Denise A Gococo-Benore
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Amanda L McKenna
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Dana M Harris
- Advisor to residents and Consultant in Primary Care Internal Medicine, Mayo Clinic, Jacksonville, FL.
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20
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Hoover A, Zimmerman JA, Wiese S, Modi A. Evaluation of Empiric Vancomycin for Fevers During High-dose Cytarabine Administration. J Pediatr Hematol Oncol 2021; 43:e1010-e1014. [PMID: 33560084 PMCID: PMC8329102 DOI: 10.1097/mph.0000000000002073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cytarabine is a nucleoside analog used in chemotherapy regimens for the treatment of multiple hematologic malignancies. One of the known adverse effects of cytarabine, particularly in patients receiving high-dose cytarabine (HDAC), is drug-induced fever. Multiple studies have demonstrated an increased risk of viridans group streptococcal bacteremia in patients who have received HDAC. For this reason, our institution and several other institutions across the country routinely include vancomycin as empiric coverage for patients who develop fever during HDAC, due to concern for resistance to cephalosporin monotherapy. MATERIALS AND METHODS Patient demographic, diagnosis, treatment, and outcome information was collected by electronic chart review for each HDAC infusion from 2007 to August 2018 at the University of Iowa Stead Family Children's Hospital. If fever was documented during or within 24 hours of HDAC, additional information was collected regarding patient outcome and diagnostic testing. RESULTS Of 208 HDAC administrations documented, patients developed fevers during the course on 82 occasions (39.4%). A median of 3 blood cultures per febrile period were obtained from time of fever onset during HDAC administration through >24 hours afebrile. One blood culture was positive for an oral flora organism determined by the microbiology lab report to be a likely contaminant. There were no other positive blood cultures in non-neutropenic or neutropenic patients. CONCLUSION Fever due to HDAC is relatively common but appears to frequently lack association with bacteremia during the time of HDAC administration. Broad-spectrum empiric antibiotic regimens including vancomycin may be unnecessary for these patients, particularly before they become neutropenic.
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MESH Headings
- Adolescent
- Adult
- Anti-Bacterial Agents/therapeutic use
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/adverse effects
- Bacteremia/chemically induced
- Bacteremia/drug therapy
- Bacteremia/microbiology
- Bacteremia/pathology
- Burkitt Lymphoma/drug therapy
- Burkitt Lymphoma/pathology
- Child
- Child, Preschool
- Cytarabine/administration & dosage
- Cytarabine/adverse effects
- Female
- Fever/chemically induced
- Fever/drug therapy
- Fever/microbiology
- Fever/pathology
- Follow-Up Studies
- Humans
- Infant
- Infant, Newborn
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Prognosis
- Retrospective Studies
- Vancomycin/therapeutic use
- Young Adult
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Affiliation(s)
- Alex Hoover
- Stead Family Department of Pediatrics, University of Iowa Stead Family Children’s Hospital, Iowa City, IA
| | - Jessica A.O. Zimmerman
- Division of Pediatric Hematology/Oncology, University of Iowa Stead Family Children’s Hospital, Iowa City, IA
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21
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Emon NU, Rudra S, Alam S, Haidar IKA, Paul S, Richi FT, Shahriar S, Sayeed MA, Tumpa NI, Ganguly A. Chemical, biological and protein-receptor binding profiling of Bauhinia scandens L. stems provide new insights into the management of pain, inflammation, pyrexia and thrombosis. Biomed Pharmacother 2021; 143:112185. [PMID: 34543985 DOI: 10.1016/j.biopha.2021.112185] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/06/2023] Open
Abstract
Bauhinia scandens L. (Family, Fabaceae) is a medicinal plant used for conventional and societal medication in Ayurveda. The present study has been conducted to screen the chemical, pharmacological and biochemical potentiality of the methanol extracts of B. scandens stems (MEBS) along with its related fractions including carbon tetrachloride (CTBS), di-chloromethane (DMBS) and n-butanol (BTBS). UPLC-QTOF-MS has been implemented to analyze the chemical compounds of the methanol extracts of Bauhinia scandens stems. Additionally, antinociceptive and anti-inflammatory effects were performed by following the acetic acid-induced writhing test and formalin-mediated paw licking test in the mice model. The antipyretic investigation was performed by Brewer Yeast induced pyrexia method. The clot lysis method was implemented to screen the thrombolytic activity in human serum. Besides, the in silico study was performed for the five selected chemical compounds of Bauhinia scandens, found by UPLC-QTOF-MS By using Discover Studio 2020, UCSF Chimera, PyRx autodock vina and online tools. The MEBS and its fractions exhibited remarkable inhibition in dose dependant manner in the antinociceptive and antiinflammatory investigations. The antipyretic results of MEBS and DMBS were close to the standard drug indomethacin. Investigation of the thrombolytic effect of MEBS, CTBS, DMBS, and BTBS revealed notable clot-lytic potentials. Besides, the phenolic compounds of the plant extracts revealed strong binding affinity to the COX-1, COX-2, mPGES-1 and plasminogen activator enzymes. To recapitulate, based on the research work, Bauhinia scandens L. stem and its phytochemicals can be considered as prospective wellsprings for novel drug development and discovery by future researchers.
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Affiliation(s)
- Nazim Uddin Emon
- Department of Pharmacy, Faculty of Science and Engineering, International Islamic University Chittagong, Chattogram 4318, Bangladesh
| | - Sajib Rudra
- Department of Botany, Faculty of Biological Sciences, University of Chittagong, Chattogram 4331, Bangladesh
| | - Safaet Alam
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka, Dhaka 1000, Bangladesh.
| | | | - Susmita Paul
- Department of Botany, Faculty of Biological Sciences, University of Chittagong, Chattogram 4331, Bangladesh
| | - Fahmida Tasnim Richi
- Department of Pharmacy, Faculty of Pharmacy, University of Dhaka, Dhaka 1000, Bangladesh
| | - Saimon Shahriar
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka, Dhaka 1000, Bangladesh
| | - Mohammed Aktar Sayeed
- Department of Pharmacy, Faculty of Science and Engineering, International Islamic University Chittagong, Chattogram 4318, Bangladesh.
| | - Nadia Islam Tumpa
- Department of Microbiology, Faculty of Biological Sciences, University of Chittagong, Chattogram 4331, Bangladesh
| | - Amlan Ganguly
- Department of Clinical Pharmacy and Pharmacology, Faculty of Pharmacy, University of Dhaka, Dhaka 1000, Bangladesh.
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22
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Xu N, Hao F, Dong X, Yao Y, Guan Y, Yang L, Chen F, Zheng F, Li Q, Liu W, Zhao C, Li W, Palavecino E, Wang W, Wang G. A two-transcript biomarker of host classifier genes for discrimination of bacterial from viral infection in acute febrile illness: a multicentre discovery and validation study. Lancet Digit Health 2021; 3:e507-e516. [PMID: 34325854 DOI: 10.1016/s2589-7500(21)00102-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/07/2021] [Accepted: 05/12/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Acute febrile illness is one of the main reasons for outpatient hospital visits worldwide. However, differential diagnosis between bacterial and viral causes is challenging and misdiagnosis can result in antimicrobial overuse and hinder prompt treatment. We aimed to build and validate a diagnostic model to discriminate bacterial from viral infection in acute febrile illness by evaluating the expression of potential classifier host genes. METHODS In this multicentre discovery and validation study, we included patients aged 14-85 years with acute febrile illness (fever for ≤14 days, axillary temperature of ≥38°C, and confirmed bacterial infection, viral infection, or non-infectious inflammatory disease), and healthy control participants (no significant medical history and no fever within the past 90 days) from four hospitals in Shandong province, China. Patients from the first hospital were divided into the screening, discovery, and internal validation groups, and patients from the three other hospitals comprised the external validation group. We measured expression of candidate genes in peripheral blood by RT-PCR, and patients for whom a successful RT-PCT result was recorded were included in the next-step analysis. For patients from the first hospital, those enrolled during the early phase of the study were assigned to the screening group, which was used to identify the optimal transcripts (IFI44L and PI3) for discrimination between bacterial and viral infections by screening four candidate genes (FAM89A, IFI44L, PI3, and ITGB2) by RT-PCR. The remaining patients were then randomly assigned (1:1) to discovery and internal validation groups by time of admission and blood drawing via the equidistant random sampling method. A logistic regression model integrating the mRNA levels of IFI44L and PI3 was built by use of the discovery group, and the diagnostic performance of the model was evaluated in the internal and external validation groups using area under the receiver operating curve (AUC), sensitivity, and specificity. FINDINGS Between March 1, 2018, and Aug 31, 2019, we assessed 1658 individuals for inclusion in the study. After exclusion of ineligible participants, 458 participants were enrolled (178 patients with acute febrile illness caused by bacterial infection, 212 with acute febrile illness caused by viral infection, 38 with non-infectious inflammatory diseases, and 30 healthy controls). The 390 patients with bacterial or viral infections were assigned to one of four groups: screening (n=64, 33 with bacterial infections and 31 with viral infections), discovery (n=124, 55 with bacterial infections and 69 with viral infections), internal validation (n=124, 55 with bacterial infections and 69 with viral infections), and external validation (n=78, 35 with bacterial infections and 43 with viral infections). Of the four candidate host genes (FAM89A, IFI44L, PI3, and ITGB2), IFI44L and PI3 showed the most discriminative expression pattern and were used to build the logistic regression model. We established the optimal cutoff of the bacterial infection likelihood score to be 0·547598. With the diagnostic result from the gold standard tests (culture and PCR) as the reference, the two-transcript classifier model had an AUC of 0·969 (95% CI 0·937-1·000), sensitivity of 0·891 (0·782-0·949), and specificity of 0·971 (0·900-0·992) to discriminate bacterial and viral infections in the internal validation group. The model showed similar results in the external validation group (AUC 0·986, 95% CI 0·968-1·000; sensitivity 0·857, 0·706-0·937; and specificity 0·954, 0·845-0·987). INTERPRETATION IFI44L and PI3 transcripts, measured by RT-PCR, are robust classifiers to discriminate bacterial from viral infection in acute febrile illness. This two-transcript biomarker has the potential to be transformed into a commercial panel and applied universally. FUNDING None.
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Affiliation(s)
- Nannan Xu
- Department of Infectious Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fanchang Hao
- School of Computer Science and Technology, Shandong Jianzhu University, Jinan, China
| | - Xiaomeng Dong
- Department of Infectious Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yongyuan Yao
- Department of Intensive Care Medicine, Rizhao People's Hospital, Rizhao, China
| | - Yanyan Guan
- Department of Infectious Disease, Rizhao People's Hospital, Rizhao, China
| | - Lulu Yang
- Department of Infectious Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fengzhe Chen
- Department of Infectious Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Feng Zheng
- Department of Infectious Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qingyan Li
- Department of Infectious Disease, Liaocheng People's Hospital, Liaocheng, China
| | - Wenguo Liu
- Department of Infectious Disease, Gaotang People's Hospital, Liaocheng, China
| | - Cui Zhao
- Department of Infectious Disease, Gaotang People's Hospital, Liaocheng, China
| | - Wen Li
- Department of Infectious Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | | | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gang Wang
- Department of Infectious Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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23
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Mukadi Kakoni P, Munyeku Bazitama Y, Nepomuceno JR, Pukuta-Simbu E, Kawhata Mawika F, Kashitu Mujinga G, Palla L, Ahuka-Mundeke S, Muyembe Tamfum JJ, Koizumi N, Kubo Y, Ariyoshi K, Smith C. Leptospirosis as a cause of fever associated with jaundice in the Democratic Republic of the Congo. PLoS Negl Trop Dis 2021; 15:e0009670. [PMID: 34403427 PMCID: PMC8396788 DOI: 10.1371/journal.pntd.0009670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/27/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Fever with jaundice is a common symptom of some infectious diseases. In public health surveillance within the Democratic Republic of the Congo (DRC), yellow fever is the only recognized cause of fever with jaundice. However, only 5% of the surveillance cases are positive for yellow fever and thus indicate the involvement of other pathogens. Leptospira spp. are the causative agents of leptospirosis, a widespread bacterial zoonosis, a known cause of fever with jaundice. This study aimed to determine the seropositivity of anti-Leptospira antibodies among suspected yellow fever cases and map the geographical distribution of possible leptospirosis in the DRC. Methods We conducted a retrospective study using 1,300 samples from yellow fever surveillance in the DRC from January 2017 to December 2018. Serum samples were screened for the presence of IgM against Leptospira spp. by a whole cell-based IgM ELISA (Patoc-IgM ELISA) at the Institut National de Recherche Biomedicale in Kinshasa (INRB) according to World Health Organization (WHO) guidance. Exploratory univariable and multivariable logistic regression analyses were undertaken to assess associations between socio-demographic factors and the presence of Leptospira IgM. Results Of the 1,300 serum samples screened, 88 (7%) showed evidence of IgM against Leptospira spp. Most positive cases (34%) were young adult males in the 20–29-year group. There were statistically significant associations between having Leptospira IgM antibodies, age, sex, and living area. Observed positive cases were mostly located in urban settings, and the majority lived in the province of Kinshasa. There was a statistically significant association between seasonality and IgM Leptospira spp. positivity amongst those living in Kinshasa, where most of the positive cases occurred during the rainy season. Conclusions This study showed that leptospirosis is likely an overlooked cause of unexplained cases of fever with jaundice in the DRC and highlights the need to consider leptospirosis in the differential diagnosis of fever with jaundice, particularly in young adult males. Further studies are needed to identify animal reservoirs, associated risk factors, and the burden of human leptospirosis in the DRC. Leptospirosis is an important bacterial zoonosis with a worldwide distribution. Each year there are an estimated one million cases, with about 60,000 deaths. The true burden of the disease, however, is unknown. The burden of leptospirosis is probably underestimated due to the lack of specific clinical symptoms and diagnostic techniques that are not readily available. Clinical diagnosis of leptospirosis is difficult because of the diversity of symptoms, ranging from asymptomatic forms to severe multivisceral icteric states. Differential diagnoses with infections presenting with fever or fever and jaundice are numerous and may mislead the clinician. Leptospirosis is considered endemic in sub-Saharan Africa and is known to cause fever with jaundice in African countries; however, for most countries, available epidemiologic data are scarce, including in the Democratic Republic of Congo (DRC). An improved understanding of the epidemiology of leptospirosis will improve clinical management, lead to policy formulation, and have implications for national surveillance of infectious diseases in these countries. We conducted a retrospective seroepidemiological study to extend the description of the pathogens responsible for fever with jaundice in the DRC and to clarify the circulation of possible leptospirosis in the country. This study showed that leptospirosis is a likely cause of fever with jaundice in the DRC.
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Affiliation(s)
- Patrick Mukadi Kakoni
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Yannick Munyeku Bazitama
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Jean Raphael Nepomuceno
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Elisabeth Pukuta-Simbu
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
| | | | - Gracia Kashitu Mujinga
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Luigi Palla
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Bacteriology I, National Institute of Infectious Diseases (NIID), Tokyo, Japan
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Nobuo Koizumi
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Italy
| | - Yoshinao Kubo
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Koya Ariyoshi
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Chris Smith
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Burstein B, Anderson G, Yannopoulos A. Prevalence of Serious Bacterial Infections Among Febrile Infants 90 Days or Younger in a Canadian Urban Pediatric Emergency Department During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2116919. [PMID: 34255052 PMCID: PMC8278260 DOI: 10.1001/jamanetworkopen.2021.16919] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This cross-sectional study compares the prevalence of severe bacterial infections in febrile neonates and infants before vs during the COVID-19 pandemic in Montreal, Quebec, Canada.
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Affiliation(s)
- Brett Burstein
- Montreal Children’s Hospital, Division of Pediatric Emergency Medicine, McGill University, Montreal, Quebec, Canada
- Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Gregory Anderson
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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25
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Izcı F, Ture Z, Sagiroglu P, Temel S, Yildiz O. A case of Crimean-Congo hemorrhagic fever with the bacteremia of Clostridium perfringens. J Med Virol 2021; 93:3929-3933. [PMID: 33295638 DOI: 10.1002/jmv.26715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/28/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a worldwide tick-borne viral infection in humans. The aim of the study is to report a case of a female patient with severe CCHF with the bacteremia of Clostridium perfringens. An 18-year-old woman admitted to the emergency department with sudden onset of fever, nausea and vomiting, myalgia, headache, generalized abdominal pain. It was learned that the patient was living in a rural area and had a history of tick bite 3 days before the admission. At laboratory examination, bicytopenia, abnormal liver function tests, and abnormal coagulation parameters were observed. The diagnosis of the case was confirmed with a positive real-time polymerase chain reaction. On the third day of hospitalization, she had an increase in abdominal pain, confusion, and respiratory distress. She was transferred to the intensive care unit for close monitoring. On the fifth day of hospitalization, she developed fever again. Catheter and peripheral anaerobic blood cultures grew C. perfringens. No evidence of perforation was observed on abdominal tomography. It has been successfully treated with a multidisciplinary approach. CCHF demonstrates different types of clinical presentations, except for common symptoms of fever and hemorrhage. A case of CCHF with C. perfringens bacteremia has not been previously reported before.
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Affiliation(s)
- Feyza Izcı
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Zeynep Ture
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Pınar Sagiroglu
- Department of Medical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Sahın Temel
- Department of Internal Medicine, Division of Intensive Care Unit, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Orhan Yildiz
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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26
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Abstract
Febrile patients, suffering from an infection, inflammatory disease or autoimmunity may present with similar or overlapping clinical symptoms, which makes early diagnosis difficult. Therefore, biomarkers are needed to help physicians form a correct diagnosis and initiate the right treatment to improve patient outcomes following first presentation or admittance to hospital. Here, we review the landscape of novel biomarkers and approaches of biomarker discovery. We first discuss the use of current plasma parameters and whole blood biomarkers, including results obtained by RNA profiling and mass spectrometry, to discriminate between bacterial and viral infections. Next we expand upon the use of biomarkers to distinguish between infectious and non-infectious disease. Finally, we discuss the strengths as well as the potential pitfalls of current developments. We conclude that the use of combination tests, using either protein markers or transcriptomic analysis, have advanced considerably and should be further explored to improve current diagnostics regarding febrile infections and inflammation. If proven effective when combined, these biomarker signatures will greatly accelerate early and tailored treatment decisions.
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Affiliation(s)
- Judith Zandstra
- Division Research and Landsteiner Laboratory, Department of Immunopathology, Sanquin Blood Supply, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, Netherlands
| | - Ilse Jongerius
- Division Research and Landsteiner Laboratory, Department of Immunopathology, Sanquin Blood Supply, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, Netherlands
- Division Research and Landsteiner Laboratory, Department of Blood Cell Research, Sanquin Blood Supply, Amsterdam UMC, Amsterdam, Netherlands
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27
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London KS, Zegre-Hemsey J, Root M, Kleinmann A, White JL. Retrospective Diagnosis of Congenital Long QT Syndrome in a Patient With Febrile Syncope. J Emerg Nurs 2021; 46:214-219. [PMID: 32164933 DOI: 10.1016/j.jen.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 12/29/2022]
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28
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Burstein B, Sabhaney V, Bone JN, Doan Q, Mansouri FF, Meckler GD. Prevalence of Bacterial Meningitis Among Febrile Infants Aged 29-60 Days With Positive Urinalysis Results: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e214544. [PMID: 33978724 PMCID: PMC8116985 DOI: 10.1001/jamanetworkopen.2021.4544] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Fever in the first months of life remains one of the most common pediatric problems. Urinary tract infections are the most frequent serious bacterial infections in this population. All published guidelines and quality initiatives for febrile young infants recommend lumbar puncture (LP) and cerebrospinal fluid (CSF) testing on the basis of a positive urinalysis result to exclude bacterial meningitis as a cause. For well infants older than 28 days with an abnormal urinalysis result, LP remains controversial. OBJECTIVE To assess the prevalence of bacterial meningitis among febrile infants 29 to 60 days of age with a positive urinalysis result to evaluate whether LP is routinely required. DATA SOURCES MEDLINE and Embase were searched for articles published from January 1, 2000, to July 25, 2018, with deliberate limitation to recent studies. Before analysis, the search was repeated (October 6, 2019) to ensure that new studies were included. STUDY SELECTION Studies that reported on healthy, full-term, well-appearing febrile infants 29 to 60 days of age for whom patient-level data could be ascertained for urinalysis results and meningitis status were included. DATA EXTRACTION AND SYNTHESIS Data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and used the Newcastle-Ottawa Scale to assess bias. Pooled prevalences and odds ratios (ORs) were estimated using random-effect models. MAIN OUTCOMES AND MEASURES The primary outcome was the prevalence of culture-proven bacterial meningitis among infants with positive urinalysis results. The secondary outcome was the prevalence of bacterial meningitis, defined by CSF testing or suggestive history at clinical follow-up. RESULTS The parent search yielded 3227 records; 48 studies were included (17 distinct data sets of 25 374 infants). The prevalence of culture-proven meningitis was 0.44% (95% CI, 0.25%-0.78%) among 2703 infants with positive urinalysis results compared with 0.50% (95% CI, 0.33%-0.76%) among 10 032 infants with negative urinalysis results (OR, 0.74; 95% CI, 0.39-1.38). The prevalence of bacterial meningitis was 0.25% (95% CI, 0.14%-0.45%) among 4737 infants with meningitis status ascertained by CSF testing or clinical follow-up and 0.28% (95% CI, 0.21%-0.36%) among 20 637 infants with positive and negative urinalysis results (OR, 0.89; 95% CI, 0.48-1.68). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, the prevalence of bacterial meningitis in well-appearing febrile infants 29 to 60 days of age with positive urinalysis results ranged from 0.25% to 0.44% and was not higher than that in infants with negative urinalysis results. These results suggest that for these infants, the decision to use LP should not be guided by urinalysis results alone.
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Affiliation(s)
- Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Vikram Sabhaney
- Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey N. Bone
- Department Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fahad F. Mansouri
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Garth D. Meckler
- Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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Gong H, Sun B, Chen Y, Chen H. The risk factors of children acquiring refractory mycoplasma pneumoniae pneumonia: A meta-analysis. Medicine (Baltimore) 2021; 100:e24894. [PMID: 33725960 PMCID: PMC7982158 DOI: 10.1097/md.0000000000024894] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Refractory mycoplasma pneumoniae pneumonia (RMPP) in children has been increasing worldwide. In this study, we conducted a meta-analysis to generate large-scale evidence on the risk factors of RMPP to provide suggestions on prevention and controlling for children. METHODS Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang (Chinese) were searched to identify relevant articles. All analyses were performed using Stata 14.0. RESULTS We conducted a meta-analysis of 15 separate studies. Fever for more than 10 days (odds ratio [OR] 3.965, 95% confidence interval [CI] 2.109-7.456), pleural effusion (OR 6.922, 95% CI 2.058-23.282), extra-pulmonary complications (OR 17.762, 95% CI 11.146-28.305), pulmonary X-ray consolidation ≥2/3 (OR 8.245, 95% CI 1.990-34.153), CRP >40 mg/L (OR 4.975, 95% CI 2.116-11.697) were significantly related to the risk of RMPP. We did not find an association between male sex (OR 0.808, 95% CI 0.548-1.189), LDH >410IU/L (OR 1.033, 95% CI 0.979-1.091) and the risk of RMPP. CONCLUSIONS Fever for more than 10 days, pleural effusion, extra-pulmonary complications, pulmonary X-ray consolidation≥ 2/3 and CRP >40 mg/L are risk factors for early evaluation of RMPP.
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Affiliation(s)
- Hui Gong
- Department of Pediatrics, Shenyang Fifth People's Hospital
| | - Baijun Sun
- Department of Infectious Disease, Shenyang Center for Disease Control and Prevention
| | - Ye Chen
- Department of Infectious Disease, Shenyang Center for Disease Control and Prevention
| | - Huijie Chen
- Department of Infectious Disease, Shenyang Center for Disease Control and Prevention
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Sharma A, Sitthi-amorn J, Gavigan P, Wolf J, Agulnik A, Brenner A, Li Y, Johnson LM. Outcomes and Disposition of Oncology Patients With Non-neutropenic Fever and Positive Blood Cultures. J Pediatr Hematol Oncol 2021; 43:47-51. [PMID: 32604334 PMCID: PMC7762736 DOI: 10.1097/mph.0000000000001878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
Abstract
Children with cancer and non-neutropenic fever (NNF) episodes are often treated as outpatients if they appear well. However, a small subset have bloodstream infections (BSIs) and must return for further evaluation. These patients may be directly admitted to inpatient units, whereas others are first evaluated in outpatient settings before admission. The best practice for securing care for patients discovered to have outpatient bacteremia are unclear. To determine outcomes and compare time to antibiotics between the 2 disposition, we retrospectively reviewed all NNF initially treated as outpatients and later had positive blood cultures from 2012 to 2016. Of 845 NNF cases initially treated in outpatient settings, 48 episodes (n=43 patients) had BSIs. Of those, 77.1% (n=37) were re-evaluated as outpatients and admitted; 14.6% (n=7) were direct admissions. The median time to antibiotic did not significantly differ between outpatient re-evaluations (119 min) and direct admissions (191 min), P=0.11. One patient met sepsis criteria upon return and required intensive care unit admission for vasopressor support. No patient died within 1 week of the febrile episode. Most patients with NNF and BSIs initially discharged are stable upon return. Institutions should evaluate their patient flows to ensure that patients receive timely care.
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Affiliation(s)
- Aditya Sharma
- Hospitalist Medicine Program, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jitsuda Sitthi-amorn
- Hospitalist Medicine Program, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Patrick Gavigan
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN
| | - Alex Brenner
- College of Medicine, Florida State University, Tallahassee, FL
| | - Ying Li
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN
| | - Liza-Marie Johnson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
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Altshuler E, Case R. Acalculous cholecystitis with gallbladder necrosis in a patient presenting without abdominal pain. BMJ Case Rep 2020; 13:13/12/e238386. [PMID: 33334767 DOI: 10.1136/bcr-2020-238386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 83-year-old man with a history of chronic myelogenous leukaemia in remission maintained with bosutinib presented with new-onset fevers. He denied pain and had no other focal symptoms. Ultrasound imaging revealed mild gallbladder wall thickening. Non-contrasted CT revealed right upper quadrant inflammation of indeterminate source. The diagnosis of acalculous cholecystitis was made on the third day when a CT with oral contrast demonstrated a remarkably inflamed biliary tree. The gallbladder was surgically removed and found to be necrotic. The case highlights an unusual presentation for a well-known condition. Both ultrasound and CT have limited diagnostic sensitivity for acalculous cystitis. This case adds to existing literature to support development of acalculous cholecystitis in non-critically ill patients. Clinicians should maintain awareness of this condition among patients presenting to the hospital or clinic with abdominal pain. Careful discussion with radiology and surgery is indicated to guide diagnostic testing when initial imaging results are indeterminate.
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Affiliation(s)
- Ellery Altshuler
- Department of Internal Medicine, University of Florida College of Meicine, Gainesville, Florida, USA
| | - Robert Case
- Department of Internal Medicine, University of Florida College of Meicine, Gainesville, Florida, USA
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Aoki T, Itoh M, Chiba A, Kuwahara M, Nogami H, Ishizaki H, Yayou KI. Heart rate variability in dairy cows with postpartum fever during night phase. PLoS One 2020; 15:e0242856. [PMID: 33237968 PMCID: PMC7688159 DOI: 10.1371/journal.pone.0242856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022] Open
Abstract
Autonomic nervous function evaluated by heart rate variability (HRV) and blood characteristics were compared between Holstein Friesian cows that developed postpartum fever (PF; n = 5) and clinically healthy (CH; n = 6) puerperal cows in this case-control study. A cow was defined as having PF when its rectal temperature rose to ≥39.5°C between 1 and 3 days postpartum. We recorded electrocardiograms during this period using a Holter-type electrocardiograph and applied power spectral analysis of HRV. Comparisons between the groups were analyzed by t test or Mann-Whitney U test, and the relationship between rectal temperature and each parameter was analyzed using multiple regression analysis. Heart rate was higher in PF cows than in CH cows (Mean ± SE, 103.3 ± 2.7 vs. 91.5 ± 1.7 bpm). This result suggested that PF cows had a relatively dominant sympathetic nervous function. Total (44,472 ± 2,301 vs. 55,373 ± 1,997 ms) and low frequency power (24.5 ± 3.8 vs. 39.9 ± 5.3 ms) were lower in PF cows than in CH cows. These findings were possibly caused by a reduction in autonomic nervous function. The total white blood cell count (54.3 ± 5.1 vs. 84.5 ± 6.4 ×102/μL) and the serum magnesium (2.1 ± 0.1 vs. 2.4 ± 0.1 mg/dL) and iron (81.5 ± 8.0 vs. 134.4 ± 9.1 μg/dL) concentrations were lower and the serum amyloid A concentration (277 ± 33 vs. 149 ± 21 μg/mL) was higher in PF cows than in CH cows. These results imply that more inflammation was present in PF cows than in CH cows. Multiple regression analysis showed that both of low frequency power and concentration of serum iron were associated with rectal temperature. We found differences in changes in hematologic results, biochemical findings, and HRV patterns between PF cows and CH cows.
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Affiliation(s)
- Takahiro Aoki
- Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
- * E-mail:
| | - Megumi Itoh
- Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Akiko Chiba
- Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Masayoshi Kuwahara
- Department of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | | | - Hiroshi Ishizaki
- Division of Grassland Farming, Institute of Livestock and Grassland Science, National Agriculture and Food Research Organization (NARO), Nasushiobara, Japan
| | - Ken-Ichi Yayou
- Division of Animal Environment and Waste Management Research, Institute of Livestock and Grassland Science, NARO, Tsukuba, Japan
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Arunasri K, Mahesh M, Sai Prashanthi G, Jayasudha R, Kalyana Chakravarthy S, Tyagi M, Pappuru RR, Shivaji S. Mycobiome changes in the vitreous of post fever retinitis patients. PLoS One 2020; 15:e0242138. [PMID: 33211730 PMCID: PMC7676714 DOI: 10.1371/journal.pone.0242138] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022] Open
Abstract
Fungi have been associated with various diseases of the eye like keratitis, uveitis and endophthalmitis. Despite this fact, fungal microbiome (mycobiome) studies compared to the bacterial microbiome studies have remained neglected. In the present study, using metagenomic sequencing, the mycobiomes of the vitreous of healthy control individuals (VC, n = 15) and individuals with post fever retinitis + non-PFR uveitis (PFR+, n = 9) were analysed and compared. The results indicated that Ascomycota was the most predominant phylum in both VC and PFR+ groups. Further, at the genera level it was observed that the abundance of 17 fungal genera were significantly different in post fever retinitis (PFR, n = 6) group compared to control group. Of these 17 genera, it was observed that 14 genera were relatively more abundant in PFR group and the remaining 3 genera in the VC group. Genus Saccharomyces, a commensal of the gut and skin, was predominantly present in the vitreous of both the cohorts, however it was significantly less abundant in PFR group. Further, significant increase in the genera that have a pathogenic interaction with the host were observed in PFR group. On the whole the mycobiome in both the groups differed significantly and formed two distinct clusters in the heatmap and Principal co-ordinate analysis. These results demonstrate significant changes in the mycobiome from the vitreous of post fever retinitis patients compared to healthy controls thus implying that dysbiotic changes in the fungal vitreous microbiome are associated with PFR.
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Affiliation(s)
- Kotakonda Arunasri
- Jhaveri Microbiology Centre, Prof Brien Holden Eye Research Centre, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, India
| | - Malleswarapu Mahesh
- Jhaveri Microbiology Centre, Prof Brien Holden Eye Research Centre, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, India
| | - Gumpili Sai Prashanthi
- Jhaveri Microbiology Centre, Prof Brien Holden Eye Research Centre, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, India
| | - Rajagopalaboopathi Jayasudha
- Jhaveri Microbiology Centre, Prof Brien Holden Eye Research Centre, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, India
| | - Sama Kalyana Chakravarthy
- Jhaveri Microbiology Centre, Prof Brien Holden Eye Research Centre, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, India
| | - Mudit Tyagi
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, India
| | - Rajeev R. Pappuru
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, India
| | - Sisinthy Shivaji
- Jhaveri Microbiology Centre, Prof Brien Holden Eye Research Centre, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, India
- * E-mail:
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Wirtz P. [A 19-year-old woman with fever and high blood pressure]. Internist (Berl) 2020; 62:95-99. [PMID: 33030562 DOI: 10.1007/s00108-020-00884-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 19-year-old female patient was admitted to hospital for further diagnostics and treatment of a febrile infection. The cause was found to be a bronchopulmonary infection due to methicillin-sensitive Staphylococcus aureus (MSSA), which led to an infective endocarditis with mitral valve infestation and two splenic abscesses. Under treatment according to the antibiogram and laparoscopic excision of the splenic abscesses, the infection-related complications could be successfully resolved. Even during the physical examination there was a suspicion of Cushing's syndrome, which was confirmed by laboratory and radiological investigations and is associated with a general immune deficiency. Remarkable was that the initially difficult to adjust high blood pressure became normalized after transsphenoidal resection of the pituitary adenoma.
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Affiliation(s)
- P Wirtz
- Medizinische Klinik II - Kardiologie, Kreiskrankenhaus Mechernich, Akademisches Lehrkrankenhaus der Universität Bonn, St. Elisabeth Str. 2-6, 53894, Mechernich, Deutschland.
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Javed F, Jabeen Q, Aslam N, Awan AM. Pharmacological evaluation of analgesic, anti-inflammatory and antipyretic activities of ethanolic extract of Indigofera argentea Burm. f. J Ethnopharmacol 2020; 259:112966. [PMID: 32418900 DOI: 10.1016/j.jep.2020.112966] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Indigofera argentea Burm. f.; commonly known as neel, jantari, hathio; is traditionally used for the treatment of headache, fever, inflammation and body pain. Local communities also used this plant for the treatment of malaria, jaundice, vertigo and gastric disorders. AIM OF THE STUDY This study is aimed to evaluate the toxicity and possible analgesic, anti-inflammatory and antipyretic activities of the ethanolic crude extract of Indigofera argentea (IaCr) to support its use in folk medicine and to screen the phytochemical constituents and antioxidant activity. MATERIALS AND METHODS Aqueous ethanolic (30:70) extract of whole plant of Indigofera argentea (IaCr) was prepared and phytochemical study was performed by preliminary methods followed by HPLC and DPPH method. In vivo experiments were performed in Wistar albino rats including hot plate, tail immersion, formalin and capsaicin-induced pain tests in rats and acetic acid-induced writhing test in mice. Anti-inflammatory activity was assessed by using in vitro human red blood cell (HRBC) membrane stabilization and carrageenan-induced rat paw edema test, while antipyretic activity was evaluated by Brewer's yeast-induced pyrexia test. RESULTS The crude extract of Indigofera argentea confirmed the presence of flavonoids, glycosides, alkaloids, saponins and tannins as soluble ethanolic constituents in preliminary study. The maximum quantity of gallic acid equivalent (GAE) phenolics, and quercetin equivalent (QE) flavonoid content found was 81 ± 2 mg GAE/g and 56 ± 1.4 mg QE/g of extract respectively. Quantification based on HPLC exposed the presence of phenols and flavonoids, quercetin, gallic acid, caffeic acid, chlorogenic acid, benzoic acid, ferulic acid and coumaric acid. In vivo experiments revealed significant P < 0.05) dose-dependent inhibition in hot plate, tail immersion and capsaicin-induced pain test. IaCr showed significant inhibition of pain latency against both phases in formalin test and considerably decreased the number of writhes caused by acetic acid at the doses of 30, 100 and 300 mg/kg. In the in vitro anti-inflammatory (HRBC) assay, IaCr showed good membrane stability with maximum percentage hemolysis inhibition of 49.29% while in carrageenan-induced paw edema test in rats the IaCr showed significant anti-inflammatory action in a dose-dependent fashion. Statistical significant reduction in rectal temperature was observed at the doses of 100 and 300 mg/kg in yeast-induced pyrexia test in rats. CONCLUSION The results of the experimental studies proved the analgesic, anti-inflammatory and antipyretic activities of Indigofera argentea and supported the traditional use of this plant.
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Affiliation(s)
- Faraza Javed
- Department of Pharmacy, Faculty of Pharmacy and Alternative Medicine, The Islamia University of Bahawalpur, Pakistan.
| | - Qaiser Jabeen
- Department of Pharmacy, Faculty of Pharmacy and Alternative Medicine, The Islamia University of Bahawalpur, Pakistan.
| | - Naveed Aslam
- Faculty of Pharmacy, Bahauddin Zakriya University, Multan, Pakistan; Primary and Secondary Healthcare Department, Government of Punjab, Pakistan.
| | - Ambreen Mehmood Awan
- Department of Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan.
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Egloff C, Sibiude J, Couffignal C, Mandelbrot L, Picone O. Causes and consequences of fever during pregnancy: A retrospective study in a gynaecological emergency department. J Gynecol Obstet Hum Reprod 2020; 49:101899. [PMID: 32853830 PMCID: PMC7444605 DOI: 10.1016/j.jogoh.2020.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Fever is a very common reason for emergency consultation during pregnancy, and may be associated with maternal, obstetrical and/or fetal adverse outcomes. The aim of this study was to determine the etiologies and to analyze the maternal or fetal complications of fever in pregnancy. STUDY DESIGN A retrospective single center study including all patients who consulted for fever above 38 °C during pregnancy in the gynecological emergency ward from August 2016 to July 2017. RESULTS A total of 100 pregnant women who consulted for fever were included. The etiologies were common viral infections (37 %), influenza (21 %), pyelonephritis (11 %), viral gastroenteritis (6%), chorioamnionitis (5%), other (5%). The etiology was unknown for 15 %. Fever was confirmed during consultation in 45/100 patients (45 %). Among patients with confirmed fever, 21/45 (47 %) were hospitalized with a median stay of 3 days [IQR 2-4] and 10/45(22 %) developed fetal or maternal complications. Probabilistic antibiotics were delivered for 34/45, 76 % patients. Only 14/45, 31 % had confirmed bacterial infections. Of the 32 patients with confirmed fever who had no etiologic diagnosis at the initial work-up in the emergency room, 19/32, 59 % received presumptive treatment with amoxicillin against Listeria monocytogenes. None had confirmed listeriosis, and all were probably common viral infections. Among all patients, the complications rate was 13 % and 22 % in the subgroup with fever confirmed at presentation. CONCLUSIONS This study quantifies the main etiologies and complications of fever during pregnancy. A challenge is to reduce excessive antibiotic use by improving rapid diagnosis of bacterial and viral infections. Prospective studies are needed to target patients at risk of complications in an optimal way and to study new management strategies.
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Affiliation(s)
- C Egloff
- Assistance Publique-Hôpitaux de Paris APHP.Nord, Service de gynécologie obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes cedex, France; FHU PREMA, France; Université de Paris, Paris, France; INSERM, IAME, UMR 1137, Paris, France.
| | - J Sibiude
- Assistance Publique-Hôpitaux de Paris APHP.Nord, Service de gynécologie obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes cedex, France; FHU PREMA, France; Université de Paris, Paris, France; INSERM, IAME, UMR 1137, Paris, France
| | - C Couffignal
- Unité de recherche clinique Paris Nord Val de Seine, URC PNVS, France; Université de Paris, Paris, France; INSERM, IAME, UMR 1137, Paris, France
| | - L Mandelbrot
- Assistance Publique-Hôpitaux de Paris APHP.Nord, Service de gynécologie obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes cedex, France; FHU PREMA, France; Université de Paris, Paris, France; INSERM, IAME, UMR 1137, Paris, France
| | - O Picone
- Assistance Publique-Hôpitaux de Paris APHP.Nord, Service de gynécologie obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes cedex, France; FHU PREMA, France; Université de Paris, Paris, France; INSERM, IAME, UMR 1137, Paris, France
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Qiu JL, Huang L, Shao MY, Chai YN, Zhang HJ, Li XF, Sun XX, Zhao QY, Duan F, Zhai WS. Efficacy and safety of azithromycin combined with glucocorticoid on refractory Mycoplasma pneumoniae pneumonia in children: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20121. [PMID: 32481378 DOI: 10.1097/md.0000000000020121] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the efficacy and safety of azithromycin (AZI) combined with glucocorticoid (GC) in the treatment of children with refractory Mycoplasma pneumoniae. METHODS Computer search for PubMed, EMbase, Cochrane Library, China Biomedical Literature Database (CBMdisc), China Knowledge Network (CNKI), Wanfang, VIP (VIP), and a randomized controlled trial (RCT) of AZI combined with GC in the treatment of children with refractory Mycoplasma pneumoniae pneumonia test (RCT), the search time limit is built until March 20, 2019. Two researchers independently performed literature screening, data extraction, and literature risk bias, and meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 12 RCTs were included, including 1130 patients. Meta-analysis showed that AZI combined with GC therapy significantly improved the total effective rate of the disease compared with the conventional treatment group (odds ratio [OR] = 6.37; 95% confidence interval [CI] 4.03, 10.07; P < .00001; I = 0%), effectively shortened the antipyretic time (SMD = -2.29; 95% CI -2.70, -1.88; P < .0001); promoted lung inflammation absorption (SMD = -1.89; 95% CI -2.38, -1.40; P < .0001), reduced cough time (SMD = -2.39; 95% CI -2.80, -1.99; P < .0001); shortened hospital stay (SMD = -2.19; 95% CI -3.21, -1.17; P < .0001); improved imaging findings (OR = 5.38; 95% CI 1.09, 26.51, P = .04); reduced inflammation index (SMD = -3.15; 95% CI -4.93, -1.36; P = .004); improved immune function (SMD = 1.29; 95% CI -0.02, 2.60; P < .0001); had no significant adverse reactions (OR = 1.18; 95% CI 0.71, 1.98; P = .53). CONCLUSIONS According to the current limited research evidence, the addition of GCs to the conventional treatment of refractory Mycoplasma pneumoniae in children can improve the clinical efficacy to a certain extent, and the safety is better. However, due to the quality and quantity of the included literature, the conclusions of this study need to be confirmed by more high-quality studies.
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Affiliation(s)
- Jian-Li Qiu
- Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province
| | - Li Huang
- Department of Rehabilitation Medicine, Foresea Life Insurance Guangzhou General Hospital, Guangzhou City, Guangdong Province
| | - Ming-Yi Shao
- Department of Scientific Research, First Affiliated Hospital of Henan University of Chinese Medicine
| | - Yu-Na Chai
- Department of pharmacy, The First Affiliated Hospital of Zhengzhou University
| | - Hui-Juan Zhang
- Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province
| | - Xiang-Feng Li
- Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province
| | - Xiao-Xu Sun
- Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province
| | - Qian-Yi Zhao
- Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province
| | - Fei Duan
- Department of Personnel, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province, People's Republic of China
| | - Wen-Sheng Zhai
- Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province
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Ndiaye C, Bassene H, Diatta G, Diagne N, Parola P, Lagier JC, Sokhna C, Raoult D. The impact of daily soap use in rural areas of Senegal on respiratory infectious diseases, fevers and skin microbiota. Int J Infect Dis 2020; 96:408-415. [PMID: 32360942 DOI: 10.1016/j.ijid.2020.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Children aged <5 years are the group most affected by infectious diseases, more specifically in underdeveloped countries. A study was performed to assess the effects of daily soap use on the incidence of diarrhoea, fever, respiratory infection, and the prevalence of pathogenic bacteria on the skin. METHODS Soap was distributed to the population of the village of Ndiop (test) for use in their daily hygiene but not to the population of the village of Dielmo (control). Fieldworkers daily recorded the clinical events in the two villages and encouraged the use of soap in Ndiop. RESULTS A total of 638 people participated in the study. The incidence rates of cough, runny nose and fever significantly decreased in 2016 compared with 2015, unlike that of diarrhoea. In 2016, significant reductions in the incidence rates of cough, runny nose and fever were observed in children aged <15 years in Ndiop. The prevalence of Streptococcus pneumoniae, Staphylococcus aureus and Streptococcus pyogenes in the palms of the hands significantly dropped in Ndiop. CONCLUSION Using soap reduces the incidence of respiratory infections, fevers and the prevalence of pathogenic bacteria on the skin. However, for diarrhoea, additional strategies are needed to improve outcomes.
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Affiliation(s)
- Codou Ndiaye
- Aix-Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France; IHU Mediterranée Infection, Marseille, France
| | - Hubert Bassene
- VITROME, Campus International IRD-UCAD de Hann, Dakar, Senegal
| | - Georges Diatta
- VITROME, Campus International IRD-UCAD de Hann, Dakar, Senegal
| | | | - Philippe Parola
- IHU Mediterranée Infection, Marseille, France; Aix-Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Jean-Christophe Lagier
- Aix-Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France; IHU Mediterranée Infection, Marseille, France
| | - Cheikh Sokhna
- IHU Mediterranée Infection, Marseille, France; VITROME, Campus International IRD-UCAD de Hann, Dakar, Senegal.
| | - Didier Raoult
- Aix-Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France; IHU Mediterranée Infection, Marseille, France
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Sgayer I, Gur T, Glikman D, Rechnitzer H, Bornstein J, Wolf MF. Routine uterine culture swab during cesarean section and its clinical correlations: A retrospective comparative study. Eur J Obstet Gynecol Reprod Biol 2020; 249:42-46. [PMID: 32348949 DOI: 10.1016/j.ejogrb.2020.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Cesarean sections, particularly non-elective cesareans, are an important risk factor for the development of postpartum endometritis, a leading cause of postpartum febrile morbidity. We evaluated the yield of obtaining routine intrauterine culture during elective and non-elective cesarean sections, in the prevention and management of postpartum endometritis. STUDY DESIGN A retrospective comparative study investigating the distribution of uterine cultures obtained immediately after fetus and placenta delivery during cesarean sections performed in a single tertiary hospital during 2017. True pathogenic bacteria were included in the study analysis and considered as positive results, while other contaminant bacteria were excluded. RESULTS Positive uterine cultures were identified in 10.7 % (88/821) of cesarean sections, with no significant difference in prevalence between elective and non-elective cesareans. Escherichia coli (E.coli), isolated in 40.9 % of the positive cultures of all women, was the most common organism in non-elective cesareans vs. Group B Streptococcus (GBS) in elective cesareans. Higher rate of positive cultures was found in term vs. preterm cesareans (17.5 % vs 10.5 %, respectively, p-value = 0.04). E.coli was the most frequent pathogen reported in both women with intact membranes or premature rupture of membranes (46.3 % and 47.3 % respectively). Eight women (9.1 %) with positive cultures presented with postpartum fever; all had undergone non-elective cesarean section. In one-third of these cases the empirical antibiotic treatment was adjusted according to the uterine culture results and susceptibility testing results. CONCLUSIONS Obtaining routine intrauterine cultures during non-elective cesarean sections might be useful for detecting significant pathogens and tailoring the antibiotic treatment in postpartum endometritis.
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Affiliation(s)
- Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Tomer Gur
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Daniel Glikman
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Hagai Rechnitzer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
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Gu XX, Zhang MP, Zhao YF, Huang GM. Clinical and microbiological characteristics of patients with biliary disease. World J Gastroenterol 2020; 26:1638-1646. [PMID: 32327912 PMCID: PMC7167412 DOI: 10.3748/wjg.v26.i14.1638] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Biliary diseases are common digestive system disorders which may combine with biliary tract infection such as cholecystitis or cholangitis. Thus, rapid identification of the bacteria and their antibiotic susceptibility profiles are crucial for reducing the mortality of patients with biliary tract infection.
AIM To identify bacterial species and antibiotic susceptibility for antibacterial therapy and analyze bile cultivation risk factors for increasing detection rates.
METHODS This retrospective study was conducted from July 2008 to July 2017. In total, 1339 bile samples which were collected during therapeutic endoscopic retrograde cholangiopan-creatography or percutaneous transhepatic cholangiodrainage or other biliary surgeries or biliary drainage were obtained to characterize pathogen spectra, antibiotic susceptibility, and clinical features. Clinical data including age, sex, comorbidities, clinical symptoms, protopathies, and history of biliary tract diseases and surgeries were collated from hospital medical records. Species identification and initial drug susceptibility were further identified by biochemical characterization using the VITEK 2 Compact test.
RESULTS Positive microbiological findings were observed in 738 samples. The most frequently encountered strains were gram-negative bacteria (74.94%), including Escherichia coli (37.78%), Pseudomonas aeruginosa (8.96%), and Klebsiella pneumoniae (10.29%). Bile bacteria were largely sensitive to carbapenems, piperacillin/tazobactam, and gentamicin. Gram-negative strains had low susceptibility to ceftriaxone, quinolones and ampicillin. Almost the same micro-organisms were present in patients with malignant and benign diseases. The number of samples with Klebsiella pneumoniae in the bile culture were significantly different between patients with malignant and benign diseases (55 vs 30; P = 0.019). Age (P < 0.001), fever (P < 0.001), history of biliary tract diseases and surgeries (both P < 0.001), benign disease (P = 0.002), and the comorbidity chronic renal insufficiency (P = 0.007) affected the positive rates of the bile samples.
CONCLUSION Gram-negative bacteria were the most commonly isolated biliary bacteria. We determined the major factors associated with positive detection rates. Microbiological analysis of bile samples allowed accurate antibiotic treatments.
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Affiliation(s)
- Xue-Xiang Gu
- Department of Gastroenterology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian 223001, Jiangsu Province, China
| | - Meng-Pei Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Yan-Feng Zhao
- Center of Laboratory Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Guang-Ming Huang
- Department of Gastroenterology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
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Trigo CE, Patel F. Febrile illness after a beach day: a case of salmonella bacteremia from oral exposure to a sand dollar. J Water Health 2020; 18:239-243. [PMID: 32300096 DOI: 10.2166/wh.2020.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This case report discusses a rare presentation of salmonella bacteremia after an oral exposure to a sand dollar in a pediatric patient. A 2-year-old Hispanic male presented to the emergency department with a chief complaint of diarrhea and fever for 8 days after a family trip to Destin beach, Florida, during the sea turtle nesting season. The symptoms began a day after the patient took a bite on a sand dollar found on the beach that caused a small wound inside his cheek. The laboratory testing done in the emergency department was remarkable for blood and stool culture testing positive for non-typhoid salmonella. The sand dollar is a type of a sea urchin commonly found on sandy beaches and consists of an anatomical filtration system to consume sandy water. It could be inferred that the increased presence of sea turtles during the time of the patient's visit to Destin beach could have led to higher levels of salmonella in the seawater and consequently in the sand dollar, possibly leading to the inoculation of salmonella in this patient. To the best of our knowledge, this is a first case report that links oral exposure of the sand dollar to invasive salmonellosis.
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Affiliation(s)
- Carlos E Trigo
- Emergency Medicine Resident PGY2 at UT Southwestern, 3355 Blackburn St. Apt 8306, Dallas, TX 75204, USA E-mail:
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Guo J, Li S, Xu S, Jiang L, Gao E, Liu Z. Nocardiosis in patients with nephrotic syndrome: a retrospective analysis of 11 cases and a literature review. Int Urol Nephrol 2020; 52:731-738. [PMID: 32124233 DOI: 10.1007/s11255-020-02415-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We evaluated the clinical manifestations and outcomes of nocardiosis, a rare opportunistic infection that occurs in patients with nephrotic syndrome. METHODS The records of NS patients with nocardiosis in a single hospital during 2000-2019 were retrieved and studied in detail. RESULTS Eleven patients were included. The mean time to develop nocardiosis after glucocorticoid therapy was 11.5 ± 14.8 months. Most patients had fever, elevated white blood cell counts and C-reactive protein, whereas procalcitonin levels were normal or slightly elevated in 91% (10/11) patients, except one patient suffered from septic shock. Nine patients were tested for CD4+ T-cell counts; of these, four patients had counts < 200 cells/μL. The most common site of nocardiosis involvement was lung (100%), followed by subcutaneous tissue (72.7%). Radiological findings for lungs in seven cases were characterized by isolated or scattered nodules and masses, usually located subpleural or close to the hilum. Positive smears of Nocardia were detected in 100% of samples of subcutaneous abscess and pleural fluid. Nine patients received oral trimethoprim-sulfamethoxazole, four of which received combined carbapenem, and the remaining two patients received carbapenem monotherapy. The long-term prognosis was excellent, with a treatment success rate of 100% in all patients. CONCLUSIONS NS patients can develop immunodeficiency after treatment with glucocorticoid and immunosuppressants. In cases where patients develop systemic multiple abscesses, or lung images reveal isolated or scattered nodules and masses that are subpleural or close to the hilum, nocardial infection should be considered. Early diagnosis and specific treatment may improve patient outcomes.
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Affiliation(s)
- Jinzhou Guo
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China
| | - Shijun Li
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China.
| | - Shutian Xu
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China
| | - Ling Jiang
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China
| | - Erzhi Gao
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China
| | - Zhihong Liu
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China
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Serling-Boyd N, Wallace Z, Jarolimova J, Arvikar S, Miloslavsky EM. An 80-Year-Old Man With Fevers, Altered Mental Status, and Joint Effusions. Arthritis Care Res (Hoboken) 2020; 72:293-300. [PMID: 31562791 PMCID: PMC7228541 DOI: 10.1002/acr.24082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/24/2019] [Indexed: 11/06/2022]
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Cheng Z, Huang Y, Wie W, Wang Y, Wang Z. Bloodstream Infection Caused by Bacteroides caccae in a Diabetic Patient: a Case Report and Review of the Literature. Clin Lab 2019; 65. [PMID: 31850719 DOI: 10.7754/clin.lab.2019.190534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Bacteroides caccae is a ubiquitous, anaerobic bacteria, but it is not a common cause of pathologic bloodstream infection. Diabetic patients are at increased risk of developing anaerobic bacteria infection. Here, we report a repeated fever case caused by Bacteroides caccae in a diabetic patient. The aim of this study was to describe the clinical characteristics and manifestations of Bacteroides caccae. METHODS The pathogenic bacteria isolated from patient blood was identified as Bacteroides caccae. Identification of the Bacteroides caccae was done by 16s rDNA sequencing and matrix-assisted laser desorption/ionization-time of light spectrometry. The infection was cured by one-week combined therapy of intravenous Piperacillin tazobactam and oral Ornidazole tablet. RESULTS After treatment had been completed, no episodes of fever occurred during the follow-up to date. CONCLUSIONS Bacteroides caccae is regarded as an intestinal, opportunistic pathogenic bacteria. It can invade the mucosa of the intestine and cause various abdominal suppurative infections. Sequencing and matrix-assisted laser desorption/ionization-time of flight spectrometry could have a role for Bacteroides caccae diagnosis. The curative effect of using first generation cephalosporines therapy was unsatisfactory. Using intravenous Piperacillin tazobactam and ornidazole tablet might obtain certain curative effect. Early diagnosis and appropriate anti-infection therapy were necessary to improve the outcome of patients with Bacteroides caccae bloodstream infection.
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Rhee C, Kharod GA, Schaad N, Furukawa NW, Vora NM, Blaney DD, Crump JA, Clarke KR. Global knowledge gaps in acute febrile illness etiologic investigations: A scoping review. PLoS Negl Trop Dis 2019; 13:e0007792. [PMID: 31730635 PMCID: PMC6881070 DOI: 10.1371/journal.pntd.0007792] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/27/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acute febrile illness (AFI), a common reason for people seeking medical care globally, represents a spectrum of infectious disease etiologies with important variations geographically and by population. There is no standardized approach to conducting AFI etiologic investigations, limiting interpretation of data in a global context. We conducted a scoping review to characterize current AFI research methodologies, identify global research gaps, and provide methodological research standardization recommendations. METHODOLOGY/FINDINGS Using pre-defined terms, we searched Medline, Embase, and Global Health, for publications from January 1, 2005-December 31, 2017. Publications cited in previously published systematic reviews and an online study repository of non-malarial febrile illness etiologies were also included. We screened abstracts for publications reporting on human infectious disease, aimed at determining AFI etiology using laboratory diagnostics. One-hundred ninety publications underwent full-text review, using a standardized tool to collect data on study characteristics, methodology, and laboratory diagnostics. AFI case definitions between publications varied: use of self-reported fever as part of case definitions (28%, 53/190), fever cut-off value (38·0°C most commonly used: 45%, 85/190), and fever measurement site (axillary most commonly used: 19%, 36/190). Eighty-nine publications (47%) did not include exclusion criteria, and inclusion criteria in 13% (24/190) of publications did not include age group. No publications included study settings in Southern Africa, Micronesia & Polynesia, or Central Asia. We summarized standardized reporting practices, specific to AFI etiologic investigations that would increase inter-study comparability. CONCLUSIONS Wider implementation of standardized AFI reporting methods, with multi-pathogen disease detection, could improve comparability of study findings, knowledge of the range of AFI etiologies, and their contributions to the global AFI burden. These steps can guide resource allocation, strengthen outbreak detection and response, target prevention efforts, and improve clinical care, especially in resource-limited settings where disease control often relies on empiric treatment. PROSPERO: CRD42016035666.
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Affiliation(s)
- Chulwoo Rhee
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Grishma A. Kharod
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nicolas Schaad
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nathan W. Furukawa
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Neil M. Vora
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - David D. Blaney
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John A. Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, United States of America
- Centre for International Health, University of Otago, New Zealand
| | - Kevin R. Clarke
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Abstract
Tularaemia is a rare infectious disease endemic in most European countries caused by the bacterium Francisella tularensis 1 Patients often show acute non-specific symptoms, which causes a delay in diagnosis and proper treatment, potentially resulting in significant morbidities such as deep neck abscess, meningitis, endocarditis and septic shock. The authors present a case of a 5-year old boy with a 4-day history of fever, sore throat and painful cervical lymphadenopathy, whose clinical progression worsened despite being treated with recommended antibiotics as per WHO guidelines once the diagnosis of Tularaemia was confirmed by serologic tests. He developed a parapharyngeal abscess and a persistent left necrotic cervical lymph node, which both were surgically drained and excised, respectively, and an extended course of antibiotic was given. Subsequently, the patient fully recovered from the illness and the follow-up was negative for relapse.
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Affiliation(s)
- Amina Nemmour
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
| | - Adzreil Bakri
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
- Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia
| | - Claude A Fischer
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
| | - Yves Brand
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
- University Basel, Basel, Switzerland
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Affiliation(s)
- A K Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Nehru Hospital, Sector 12, Chandigarh, India
| | - A K Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Nehru Hospital, Sector 12, Chandigarh, India
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Pandey A, Sah AK, Belbase P, Sah AK, Jha AK. Febrile Illness Outbreak Investigation in Sundarharicha-5 Foklan Tapu, Morang District. J Nepal Health Res Counc 2019; 17:148-152. [PMID: 31455925 DOI: 10.33314/jnhrc.v17i01.1945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND On the date of 24 July 2017, the major national daily newspaper reported that there were two death cases from an unknown disease in the Morang district, Sundarharicha Municipality 5, Foklan Tapu. A team of researcher and experts were mobilized in the affected area to investigate and identify the etiological and epidemiological causes. METHODS Both qualitative and quantitative methods was used to conduct the outbreak investigation. 83 blood samples were taken from the patients and microbiological analysis was done at National Public Health Laboratory, Kathmandu. Similarly, 2 verbal autopsies and 5 Key in-depth interviews were taken from a local community leader, local health service providers, medical officer of Koshi Zonal Hospital, district public health officer and medical director of WHO. RESULTS Out of 83 participants, 49% and 25% of the participants were positive to IgM and IgG antibodies of Leptospira species respectively. 87% of the participants were exposed to animal living in his/her home (including pets). CONCLUSIONS An outbreak which was existing during this investigation turned out to be leptospirosis outbreak, whose exposure was consumption of unhealthy meat during social gathering.
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Affiliation(s)
- Ashok Pandey
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | - Arun Kumar Sah
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | - Pradeep Belbase
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | - Anil Kumar Sah
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
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Msefula CL, Olgemoeller F, Jambo N, Segula D, Van Tan T, Nyirenda TS, Nedi W, Kennedy N, Graham M, Henrion MYR, Baker S, Feasey N, Gordon M, Heyderman RS. Ascertaining the burden of invasive Salmonella disease in hospitalised febrile children aged under four years in Blantyre, Malawi. PLoS Negl Trop Dis 2019; 13:e0007539. [PMID: 31314752 PMCID: PMC6663031 DOI: 10.1371/journal.pntd.0007539] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/29/2019] [Accepted: 06/10/2019] [Indexed: 11/19/2022] Open
Abstract
Typhoid fever is endemic across sub-Saharan Africa. However, estimates of the burden of typhoid are undermined by insufficient blood volumes and lack of sensitivity of blood culture. Here, we aimed to address this limitation by exploiting pre-enrichment culture followed by PCR, alongside routine blood culture to improve typhoid case detection. We carried out a prospective diagnostic cohort study and enrolled children (aged 0-4 years) with non-specific febrile disease admitted to a tertiary hospital in Blantyre, Malawi from August 2014 to July 2016. Blood was collected for culture (BC) and real-time PCR after a pre-enrichment culture in tryptone soy broth and ox-bile. DNA was subjected to PCR for invA (Pan-Salmonella), staG (S. Typhi), and fliC (S. Typhimurium) genes. A positive PCR was defined as invA plus either staG or fliC (CT<29). IgM and IgG ELISA against four S. Typhi antigens was also performed. In total, 643 children (median age 1.3 years) with nonspecific febrile disease were enrolled; 31 (4.8%) were BC positive for Salmonella (n = 13 S. Typhi, n = 16 S. Typhimurium, and n = 2 S. Enteritidis). Pre-enrichment culture of blood followed by PCR identified a further 8 S. Typhi and 15 S. Typhimurium positive children. IgM and IgG titres to the S. Typhi antigen STY1498 (haemolysin) were significantly higher in children that were PCR positive but blood culture negative compared to febrile children with all other non-typhoid illnesses. The addition of pre-enrichment culture and PCR increased the case ascertainment of invasive Salmonella disease in children by 62-94%. These data support recent burden estimates that highlight the insensitivity of blood cultures and support the targeting of pre-school children for typhoid vaccine prevention in Africa. Blood culture with real-time PCR following pre-enrichment should be used to further refine estimates of vaccine effectiveness in typhoid vaccine trials.
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Affiliation(s)
- Chisomo L. Msefula
- Pathology Department, College of Medicine, University of Malawi, Blantyre, Malawi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- * E-mail:
| | - Franziska Olgemoeller
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Paediatrics, Queen Elizabeth Central Hospital, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ndaru Jambo
- Pathology Department, College of Medicine, University of Malawi, Blantyre, Malawi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- University of Liverpool, Liverpool, United Kingdom
| | - Dalitso Segula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Internal Medicine, Queen Elizabeth Central Hospital, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Trinh Van Tan
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tonney S. Nyirenda
- Pathology Department, College of Medicine, University of Malawi, Blantyre, Malawi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Wilfred Nedi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Neil Kennedy
- Department of Paediatrics, Queen Elizabeth Central Hospital, College of Medicine, University of Malawi, Blantyre, Malawi
- Centre for Medical Education, Queens University, Belfast, United Kingdom
| | - Matthew Graham
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Marc Y. R. Henrion
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Stephen Baker
- The Department of Medicine, The University of Cambridge, Cambridge, United Kingdom
| | - Nicholas Feasey
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Melita Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- University of Liverpool, Liverpool, United Kingdom
| | - Robert S. Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- Division of Infection & Immunity, University College London, London, England, United Kingdom
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Sea-liang N, Sereemaspun A, Patarakul K, Gaywee J, Rodkvamtook W, Srisawat N, Wacharaplusadee S, Hemachudha T. Development of multiplex PCR for neglected infectious diseases. PLoS Negl Trop Dis 2019; 13:e0007440. [PMID: 31283768 PMCID: PMC6613674 DOI: 10.1371/journal.pntd.0007440] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 05/06/2019] [Indexed: 01/28/2023] Open
Abstract
Scrub typhus, murine typhus, and leptospirosis are widely neglected infectious diseases caused by Orientia tsutsugamushi, Rickettsia typhi, and pathogenic Leptospira spp., respectively. Patients usually present with non-specific symptoms and therefore are commonly diagnosed with acute undifferentiated febrile illness. Consequently, patients face delayed treatment and increased mortality. Antibody-based serological test currently used as gold standard has limitations due to insufficient antibody titers, especially in the early phase of infection. In this study, we aimed to develop multiplex PCR to combine 3 primer pairs that target specific genes encoding 56-kDa TSA of O. tsutsugamushi, 17-kDa antigen of R. typhi, and LipL32 of L. Interrogans and evaluate its performance in comparison to the standard serological tests. Using EDTA blood samples of known patients, the sensitivity and specificity of our multiplex PCR was 100% and 70%, respectively. In addition, the assay was able to diagnose the co-infection of scrub typhus and leptospirosis. The assay may be useful in identifying causative agents during the early phase of these diseases, enabling prompt and appropriate treatment. Scrub typhus, murine typhus, and leptospirosis are diagnosed as acute undifferentiated febrile illness. Diagnostic tests for these diseases depend on antibody detection. However, antibody detection is still limited by its tendency to return negative results during the early phase of aforementioned diseases. In this study, a novel multiplex PCR has been developed for detecting Orientia tsutsugamushi, Rickettsia typhi, and Leptospira interrogans that are simultaneously amplified in a single tube. The results have shown that multiplex PCR could be used as a diagnostic tool for detecting bacteria during the early phase of scrub typhus, murine typhus, and leptospirosis, allowing for administration of appropriate treatment.
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Affiliation(s)
- Nutchanart Sea-liang
- Nanomedicine Research Unit, Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Amornpun Sereemaspun
- Nanomedicine Research Unit, Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
| | - Kanitha Patarakul
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jariyanart Gaywee
- Armed Forces Research Institute of Medical Science, Royal Thai Army, Bangkok, Thailand
| | - Wuttikon Rodkvamtook
- Armed Forces Research Institute of Medical Science, Royal Thai Army, Bangkok, Thailand
| | - Nattachai Srisawat
- Nephrology Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supaporn Wacharaplusadee
- Thai Red Cross Emerging Infectious Diseases-Health Science Centre, World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thiravat Hemachudha
- Thai Red Cross Emerging Infectious Diseases-Health Science Centre, World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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