1
|
Ekinci O, Ozbek E. Infective Endocarditis caused by Gemella Sanguinis: A Case with Fever of Unknown Origin and Anemia. J Coll Physicians Surg Pak 2021; 31:1133-1134. [PMID: 34500541 DOI: 10.29271/jcpsp.2021.09.1133] [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] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/06/2020] [Indexed: 06/13/2023]
Affiliation(s)
- Omer Ekinci
- Department of Hematology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Emrah Ozbek
- Department of Cardiology, Faculty of Medicine, Yüzüncü Yıl University, Van, Turkey
| |
Collapse
|
2
|
Liu H, Fan H, Huang X, Jiao Y. The clinical characteristics and outcomes of patients with fever of unknown origin caused by parasitic infection. Medicine (Baltimore) 2021; 100:e25538. [PMID: 33879698 PMCID: PMC8078278 DOI: 10.1097/md.0000000000025538] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/26/2021] [Indexed: 11/25/2022] Open
Abstract
There are over 200 causes of fever of unknown origin (FUO), and although parasitic infection is an increasingly uncommon cause, a definitive diagnosis remains important to ensure rapid treatment and to prevent adverse sequelae through delay. Here, we studied the clinical features and outcomes of patients admitted with FUO and diagnosed with parasitic infection to improve our understanding of the features of parasitic FUO.Medical records of patients admitted to Peking Union Medical College Hospital between 2013 and 2019 with FUO and diagnosed with parasitic infection were reviewed. The clinical features and outcomes of patients for whom follow-up data were available were summarized.Six patients were admitted with FUO and diagnosed with parasitic infections (6/1013; 0.59%). Patients were more commonly middle-aged men and had a relatively long disease course. Most suffered from hyperpyrexia and other non-specific symptoms. Routine examinations were non-specific, and some patients had positive tumor markers, antinuclear antibodies, or positron emission tomography/computed tomography results. Diagnoses were confirmed by bone marrow smears, serum antibody testing, or feces examination. All 6 cases received anthelmintic treatments and recovered well.Parasitic infections must be screened for and actively excluded in FUO patients so that targeted therapy can be rapidly administered to ensure optimal outcomes.
Collapse
Affiliation(s)
| | | | - Xiaoming Huang
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Jiao
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
3
|
Nyaoke BA, Mureithi MW, Beynon C. Factors associated with treatment type of non-malarial febrile illnesses in under-fives at Kenyatta National Hospital in Nairobi, Kenya. PLoS One 2019; 14:e0217980. [PMID: 31194782 PMCID: PMC6563973 DOI: 10.1371/journal.pone.0217980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/10/2018] [Accepted: 05/22/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Non-malarial febrile illnesses comprise of almost half of all fever presenting morbidities, among under-five children in sub-Saharan Africa. Studies have reported cases of prescription of antimalarial medications to these febrile under-fives who were negative for malaria. The treatment of these children with antimalarial medications increases incidences of antimalarial drug resistance as well as further morbidities and mortalities, due to failure to treat the actual underlying causes of fever. AIM To identify clinical and demographic factors associated with treatment type (malarial/non-malarial) of non-malarial febrile illnesses (NMFI) in children aged ≤5 at the Kenyatta National Hospital in Nairobi, Kenya. METHODS A positivist epistemological approach, cross sectional descriptive study design was used. A structured questionnaire was used on a sample of 341 medical records of children aged ≤5 years to extract data on clinical examinations (recorded as yes or no), diagnostic test results, and demographic data on the child's sex and age. Descriptive and inferential analysis was applied to the data. RESULTS Prescription of antimalarial drugs despite negative microscopy results was found in 44 (12.9%) of the children, with mortality reported in 48 (14.1%). Assessment of respiratory distress was 0.13 (0.03,0.58) times associated with less likelihood of prescribing an antimalarial in those with a negative microscopy. A male patient was 0.21 (0.05,0.89) times less likely to receive an intravenous antimalarial after a negative microscopy. Patients aged ˂1 with a negative microscopy result were more likely to receive an antimalarial than older children. CONCLUSION There is a need to eliminate incorrect treatment of NMFI with antimalarial medication, while ensuring correct diagnosis and treatment of the specific illness occurs. This requires strengthening and adherence to diagnostic and treatment guidelines of febrile illnesses in under-fives, consequently reducing morbidities and mortalities associated with inadequate management of NMFIs.
Collapse
Affiliation(s)
- Borna A. Nyaoke
- The University of Liverpool, Liverpool, United Kingdom
- The University of Nairobi, Nairobi, Kenya
- * E-mail:
| | | | - Caryl Beynon
- The University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
4
|
Van de Wyngaert Z, Berthon C, Debarri H, Bories C, Bonnet S, Nudel M, Carpentier B, Legrand C, Barbieux S, Chauvet P, Simonnet A, Willaume A, Bossard JB, Renaud L, Wattebled KJ, Escure G, Branche N, Arib I, Titecat M, Quesnel B, Alfandari S. Discontinuation of antimicrobial therapy in adult neutropenic haematology patients: A prospective cohort. Int J Antimicrob Agents 2019; 53:781-788. [PMID: 30831232 DOI: 10.1016/j.ijantimicag.2019.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/17/2018] [Revised: 02/14/2019] [Accepted: 02/26/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Antibiotics for febrile neutropenia (FN) in acute myeloid leukaemia (AML) patients undergoing intensive chemotherapy are usually maintained until neutropenia resolution, because of the risk of uncontrolled sepsis in this vulnerable population. This leads to unnecessarily prolonged antimicrobial therapy. METHODS Based on ECIL-4 recommendations, we modified our management strategy and discontinued antibiotics after a pre-established duration in patients treated for a first episode of FN between August 2014 and October 2017. RESULTS Antibiotics were stopped during 62 FN episodes, and maintained in the control group (n = 13). Median age of patients was 54 years. A total of 39 (63%) patients received induction and 23 (37%) consolidation chemotherapy; 36 (58%) patients had fever of unknown origin. Median neutropenia length was 26 days (IQR 24-30). Antibiotics were started at day 9 (IQR 5-13). Most patients received piperacillin-tazobactam (56%) or cefepime (32%). Antimicrobial therapy was longer in the control group than in the policy compliant group, 10 (IQR 7-16) vs. 19 days (IQR 15-23), P = 0.0001. After antibiotics discontinuation, 20% patients experienced fever recurrence, within 5.5 days (IQR 3-7.5). None of these febrile episodes were severe and 80% patients remained afebrile, with neutrophil recovery occurring within 5 days (IQR 2-8.5). Overall, 287 antibiotics days were spared; this represents 49% of all days with antibiotics. No patient had died at day 30 from intervention; six died during late follow-up, two from graft-versus-host disease and four from relapsed or refractory leukaemia. CONCLUSIONS Discontinuing antibiotics in neutropenic AML patients treated for a first episode of FN is safe, and results in significant antibiotic sparing.
Collapse
Affiliation(s)
- Zoé Van de Wyngaert
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France.
| | - Céline Berthon
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France; INSERM, UMR-S 1172; Institut pour la recherche sur le Cancer de Lille, Place de Verdun, F-59000 Lille France
| | - Houria Debarri
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Claire Bories
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Sarah Bonnet
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Morgane Nudel
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Benjamin Carpentier
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Charline Legrand
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Sarah Barbieux
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Paul Chauvet
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Arthur Simonnet
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Alexandre Willaume
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Jean-Baptiste Bossard
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Loic Renaud
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Kevin James Wattebled
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Guillaume Escure
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Nicolas Branche
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Ines Arib
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France
| | - Marie Titecat
- Service de bactériologie, Centre de biologie-pathologie, Rue du Pr Jules LECLERCQ, CHU de Lille, France
| | - Bruno Quesnel
- CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France; INSERM, UMR-S 1172; Institut pour la recherche sur le Cancer de Lille, Place de Verdun, F-59000 Lille France; Univ. Lille, 2 Avenue Eugène Avinée, F-59000 Lille, France
| | - Serge Alfandari
- Service de réanimation et maladies infectieuses, CH Tourcoing, 59208 Tourcoing, France
| |
Collapse
|
5
|
Mulders-Manders CM, Engwerda C, Simon A, van der Meer JW, Bleeker-Rovers CP. Long-term prognosis, treatment, and outcome of patients with fever of unknown origin in whom no diagnosis was made despite extensive investigation: A questionnaire based study. Medicine (Baltimore) 2018; 97:e11241. [PMID: 29924054 PMCID: PMC6024966 DOI: 10.1097/md.0000000000011241] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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] [Indexed: 11/18/2022] Open
Abstract
In 30-50% of patients with fever of unknown origin (IUO) no explanation for the fever can be found. Prognosis and effects of empirical treatment of these patients are largely unknown.With this retrospective, questionnaire based corort study in all unexplained FUO patients in an expert center between 2003 and 2014 we studied mortality and outcome.In 131 of 274 FUO patients, FUO remained unexplained. Ninety-nine of them responded to the long-term follow up questionnaire. Adter a median duration of follow-up of 60 months, spontaneous remission of fever occured in 47.3%. Empirical treatment was effective in 66.7% of patients. Mortality was 6.9%. The cause of death was considered not to be related to the febrile disease in five out of six patients. Ten out of 99 responders reported to have received a final explanation for FUO after evaluation in the expertise center, but this diagnosis could not be confirmed in six cases and was considered to be an unlikely explanation for FUO in four out of six cases.We conclude that mortality in unexplained FUO is low en mostly unrelated to the febrile disease. Spontaneous resolution of fever is common. Empirical treatment prescribed by an expert physician is often effective, but should be avoided untill all diagnostic possibilities have been exhaused.
Collapse
Affiliation(s)
- Catharina M. Mulders-Manders
- Department of Internal Medicine
- Expertise Center for Immunodeficiency and Autoinflammation, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Anna Simon
- Department of Internal Medicine
- Expertise Center for Immunodeficiency and Autoinflammation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jos W.M. van der Meer
- Department of Internal Medicine
- Expertise Center for Immunodeficiency and Autoinflammation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Chantal P. Bleeker-Rovers
- Department of Internal Medicine
- Expertise Center for Immunodeficiency and Autoinflammation, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
6
|
Hehli DJ, Aebi C, von Vigier RO. [Not Available]. Praxis (Bern 1994) 2017; 106:519-526. [PMID: 28488535 DOI: 10.1024/1661-8157/a002676] [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] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Hintergrund: Die Wirksamkeit der peroralen antibiotischen Therapie bei Säuglingen und Kleinkindern mit akuter Pyelonephritis wurde unlängst gezeigt; systematische Daten über die Häufigkeit limitierender Faktoren dieser Therapieform sind nicht verfügbar. Ziel: Charakterisierung von Patienten mit erstmaliger Pyelonephritis unter dem Gesichtspunkt möglicher erfolgslimitierender Faktoren einer peroralen Therapie. Methoden: Retrospektive Analyse 108 stationär behandelter Patienten mit erstmaliger Pyelonephritis, unterteilt in zwei Altersgruppen (A: 2–6 Monate, B: 7–36 Monate). Resultate: Ältere Patienten (B) hatten vor Eintritt länger andauerndes und höheres Fieber (p <0,05), bei Aufnahme höhere CRP-Werte (p <0,01) und wurden später afebril (p <0,001). Mehrfaches Erbrechen fand sich bei 9 % (A = B), resistente Erreger bei 2 %, und persistierendes Fieber (Tag 3) bei 19 % (B >>A) der Patienten. Schlussfolgerungen: Persistierendes Erbrechen und Fieber nach Therapiebeginn können limitierende Faktoren der peroralen Therapie akuter Pyelonephritiden bei pädiatrischen Patienten darstellen.
Collapse
Affiliation(s)
| | - Christoph Aebi
- 1 Universitätsklinik für Kinderheilkunde, Inselspital, Bern
| | | |
Collapse
|
7
|
Busch M, Priyambada P, Wells T, Jarrett D, Kraleti S. Persistent fever investigation saves patient's life. J Fam Pract 2016; 65:812-813. [PMID: 28087867] [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] [Indexed: 06/06/2023]
Abstract
A 47-year-old woman had been hospitalized one month earlier for lupus nephritis with a hypertensive emergency that led to a seizure. During this earlier hospitalization, she was given a diagnosis of posterior reversible encephalopathy syndrome.
Collapse
Affiliation(s)
- Megan Busch
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AK, USA.
| | - Priya Priyambada
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AK, USA
| | - Tina Wells
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AK, USA
| | - Diane Jarrett
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AK, USA
| | - Shashank Kraleti
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AK, USA.
| |
Collapse
|
8
|
Müller J, Oberlin D, Nüesch R. [Not Available]. Praxis (Bern 1994) 2016; 105:1033-1036. [PMID: 27560818 DOI: 10.1024/1661-8157/a002450] [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] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Zusammenfassung: Wir schildern den Fall einer 60-jährigen Süditalienerin mit rezidivierenden Fieberschüben bei erhaltenem Allgemeinzustand. Nach umfangreicher infektiologischer, hämatologischer und rheumatologischer Diagnostik ohne wegweisende Befunde erfolgte unter dem Verdacht auf eine atypische Form des familiären Mittelmeerfiebers aufgrund der ethnischen Herkunft der Patientin eine probatorische Colchicin-Therapie. Der schnell eingetretene, anhaltende Therapieerfolg sichert retrospektiv entsprechend den aktuell gültigen modifizierten Tel-Hashomer-Kriterien die Diagnose.
Collapse
|
9
|
Abstract
In 1925, Sir Thomas Horder, a leading physician of his day, gave a lecture, published in this journal, entitled 'Some cases of pyrexia without physical signs'. The paper highlighted what was already a familiar clinical presentation "which taxes our resources to the utmost". Fast-forward through 90 years of careful clinical description, technological innovation in diagnosis and treatment, emergent infections, novel diagnoses, demographic shifts, and radical changes in the health economy. Sir Thomas would find certain aspects familiar, and others revolutionary, in the differential diagnosis and management of the 21st century patient with pyrexia of unknown origin (PUO). Within high-income settings, the proportion of cases due to infection has declined, albeit unevenly. The era of untreated HIV, and the consequences of iatrogenic intervention and immunosuppression, led to Durack and Street's subclassification of the condition in the early 1990 s into classic, nosocomial, neutropenic and HIV-associated PUO. Shifts towards ambulatory care have driven a change in the definition of many diseases. An era of observant clinicians, who lent their names to eponymous syndromes, followed by meticulous serological, genetic and clinicopathological correlation, generated a battery of diagnoses that, along with malignancy, form a large proportion of diagnoses in more recent clinical care. In the current era, universal access to cross-sectional imaging and an infinite array of laboratory tests has undermined the attention paid to history and examination. In some areas of the clinical assessment, such as assessing the fever pattern, this shift is supported by research evidence. The issues that need to be addressed in the next 90 years of technological innovation, information sharing and health service transformation are likely to include: transcriptomic approaches to diagnosis; the place of positron emission tomography (PET) in the diagnostic pathway; the optimal management of high ferritin states; and the most cost-effective diagnostic environment, in the face of this era of specialisation and fragmentation of care. In the meantime, this review covers some important early 21st century lessons to be shared in avoiding diagnostic pitfalls and choosing empirical therapy.
Collapse
|
10
|
Abstract
More than 50 years after the first definition of fever of unknown origin (FUO), it still remains a diagnostic challenge. Evaluation starts with the identification of potential diagnostic clues (PDCs), which should guide further investigations. In the absence of PDCs a standardised diagnostic protocol should be followed with PET-CT as the imaging technique of first choice. Even with a standardised protocol, in a large proportion of patients from western countries the cause for FUO cannot be identified. The treatment of FUO is guided by the final diagnosis, but when no cause is found, antipyretic drugs can be prescribed. Corticosteroids should be avoided in the absence of a diagnosis, especially at an early stage. The prognosis of FUO is determined by the underlying cause. The majority of patients with unexplained FUO will eventually show spontaneous remission of fever. We describe the definition, diagnostic workup, causes and treatment of FUO.
Collapse
Affiliation(s)
- Catharina Mulders-Manders
- Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Anna Simon
- Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Chantal Bleeker-Rovers
- Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
11
|
Sime FB, Roberts MS, Tiong IS, Gardner JH, Lehman S, Peake SL, Hahn U, Warner MS, Roberts JA. Can therapeutic drug monitoring optimize exposure to piperacillin in febrile neutropenic patients with haematological malignancies? A randomized controlled trial. J Antimicrob Chemother 2015; 70:2369-75. [PMID: 25953805 DOI: 10.1093/jac/dkv123] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 02/06/2015] [Accepted: 04/11/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objectives of this study were to describe piperacillin exposure in febrile neutropenia patients and determine whether therapeutic drug monitoring (TDM) can be used to increase the achievement of pharmacokinetic (PK)/pharmacodynamic (PD) targets. METHODS In a prospective randomized controlled study (Australian New Zealand Registry, ACTRN12615000086561), patients were subjected to TDM for 3 consecutive days. Dose was adjusted in the intervention group to achieve a free drug concentration above the MIC for 100% of the dose interval (100% fT>MIC), which was also the primary outcome measure. The secondary PK/PD target was 50% fT>MIC. Duration of fever and days to recovery from neutropenia were recorded. RESULTS Thirty-two patients were enrolled. Initially, patients received 4.5 g of piperacillin/tazobactam every 8 h or every 6 h along with gentamicin co-therapy in 30/32 (94%) patients. At the first TDM, 7/32 (22%) patients achieved 100% fT>MIC and 12/32 (38%) patients achieved 50% fT>MIC. Following dose adjustment, 11/16 (69%) of intervention patients versus 3/16 (19%) of control patients (P = 0.012) attained 100% fT>MIC, and 15/16 (94%) of intervention patients versus 5/16 (31%) of control patients (P = 0.001) achieved 50% fT>MIC. After the third TDM, the proportion of patients attaining 100% fT>MIC improved from a baseline 3/16 (19%) to 11/15 (73%) in the intervention group, while it declined from 4/16 (25%) to 1/15 (7%) in the control group. No difference was noted in the duration of fever and days to recovery from neutropenia. CONCLUSIONS Conventional doses of piperacillin/tazobactam may not offer adequate piperacillin exposure in febrile neutropenic patients. TDM provides useful feedback of dosing adequacy to guide dose optimization.
Collapse
Affiliation(s)
- Fekade Bruck Sime
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia Therapeutics Research Centre, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Michael S Roberts
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia Therapeutics Research Centre, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, Australia Therapeutics Research Centre, School of Medicine, University of Queensland, Brisbane, Australia
| | - Ing Soo Tiong
- Department of Haematology/Oncology, The Queen Elizabeth Hospital, Adelaide, Australia SA Pathology and the University of Adelaide, Adelaide, Australia
| | - Julia H Gardner
- Department of Haematology/Oncology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Sheila Lehman
- Department of Haematology/Oncology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Sandra L Peake
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Uwe Hahn
- Department of Haematology/Oncology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Morgyn S Warner
- SA Pathology and the University of Adelaide, Adelaide, Australia
| | - Jason A Roberts
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia Burns, Trauma, and Critical Care Research Centre, University of Queensland, Herston, Brisbane, Queensland, Australia Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
12
|
Tada N, Tanaka E, Motoyoshi Y. [Case of a 14-year-old boy with chronic tubulointerstitial nephritis first diagnosed as acute focal bacterial nephritis]. Nihon Jinzo Gakkai Shi 2015; 57:270-275. [PMID: 25735087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 14-year-old boy was admitted to a general hospital because of prolonged fever of unknown origin. After Enterococcus feacalis was detected from his urine and abdominal contrast enhanced computed tomography and 99m-Tc dimercaptosuccinic acid scintigram showed multiple focal defects, he was diagnosed as acute focal bacterial nephritis (AFBN). His condition recovered as a result of Ampicillin (ABPC)and Cefotaxime infusion. There was no specific finding in voiding cystography. Six months later, his fever recurred and he was diagnosed as refractory AFBN because Enterococcus feacalis was detected in his urine again. He was treated with ABPC and Meropenem (MEPM) infusion, but the fever persisted and his renal function deteriorated. He was transferred to our hospital for intensive treatment. On admission, blood examination showed findings of inflammation (WBC 14,400/μL, CRP 3.7 mg/dL, erythrocyte sedimentation rate : 69 mm/h, IgG : 2,107 mg/dL) and renal impairment (Cr : 1.8 mg/dL, cystatin C : 2.0 mg/L). Although neither pyuria nor pathogenic bacteria were detected in his urine, Enterococcusfeacalis was detected at the hospital where he had been treated previously, hence we started treatment for AFBN with ABPC, MEPM, Levofloxacin, then Linezolid. However, the fever persisted and his renal function deteriorated (Cr 2.0 mg/dL). Kidney-specific accumulation was found in Ga scintigraphy, which suggested chronic inflammation. Clinical course and laboratory findings showed no symptoms of bacterial, viral, fungal, or tuberculous infections nor collagen disease. Although renal biopsy revealed no glomerular abnormality, tubulointerstitial edema, fibrosis and tubulitis were observed. Rupture of the tubular basal membrane and non-caseating granulomas also existed. Pathological findings did not match those of renal sarcoidosis. Ophthalmological screening negated the existence of tubulointerstitial nephritis with uveitis syndrome. After methylprednisolone pulse therapy, the fever recovered immediately and his renal impairment imroved gradually (Cr 1.49 mg/dL). He continues to undergo treatment as an outpatient. Although tubulointerstitial nephritis is rare in children, some patients have a poor renal prognosis. It is important to determine the existence of tubulointerstitial nephritis on treating a patient with renal impairment.
Collapse
|
13
|
Dagogo-Jack I, Vaidya A, Geller B, Baden LR, Stone R. Interactive medical case. A man with fever, cough, and rash. N Engl J Med 2014; 371:e11. [PMID: 25140977 DOI: 10.1056/nejmimc1310796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
14
|
Markun S. [Not Available]. Praxis (Bern 1994) 2013; 102:1430-1431. [PMID: 24220065 DOI: 10.1024/1661-8157/a001473] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Stefan Markun
- Horten-Zentrum für praxisorientierte Forschung und Wissenstransfer Universitätsspital Zürich
| |
Collapse
|
15
|
Saxena S, Dwivedi M, Batra P, Dutta R. Fever of unknown origin attributable to haematocolpos infected with Salmonella enterica Serotypetyphi resistant to nalidixic acid: a case report. J Health Popul Nutr 2013; 31:403-404. [PMID: 24288955 PMCID: PMC3805891 DOI: 10.3329/jhpn.v31i3.16833] [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] [Indexed: 06/02/2023]
Abstract
The prevalence of nalidixic acid-resistant Salmonella Typhi (NARST) infection is increasing worldwide. We are reporting an unusual case of infected haematocolpos presenting as urinary obstruction in a patient with fever of unknown origin (FUO). This case report highlights the importance of quinolone-resistant typhoid fever in the differential diagnosis of any acute febrile illness in countries, like India, where Salmonella infection is endemic.
Collapse
Affiliation(s)
- Sonal Saxena
- Department of Microbiology, Lady Hardinge Medical College, New Delhi I 10 00 I1, India.
| | | | | | | |
Collapse
|
16
|
Koura KG, Garcia A, Todoégnon B, Deloron P, Cot M, Faucher JF. Prevalence and factors related to antibiotic prescription in Benin: a school-based study. Acta Trop 2013; 127:87-90. [PMID: 23587697 DOI: 10.1016/j.actatropica.2013.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 10/15/2012] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 11/16/2022]
Abstract
Rational use of antibiotics in poor-resource settings countries is challenging. In order to assess the factors related to antibiotic prescription, a cross sectional study was carried out in four school infirmaries from February to June 2008 in the district of Allada in Benin. For each patient, socio-demographic characteristics, symptoms motivating medical visits, diagnosis and therapeutic prescriptions were collected. A malaria rapid diagnostic test was used in case of fever. Data were entered and validated with Epidata(®) software, and analysed with STATA 11(®) software. One thousand six hundred and thirty medical visits occurred during the study period. Fever was reported by 57% of children. Malaria was the leading diagnosis (32%), followed by respiratory infection (17.5%). Antibiotic was prescribed to 40% of the children. Respiratory infection and skin disorders were positively related to antibiotic usage [OR=59.5 (33.4-105.7); P<10(-3) and OR=6.4 (4.6-8.8); P<10(-3) respectively]. Malaria [OR=0.11 (0.03-0.11); P<10(-3)] and fever of unknown origin [OR=0.05 (0.03-0.11); P<10(-3)] were negatively related to antibiotic usage. Further clinical surveys and trials aimed at rationalizing antibiotics usage in this area should focus on the management of acute respiratory illnesses.
Collapse
Affiliation(s)
- Kobto G Koura
- IRD UMR216, Mère et enfant face aux infections tropicales, Paris, France.
| | | | | | | | | | | |
Collapse
|
17
|
Sardesai V. Pyrexia of unknown origin--an uncommon presentation of subacute thyroiditis. J Indian Med Assoc 2013; 111:135. [PMID: 24003577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
18
|
Woolley AK, Hedger NA, Veettil RP. Problem based review: The patient with a pyrexia of unknown origin. Acute Med 2013; 12:107-110. [PMID: 23732136] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pyrexia of unknown origin (PUO) is a frequent presentation to the Acute Medical Unit, and is a source of significant morbidity, both the psychological burden of an uncertain diagnosis and prognosis and untreated complications of the underlying pathology. We present a problem based review of the management of PUO, illustrated by a patient who recently presented to our unit with fever and systemic malaise after returning from abroad and in whom no cause could be found for more than two months. We describe a structured approach making use of complex modern techniques such as Positron Emission Tomography-Computed Tomography (PET-CT) which ultimately provided the diagnosis for our patient.
Collapse
|
19
|
Abstract
We report the case of a 39-year old patient with septicemia treated for pharyngitis with antibiotics since a few days. She wasn't able to swallow her antibiotics anymore because of dysphagia. Radiologic examination revealed pulmonary infiltrates and Vena iugularis interna-thrombosis. These findings and anamnesis led to the diagnosis of Lemierre syndrome inspite of lacking detection of bacteria. After changing the antibiotic therapy and start of anticoagulation further course of illness was favorable. The long duration of hospitalization was indepted to high morbidity typically seen in Lemierre syndrome.
Collapse
Affiliation(s)
- B Heimgartner
- Universitätsklinik für Allgemeine Innere Medizin, Inselspital, Universitätsspital Bern
| | | | | |
Collapse
|
20
|
Fatima J, Shukla V, Karoli R. Behcet's syndrome presenting as FUO. J Assoc Physicians India 2010; 58:331-332. [PMID: 21121102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
21
|
Gómez L, Estrada C, Gómez I, Márquez M, Estany C, Martí JM, Bastús R, Cirera L, Quintana S, Garau J. Low-dose beta-lactam plus amikacin in febrile neutropenia: cefepime vs. piperacillin/tazobactam, a randomized trial. Eur J Clin Microbiol Infect Dis 2010; 29:417-27. [PMID: 20195673 DOI: 10.1007/s10096-010-0879-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 06/29/2009] [Accepted: 01/05/2010] [Indexed: 11/28/2022]
Abstract
Patients with fever and granulocytopenia are at risk of developing severe infection. We performed a prospective, randomized trial to evaluate the efficacy of low-dose cefepime plus amikacin (C-A) compared to low-dose piperacillin/tazobactam plus amikacin (PT-A). Patients received cefepime (2 g/12 h) plus amikacin (15 mg/kg/day) or piperacillin/tazobactam (4 g/500 mg/8 h) plus amikacin. A total of 317 episodes of febrile granulocytopenia in 190 patients were studied (152 in the C-A group, 165 in the PT-A group). A microbiologically documented infection was present in 53 (35%) episodes in the C-A group and 41 (25%) episodes in the PT-A group (p = ns); a clinically documented infection was observed in 39 (26%) and 47 (28%) episodes, respectively. Toxicity was observed in 6 (4%) episodes in the C-A group and in 5 (3%) episodes in the PT-A group. The antibiotic success rate (no change or addition of antibiotics) was recorded in 89 (59%) and 105 (64%) cases, respectively (p = ns). Mortality related to infection was similar in each arm (3.9% vs. 3.6%). Combination therapy of low-dose beta-lactam with an aminoglycoside achieves very good response rates and low rates of toxicity. It might be an attractive option in an environment of increasing resistance among gram-negative bacteria.
Collapse
Affiliation(s)
- L Gómez
- Infectious Diseases Unit, Hospital Universitari Mutua de Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Affiliation(s)
- Zehra Haider
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Constantine Tsigrelis
- Fellow in Infectious Diseases, Mayo School of Graduate Medical Education, Rochester, MN
| | - Larry M. Baddour
- Adviser to resident and fellow and Consultant in Infectious Diseases, Mayo Clinic, Rochester, MN
- Individual reprints of this article are not available. Address correspondence to Larry M. Baddour, MD, Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ().
| |
Collapse
|
23
|
Mebis J, Goossens H, Berneman ZN. Cefepime and mortality. Lancet Infect Dis 2009; 9:585-586. [PMID: 19778758 DOI: 10.1016/s1473-3099(09)70238-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
24
|
Ikuta K, Torimoto Y, Shindo M, Sato K, Kohgo Y. Atypical Takayasu arteritis with solitary stenosis in the short segment of right axillary artery. Rheumatol Int 2009; 30:1635-7. [PMID: 19701753 DOI: 10.1007/s00296-009-1110-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 06/18/2009] [Accepted: 08/07/2009] [Indexed: 01/17/2023]
Abstract
Takayasu arteritis is a rare, idiopathic, and chronic inflammatory large vessel vasculitis, involving mainly the aorta and its major branches. Takayasu arteritis predominantly affects women. The clinical presentation is characterized by an acute phase with constitutional symptoms, followed by a chronic phase in which symptoms relate to stenosis or occlusion of vessels. We here report a rare case of Japanese male patient with a fever of unknown origin, and showed a solitary stenosis in the short segment of right axillary artery.
Collapse
Affiliation(s)
- Katsuya Ikuta
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College, 2-1-1-1 Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan.
| | | | | | | | | |
Collapse
|
25
|
Dua JS, Chessa M, Jones N, Negura D, Micheletti A, Carminati M. Fever after BioSTAR implantation: is it a systemic reaction to the collagen matrix? J Invasive Cardiol 2009; 21:255. [PMID: 19418636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
26
|
Abstract
There are many potential causes of FUO. Most cases are due to unusual presentations of common diseases rather than rare or exotic diseases. The key to establishing the diagnosis is a careful history and careful repeated examinations followed by targeted investigations.
Collapse
Affiliation(s)
- John Williams
- Department of Infection and Travel Medicine, James Cook University Hospital, Middlesbrough
| | | |
Collapse
|
27
|
Stam WB, Aversa F, Kumar RN, Jansen JP. Economic evaluation of caspofungin versus liposomal amphotericin B for empiric antifungal treatment in patients with neutropenic fever in Italy. Value Health 2008; 11:830-841. [PMID: 18494752 DOI: 10.1111/j.1524-4733.2008.00324.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of caspofungin versus liposomal amphotericin B as empiric antifungal treatment in patients with neutropenic fever in Italy. METHODS The cost-effectiveness of caspofungin versus liposomal amphotericin B was evaluated using a decision-tree model. Patients were stratified by presence or absence of baseline infection. Model outcomes included success in terms of resolution of fever, resolution of baseline infection, absence of breakthrough infection, survival, and quality-adjusted life years (QALYs) saved. Discontinuation because of nephrotoxicity or other adverse events were included in the model. Efficacy and safety data were based on a randomized, double-blind, multinational trial of caspofungin compared to liposomal amphotericin B (Walsh 2004). Information on life expectancy, quality of life, medical resource consumption, and costs was obtained from the literature. RESULTS The caspofungin estimated total treatment cost amounted to 8351 euros (95% uncertainty interval 7801 euros-8903 euros), which is 3470 euros (2575 euros-4382 euros) less than with liposomal amphotericin B. Treatment with caspofungin resulted in 0.25 (-0.11; 0.59) QALYs saved in comparison to treatment with liposomal amphotericin B. Probabilistic sensitivity analysis demonstrated a 93% probability that caspofungin was economically dominant, i.e., cost and QALY saving, and a probability of more than 99% that the costs per QALY saved were below 20,000 euros, a commonly accepted threshold for cost-effectiveness. Additional analyses with alternative doses of liposomal amphotericin B confirmed these findings. CONCLUSION Given the underlying assumptions, our economic evaluation demonstrated that caspofungin is cost-effective compared to liposomal amphotericin B in empiric antifungal treatment of patients with neutropenic fever in Italy.
Collapse
|
28
|
Joshi R, Colford JM, Reingold AL, Kalantri S. Nonmalarial acute undifferentiated fever in a rural hospital in central India: diagnostic uncertainty and overtreatment with antimalarial agents. Am J Trop Med Hyg 2008; 78:393-399. [PMID: 18337332] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Nonmalarial acute undifferentiated fever (NMAUF) refers to a febrile illness with no indication of an organ-specific disease after diagnosis of malaria has been excluded. In developing countries, the empirical treatment of NMAUFs with antimalarial drugs continues even in the era of highly specific rapid diagnostic tests (RDTs) for malaria. We carried out a retrospective review of patients with fever admitted to a rural teaching hospital in central India. We categorized patients with NMAUF into different clinical syndromes and determined their demographic profile, inhospital course, and the pattern of antimalarial use. The study sample included 1,197 adult patients who were investigated for malaria; 1,053 (88%) of them had NMAUF, and use of further diagnostics in this group was limited. Despite one or more negative tests for malaria, many patients (39.9%, 95% CI 37.0-43.3) received antimalarial drugs. These results suggest a need for guidelines and training to improve empirical treatment of NMAUF.
Collapse
Affiliation(s)
- Rajnish Joshi
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California 94720, USA.
| | | | | | | |
Collapse
|
29
|
Abstract
Fever is a common complaint of young children who seek care in the emergency department. Recent advances, such as universal vaccination with the pneumococcal conjugate vaccine, require the review of traditional approaches to these patients. This article discusses newer strategies in the evaluation and management of the young child with fever, incorporating changes based on the shifting epidemiology of bacterial infection.
Collapse
Affiliation(s)
- Paul Ishimine
- Departments of Medicine and Pediatrics, School of Medicine, University of California-San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA.
| |
Collapse
|
30
|
Abstract
BACKGROUND Activity and efficacy of liposomal amphotericin B have been established for the treatment of severe fungal infections. Nephrotoxic side effects, especially during prolonged administration, are regarded as a major disadvantage. In this study we examined the response rates and side effects, particularly nephrotoxicity, of treatment with liposomal amphotericin B in a large cohort of patients. PATIENTS AND METHODS 406 patients treated with liposomal amphotericin B between January 1999 and August 2003 in participating German hospitals were included. Documentation included demographic and clinical data, reason for the treatment with liposomal amphotericin B, length of treatment, response to antifungal treatment and side effects. RESULTS 42.4% of the 406 patients were females. Their ages ranged from 1 day to 77 years. 83 % of the patients had malignancies and 65.5 % had fever of unknown origin (FUO). Mean duration of treatment with liposomal amphotericin B was 20 +/- 20 days, at an average dose of 2.3 mg/kg/d. 209 patients (51.5 %) showed complete response (CR),105 patients (25.9 %) partial response (PR) and 51 (12.6 %) patients died during the observation. 80.0 % of patients with FUO showed complete or partial response of symptoms. Mean serum creatinine increased from 0.9 mg/kg before start of therapy with liposomal amphotericin B to 1.1 mg/kg during treatment. Side effects (common toxicity criteria > grade 1) occurred in 94 patients (23/2 %). Among these hypokalemia (6.2 %) and liver damage (5,2 %) were the most common. Nephrotoxicity was documented in 17 patients (4.2 %). CONCLUSION Liposomal amphotericin B is a safe and efficacious antifungal drug in the treatment of severe invasive fungal infections and fever of unknown origin. Nephrotoxicity is usually not a limiting factor when using liposomal amphotericin B, if it is administered in approved dosage.
Collapse
Affiliation(s)
- C T Rieger
- Medizinische Klinik und Poliklinik III, Abteilung für Hämatologie und Onkologie, Klinikum der Universität München - Campus Grosshadern, München, Deutschland.
| | | | | |
Collapse
|
31
|
Simon A, Lehrnbecher T, Bode U, Groll AH, Tramsen L, Wieland R, Molitor E, Fleischhack G, Laws HJ. Piperacillin-tazobactam in pediatric cancer patients younger than 25 months: a retrospective multicenter survey. Eur J Clin Microbiol Infect Dis 2007; 26:801-6. [PMID: 17786491 DOI: 10.1007/s10096-007-0382-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Piperacillin-Tazobactam (Pip-Taz) is an evidence-based empirical treatment of febrile neutropenia in adolescents and adults. No data are available in pediatric cancer patients <25 months of age. In this retrospective, multicenter data survey, the analysis focuses on safety, tolerance, and efficacy. The daily dose administered was 240 mg/kg given in three equally divided doses. Data on 156 Pip-Taz treatment courses in 69 children <25 months from five pediatric cancer treatment centers (2001-2005) were analyzed. The median duration of treatment with Pip-Taz was 5 days (range, 1-23 days; 1-12 Pip-Taz courses per patient). Pip-Taz was started on the first day of fever in 90% of all courses, in 6% in the first 72 h, and in 4% as second- or third-line agent. Forty-five percent of all patients were neutropenic. In all patients, the outcome was favorable independent whether Pip-Taz was given as monotherapy (42 courses; 27%) or in combination. Overall, Pip-Taz was well tolerated and discontinued due to adverse events in only two patients who experienced non-life-threatening allergic reactions (skin rash and wheezing). The results of this study are preliminary due to the methodological limitations of a retrospective survey. Taking this bias into consideration, Pip-Taz appears to be a safe, and feasible alternative in pediatric cancer patients with febrile neutropenia <25 months of age suggesting that the inclusion of children of all age groups in future prospective controlled studies evaluating Pip-Taz is justified.
Collapse
Affiliation(s)
- A Simon
- Pediatric Hematology/Oncology, Children's Hospital Medical Centre, University of Bonn, Bonn, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Capapé Zache S, Luaces Cubells C, Garrido Romero R, Claret Teruel G, Fernández Landaluce A, Benito Fernández J. Impacto de la vacunación neumocócica en el manejo del lactante con fiebre, en relación al porcentaje de vacunación. An Pediatr (Barc) 2007; 67:30-6. [PMID: 17663903 DOI: 10.1157/13108077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To calculate the impact of the heptavalent pneumococcal conjugate vaccine (PCV-7) in the management of fever without source (FWS) in infants according to vaccination rates. METHODS The rate of pneumococcal vaccination in infants visiting 14 pediatric emergency departments (PEDs) was calculated. For the statistical analysis, two groups were established; group A: hospitals with vaccination rates of > or = 40%, and group B: hospitals with vaccination rates of < 40 %. A survey was carried out among pediatricians from 14 PEDs on the specific management of two hypothetical clinical cases of FWS (case 1: 7-month-old girl; case 2: 20-month-old girl) depending on their pneumococcal vaccination status (no vaccination, 1 o 2 doses, or 3 doses). RESULTS In February 2005, data were collected in 1357 patients, aged 3 to 36 months; 568 (41.86 %) had received at least one dose of PCV-7. A total of 235 questionnaires were collected, 104 in group A and 131 in group B. Pneumococcal vaccination would lead (with statistically significant differences) to fewer diagnostic tests (complete blood cell counts and blood culture). This decrease would be more pronounced in group A than in group B (56.7 % vs 26.7 % and 55.8 vs 26.7 % in case 1 and 54.8 % vs 26 % and 57.7 vs 13.7 %, case 2, respectively), p < 0.05. Infants who had received complete pneumococcal vaccination would receive fewer antibiotics and would be more likely to be discharged directly from hospital (p < 0.001). CONCLUSIONS In the previously vaccinated infant with FWS, there would be a significant reduction in the number of diagnostic tests, need for observation in the PED, rates of hospitalization and antibiotic therapy. The reduction in diagnostic tests would increase in areas with higher rates of pneumococcal vaccination.
Collapse
Affiliation(s)
- S Capapé Zache
- Urgencias de Pediatría, Hospital de Cruces, Baracaldo, España.
| | | | | | | | | | | |
Collapse
|
33
|
Hoffmann F, Wintergerst U. [Feverish infant]. MMW Fortschr Med 2007; 149:46-7. [PMID: 17668792 DOI: 10.1007/bf03365043] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- F Hoffmann
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital der LMU Müchen, Müchen.
| | | |
Collapse
|
34
|
Schuler U, Bammer S, Aulitzky WE, Binder C, Böhme A, Egerer G, Sandherr M, Schwerdtfeger R, Silling G, Wandt H, Glasmacher A, Ehninger G. Safety and efficacy of itraconazole compared to amphotericin B as empirical antifungal therapy for neutropenic fever in patients with haematological malignancy. Oncol Res Treat 2007; 30:185-91. [PMID: 17396041 DOI: 10.1159/000100055] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Safety, tolerability and efficacy of itraconazole and amphotericin B (AMB) were compared for empirical antifungal treatment of febrile neutropenic cancer patients. PATIENTS AND METHODS In an open, randomised study, 162 patients with at least 72 h of antimicrobial treatment received either intravenous followed by oral itraconazole suspension or intravenous AMB for a maximum of 28 days. Permanent discontinuation of study medication due to any adverse event was the primary safety parameter. Efficacy parameters included response and success rate for both treatment groups. RESULTS Significantly fewer itraconazole patients discontinued treatment due to any adverse event (22.2 vs. 56.8% AMB; p < 0.0001). The main reason for discontinuation was a rise in serum creatinine (1.2% itraconazole vs. 23.5% AMB). Renal toxicity was significantly higher and more drug-related adverse events occurred in the AMB group. Intention-to-treat (ITT) analysis showed favourable efficacy for itraconazole: response and success rate were both significantly higher than for AMB (61.7 vs. 42% and 70.4 vs. 49.3%, both p < 0.0001). Treatment failure was markedly reduced in itraconazole patients (25.9 vs. 43.2%), largely due to the better tolerability. CONCLUSIONS Itraconazole was tolerated significantly better than conventional AMB and also showed advantages regarding efficacy. This study confirms the role of itraconazole as a useful and safe agent in empirical antifungal therapy of febrile neutropenic cancer patients.
Collapse
Affiliation(s)
- Ulrich Schuler
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
BACKGROUND Urinary tract infection (UTI) is one of the most common causes of unexplained fever in infants with a reported prevalence range of 5-11%. The clinical and laboratory findings were reviewed, and diagnosis and treatment for 95 infants with primary UTI were evaluated in this study. METHODS All patients underwent renal ultrasonography, voiding cystourethrogram and 99mTc dimercaptosuccinic acid (DMSA) scan during hospitalization before treatment, with treatment consisting of 2- or 4-week appropriated antibiotic therapy for the patients associated upper UTI, followed by a second DMSA scan 6 months after therapy. RESULTS In the present study the main symptom of UTI in infants was fever. High white blood cell count was not necessarily present, and urinalysis was also an imperfect diagnostic tool for discriminating UTI. In addition, colony count from urine culture and kidney ultrasonography was not efficacious in terms of predicting the occurrence of pyelonephritis. Intravenous antibiotic for 1 week followed by 3 weeks of the same oral antibiotic provided good prophylaxis for uncomplicated pyelonephritis. CONCLUSION Four weeks of antibiotic treatment resulted in good recovery from pyelonephritis in the present sample of infant primary UTI cases. voiding cystourethrogram, DMSA and ultrasonography scanning should be performed in primary infant UTI.
Collapse
Affiliation(s)
- Kong-Sang Wan
- Department of Pediatrics, Taipei City Hospital, Yangming Branch and School of Medicine, National Yang-Ming University, Tapei, Taiwan.
| | | | | |
Collapse
|
36
|
Miller AC, Chacko T, Rashid RM, Ledford DK. Fever of unknown origin and isolated noncaseating granuloma of the marrow: could this be sarcoidosis? Allergy Asthma Proc 2007; 28:230-5. [PMID: 17479610 DOI: 10.2500/aap.2007.28.2982] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fever of unknown origin (FUO) is both a clinical and a diagnostic challenge. Furthermore, an FUO case with isolated marrow noncaseating granuloma can further confound diagnosis. However, these two findings together may help narrow down the pathological possibilities. This article presents a case report of FUO and lymphopenia for 2 months. Multiple studies to evaluate infectious etiology were unremarkable. Bone marrow biopsy revealed isolated bone marrow granuloma, suggestive of sarcoid. The patient responded well to glucocorticosteroids with resolution of lymphopenia. Sarcoid should enter the differential of lymphopenia and FUO even without lymphadenopathy or abnormal chest radiography. This article provides a of review of CD4 lymphopenia, noncaseating granuloma of the marrow, and sarcoidosis.
Collapse
Affiliation(s)
- Andrew C Miller
- Department of Internal Medicine, State University of New York Downstate Medical Center and Kings County Hospital Center Brooklyn, New York, USA
| | | | | | | |
Collapse
|
37
|
Nakashiki K, Yoshifuku S, Kataoka T, Sakata R, Tei C. [Unknown fever in a patient with implanted intracardiac lead]. J Cardiol 2007; 49:103-5. [PMID: 17354585] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Kenichi Nakashiki
- Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima.
| | | | | | | | | |
Collapse
|
38
|
Abstract
Persistent undiagnosed fever remains a common problem in clinical practice. In a variable number of cases, no definitive diagnosis is made. This lack of a clear etiology indicates that certain disorders are not being detected despite the recently developed technology usually applied in this situation. On occasion, dental disease is one potential cause of persistent fever. Oral symptoms usually are not present, thus allowing the oral cavity to be overlooked during physical examination. We describe three patients with persistent fever due to dental disease and discuss the pathogenesis of this disease.
Collapse
|
39
|
Brockmann V P, Ibarra G X, Silva W I, Hirsch B T. Etiología del síndrome febril agudo sin foco en niños bajo 36 meses de edad que consultan a un servicio de urgencia. Rev Chilena Infectol 2007; 24:33-9. [PMID: 17369968 DOI: 10.4067/s0716-10182007000100005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED Fever is a frequent symptom of consultation in Pediatric Emergency Department. OBJECTIVES to describe causes of acute fever of unknown origin (FUO) in infants under 36 months of age, the utility of requested tests and pediatrician decisions. PATIENTS AND METHODS 309 cards of children under 36 months who consulted at Emergency Department for acute FUO were reviewed. RESULTS 64 % were classified with well clinical condition. Most frequent causes were: probable viral respiratory infections (72%), urinary tract infection (7.4%), pneumonia (2.9%), bacteremia (1.9%), and bacterial meningitis (1.3%). Streptococcus pneumoniae was the most frequent agent isolated from blood cultures. Tests of best utility were: urine analysis and urine culture. Leukocytes count < 15.000/mm(3) and PCR < 4.0 mg/dl had a negative predictive value of 96 %. Nine point seven percent of the patients were hospitalized, while 14.2% received antibiotic treatment at home. CONCLUSIONS We suggest to perform urine analysis and culture as the initial study for children with acute FUO and well clinical condition.
Collapse
Affiliation(s)
- Pablo Brockmann V
- Departamento de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | | | | | | |
Collapse
|
40
|
Fernández-Ruiz M, Guerra-Vales JM, Francisco-Javier CF, Yolanda RG, Miguel-Ingel MG, Cristina GC, Jesús RC. Fever of unknown origin in a patient with common variable immunodeficiency associated with multisystemic granulomatous disease. Intern Med 2007; 46:1197-202. [PMID: 17675769 DOI: 10.2169/internalmedicine.46.6414] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 11/06/2022] Open
Abstract
Non-caseating epithelioid granulomas have been described in a small number of patients with common variable immunodeficiency (CVID). We report a 26-year-old woman diagnosed with CVID nine years earlier, who developed non-caseating granulomas in the liver, bone marrow and skin. She was referred to our department for a fever of more than one year duration without apparent focus. Extensive search for underlying malignancy or occult infection was unremarkable. Empirical treatment with prednisone was begun and the patient showed a marked improvement. The literature on the association between CVID and non-caseating granulomatous disease, and the differential diagnosis of hepatic granulomas as a cause of fever of unknown origin, is also reviewed.
Collapse
|
41
|
Radzikowski A. [Fever of unknown origin--pyelonephritis? Pneumonia? Mastoiditis? Ethmoiditis?]. Przegl Lek 2007; 64 Suppl 3:9-11. [PMID: 18431903] [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] [Indexed: 05/26/2023]
Abstract
Fever of unknown origin is alarming phenomenon in childhood. Diagnostic procedures should be focused on severe bacterial infection: pyelonephritis, pneumonia and other respiratory tract infections such as mastoiditis and sinusitis in particular ethmoiditis. The principles of treatment and diagnostics were discussed depending on age and general status of the child.
Collapse
Affiliation(s)
- Andrzej Radzikowski
- Klinika Gastroenetrologii i Zywienia Dzieci, Akademii Medycznej w Warszawie, 01-184 Warszawa, ul. Działdowska 1
| |
Collapse
|
42
|
Sturm E, Rings EHHM, Schölvinck EH, Gouw ASH, Porte RJ, Pruim J. Fluordeoxyglucose positron emission tomography contributes to management of pediatric liver transplantation candidates with fever of unknown origin. Liver Transpl 2006; 12:1698-704. [PMID: 17058252 DOI: 10.1002/lt.20922] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 02/07/2023]
Abstract
Fever of unknown origin (FUO) frequently complicates the management of pediatric patients with terminal chronic liver failure during the pretransplantation period and may lead to increased morbidity and mortality. Nonhepatic origins of systemic infections may render the patient unsuitable for transplantation whereas infections within the liver may require organ resection for a cure. Therefore, accurate localization of the infection focus is critical for optimal management of children on the waiting list for liver transplantation. Here we report our experience using [18 F]fluordeoxyglucose (FDG)-positron emission tomography (PET) to detect the origin of infection in 11 children with biliary cirrhosis presenting with FUO during the waiting period for liver transplantation. In 5 children, positive intrahepatic FDG-PET signals correlated with bacterial cultures of the excised liver and/or anatomic or histologic signs of infection. Based on the FDG-PET findings, these patients underwent transplantation after continuous antibiotic treatment with ongoing, recurrent episodes of fever. In 6 children, no abnormal hepatic FDG-PET signals were found and no infections could be detected in the liver. Transplantation in these patients was performed only after becoming afebrile. Standard imaging techniques did not reveal abnormalities compatible with infection in any of the children. In conclusion, in children with biliary cirrhosis and FUO on the waiting list for liver transplantation, information obtained by FDG-PET imaging may be useful for decisions on therapy and suitability for liver transplantation.
Collapse
Affiliation(s)
- Ekkehard Sturm
- Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
43
|
Simon A, Gröger N, Wilkesmann A, Hasan C, Wiszniewsky G, Engelhart S, Kramer MH, Bode U, Ammann RA, Fleischhack G. Restricted use of glycopeptides in paediatric cancer patients with fever and neutropenia. Int J Antimicrob Agents 2006; 28:417-22. [PMID: 17046210 DOI: 10.1016/j.ijantimicag.2006.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 03/29/2006] [Revised: 06/25/2006] [Accepted: 06/27/2006] [Indexed: 10/24/2022]
Abstract
Until now, studies confirming the safety of glycopeptide restriction in the empirical treatment of prolonged fever and neutropenia included only nine children. In an open-label observational study, the use of teicoplanin in paediatric oncology patients was investigated. A period of unrestricted use (2001-2003) was compared with a second period (2004) following implementation of a restrictive treatment guideline. Empirical first-line treatment consisted of piperacillin/tazobactam; in 2004, fosfomycin was added after 72 h as the second-line combination instead of teicoplanin. In total, 213 episodes (n=163 in 2001-2003; n=50 in 2004) managed with teicoplanin or fosfomycin (only 2004) were eligible. Empirical treatment of fever of unknown origin with teicoplanin was reduced by 97%. In 2004, the mean length of stay was 0.4 days shorter, no infection-related death occurred and no vancomycin-resistant enterococci were detected. Restriction of empirical glycopeptides is safe in paediatric cancer patients after first-line treatment with piperacillin/tazobactam. Fosfomycin appears to offer a feasible and cost-saving alternative in second-line combination therapy.
Collapse
Affiliation(s)
- Arne Simon
- Department of Pediatric Hematology and Oncology, Children's Hospital Medical Center, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Petrogiannopoulos C, Papamichael K, Karachalios G, Karachaliou I, Kostakos N, Barbati K, Zacharof A. Autoimmune cholangitis presented as fever of unknown origin. Chemotherapy 2006; 52:282-4. [PMID: 17008778 DOI: 10.1159/000095958] [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: 05/03/2005] [Accepted: 09/05/2005] [Indexed: 11/19/2022]
Abstract
Autoimmune cholangitis is a rare chronic cholestatic liver disease. Fever of unknown origin is defined as a temperature higher than 38.3 degrees C that lasts for more than 3 weeks with no obvious source despite appropriate investigation. We describe the case of a 62-year-old woman who presented with fever, fatigue and weight loss. The serum biochemical study showed an increase in alkaline phosphatase and gamma-glutamyl transpeptidase levels. Antinuclear, antimitochondrial, anti-smooth-muscle antibodies and antibodies against the cytoplasm of neutrophils were negative. Liver biopsy was compatible with autoimmune cholangitis. The patient was successfully treated with methylprednisolone and ursodeoxycholic acid. We describe here a rare case of fever as preceding and leading symptom of autoimmune cholangitis.
Collapse
|
45
|
Madsen M, Nielsen H. Cytomegalovirus esophagitis in a child with human immunodeficiency virus-1 infection presenting as fever of unknown origin and stunted growth. Eur J Pediatr 2006; 165:665-6. [PMID: 16642367 DOI: 10.1007/s00431-006-0144-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/02/2006] [Accepted: 03/21/2006] [Indexed: 11/24/2022]
Abstract
We report a 12-year old boy with human immunodeficiency virus-1 infection and cytomegalovirus-associated esophagitis, who presented with an indolent clinical course associated with fever of an unknown origin, failure to thrive and weight loss.
Collapse
Affiliation(s)
- Mette Madsen
- Department of Infectious Diseases, Aalborg Hospital, Aarhus University Hospital, 9000 Aalborg, Denmark
| | | |
Collapse
|
46
|
Bernadich O, Arguis P, González J, Ramírez J. Mujer de 68 años con fiebre prolongada. Med Clin (Barc) 2006; 126:589-96. [PMID: 16756924 DOI: 10.1157/13087699] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Oscar Bernadich
- Sección de Neumología, Hospital Sant Bernabé, Berga, Barcelona, España
| | | | | | | |
Collapse
|
47
|
Madsen KA, Bennett JE, Downs SM. The role of parental preferences in the management of fever without source among 3- to 36-month-old children: a decision analysis. Pediatrics 2006; 117:1067-76. [PMID: 16585300 DOI: 10.1542/peds.2005-1865] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 11/24/2022] Open
Abstract
OBJECTIVES Recent analyses assessing the impact of the conjugate pneumococcal vaccine on the care of febrile children do not reflect the role parental preferences play in physicians' decisions. The objective of this study was to identify the management strategy that would best suit parents, on the basis of their values for possible outcomes of fever of > or =39 degrees C without source among well-appearing, 3- to 36-month-old children. METHODS A decision analysis was performed to compare the benefits and outcomes of 3 management options (treat: blood culture and antibiotics for all children; test: blood culture and complete blood count for all children, with antibiotics for selected children; observe: no immediate intervention). A hypothetical cohort of 100,000 children with fever of > or =39 degrees C with no obvious source of infection was modeled for each strategy. Using this model, we identified the treatment option that would best suit each parent's preferences, on the basis of parental utilities (from a prior study) for various interventions and outcomes at vaccine efficacies of 0% (ie, no vaccine) and 95%. In addition, we performed survival analyses to assess the morbidity and mortality rates associated with each treatment strategy at various vaccine efficacies. RESULTS At a vaccine efficacy of 0%, the majority of parents' preferences suggested the treat option, the strategy with the lowest mortality rate. At a vaccine efficacy of 95%, mortality rates were similar for all 3 management options (approximately 1 in 100,000), but parental preferences were still aligned with different options; 50% suggested observe, 42% suggested test, and 8% suggested treat. CONCLUSIONS Like physicians, parents have different approaches to risk. With the conjugate pneumococcal vaccine, risks of complications from fever without source are low regardless of treatment strategy. Rather than having a "one size fits all" approach, it is reasonable to incorporate parental preferences into the treatment decision.
Collapse
Affiliation(s)
- Kristine A Madsen
- Department of Pediatrics, University of California, San Francisco, CA 94118, USA.
| | | | | |
Collapse
|
48
|
Heppner HJ, Sieber C, Mühlberg W, Esslinger AS. [Fever in the elderly patient]. MMW Fortschr Med 2006; 148:39-42. [PMID: 16502799] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The multimorbid geriatric patient with age-related functional deficits is at particular risk from fever. Although the underlying cause is usually an infection, collagenosis, malignomas or drug-associated side effects all play an increasingly important role in patients of advanced age. In this segment of the population, the question of the reasonableness of a diagnostic work-up weighed against the expected improvement in quality of life is of particular relevance. The most common complication is dehydration, which may be followed by marked confusion. Account being taken of the requirements and the social situation of the individual concerned, any critical development should prompt early hospitalization, ideally in a geriatric hospital.
Collapse
Affiliation(s)
- H J Heppner
- Medizinische Klinik 2, Lehrstuhl für Innere Medizin V-Geriatrie, Klinikum Nürnberg.
| | | | | | | |
Collapse
|
49
|
Abstract
Fever of unknown origin has been defined as axillary temperature higher than 37.8 degrees C on several occasions, persisting without diagnosis for at least 3 weeks in spite of at least 1 week's investigation in hospital. Lately, the definition has been modified and extended to reflect evolutionary changes in clinical practice. In response to this new evolving environment, cases of fever of unknown origin are currently classified as: classic, nosocomial, in neutropenia, and human immunodeficiency virus-related. The objective of our review was to try and define and to update the information on the subject.
Collapse
Affiliation(s)
- José Roberto Lambertucci
- Serviço de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | | | | |
Collapse
|
50
|
Fliciński J, Milchert M, Ostanek L, Brzosko I, Przepiera-Bedzak H, Prajs K, Brzosko M. [Adult-onset Still's disease]. Ann Acad Med Stetin 2006; 52 Suppl 2:111-4. [PMID: 17471846] [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] [Indexed: 05/15/2023]
Abstract
INTRODUCTION The authors present the course and manifestations of adult-onset Still's disease on the basis of five cases diagnosed at the Department of Rheumatology, Pomeranian Medical University in Szczecin. MATERIAL AND METHODS The usefulness of two most popular sets of diagnostic criteria of adult-onset Still's disease (Yamaguchi and Cush) was analyzed. At onset of the disease, two out of five patients met both sets of the diagnostic criteria, two others met criteria of Yamaguchi and one of Cush. During follow-up, criteria of Yamaguchi were met in all cases. RESULTS The authors suggest to use the Cushs criteria of adult-onset Still's disease when the patient does not meet the criteria of Yamaguchi and other causes of fever are excluded.
Collapse
Affiliation(s)
- Jacek Fliciński
- Klinika Reumatologii Pomorskiej Akademii Medyczne, ul. Unii Lubelskiej 1, 71-252 Szczecin
| | | | | | | | | | | | | |
Collapse
|