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1.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2019 Dec 20;37(12):925-927. doi: 10.3760/cma.j.issn.1001-9391.2019.12.012.

[A case analysis of brucella infection in a non-epidemic area].

[Article in Chinese; Abstract available in Chinese from the publisher]

Author information

1
Tianjin First Central Hospital, Tianjin 300192, China.
2
Tianjin Medical University, Tianjin 300070, China.

Abstract

The incidence of human brucellosis is on the rise worldwide. The disease can affect various systems. The clinical manifestations are complex and non-specific, and the diagnosis is difficult. Especially the clinicians in the non-epidemic areas have sporadic cases on the pest free areas. Lack of experience in diagnosis and treatment leads to misdiagnosis and mistreatment, which affects prognosis. This article reports on the epidemiology, clinical manifestations, laboratory tests and treatment of a patient with unexplained fever and brucellosis in our department in June 2019. Raise the attention of clinicians in non-epidemic areas to the disease and enhance people's awareness of protection in non-epidemic areas.

KEYWORDS:

Brucellosis; Diagnosis, differential; Non-epidemic area; Unexplained fever

[Indexed for MEDLINE]
2.
Pan Afr Med J. 2019 Oct 30;34:120. doi: 10.11604/pamj.2019.34.120.19963. eCollection 2019.

[Idiopathic thyroid abscess: a case study conducted at Marc Sankale Center Dakar].

[Article in French]

Author information

1
Clinique Médicale II, Centre Hospitalier Abass Ndao, Université Cheikh-Anta-Diop, Dakar, Sénégal.

Abstract

Thyroid abscess is a very rare disease due to its anatomical position and the physiology of the gland. It most often occurs in the immunosuppressed population. The diagnosis is easy and is based on ultrasound. However it is often unrecognised. Bacteriological examination allows to identify the germ responsible for this condition. We report the case of a Mauritanian patient living in the said country presenting with painful cervical swelling associated with fever. The diagnosis was based on ultrasound and confirmed by fluid examination. Bacteriological assessment didn't identify the cause of this condition. Patient's outcome was marked by regression of symptoms under antibiotic therapy, with normalization of the gland structure after two months.

KEYWORDS:

Abscess; Senegal; thyroid

PMID:
31934261
PMCID:
PMC6945378
DOI:
10.11604/pamj.2019.34.120.19963
[Indexed for MEDLINE]
Free PMC Article
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3.
Orv Hetil. 2020 Jan;161(3):103-109. doi: 10.1556/650.2020.31638.

[Epidemiology of early infections after autologous hematopoietic stem cell transplantation. Analysis of data from 699 patients treated in a Hungarian centre].

[Article in Hungarian; Abstract available in Hungarian from the publisher]

Author information

1
Országos Hematológiai és Infektológiai Intézet, Infektológiai Osztály, Dél-pesti Centrumkórház Budapest.
2
Radiológiai és Onkoterápiás Klinika, Semmelweis Egyetem Budapest.
3
Országos Hematológiai és Infektológiai Intézet, Gyermekhematológiai és Őssejt-transzplantációs Osztály, Dél-pesti Centrumkórház Budapest.
4
Általános Orvostudományi Kar, Semmelweis Egyetem Budapest.
5
Országos Hematológiai és Infektológiai Intézet, Mikrobiológiai Laboratórium, Dél-pesti Centrumkórház Budapest.
6
Általános Orvostudományi Kar, I. Patológiai és Kísérleti Rákkutató Intézet, Semmelweis Egyetem Budapest.
7
Országos Hematológiai és Infektológiai Intézet, Hematológiai Osztály, Dél-pesti Centrumkórház Budapest, Albert Flórián út 5-7., 1097.
8
Általános Orvostudományi Kar, III. Belgyógyászati Klinika, Semmelweis Egyetem Budapest.

Abstract

Introduction: Autologous hemopoietic stem cell transplantation remains a promising therapy in certain malignant and non-malignant conditions. The procedure, however, will increase the risk of complications, most notably early and late infections. Aim: To analyze the frequency and spectrum of pathogens in early (<+100 days) post-transplant infections and to evaluate risk factors for mortality. Method: Prospectively collected data from 699 patients undergoing autologous hemopoietic stem cell transplantation between 2007 and 2014 at our center were retrospectively reviewed and analyzed. Results: The median age of 699 patients was 56 (interquartile range: 43-62) years, 54% (376) were male. 25 patients have been transferred to other centers and 19 patients were lost to follow up. Neutropenic fever occurred in 69.8% (488) of patients. In addition, 102 infectious episodes in 96 patients were identified. Most commonly bacteremia occurred (49 episodes) with a median onset of 7 (5-11) days. The majority (33/49) of bacteremias have been observed during the pre-engraftment period. Their incidence proved to be higher in patients with malignant lymphoma compared to individuals with plasma cell disorders (p = 0.0005, OR: 2.41, 95% CI: 1.49-3.99). 12 episodes of viral infections and 8 cases of proven or probable invasive mycoses have been identified. Among the 655 patients with complete follow up, 16 in-hospital deaths (2.4%) occurred, 8 of them were associated with infections. Survival was adversely affected by early infections (p = 0.0001). Conclusion: In autologous stem cell transplantation, microbiologically unconfirmed neutropenic fever is common. Documented early bacteremia, however, is infrequent. Lymphoma patients have a significantly higher chance to develop bloodstream infections compared to individuals with plasma cell disorders. Early infections decrease the chance of survival; thus, an effective prophylaxis and therapy remains of paramount importance. Orv Hetil. 2020; 161(3): 103-109.

KEYWORDS:

autologous hematopoietic stem cell transplantation; autológ haemopoeticus őssejt-transzplantáció; bloodstream infection; epidemiology; epidemiológia; halálozás; mortality; profilaxis; prophylaxis; véráram-infekció

PMID:
31928060
DOI:
10.1556/650.2020.31638
[Indexed for MEDLINE]
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4.
Crit Care. 2020 Jan 6;24(1):6. doi: 10.1186/s13054-019-2721-1.

High Quality Targeted Temperature Management (TTM) After Cardiac Arrest.

Author information

1
Department of Intensive Care, Cliniques Universitaires de Bruxelles Hopital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium. ftaccone@ulb.ac.be.
2
Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
3
Department of Intensive Care, Cliniques Universitaires de Bruxelles Hopital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium.

Abstract

Targeted temperature management (TTM) is a complex intervention used with the aim of minimizing post-anoxic injury and improving neurological outcome after cardiac arrest. There is large variability in the devices used to achieve cooling and in protocols (e.g., for induction, target temperature, maintenance, rewarming, sedation, management of post-TTM fever). This variability can explain the limited benefits of TTM that have sometimes been reported. We therefore propose the concept of "high-quality TTM" as a way to increase the effectiveness of TTM and standardize its use in future interventional studies.

KEYWORDS:

Cardiac arrest; Outcome; Quality; Temperature

PMID:
31907075
PMCID:
PMC6945621
DOI:
10.1186/s13054-019-2721-1
[Indexed for MEDLINE]
Free PMC Article
Icon for BioMed Central Icon for PubMed Central
5.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2019 Jul 25;48(5):567-572.

[Research progress on early identification of severe adenovirus pneumonia in children].

[Article in Chinese]

Author information

1
The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.

Abstract

Severe adenovirus pneumonia has a high mortality and incidence of sequelae. Fever and cough are the main symptoms of children's severe adenovirus pneumonia, but such clinical manifestations are lack of specificity. For children with persistent high fever who are in the epidemic age and season, the adenovirus etiology detection, blood routine, cytokines, T cell subsets and imaging examinations are suggested. Children with early manifestations of infiltration of lung segment and lobar parenchyma, obvious emphysema, interstitial pneumonia or a large amount of pleural effusion should be alerted to have severe adenovirus pneumonia. This article reviews the epidemiological characteristics and risk factors of adenovirus pneumonia in different seasons, regions and serology, and the laboratory findings and imaging features of severe adenovirus pneumonia, which would be helpful for the early identification of the disease.

PMID:
31901033
[Indexed for MEDLINE]
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6.
Medicine (Baltimore). 2020 Jan;99(1):e18613. doi: 10.1097/MD.0000000000018613.

Fever after varus derotational osteotomy is common, but not a risk factor for infection.

Author information

1
Children's Orthopedic Center, Children's Hospital Los Angeles.
2
Children's Bone and Spine Surgery, Las Vegas, NV.
3
Keck School of Medicine, University of Southern California, Los Angeles, CA.

Abstract

Postoperative fever in pediatric patients following reconstructive hip surgery is of unknown significance. This study identifies the prevalence of postoperative fever after corrective hip surgery, its relationship to infection, and whether preventative use of anti-pyretics affects patient outcomes.Overall, 222 patients who underwent a varus derotational osteotomy (VDRO) between 11/1/2004 to 8/1/2014 with minimum 6 months follow up were retrospectively identified. Variables included diagnosis, inpatient stay, daily maximum temperature, duration of fever, fever workup, and administration of scheduled anti-pyretics. Fever was defined as temperature ≥38°C.In total, 123/222 (55.4%) and 70/222 (31.5%) had postoperative fevers of ≥38°C and ≥38.5°C, respectively. Average inpatient stay was 2.7 days postoperatively. Temperature (mean = 38.0°C) was greatest on postoperative day 1 (POD1), and 43.7% of patients had T ≥38°C on POD1. Anti-pyretics did not influence the duration of fever. Anti-pyretics on the day of surgery (POD0) did not influence the incidence of fever. Acetaminophen on POD0 significantly reduced likelihood of fever on POD1 (P = .02). Average length of fevers ≥38°C and 38.5°C were 8.4 and 4.2 hours, respectively. 3/18 (16.7%) fever workups administered were positive. Postoperative fever did not predict infection. 9/222 (4/1%) patients had postoperative infection - 5/123 (4.1%) with fever ≥38°C and 4/70 (5.7%) with fever ≥38.5°C. Rates of infection in patients with and without fevers were not significantly different (P = .97 for T ≥38°C and P = .38, for T ≥38.5°C).Though common, postoperative fever does not increase risk of infection. The low prevalence of positive cultures indicates routine fever workups can safely be avoided in most patients.Level of Evidence: III, retrospective comparative study.

PMID:
31895814
DOI:
10.1097/MD.0000000000018613
[Indexed for MEDLINE]
Free full text
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7.
FP Essent. 2020 Jan;488:25-34.

Urologic Conditions in Infants and Children: Urinary Tract Infection and Vesicoureteral Reflux.

Author information

1
LewisGale Medical Center Family Medicine Residency Program, 1900 Electric Rd Salem, VA 24153.

Abstract

Acute urinary tract infection (UTI) is among the most common bacterial infections in infants and children. Diagnosis requires evidence of infection and the presence of at least 50,000 colony-forming units (CFU)/mL of a pathogen cultured from an appropriately collected urine specimen. Febrile UTIs (ie, temperature 38°C [100.4°F] or greater) are most common during the first two years of life. Risk factors for UTI in febrile female infants are white race, age younger than 12 months, temperature 39°C (102.2°F) or greater, fever lasting 2 days or more, and absence of another source of infection. For febrile male infants, risk factors include being uncircumcised. If circumcised, risk factors include nonblack race, temperature 39°C (102.2°F) or greater, fever for more than 24 hours, and absence of another source of infection. Antibiotic treatment should be continued for 7 to 14 days. Renal and bladder ultrasonography is indicated for infants ages 2 to 24 months with a febrile UTI. If ultrasonography results are abnormal, a voiding cystourethrogram (VCUG) is indicated. VCUG also is indicated for children with recurrence of febrile UTI to identify vesicoureteral reflux and/or other anatomic findings associated with recurrent UTI. Recent studies have shown a statistically significant benefit of continuous antibiotic prophylaxis for prevention of recurrent UTI.

PMID:
31894953
[Indexed for MEDLINE]
8.
Zhongguo Zhong Yao Za Zhi. 2019 Sep;44(18):3890-3894. doi: 10.19540/j.cnki.cjcmm.20190121.002.

[Theoretical discussion and clinical application of treating the same syndrome with different methods in "treatise on febrile and miscellaneous diseases"].

[Article in Chinese]

Author information

1
Guang'anmen Hospital,China Academy of Chinese Medical Sciences Beijing 100053,China.
2
Guang'anmen Hospital,China Academy of Chinese Medical Sciences Beijing 100053,China Beijing University of Chinese Medicine Beijing 100029,China.

Abstract

The theory of " treating same syndrome with different methods" has been widely used in traditional Chinese medicine( TCM). It originated from Treatise on Febrile and Miscellaneous Diseases,and had objective formation factors. The " syndrome" in TCM was a comprehensive manifestation of etiology,characteristics,disease location and trend of disease. Considering the rich connotation of " syndrome",the diverse treatment methods,and the complex ingredients in prescriptions,different specific methods or prescriptions have been often applied to treat the same syndrome. Therefore,based on the theory of " treating same syndrome with different methods",the concept of " prescriptions corresponding to syndromes" was extended,suggesting one syndrome treated with several different prescriptions. Moreover,the concept of " prescription corresponding to syndrome" doesn't refer to a random match between the " syndrome" and the " prescription". Instead,it would refine and objectify the " same syndrome" and seek subtle differences in symptoms,signs and chemical indicators of different diseases and individuals. It further embodied the new diagnosis and treatment model of " pathogenesis combined with pathology,drug properties combined with pharmacology". As a result,the nature of " treating same syndrome with different methods" lies in different microscopic pathological changes or trends,which traditionally expressed as the same syndrome with different symptoms,the same syndrome with different trends,and the same syndrome with different diseases and the same syndrome with different physiques. Therefore,by enriching the connotation of " syndrome",and further defining its objective pathology and development trend,the correspondence between " syndrome" and " prescription" became more precise. By carefully identifying the different characterizations,trends and prognosis in same syndrome,medical practitioners could give individual and dynamic prescriptions,so as to improve the clinical efficacy.

KEYWORDS:

classic formula; clinical application; prescriptions corresponding to syndromes; treating same syndrome with different methods

[Indexed for MEDLINE]
9.
Zhongguo Zhong Yao Za Zhi. 2019 Sep;44(18):3876-3882. doi: 10.19540/j.cnki.cjcmm.20190117.001.

[Exploration of Chaige Jieji Decoction formula syndromes based on severe cases of critical care and its application for acute exogenous fever and nosocomial infection].

[Article in Chinese]

Author information

1
Guang'anmen Hospital,China Academy of Chinese Medical Sciences Beijing 100053,China.

Abstract

Chaige Jieji Decoction recorded in Six Books of Exogenous Febrile Disease could be used to treat exterior syndrome due to wind-cold and heat caused by stagnation. The indications of Chaige Jieji Decoction include acute exogenous febrile diseases,such as influenza,upper respiratory tract infection,nosocomial infection; symptoms and signs,such as headache,eye pain,orbital pain,dizziness; fever,cold and hot exchanges; dry mouth,thirst,cold drinks,bitter mouth,dry throat; dry nose,stuffy nose,runny nose; poor appetite,silent appetite; strong neck,stiff back; insomnia,difficulty in sleeping; cough and sputum; abdominal pain,limb twitching;slightly torrent pulse. Disease involving all three Yang channels is very common in acute exogenous febrile diseases; the pathogenesis of exogenous diseases is quite different between cases in South China and North China. Most of the exogenous diseases in North China involves all three Yang channels. Disease involving all three Yang channels is the core of the pathogenesis of Chaige Jieji Decoction syndrome,in which headache is the key indications. Chaige Jieji Decoction can not only treat exogenous diseases,but also treat nosocomial infections in critically ill patients during hospitalization. Although Chaige Jieji Decoction,Xiaochaihu-Maxing Shigan Decoction,and Xiaochaihu-Daqinglong Decoction could be used to treat disease involving all three Yang channels,there are differences in indicators among them.

KEYWORDS:

Chaige Jieji Decoction; Six Books of Exogenous Febrile Disease; critical care medicine; disease involving all three Yang channels; exogenous fever; nosocomial infection

[Indexed for MEDLINE]
10.
Zhongguo Zhong Yao Za Zhi. 2019 Sep;44(18):3869-3875. doi: 10.19540/j.cnki.cjcmm.20190416.503.

[Exploration of Mahuang Fuzi Xixin Decoction formula syndromes based on severe cases of critical care and its application for nosocomial infection in critical care medicine including hyperpyrexia after tracheotomy and severe pain accompanied by acute myocardial infarction and diabetic peripheral neuropathy].

[Article in Chinese]

Author information

1
Guang'anmen Hospital,China Academy of Chinese Medical Sciences Beijing 100053,China.

Abstract

Mahuang Fuzi Xixin Decoction recorded in Treatise on Febrile Diseases by Zhang Zhongjing in the Han Dynasty have been widely used in treating Yang deficiency and exogenous wind-cold syndrome by traditional Chinese medicine physicians for thousands of years. The indications of Mahuang Fuzi Xixin Decoction include bradyarrhythmia,sinus bradycardia,sick sinus node syndrome,senile exogenous,asthmatic cold,rhinitis,bronchial asthma,optic neuritis,optic atrophy,sudden blindness,sudden onset of cough,laryngeal obstruction,migraine,joint pain,low back pain,insomnia,shock,heart failure,renal failure,accompanied by fever or nosocomial infection,and hyperpyrexia after tracheotomy; dark complexion,chills,cold limbs,listlessness,fatigue,insomnia,lack of thirst,liking hot drinks,slightly swollen limbs or whole body,pale fat tongue,greasy fur,and deep pulse. Mahuang Fuzi Xixin Decoction is a potential drug for Shaoyin disease complicated with fever and pain. Tracheal intubation is an artificial ephedrine syndrome. It is necessary to distinguish Yin and Yang syndrome in treating hyperpyrexia after tracheotomy. However,it belongs to Yin syndrome,which could be treated by Mahuang Fuzi Xixin Decoction. Mahuang Fuzi Xixin Decoction is effective in the treatment of sick sinus syndrome,second degree atrioventricular block and third degree atrioventricular block. It can significantly alleviate symptoms,improve heart rate,and heart rhythm in a short period of time. However,after one year of drug withdrawal,the diseases may recur,indicating that Mahuang Fuzi Xixin Decoction may not improve the long-term prognosis of slow arrhythmia. Mahuang Fuzi Xixin Decoction is often used for fever or nosocomial infection in critical care medicine. In the treatment of critical care medicine complicated with high fever,Mahuang Fuzi Xixin Decoction is often taken continuously by stomach tube.

KEYWORDS:

Mahuang Fuzi Xixin Decoction; critical care medicine; diabetic peripheral neuropathy; hyperpyrexia; severe and migratory arthralgia; tracheotomy

[Indexed for MEDLINE]
11.
Acta Neurol Taiwan. 2019 Jun 15;28(2):52-56.

A Case of Fabry Disease Presenting with Young Stroke and Fever.

Author information

1
Department of Neurology, Pathology and Nephrology, Mennonite Christian Hospital, Hualien, Taiwan.

Abstract

Although it is known that Fabry disease should be included in the differential diagnosis of young stroke and fever of unknown origin, it has not been reported in the literature of stroke with fever as the presentation of Fabry disease. This is relevant because stroke with fever may misguide the differential diagnosis. Here we present a young stroke patient with fever. DWI of brain MRI revealed acute multiple infarctions. Due to the fever, infectious and inflammatory origins such as infective endocarditis and autoimmune diseases were examined first. However, we could not identify the source of fever after fever workup. The fever did not respond to one week of acetaminophen and antibiotics, but responded promptly to steroid. Our patient is also a case of de novo mutation rather than being inherited that further complicates the diagnosis of this patient. Because of the rare combined presentation of stroke with fever, Fabry disease should also be considered in stroke with fever, even without family history of Fabry disease.

PMID:
31867707
[Indexed for MEDLINE]
12.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2019 Dec;27(6):1845-1849. doi: 10.19746/j.cnki.issn.1009-2137.2019.06.022.

[Significance of Bone Marrow Unclassifiable Cells in Diagnosis of Fever of Unknown Origin].

[Article in Chinese; Abstract available in Chinese from the publisher]

Author information

1
Departement of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Provinc, China.
2
Departement of Internal Medicine, The Yuyang District Traditional Chinese Medical Hospital,Yulin 719000, Shaanxi Province, China.
3
Departement of infectious disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
4
Departement of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Provinc, China E-mail: 1084749721@qq.com.

Abstract

OBJECTIVE:

To investigate the clinical significance of bone marrow unclassifiable cells in diagnosis of fever of unknown origin(FUO).

METHODS:

The clinical data of 60 patients with FUO admitted in the first affiliated hospital of Xi'an Jiaotong university from June 2014 to May 2016 were collected, and 60 patients with FUO were divided into 2 group: group A(30 cases) in which the unclassifiable cells in bone marrow were observed by bone marrow examination, and group B(30 cases) in which the unclassifiable cells in bone marrow not were found by bone marrow examination. The clinical characteristics, bone marrow features, immunophenotypes of bone marrow cells and prognosis of patients in 2 groups were analyzed retrospectively.

RESULTS:

Out of 30 patients in group A, 18 were diagnosed as malignant tumors including 12 cases of lymphoma, while out of 30 patients in group B, 5 cases were diagnosed as malignant tumor, including 3 cases of lymphoma. For the patients with non-tumor diseases, the bone marrow unclassifiable cells disappeared after the patients condition was improved.

CONCLUSION:

The bone marrow examination including the smear and biopsy shonld be performed routinely for the patients with FUO. If the unclassifiable cells are observed morphologically in bone marrow of patients with FUO, the disease of patients should be considered as malignant tumor, especially, lymphoma.

[Indexed for MEDLINE]
13.
Harefuah. 2019 Dec;158(12):787-788.

[A CLINICAL DISCUSSION: FEVER OF UNKNOWN ORIGIN IN THE MODERN ERA - MORE QUESTIONS THAN ANSWERS].

[Article in Hebrew]

Author information

1
The Rheumatology Unit, and Internal Medicine Ward F, Sheba Medical Center, Tel-Hashomer, Israel.
2
Laboratory of FMF, Amyloidosis and Rare Autoinflammatory Diseases, Sheba Medical Center, Tel Hashomer, Israel.

Abstract

In this case report we discuss a patient who suffers from recurrent bouts of fever and as part of the clinical workup for autoinflammatory diseases was genetically tested for mutations in 26 genes related to autoinflammatory disease with a next generation sequencing test. We discuss the benefits and pitfalls of using this test.

PMID:
31823531
[Indexed for MEDLINE]
14.
Pol Merkur Lekarski. 2019 Nov 29;47(281):187-189.

Dyspnoe, cough and fever in 80-year old patient with chronic heart failure.

Author information

1
Medical University of Warsaw: Student Scientific Group "Pressor", Department of Internal Medicine, Hypertension and Angiology.
2
Medical University of Warsaw: 2Department of Internal Medicine, Hypertension and Angiology.

Abstract

The prevalence of heart failure (HF) in developed countries exceeds 10% in adults over 70 year old. At the following report we aim to present a case of HF worsening complicated by gout attack.

CASE REPORT:

80-year old patient was admitted to the hospital, with the suspicion of pneumonia, because of 3-day history of dyspnoe, cough and fever. Patient reported redness, swelling and pain in the area of left elbow. Prior to admission patient was diagnosed with bursitis and treated with antibiotic without symptoms resolution. There was past medical history of atrial fibrillation, hypertension, intermittent claudication, COPD. One month before, patient was hospitalized due to HF worsening. Diuretics' dosage was increased at that time and symptoms resolved. On admission: blood pressure 145/88 mm Hg, HR 96/min irregular, saturation O2 88% without oxygen therapy. On physical examination, bilateral pulmonary crackles, redness, tenderness of left elbow were found. Laboratory tests demonstrated elevated parameters of inflammation - leukocytosis 13.4G/L, neutrophilia 11G/L, CRP 142.5 mg/L, but normal procalcitonin 0.27 ng/ml. Moreover, high NTproBNP 8573 pg/ml and hyperuricemia 13.1 mg/dl were detected. Chest X-ray indicated pulmonary venous congestion. ECG revealed atrial fibrillation with QRS rate of 100/min, left axis deviation. Therefore, gout attack was diagnosed and after colchicine administration symptoms resolved quickly.

CONCLUSIONS:

Clinical signs including fever, elevated parameters of inflammation and dyspnoe justify pneumonia consideration in differential diagnosis. Importantly, non-infectious causes of inflammatory conditions, like gout must be also considered. Patients with HF often develop hyperuricemia due to diuretic treatment, aggravated catabolism and often co-prevalent chronic kidney disease.

KEYWORDS:

diuretics; elbow joint; gout attack; heart failure; hyperuricemia

PMID:
31812973
[Indexed for MEDLINE]
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15.
Malawi Med J. 2018 Dec;30(4):276-282. doi: 10.4314/mmj.v30i4.11.

A cross sectional study of dengue virus infection in febrile patients presumptively diagnosed of malaria in Maiduguri and Jos plateau, Nigeria.

Author information

1
Department of Medical Microbiology, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria.
2
WHO National Polio/Infectious and tropical Diseases Laboratory, University of Maiduguri Teaching hospital, Maiduguri, Nigeria.
3
Infectious Diseases/Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, PMB 01129, Ituku/Ozalla, Enugu, Nigeria.
4
Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria.
5
Department of Medical Microbiology, Ben Carson School of Medicine, Babcock University, Ogun State, Nigeria.
6
Department of Community Health, University of Jos, PMB 2084, Jos, Nigeria.

Abstract

Background:

In Nigeria, where malaria is endemic, greater than 70% of febrile illnesses are treated presumptively as malaria, often without a laboratory evaluation for other possible causes of fever. This cross-sectional study evaluated the presence of dengue virus infection in febrile patients, presumptively diagnosed of malaria infections in the clinic.

Methodology:

Blood samples were collected from 529 febrile patients (246 in Jos and 283 in Maiduguri) attending the general outpatient clinics of the Jos University Teaching Hospital (JUTH) and the University of Maiduguri Teaching Hospital (UMTH) and tested for anti-dengue immunoglobulin M (IgM) and immunoglobulin G (IgG), as well as anti-non-structural protein (NS1) by ELISA. The samples were also evaluated for presence of P. falciparum malaria parasites by microscopic examination of Giemsa-stained blood smears.

Results:

The prevalence of confirmed, highly suggestive and probable dengue virus infections categorized in relation to duration of illness since onset of fever were 2.3%, 5.5% and 1.5% respectively, while the prevalence of anti-flavivirus IgG and IgM seropositivity was 11.7%. In a total of 117 (22.1%) patients (32 in Jos, 85 in Maiduguri), malaria parasites were detected by blood smear microscopy, out of which 7 (6%) also had a positively confirmed, highly suggestive or probable dengue test result.

Conclusion:

Although the high cross-reactivity of anti-flavivirus antibodies should be taken into account in the interpretation of the seroprevalence data, our findings suggest a significant presence of dengue virus in this environment, some of which may otherwise be misdiagnosed as malaria. These findings are strong enough to recommend serological screening for anti-dengue virus titer and NS1 antigen for all febrile patients, as part of fever diagnostic protocols in tropical regions. Given the prevalence of dengue virus infections, there is also a need for a dengue control program and public education to prevent outbreaks and occurrence of severe dengue complications.

KEYWORDS:

Dengue; Febrile illness; Jos; Maiduguri; Malaria; Nigeria

PMID:
31798807
PMCID:
PMC6863422
DOI:
10.4314/mmj.v30i4.11
[Indexed for MEDLINE]
Free PMC Article
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16.
Afr J Reprod Health. 2019 Sep;23(3):30-41. doi: 10.29063/ajrh2019/v23i3.3.

Factors Associated with Postpartum Health Problems among Married Women of Reproductive Age in the Democratic Republic of the Congo: A Cross-sectional Study in Kenge City.

Author information

1
Department of Health Administration, Graduate School, Yonsei University, Wonju, Korea.
2
Yonsei Global Health Center, Yonsei University, Wonju, Korea.
3
Department of Nursing, Gangneung-Wonju National University, Wonju, Korea.
4
Graduate School of Public Health, Kinshasa University, Kinshasa, Democratic Republic of the Congo.

Abstract

Maternal mortality is attracting attention worldwide, but maternal health problems after delivery have received less attention. Most studies focus on prenatal maternal health problems. We aimed to identify factors associated with postpartum health problems among married women of reproductive age in Democratic Republic of the Congo. We employed a cross-sectional study design and randomly enrolled 700 married women of reproductive age in Kenge city. Data collection instrument was developed using the UNICEF Multiple Indicator Cluster Survey. T-test, chi-square test, and binary logistic regression analysis were performed using the SPSS version 24.0. Significant risk factors associated with postpartum health problems were initial postnatal care period; within 24 hours (Odds Ratio [OR]=2.197, 95% confidence interval [CI]: [1.156-4.174], p=.016); within 7 days (OR=1.972, 95% CI: [1.102-3.528, p=.022]; within 14 days (OR=2.124, 95% CI: [1.082-4.172], p=.029) among reproductive health and health service utilization characteristics. Health education by RECO (Relais Cmunataure) was associated with postpartum health problems including PCIME (Prise en Charge Integree des Maladies de l'Enfant; OR=1.845, 95% CI: [1.038- 3.282], p=.037); hand washing (OR=1.897, 95% CI: [1.060-3.396], p=.031); malaria (OR=2.003, 95% CI: [1.192-3.366], p=.009) among Maternal and Child Health intervention characteristics. In conclusion, it is necessary to develop and promote health policies and educational programs focusing on PNC service within 24 hours, PNC services within 7 days, PCIME, hand washing, prevention of malaria.

KEYWORDS:

Democratic Republic of the Congo; Health education; Maternal health; Postnatal care; Postpartum Health Problem

PMID:
31782629
DOI:
10.29063/ajrh2019/v23i3.3
[Indexed for MEDLINE]
18.
Rev Assoc Med Bras (1992). 2019 Nov 7;65(10):1308-1313. doi: 10.1590/1806-9282.65.10.1308. eCollection 2019.

Fever of unknown origin in special groups.

Author information

1
. Discente de Medicina na Universidade Federal do Vale do São Francisco (UNIVASF), Petrolina, PE, Brasil.
2
. Médica formada pela UNIVASF, Petrolina, PE, Brasil.
3
. Médico Infectologista. Professor MSC efetivo da disciplina de Infectologia da UNIVASF, Petrolina, PE, Brasil.
4
. Médico Hematologista. Preceptor da Residência Médica de Clínica Médica do Hospital Universitário da Unifasf. Professor efetivo das disciplinas de Doenças hematológicas e de Oncologia da UNIVASF, Petrolina, PE, Brasil.
5
. Médica Reumatologista. Preceptora da Residência Médica de Clínica Médica do Hospital Universitário da UNIVASF. Professora efetiva da disciplina de Reumatologia da UNIVASF, Petrolina, PE, Brasil.
6
. Médico Nefrologista. Preceptor da Residência Médica de Clínica Médica do Hospital Universitário da UNIVASF. Professor MSC efetivo da disciplina de Medicina de Urgência da UNIVASF, Petrolina, PE, Brasil.

Abstract

Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.

PMID:
31721964
DOI:
10.1590/1806-9282.65.10.1308
[Indexed for MEDLINE]
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19.
Kyobu Geka. 2019 Nov;72(12):1034-1037.

[Bronchogenic Cyst with Rapid Increase and Emergency Operation;Report of a Case].

[Article in Japanese]

Author information

1
Department of Chest Surgery, Nagano Municipal Hospital, Nagano, Japan.

Abstract

A 21-year-old man was admitted with fever and back pain. Chest computed tomography(CT) showed a cystic mass of 7×6 cm in the right middle mediastinum. After 3 days, symptoms worsen, and chest X-ray revealed the enlargement of the cyst, and an emergent operation was performed. Since the tumor was severely adhered to the superior vena cava and the azygous vein, the cystic mass was partially resected. The pathological diagnosis was bronchogenic cyst.

PMID:
31701917
[Indexed for MEDLINE]
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20.

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