Fever of Unknown Origin
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Hepatitis B Patient with Fever Due to Focal Infection
DOI: 10.5272/jimab.2012184.251 Journal of IMAB - Annual Proceeding (Scientific Papers) 2012, vol. 18, book 4 HEPATITIS B PATIENT WITH FEVER DUE TO FOCAL INFECTION Assya Krasteva*, Dobriana Panova**, Krasimir Antonov**, Angelina Kisselova* * Department of Imaging and Oral Diagnostic, Faculty of Dental Medicine, ** Clinic of gastroenterology, “St. Ivan Rilski” University Hospital, Medical University - Sofia, Bulgaria. ABSTRACT enzymes, CRP and albumin returned to normal after Persistent undiagnosed fever remains a common performance of dental recommendations. problem in clinical practice. It is a fact that dental sepsis Key words: fever, focal infection, dental sepsis is one potential cause of persistent fever that can escape detection (Siminoski, K., 1993). INTRODUCTION We present a 50 years old woman with chronic Adult patients frequently visit physicians with date hepatitis B, febrile for the past two months (max. 38.60C) of persistent fever and the cause of the fever sometimes with characteristic of septic fever. She underwent cannot be found. consultations with endocrinologist, rheumatologist, The definition of fever of unknown origin (FUO), as neurologist, gynecologist, pulmonologist and infectionst. All based on a case series of 100 patients, is defined as a negative for any disease, also negative serology for Lyme temperature higher than 38.3 C (100.9 F) that lasts for more disease. She had no data for urine infection. She had than three weeks with no obvious source despite appropriate negative cultures. The patient was treated with investigation (Roth, A., 2003), and evaluation of at least 3 corticosteroids for 30 days with no effect; she had no outpatient visits or 3 days in hospital (Durack, DT.,1991). -
Drug Prescribing for Dentistry Dental Clinical Guidance
Scottish Dental Clinical Effectiveness Programme SDcep Drug Prescribing For Dentistry Dental Clinical Guidance Second Edition August 2011 Scottish Dental Clinical Effectiveness Programme SDcep The Scottish Dental Clinical Effectiveness Programme (SDCEP) is an initiative of the National Dental Advisory Committee (NDAC) and is supported by the Scottish Government and NHS Education for Scotland. The programme aims to provide user-friendly, evidence-based guidance for the dental profession in Scotland. SDCEP guidance is designed to help the dental team provide improved care for patients by bringing together, in a structured manner, the best available information that is relevant to priority areas in dentistry, and presenting this information in a form that can interpreted easily and implemented. ‘Supporting the dental team to provide quality patient care’ Scottish Dental Clinical Effectiveness Programme SDcep Drug Prescribing For Dentistry Dental Clinical Guidance Second Edition August 2011 Drug Prescribing For Dentistry © Scottish Dental Clinical Effectiveness Programme SDCEP operates within NHS Education for Scotland. You may copy or reproduce the information in this document for use within NHS Scotland and for non-commercial educational purposes. Use of this document for commercial purpose is permitted only with written permission. ISBN 978 1 905829 13 2 First published 2008 Second edition published August 2011 Scottish Dental Clinical Effectiveness Programme Dundee Dental Education Centre, Frankland Building, Small’s Wynd, Dundee DD1 -
Clinical Characteristics and Outcomes of Paediatric Orbital Cellulitis in Hospital Universiti Sains Malaysia: a Five-Year Review
Singapore Med J 2020; 61(6): 312-319 Original Article https://doi.org/10.11622/smedj.2019121 Clinical characteristics and outcomes of paediatric orbital cellulitis in Hospital Universiti Sains Malaysia: a five-year review Ismail Mohd-Ilham1,2, MBBS, MMed, Abd Bari Muhd-Syafi1,2, MBBS, Sonny Teo Khairy-Shamel1,2, MD, MMed, Ismail Shatriah1,2, MD, MMed INTRODUCTION Limited data is available on paediatric orbital cellulitis in Asia. We aimed to describe demographic data, clinical presentation, predisposing factors, identified microorganisms, choice of antibiotics and management in children with orbital cellulitis treated in a tertiary care centre in Malaysia. METHODS A retrospective review was performed on children with orbital cellulitis aged below 18 years who were admitted to Hospital Universiti Sains Malaysia, Kelantan, Malaysia, between January 2013 and December 2017. RESULTS A total of 14 paediatric patients fulfilling the diagnostic criteria for orbital cellulitis were included. Their mean age was 6.5 ± 1.2 years. Boys were more likely to have orbital cellulitis than girls (71.4% vs. 28.6%). Involvement of both eyes was observed in 14.3% of the patients. Sinusitis (28.6%) and upper respiratory tract infection (21.4%) were the most common predisposing causes. Staphylococcus aureus (28.6%) was the leading pathogen. Longer duration of hospitalisation was observed in those infected with methicillin-resistant Staphylococcus aureus and Burkholderia pseudomallei. 10 (71.4%) patients were treated with a combination of two or three antibiotics. In this series, 42.9% had surgical interventions. CONCLUSION Young boys were found to be more commonly affected by orbital cellulitis than young girls. -
Patients Diagnosed with Infective Endocarditis: a Retrospective Chart Review
Patients Diagnosed with Infective Endocarditis: A Retrospective Chart Review Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Chloe A. Wong, DMD Graduate Program in Dentistry The Ohio State University 2020 Thesis Committee Ashok Kumar DDS, MS, Advisor Paul Casamassimo, DDS, MS Daniel Claman, DDS John Kovalchin, MD William Hunt, MD Copyrighted by Chloe A. Wong DMD 2020 2 Abstract Purpose: To describe characteristics and associations of risk factors for patients admitted to Nationwide Children’s Hospital (NCH) for infective endocarditis (IE), and to provide a descriptive overview of IE in a representative U.S. children’s hospital. Methods: A retrospective chart review of electronic medical records from January 1, 2008 to January 1, 2020 of patients who met the modified Duke criteria for definite or possible IE. Study variables include demographics, medical and cardiac history, predisposing conditions and risk factors, bacterial isolates, hospital course, treatment, complications, and dental history. Results: Initial search query found 242 patients. 67 patients met inclusion criteria. 69% had an underlying cardiac condition. S. aureus and viridans streptococcus were most common. Age was significantly associated with presence of intracardiac hardware. The mean length of hospital stay was 25 days and the mortality rate was 9%. 32% patients had a dental consult during admission. Conclusion: Increased survival of children with significant heart conditions increases the likelihood of them becoming pediatric dental patients. Occurrence of IE in healthy children and the questioning of IE association with dental procedures suggest further research is needed. -
The Diagnosis & Management of Skin & Soft Tissue Infection
THE DIAGNOSIS & MANAGEMENT OF SKIN & SOFT TISSUE INFECTION 7th December 2020 7th December 2022 Version History Version Status Date Editor Description 1.0 Final 7th December 2020 Guidelines Team Version for Publication. Citation Suggested citation style: Ministry of Public Health Qatar. National Clinical Guideline: The Diagnosis and Management of Skin and Soft Tissue Infection (2020). Abbreviations The abbreviations used in this guideline are as follows: ART Antiretroviral Therapy BIT Burrow Ink Test CA-MRSA Community-Associated Methicillin-Resistant Staphylococcus aureus CT Computed Tomography EPSD Epidermal Parasitic Skin Diseases FGSI Fournier’s Gangrene Severity Index HIV Human Immunodeficiency Virus HrCLM Hookworm-Related Cutaneous Larva Migrans LRINEC Laboratory Risk Indicator for Necrotising Fasciitis MMR Measles-Mumps-Rubella MCV Molluscum Contagiosum Virus MMRV Measles-Mumps-Rubella-Varicella MRI Magnetic Resonance Imaging MRSA Methicillin-Resistant Staphylococcus aureus MSSA Methicillin-Sensitive Staphylococcus aureus NSAID Non-Steroidal Anti-Inflammatory Drug S. aureus Staphylococcus aureus S. pyogenes Streptococcus pyogenes SSTIs Skin and Soft-Tissue Infections VZV Varicella Zoster Virus The Diagnosis and Management of Skin and Soft Tissue Infection (Date of next revision: 7th December 2022) 2 Table of Contents 1 Information about this Guideline ........................................................................................................... 6 1.1 Objective and Purpose of the Guideline ....................................................................................... -
Overview of Fever of Unknown Origin in Adult and Paediatric Patients L
Overview of fever of unknown origin in adult and paediatric patients L. Attard1, M. Tadolini1, D.U. De Rose2, M. Cattalini2 1Infectious Diseases Unit, Department ABSTRACT been proposed, including removing the of Medical and Surgical Sciences, Alma Fever of unknown origin (FUO) can requirement for in-hospital evaluation Mater Studiorum University of Bologna; be caused by a wide group of dis- due to an increased sophistication of 2Paediatric Clinic, University of Brescia eases, and can include both benign outpatient evaluation. Expansion of the and ASST Spedali Civili di Brescia, Italy. and serious conditions. Since the first definition has also been suggested to Luciano Attard, MD definition of FUO in the early 1960s, include sub-categories of FUO. In par- Marina Tadolini, MD Domenico Umberto De Rose, MD several updates to the definition, di- ticular, in 1991 Durak and Street re-de- Marco Cattalini, MD agnostic and therapeutic approaches fined FUO into four categories: classic Please address correspondence to: have been proposed. This review out- FUO; nosocomial FUO; neutropenic Marina Tadolini, MD, lines a case report of an elderly Ital- FUO; and human immunodeficiency Via Massarenti 11, ian male patient with high fever and virus (HIV)-associated FUO, and pro- 40138 Bologna, Italy. migrating arthralgia who underwent posed three outpatient visits and re- E-mail: [email protected] many procedures and treatments before lated investigations as an alternative to Received on November 27, 2017, accepted a final diagnosis of Adult-onset Still’s “1 week of hospitalisation” (5). on December, 7, 2017. disease was achieved. This case report In 1997, Arnow and Flaherty updated Clin Exp Rheumatol 2018; 36 (Suppl. -
Dental Abscess: Primary and Permanent Teeth ______Ears, Eyes, Nose, Throat and Mouth
Dental Abscess: Primary and Permanent Teeth _____________________________ Ears, Eyes, Nose, Throat and Mouth Clinical Decision Tool for RNs with Effective Date: December 1, 2019 Authorized Practice [RN(AAP)s] Review Date: December 1, 2022 Background Dental abscess is an acute infection of the teeth or the structures supporting the teeth and/or gums. Twenty primary teeth typically erupt between six months and two years of age (Stephens, Wiedemer, & Kushner, 2018). The typical adult has 32 permanent teeth which begin to erupt at about age six with the process complete by age 18 (Stephens et al., 2018). Dental abscesses are the result of untreated dental caries (Stephens et al., 2018). There are two types of dental abscess including apical and periodontal (Robertson, Keys, Rautemaa-Richardson, Burns, & Smith, 2015). Apical abscesses are the most common and originate in the dental pulp (Robertson et al., 2015). Periodontal abscesses originate in the supporting structure of the teeth, between teeth and gums, and are usually a result of chronic periodontitis (Robertson et al., 2015). Most commonly dental abscesses are caused by a combination of oral streptococci (especially the Streptococcus anginosus group), and strict anaerobes (such as anaerobic streptococci, Prevotella species, and Fusobacterium species) (Robertson et al., 2015; Troeltzsch et al., 2015). Immediate Consultation Requirements The RN(AAP) should seek immediate consultation from a physician/NP when any of the following circumstances exist: ● gingival or facial cellulitis -
The Diagnostic Approach to Fever of Unknown Origin in Cats*
3 CE CREDITS CE Article 2 The Diagnostic Approach to Fever of Unknown Origin in Cats* ❯❯ Julie Flood, DVM, DACVIM Abstract: Identifying the cause of fever of unknown origin (FUO) in cats is a diagnostic challenge, Antech Diagnostics just as it is in dogs. Infection is the most common cause of FUO in cats. As in dogs, the diagnostic Irvine, California workup can be frustrating, but most FUO causes can eventually be determined. This article address- es the potential diagnostic tests for, and the differential diagnosis and treatment of, FUO in cats. rue fever (pyrexia) is defined as an during the initial workup or responds to increase in body temperature due to antibiotic treatment; therefore, most cats T an elevation of the thermal set point do not have a true FUO.4 in the anterior hypothalamus secondary to the release of pyrogens.1 With hyperther- Differential Diagnosis mic conditions other than true fever, the Information regarding FUO in cats is hypothalamic set point is not adjusted.1 extremely limited, and there are no retro- At a Glance Nonfebrile hyperthermia occurs when heat spective studies. Fevers are common in cats, gain exceeds heat loss, such as with inade- and most diseases associated with FUO Differential Diagnosis quate heat dissipation, exercise, and patho- in cats are infectious.5 Neoplasia is a less Page 26 logic or pharmacologic causes.1 common cause of FUO in cats, and FUO Clinical Approach Cats with true fever typically have body due to immune-mediated disease is rare in Page 26 temperatures between 103°F and 106°F cats.6 FUO causes are often separated into Potential Causes of Fever (39.5°C to 41.1°C).2 Cats are less likely than groups based on the underlying disease of Unknown Origin in Cats dogs to succumb to the dangerous effects mechanism.2,3,7 Most FUOs are caused by a Page 27 of body temperatures greater than 106°F, common disease presenting in an obscure 8 Staged Diagnostic which are usually seen with nonfebrile fashion. -
Fever of Unknown Origin (FUO) Clinical Presentation Updated: Mar
Fever of Unknown Origin (FUO) Clinical Presentation Updated: Mar 20, 2017 Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD Sandra G Gompf, MD, FACP, FIDSA Associate Professor of Infectious Diseases and International Medicine, University of South Florida College of Medicine; Chief, Infectious Diseases Section, Director, Occupational Health and Infection Control Programs, James A Haley Veterans Hospital Sandra G Gompf, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center Charles V Sanders, MD is a member of the following medical societies: American College of Physicians, Alliance for the Prudent Use of Antibiotics, The Foundation for AIDS Research, Southern Society for Clinical Investigation, Southwestern Association of Clinical Microbiology, Association of Professors of Medicine, Association for Professionals in Infection -
Fever of Unknown Origin in Childhood: Difficulties in Diagnosis
Annals of the Rheumatic Diseases 1994; 53: 429-433 429 MASTERCLASS Ann Rheum Dis: first published as 10.1136/ard.53.7.429 on 1 July 1994. Downloaded from Fever of unknown origin in childhood: difficulties in diagnosis Katherine Martin, E Graham Davies, John S Axford Case report (CRP) 208 mg/I. Liver function tests were A twelve year old white boy presented to abnormal: alanine transaminase 91 IUAL another hospital with a two month history of (normal range 1-40), gamma glutamyl intermittent fever with night sweats, general transferase 134 IUAL (normal range 0-60), malaise, arthralgia and myalgia. He had bilirubin 18 micromolVL (0-17), alkaline marked cervical lymphadenopathy. Latex phosphatase 217 IU/L (30-100) and albumin agglutination for toxoplasma antibodies was 18 g/l (35-45). Renal impairment was apparent positive at a dilution of 1/128. A diagnosis of with a raised serum creatinine (224 micromol/ acquired toxoplasmosis was made and sulpha- L (60-110)). Chest radiograph showed right diazine 1 g four times a day, trimethoprim 300 middle lobe consolidation. Abdominal mg twice a day and folinic acid 15 mg ultrasound scan (USS) confirmed hepato- alternative days, were started. Over the next splenomegaly and ascites. Echocardiogram week he developed a generalised urticarial rash, showed a small pericardial effusion. peripheral oedema and profuse bloody A diagnosis of Stevens-Johnson syndrome diarrhoea and was referred to our unit. with acute renal failure and disseminated On examination he was delirious with a intravascular coagulation (DIC) was made. persistent fever of up to 42°C and he was Supportive therapy, broad spectrum anti- bleeding from his nose and mouth. -
Dermatological Indications of Disease - Part II This Patient on Dialysis Is Showing: A
“Cutaneous Manifestations of Disease” ACOI - Las Vegas FR Darrow, DO, MACOI Burrell College of Osteopathic Medicine This 56 year old man has a history of headaches, jaw claudication and recent onset of blindness in his left eye. Sed rate is 110. He has: A. Ergot poisoning. B. Cholesterol emboli. C. Temporal arteritis. D. Scleroderma. E. Mucormycosis. Varicella associated. GCA complex = Cranial arteritis; Aortic arch syndrome; Fever/wasting syndrome (FUO); Polymyalgia rheumatica. This patient missed his vaccine due at age: A. 45 B. 50 C. 55 D. 60 E. 65 He must see a (an): A. neurologist. B. opthalmologist. C. cardiologist. D. gastroenterologist. E. surgeon. Medscape This 60 y/o male patient would most likely have which of the following as a pathogen? A. Pseudomonas B. Group B streptococcus* C. Listeria D. Pneumococcus E. Staphylococcus epidermidis This skin condition, erysipelas, may rarely lead to septicemia, thrombophlebitis, septic arthritis, osteomyelitis, and endocarditis. Involves the lymphatics with scarring and chronic lymphedema. *more likely pyogenes/beta hemolytic Streptococcus This patient is susceptible to: A. psoriasis. B. rheumatic fever. C. vasculitis. D. Celiac disease E. membranoproliferative glomerulonephritis. Also susceptible to PSGN and scarlet fever and reactive arthritis. Culture if MRSA suspected. This patient has antithyroid antibodies. This is: • A. alopecia areata. • B. psoriasis. • C. tinea. • D. lichen planus. • E. syphilis. Search for Hashimoto’s or Addison’s or other B8, Q2, Q3, DRB1, DR3, DR4, DR8 diseases. This patient who works in the electronics industry presents with paresthesias, abdominal pain, fingernail changes, and the below findings. He may well have poisoning from : A. lead. B. -
South Central Antimicrobial Network Guidelines for Antibiotic Prescribing in the Community 2018
South Central Antimicrobial Network Guidelines for Antibiotic Prescribing in the Community 2018 Adapted from the Public Health England (PHE) and British Infection Association Management of Infection Guidance for Primary Care by the South Central Antimicrobial Network Group (SCAN) In conjunction with all WESSEX CCGs, Berkshire East, Berkshire West, Surrey Heath, Coastal West Sussex and Oxfordshire CCG Index Foreword 3 n Recurrent UTI in Non-Pregnant n Threadworms 50 Guideline Development Group 5 Women – Prophylaxis 29 n Cholecystitis 51 Aims, Implications, Principles 7 n Acute Pyelonephritis (Upper UTI) 30 Skin & Soft tissue Infections Risk Assessment 9 Genital Tract Conditions n Impetigo 53 Sepsis Screening 11 n Criteria for referring patients to n Scabies 54 Ear, Nose and Throat Infections specialist care 31 n Eczema 55 n Acute Sore Throat 13 n Vulvovaginal Candidiasis 32 n Acne Vulgaris 56 n Fever Pain 14 n Bacterial Vaginosis 33 n Acne Rosacea 57 n Acute Otitis Media (AOM) 15 n Chlamydia Trachomatis 34 n Cellulitis 58 n Acute Otitis Externa 16 n Trichomoniasis 35 n Leg Ulcers 59 n Acute Rhinosinusitis 17 n Pelvic Inflammatory Disease (PID) 36 n Diabetic Foot Ulcer 60 n Oral Candidiasis 18 n Acute Prostatitis 37 n MRSA (meticillin-resistant n Balanitis 38 Staphylococcus aureus) 61 Respiratory Tract Infections n Epididymo-Orchitis 39 n Animal Bite 62 n Acute Cough, Bronchitis 19 n Genital Herpes 40 n Human Bite 63 n Influenza 20 n Insect bites 64 n Bartholin’s Cyst, Post Top n COPD Acute Exacerbation 21 Endometritis, Gonorrhoea 41 n Fungal Infection – Skin 65 n Community-Acquired Pneumonia (CAP) 22 n Fungal Infection – Fingernail or Toenail 66 Gastro-intestinal Infections Central Nervous System n Varicella Zoster (chicken pox), n Eradication of Helicobacter pylori 43 n Meningitis or Suspected Herpes Zoster (shingles) & Cold Sores 67 n Eradication of Helicobacter pylori cont.