DOCSLIB.ORG

Evaluation of Unexplained Lymphadenopathy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Unexplained Lymphadenopathy: Evaluation and Differential Diagnosis HEIDI L. GADDEY, MD, and ANGELA M. RIEGEL, DO, Ehrling Bergquist Family Medicine Residency Program, Offutt Air Force Base, Nebraska Lymphadenopathy is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoim- mune disorders, as well as medications and iatrogenic causes. The history and physical examination alone usually identify the cause of lymphadenopathy. When the cause is unknown, lymphadenopathy should be classified as local- ized or generalized. Patients with localized lymphadenopathy should be evaluated for etiologies typically associated with the region involved according to lymphatic drainage patterns. Generalized lymphadenopathy, defined as two or more involved regions, often indicates underlying systemic disease. Risk factors for malignancy include age older than 40 years, male sex, white race, supraclavicular location of the nodes, and presence of systemic symptoms such as fever, night sweats, and unexplained weight loss. Palpable supraclavicular, popliteal, and iliac nodes are abnormal, as are epitrochlear nodes greater than 5 mm in diameter. The workup may include blood tests, imaging, and biopsy depend- ing on clinical presentation, location of the lymphadenopathy, and underlying risk factors. Biopsy options include fine-needle aspiration, core needle biopsy, or open excisional biopsy. Antibiotics may be used to treat acute unilateral cervical lymphadenitis, especially in children with systemic symptoms. Corticosteroids have limited usefulness in the management of unexplained lymphadenopathy and should not be used without an appropriate diagnosis. (Am Fam Physician. 2016;94(11):896-903. Copyright © 2016 American Academy of Family Physicians.) CME This clinical content ymphadenopathy refers to lymph associated symptoms, and location (localized conforms to AAFP criteria nodes that are abnormal in size vs. generalized). Table 2 lists common his- for continuing medical 2 education (CME). See (e.g., greater than 1 cm) or con- torical clues and their associated diagnoses. CME Quiz Questions on sistency. Palpable supraclavicular, Other historical questions include asking page 868. Lpopliteal, and iliac nodes, and epitrochlear about time course of enlargement, tender- Author disclosure: No rel- nodes greater than 5 mm, are considered ness to palpation, recent infections, recent evant financial affiliations. abnormal. Hard or matted lymph nodes may immunizations, and medications.4 suggest malignancy or infection. In primary care practice, the annual incidence of unex- AGE AND DURATION plained lymphadenopathy is 0.6%.1 Only About one-half of otherwise healthy chil- 1.1% of these cases are related to malignancy, dren have palpable lymph nodes at any one but this percentage increases with advancing time.4 Most lymphadenopathy in children is age.1 Cancers are identified in 4% of patients benign or infectious in etiology. In adults and 40 years and older who present with unex- children, lymphadenopathy lasting less than plained lymphadenopathy vs. 0.4% of those two weeks or greater than 12 months without younger than 40 years.1 Etiologies of lymph- change in size has a low likelihood of being adenopathy can be remembered with the neoplastic.2,5 Exceptions include low-grade MIAMI mnemonic: malignancies, infections, Hodgkin lymphomas and indolent non- autoimmune disorders, miscellaneous and Hodgkin lymphoma, although both typically unusual conditions, and iatrogenic causes have associated systemic symptoms.6 (Table 1).2,3 In most cases, the history and physical examination alone identify the cause. EXPOSURES Environmental, travel-related, animal, and History insect exposures should be ascertained. Factors that can assist in identifying the etiol- Chronic medication use, infectious expo- ogy of lymphadenopathy include patient age, sures, immunization status, and recent duration of lymphadenopathy, exposures, immunizations should be reviewed as well. 896Downloaded American from the Family American Physician Family Physician website at www.aafp.org/afp.www.aafp.org/afp Copyright © 2016 American AcademyVolume of Family 94, NumberPhysicians. 11 For ◆ theDecember private, noncom 1, 2016- mercial use of one individual user of the website. All other rights reserved. Contact [email protected] for copyright questions and/or permission requests. Unexplained Lymphadenopathy SORT: KEY RECOMMENDATIONS FOR PRACTICE Evidence Clinical recommendation rating References Ultrasonography should be used as the initial imaging modality for children up to 14 years C 15 presenting with a neck mass with or without fever. Computed tomography should be used as the initial imaging modality for children older than C 15 14 years and adults presenting with solitary or multiple neck masses. In children with acute unilateral anterior cervical lymphadenitis and systemic symptoms, empiric C 17 antibiotics that target Staphylococcus aureus and group A streptococci may be given. Corticosteroids should be avoided until a definitive diagnosis of lymphadenopathy is made because C 4 they could potentially mask or delay histologic diagnosis of leukemia or lymphoma. Fine-needle aspiration may be used to differentiate malignant from reactive lymphadenopathy. C 19-22 A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort. Table 3 lists medications commonly associ- drainage patterns, as well as common etiol- ated with lymphadenopathy.2 Tobacco and ogies of lymphadenopathy in these regions.2 alcohol use and ultraviolet radiation expo- A skin examination should be performed to sure increase concerns for neoplasm. An rule out other lesions that would point to occupational history that includes mining, malignancy and to evaluate for erythema- masonry, and metal work may elicit work- tous lines along nodal tracts or any trauma related etiologies of lymphadenopathy, such that could lead to an infectious source of as silicon or beryllium exposure. Asking the lymphadenopathy. Finally, abdomi- about sexual history to assess exposure to nal examination focused on splenomegaly, genital sores or participation in oral inter- although rarely associated with lymph- course is important, especially for ingui- adenopathy, may be useful for detecting nal and cervical lymphadenopathy. Finally, family history may identify familial causes of lymphadenopathy, such as Li-Fraumeni 2 Table 1. MIAMI Mnemonic for Differential Diagnosis syndrome or lipid storage diseases. of Lymphadenopathy ASSOCIATED SYMPTOMS Malignancies A thorough review of systems aids in iden- Kaposi sarcoma, leukemias, lymphomas, metastases, skin neoplasms tifying any red flag symptoms. Arthralgias, Infections muscle weakness, and rash suggest an auto- Bacterial: brucellosis, cat-scratch disease (Bartonella), chancroid, cutaneous immune etiology. Constitutional symptoms infections (staphylococcal or streptococcal), lymphogranuloma venereum, of fever, chills, fatigue, and malaise indicate primary and secondary syphilis, tuberculosis, tularemia, typhoid fever an infectious etiology. In addition to fever, Granulomatous: berylliosis, coccidioidomycosis, cryptococcosis, drenching night sweats and unexplained histoplasmosis, silicosis weight loss of greater than 10% of body Viral: adenovirus, cytomegalovirus, hepatitis, herpes zoster, human immuno- weight may suggest Hodgkin lymphoma or deficiency virus, infectious mononucleosis (Epstein-Barr virus), rubella non-Hodgkin lymphoma.2,3,6 Other: fungal, helminthic, Lyme disease, rickettsial, scrub typhus, toxoplasmosis Physical Examination Autoimmune disorders Overall state of health and height and Dermatomyositis, rheumatoid arthritis, Sjögren syndrome, Still disease, systemic lupus erythematosus weight measurements may help identify Miscellaneous/unusual conditions signs of chronic disease, especially in chil- Angiofollicular lymph node hyperplasia (Castleman disease), histiocytosis, 7 dren. A complete lymphatic examination Kawasaki disease, Kikuchi lymphadenitis, Kimura disease, sarcoidosis should be performed to rule out generalized Iatrogenic causes lymphadenopathy, followed by a focused Medications, serum sickness lymphatic examination with consideration of lymphatic drainage patterns. Figures 1 Information from references 2 and 3. through 3 demonstrate typical lymphatic December 1, 2016 ◆ Volume 94, Number 11 www.aafp.org/afp American Family Physician 897 Unexplained Lymphadenopathy infectious mononucleosis, lymphocytic leu- qualitative characteristics are unable to reli- kemias, lymphoma, or sarcoidosis.2,5 ably predict malignancy. Painful or tender lymphadenopathy is nonspecific and may NODAL CHARACTER AND SIZE represent possible inflammation caused The quality and size of lymph nodes should by infection, but it can also be the result of be assessed. Lymph node qualities include hemorrhage into a node or necrosis.3 No spe- warmth, overlying erythema, tenderness, cific nodal size is indicative of malignancy.3 mobility, fluctuance, and consistency. Shotty lymphadenopathy is the presence of multiple Localized Lymphadenopathy small lymph nodes that feel like “buck shots” HEAD AND CERVICAL under the skin.8 This usually implies reac- Head and neck lymphadenopathy can be tive lymphadenopathy from viral infection. classified as submental,
Recommended publications
  • A New Mother with Night Sweats

    A New Mother with Night Sweats

    MedicineToday PEER REVIEWED CLINICAL CASE REVIEW A new mother with night sweats Commentary by CASE SCENARIO JOHN EDEN MB BS, FRCOG, FRANZCOG, CREI Sally is a 35-year-old woman who presents for her three-monthly contraceptive injection of depot medroxyprogesterone. She mentions in passing that since the birth of her second child, A 35-year-old woman has been experiencing nine months previously, she has been experiencing night sweats three or four times a week. She has no obvious focus of infec- night sweats since the birth of her second tion, no pain and no other systemic symptoms, although she child nine months previously. says she often feels very tired. She also reports that she is still producing some breast milk despite having stopped breastfeed- MedicineToday 2013; 14(4): 67-68 ing six months previously. Sally recalls that about two years ago, before she conceived her second child, she was quite sick with an ‘ovarian infection’ and then an ectopic pregnancy. Sally’s pelvic ultrasound results are normal, as are the results of urine and blood tests, including a full blood count, erythrocyte sedimentation rate, C-reactive protein level, thyroid function and serum prolactin level. Her serum follicle-stimulating hormone and other reproductive hormone levels are in the normal range for the luteal phase of the menstrual cycle. Professor Eden is Associate Professor of Reproductive Endocrinology at the What could be causing Sally’s night sweats? University of New South Wales; Director of the Barbara Gross Research Unit at the Royal Hospital for Women and the University of New South Wales; COMMENTARY Director of the Women’s Health and Research Institute of Australia; and Hot flushes and sweats are not unusual in women who are having Director of the Sydney MenopauseCopyright _LayoutCentre and 1 Medical 17/01/12 Co-Director 1:43 PM of Pagethe 4 regular menstrual cycles, especially during the bleeding phase © ISTOCKPHOTO/LISA VALDER.
  • A Fatal Case of Necrotising Fasciitis of the Eyelid

    A Fatal Case of Necrotising Fasciitis of the Eyelid

    Br J Ophthalmol: first published as 10.1136/bjo.72.6.428 on 1 June 1988. Downloaded from British Journal of Ophthalmology, 1988, 72, 428-431 A fatal case of necrotising fasciitis of the eyelid R WALTERS From Southampton Eye Hospital, Wilton A venue, Southampton S09 4XW SUMMARY A fatal case of necrotising fasciitis in a 35-year-old man is described and the differential diagnosis and management discussed. Necrotising fasciitis is a potentially fatal skin were taken. The Gram stain revealed Gram-positive infection which is being increasingly recognised as an cocci. He was then treated with intravenous underdiagnosed condition. It requires prompt diag- cefotaxime and gentamicin and topical chlor- nosis, investigation, and treatment. Early surgical amphenicol and gentamicin drops. Because of the debridement is, in combination with suitable intra- poor visual acuity of the right eye it was thought that venous antibiotics, the mainstay of treatment. an orbital cellulitis could not be excluded despite the normal eye movements and absence of proptosis. He Case report was therefore transferred to the General Hospital under the care of an ear, nose, and throat consultant In December 1985 a previously fit 35-year-old factory in order to exclude underlying sinus disease and an manager was referred by his general practitioner to associated abscess. the Casualty Department of the Southampton Eye Skull x-rays (including sinus views) revealed no Hospital with a 12-hour history of increasing redness abnormality and he was therefore continued on his and swelling of his right upper lid. He said that two medical treatment (with the addition of intravenous http://bjo.bmj.com/ days previously he had been poked in the same eye by metronidazole), the presumed diagnosis being his daughter (who had been playing with her guinea- preseptal cellulitis.
  • Ehrlichiosis and Anaplasmosis Are Tick-Borne Diseases Caused by Obligate Anaplasmosis: Intracellular Bacteria in the Genera Ehrlichia and Anaplasma

    Ehrlichiosis and Anaplasmosis Are Tick-Borne Diseases Caused by Obligate Anaplasmosis: Intracellular Bacteria in the Genera Ehrlichia and Anaplasma

    Ehrlichiosis and Importance Ehrlichiosis and anaplasmosis are tick-borne diseases caused by obligate Anaplasmosis: intracellular bacteria in the genera Ehrlichia and Anaplasma. These organisms are widespread in nature; the reservoir hosts include numerous wild animals, as well as Zoonotic Species some domesticated species. For many years, Ehrlichia and Anaplasma species have been known to cause illness in pets and livestock. The consequences of exposure vary Canine Monocytic Ehrlichiosis, from asymptomatic infections to severe, potentially fatal illness. Some organisms Canine Hemorrhagic Fever, have also been recognized as human pathogens since the 1980s and 1990s. Tropical Canine Pancytopenia, Etiology Tracker Dog Disease, Ehrlichiosis and anaplasmosis are caused by members of the genera Ehrlichia Canine Tick Typhus, and Anaplasma, respectively. Both genera contain small, pleomorphic, Gram negative, Nairobi Bleeding Disorder, obligate intracellular organisms, and belong to the family Anaplasmataceae, order Canine Granulocytic Ehrlichiosis, Rickettsiales. They are classified as α-proteobacteria. A number of Ehrlichia and Canine Granulocytic Anaplasmosis, Anaplasma species affect animals. A limited number of these organisms have also Equine Granulocytic Ehrlichiosis, been identified in people. Equine Granulocytic Anaplasmosis, Recent changes in taxonomy can make the nomenclature of the Anaplasmataceae Tick-borne Fever, and their diseases somewhat confusing. At one time, ehrlichiosis was a group of Pasture Fever, diseases caused by organisms that mostly replicated in membrane-bound cytoplasmic Human Monocytic Ehrlichiosis, vacuoles of leukocytes, and belonged to the genus Ehrlichia, tribe Ehrlichieae and Human Granulocytic Anaplasmosis, family Rickettsiaceae. The names of the diseases were often based on the host Human Granulocytic Ehrlichiosis, species, together with type of leukocyte most often infected.
  • Review of Systems – Return Visit Have You Had Any Problems Related to the Following Symptoms in the Past Month? Circle Yes Or No

    Review of Systems – Return Visit Have You Had Any Problems Related to the Following Symptoms in the Past Month? Circle Yes Or No

    REVIEW OF SYSTEMS – RETURN VISIT HAVE YOU HAD ANY PROBLEMS RELATED TO THE FOLLOWING SYMPTOMS IN THE PAST MONTH? CIRCLE YES OR NO Today’s Date: ______________ Name: _______________________________ Date of Birth: __________________ GENERAL GENITOURINARY Fatigue Y N Blood in Urine Y N Fever / Chills Y N Menstrual Irregularity Y N Night Sweats Y N Painful Menstrual Cycle Y N Weight Gain Y N Vaginal Discharge Y N Weight Loss Y N Vaginal Dryness Y N EYES Vaginal Itching Y N Vision Changes Y N Painful Sex Y N EAR, NOSE, & THROAT SKIN Hearing Loss Y N Hair Loss Y N Runny Nose Y N New Skin Lesions Y N Ringing in Ears Y N Rash Y N Sinus Problem Y N Pigmentation Change Y N Sore Throat Y N NEUROLOGIC BREAST Headache Y N Breast Lump Y N Muscular Weakness Y N Tenderness Y N Tingling or Numbness Y N Nipple Discharge Y N Memory Difficulties Y N CARDIOVASCULAR MUSCULOSKELETAL Chest Pain Y N Back Pain Y N Swelling in Legs Y N Limitation of Motion Y N Palpitations Y N Joint Pain Y N Fainting Y N Muscle Pain Y N Irregular Heart Beat Y N ENDOCRINE RESPIRATORY Cold Intolerance Y N Cough Y N Heat Intolerance Y N Shortness of Breath Y N Excessive Thirst Y N Post Nasal Drip Y N Excessive Amount of Urine Y N Wheezing Y N PSYCHOLOGY GASTROINTESTINAL Difficulty Sleeping Y N Abdominal Pain Y N Depression Y N Constipation Y N Anxiety Y N Diarrhea Y N Suicidal Thoughts Y N Hemorrhoids Y N HEMATOLOGIC / LYMPHATIC Nausea Y N Easy Bruising Y N Vomiting Y N Easy Bleeding Y N GENITOURINARY Swollen Lymph Glands Y N Burning with Urination Y N ALLERGY / IMMUNOLOGY Urinary
  • Spider Bite Inducing Superficial Lymphangitis: a Case Report

    Spider Bite Inducing Superficial Lymphangitis: a Case Report

    ISSN: 2574-1241 Volume 5- Issue 4: 2018 DOI: 10.26717/BJSTR.2018.12.002232 El Anzi Ouiam. Biomed J Sci & Tech Res Case Report Open Access Spider Bite Inducing Superficial Lymphangitis: A Case Report El Anzi Ouiam*, Meziane Mariam and Hassam Badredine Department of Dermatology-Venereology, Morocco Received: Published: *Corresponding: December author: 04, 2018; : December 17, 2018 El Anzi Ouiam, Department of Dermatology-Venereology, Morocco Abstract Superficial lymphangitis after insect bite is the result of an allergic reaction to the insect antigen. We present the case of a 22-year-old patient with no notable medical history, presented with a pruritic rash on the chest, two days after an insect bite. Unlike bacterial lymphangitis, the site of insectKeywords: bite is not painful but pruritic. Spider Bite; Lymphangitis; Allergic Reaction Introduction lymphadenopathy. Different authors assume that superficial Superficial lymphangitis after insect bite is the result of an lymphangitis after spider sting is the consequence of an allergic allergic reaction to the insect antigen, which is injected into the skin immune reaction due to insect toxins [3]. Unlike bacterial andClinical drained Case by lymphatic vessels [1]. lymphangitis, the site of insect bite is not painful but pruritic. It’s also characterised by the absence of fever and lymph node A 22-year-old female with no notable medical history, presented enlargement and a rapid spontaneous regression [1-3] (Figure 1). with a pruritic rash on the chest. She mentioned intense pruritus and low pain. Two days before she had been bitten on the shoulder by a spider. Physical examination showed a red linear lesion starting from erythematous macule of the shoulder and extending toward the anterior wall of the chest.
  • Tick-Borne Diseases in Maine a Physician’S Reference Manual Deer Tick Dog Tick Lonestar Tick (CDC Photo)

    Tick-Borne Diseases in Maine a Physician’S Reference Manual Deer Tick Dog Tick Lonestar Tick (CDC Photo)

    tick-borne diseases in Maine A Physician’s Reference Manual Deer Tick Dog Tick Lonestar Tick (CDC PHOTO) Nymph Nymph Nymph Adult Male Adult Male Adult Male Adult Female Adult Female Adult Female images not to scale know your ticks Ticks are generally found in brushy or wooded areas, near the DEER TICK DOG TICK LONESTAR TICK Ixodes scapularis Dermacentor variabilis Amblyomma americanum ground; they cannot jump or fly. Ticks are attracted to a variety (also called blacklegged tick) (also called wood tick) of host factors including body heat and carbon dioxide. They will Diseases Diseases Diseases transfer to a potential host when one brushes directly against Lyme disease, Rocky Mountain spotted Ehrlichiosis anaplasmosis, babesiosis fever and tularemia them and then seek a site for attachment. What bites What bites What bites Nymph and adult females Nymph and adult females Adult females When When When April through September in Anytime temperatures are April through August New England, year-round in above freezing, greatest Southern U.S. Coloring risk is spring through fall Adult females have a dark Coloring Coloring brown body with whitish Adult females have a brown Adult females have a markings on its hood body with a white spot on reddish-brown tear shaped the hood Size: body with dark brown hood Unfed Adults: Size: Size: Watermelon seed Nymphs: Poppy seed Nymphs: Poppy seed Unfed Adults: Sesame seed Unfed Adults: Sesame seed suMMer fever algorithM ALGORITHM FOR DIFFERENTIATING TICK-BORNE DISEASES IN MAINE Patient resides, works, or recreates in an area likely to have ticks and is exhibiting fever, This algorithm is intended for use as a general guide when pursuing a diagnosis.
  • Leptospirosis: a Waterborne Zoonotic Disease of Global Importance

    Leptospirosis: a Waterborne Zoonotic Disease of Global Importance

    August 2006 volume 22 number 08 Leptospirosis: A waterborne zoonotic disease of global importance INTRODUCTION syndrome has two phases: a septicemic and an immune phase (Levett, 2005). Leptospirosis is considered one of the most common zoonotic diseases It is in the immune phase that organ-specific damage and more severe illness globally. In the United States, outbreaks are increasingly being reported is seen. See text box for more information on the two phases. The typical among those participating in recreational water activities (Centers for Disease presenting signs of leptospirosis in humans are fever, headache, chills, con- Control and Prevention [CDC], 1996, 1998, and 2001) and sporadic cases are junctival suffusion, and myalgia (particularly in calf and lumbar areas) often underdiagnosed. With the onset of warm temperatures, increased (Heymann, 2004). Less common signs include a biphasic fever, meningitis, outdoor activities, and travel, Georgia may expect to see more leptospirosis photosensitivity, rash, and hepatic or renal failure. cases. DIAGNOSIS OF LEPTOSPIROSIS Leptospirosis is a zoonosis caused by infection with the bacterium Leptospira Detecting serum antibodies against leptospira interrogans. The disease occurs worldwide, but it is most common in temper- • Microscopic Agglutination Titers (MAT) ate regions in the late summer and early fall and in tropical regions during o Paired serum samples which show a four-fold rise in rainy seasons. It is not surprising that Hawaii has the highest incidence of titer confirm the diagnosis; a single high titer in a per- leptospirosis in the United States (Levett, 2005). The reservoir of pathogenic son clinically suspected to have leptospirosis is highly leptospires is the renal tubules of wild and domestic animals.
  • Erysipelas Following a Fracture: About a Case

    Erysipelas Following a Fracture: About a Case

    Journal of Dermatology & Cosmetology Case Report Open Access Erysipelas following a fracture: about a case Abstract Volume 3 Issue 1 - 2019 Erysipelas on postoperative scar is a rare entity. In orthopedic traumatology, Abdelhafid El Marfi,1 Mohamed El Idrissi,1 El we have only the 3cases reported in the work of Dhrif occurred during prosthetic Ibrahimi Abdelhalim,1 Abdelmajid El Mrini,1 implantation. We present through this article, the case of postoperative erysipelas on 2 2 an osteosynthesis scar of a fracture of the lower quarter of the leg in a 58-year-old Kaoutar Laamari, Fatima Zahra Mernissi 1 woman. Department of Traumatology Orthopedy B4, University Hospital Hassan II Fez, Morocco 2Department of Dermatology, University Hospital Hassan II Fez, Morocco Correspondence: Abdelhafid El Marfi, Department of Traumatology Orthopedy B4, University Hospital Hassan II Fez, Morocco, Tel 0021 2678 3398 79, Email Received: January 04, 2018 | Published: January 28, 2019 Introduction Erysipelas is an infectious disease of the dermis and subcutaneous tissue commonly caused by streptococci.1 It is a clinical form of acute cellulitis.2 Clinically, it is characterized by the acute onset of local signs of inflammation such as erythema, oedema, pain and heat. In its classic form, it is accompanied by systemic signs such as fever, chills and malaise and sometimes nausea and vomiting.3,4 Erysipelas can be serious but rarely fatal. It has a rapid and favorable response to antibacterial therapy.5,6 From an epidemiological point of view, we consider the existence of a portal of entry, lymphoedema and obesity as the main risk factors for occurrence.
  • Periorbital Necrotising Fasciitis

    Periorbital Necrotising Fasciitis

    Eye (1991) 5, 736--740 Periorbital Necrotising Fasciitis GEOFFREY E. ROSE,! DAVID 1. HOWARD,2 MARK R. WATTS! London Summary Three cases of periorbital necrotising fasciitis are described, one occurring in a three-year-old child. The cases in adults required debridement of necrotic tissue, in one of whom there was extensive disease involving the face and orbital fat. ft is probable that the early stages of this condition are under-recognised; the importance of early signs and intensive treatment of this life-threatening disease are illustrated. N ecrotising fasciitis is an ischaemic necrosis of periorbital (and, in one case, facial and intra­ subcutaneous tissues (fascia), generally due orbital) tissues was required. to an overwhelming infection with �-haemo­ lytic Streptococcus pyogenes.1,2 The disease Case Reports has a rapid onset, often within a few days of minor breaks in the skin, and spreads exten­ Case 1 sively and rapidly through subcutaneous fas­ A 3l-year-old, otherwise healthy, girl was admitted cial planes. to the referring hospital with a 24-hour history of The condition occurs most frequently in the periorbital pain, general malaise, lethargy and a rapidly increasing severe periorbital swelling. For limbs or the abdominal wall, where it has been three days prior to admission, she had been treated given various terms, such as haemolytic strep­ with oral nystatin for perineal candidiasis and for tococcus gangrene/ gangrenous or necrotis­ two days had symptoms of an infection of the upper lng erysipelas, suppurative fasciitis and respiratory tract. Her right eyelids were closed by Fournier's gangrene. Periorbital necrotising gross erythematous swelling, but her eye move­ fasciitis is reported rarely, with a total of only ments were normal and there was no relative affe­ 16 cases cited in a recent review.1 The low inci­ rent pupillary defect.
  • Ehrlichiosis in Brazil

    Ehrlichiosis in Brazil

    Review Article Rev. Bras. Parasitol. Vet., Jaboticabal, v. 20, n. 1, p. 1-12, jan.-mar. 2011 ISSN 0103-846X (impresso) / ISSN 1984-2961 (eletrônico) Ehrlichiosis in Brazil Erliquiose no Brasil Rafael Felipe da Costa Vieira1; Alexander Welker Biondo2,3; Ana Marcia Sá Guimarães4; Andrea Pires dos Santos4; Rodrigo Pires dos Santos5; Leonardo Hermes Dutra1; Pedro Paulo Vissotto de Paiva Diniz6; Helio Autran de Morais7; Joanne Belle Messick4; Marcelo Bahia Labruna8; Odilon Vidotto1* 1Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina – UEL 2Departamento de Medicina Veterinária, Universidade Federal do Paraná – UFPR 3Department of Veterinary Pathobiology, University of Illinois 4Department of Veterinary Comparative Pathobiology, Purdue University, Lafayette 5Seção de Doenças Infecciosas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul – UFRGS 6College of Veterinary Medicine, Western University of Health Sciences 7Department of Clinical Sciences, Oregon State University 8Departamento de Medicina Veterinária Preventiva e Saúde Animal, Universidade de São Paulo – USP Received June 21, 2010 Accepted November 3, 2010 Abstract Ehrlichiosis is a disease caused by rickettsial organisms belonging to the genus Ehrlichia. In Brazil, molecular and serological studies have evaluated the occurrence of Ehrlichia species in dogs, cats, wild animals and humans. Ehrlichia canis is the main species found in dogs in Brazil, although E. ewingii infection has been recently suspected in five dogs. Ehrlichia chaffeensis DNA has been detected and characterized in mash deer, whereas E. muris and E. ruminantium have not yet been identified in Brazil. Canine monocytic ehrlichiosis caused by E. canis appears to be highly endemic in several regions of Brazil, however prevalence data are not available for several regions.
  • Download Article

    Download Article

    Advances in Social Science, Education and Humanities Research, volume 356 2nd International Conference on Contemporary Education, Social Sciences and Ecological Studies (CESSES 2019) A New Exploration of the Combined Treatment of Symptoms and Social Work Psychology in Male Sexual Addiction Patients Chengchung Tsai Minyi Li School of Management School of Social Sciences Putian University University of Macau Putian, China Macau, China Abstract—Post-Orgasmic Illness Syndrome (POIS) was progesterone, low cholesterol, low dehydroepiandrosterone, first discovered by Professor Waldinger and Schweitzerl in low cortisol, high prolactin or hypothyroidism. Some cases 2002. After publishing several papers such as "POIS Records encountered by the author team indicate that when the of Emotional, Psychological and Behavioral Changes in Male mother was pregnant in the early years, she or her family had Patients" and "POIS Patients", "Clinical Observation Records smoking habits. Some mothers had long-term use of of Psychological and Behavioral Changes" and "POIS Male contraceptives or were used to eating animal internal organs. Disease Self-reports and Treatment Methods", in this paper, Even some cases were diagnosed as male gynecomastia. the author will cite the views of Chinese medicine practitioners on the treatment of POIS, and hope to provide more practical treatment methods and references for future research. TABLE I. SEVEN GROUPS OF POIS SYMPTOMS FOUND BY WALDINGER AND OTHER MEDICAL TEAMS Keywords—POIS; male; ejaculation; mental state; disorder; Body parts Various local sensations emotion Behavioral symptoms extreme fatigue, exhaustion, palpitations, forgetting words, being too lazy to talk, incoherent, inattention, irritability, I. INTRODUCTION photophobia, depression The main research objects of this paper are journalists, Flu symptoms fever, cold, hot, sweaty, trembling writers and other text workers, as well as creative designers Head symptoms head dizziness, groggy, confused and heavy who take creativity as the selling point as the research object.
  • Severe Acute Dried Gangrene in COVID-19 Infection: a Case Report

    Severe Acute Dried Gangrene in COVID-19 Infection: a Case Report

    European Review for Medical and Pharmacological Sciences 2020; 24: 5769-5771 Severe acute dried gangrene in COVID-19 infection: a case report E. NOVARA1, E. MOLINARO1, I. BENEDETTI2, R. BONOMETTI3, E.C. LAURITANO3, R. BOVERIO3 1Department of Emergency Medicine, IRCCS San Matteo Hospital Foundation University of Pavia, Pavia, Italy 2Department of Internal Medicine, IRCCS San Matteo Hospital Foundation University of Pavia, Pavia, Italy 3Department of Emergency Medicine, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy Abstract. – OBJECTIVE: Coronavirus dis- recognized in Wuhan, China, in December 2019. ease 2019 (COVID-19) related coagulopathy Genetic sequencing of the virus suggests that may be the first clinical manifestation even in SARS-CoV-2 is a beta-coronavirus closely linked non-vasculopathic patients and is often associ- to the SARS virus1. ated with worse clinical outcomes. While most people with COVID-19 develop CASE PRESENTATION: A 78 years old woman was admitted to the Emergency Unit with respi- mild or uncomplicated illness, approximately ratory symptoms, confusion and cyanosis at the 14% develop severe disease requiring hospital- extremity, in particular at the nose area, hands ization and oxygen support and 5% require ad- and feet fingers. A nasal swab for COVID-19 was mission to an intensive care unit (ICU)1. In severe performed, which resulted positive, and so ther- cases, COVID-19 can be complicated by acute apy with doxycycline, hydroxychloroquine and respiratory disease syndrome (ARDS), sepsis and antiviral agents was started. At admission, the septic shock, multi-organ failure, including acute patient was hemodynamically unstable requir- 2 ing circulatory support with liquids and norepi- kidney injury and cardiac injury .