DOCSLIB.ORG

Overview of Fever of Unknown Origin in Adult and Paediatric Patients L

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
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: marina.tadolini@unibo.it 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. 110): highlights the difficulties in diagnosing the FUO definition and considered the S10-S24. certain causes of FUO that requires a type of diagnostic panel to be more im- © Copyright CLINICAL AND very high index of suspicion. The main portant than the duration of investiga- EXPERIMENTAL RHEUMATOLOGY 2018. causes of FUO in paediatric and adult tions (6). They considered the follow- patients will be reviewed here, under- ing list to be the “Minimum diagnostic Key words: fever of unknown origin, lying the fact that a physician should evaluation to qualify as FUO”: com- autoinflammatory disease, infections, also consider the possibility that a pa- prehensive history; repeated physical malignancies, non-genetic periodic tient with FUO may have a monogenic examination; complete blood count, in- fevers, non-infectious inflammatory autoinflammatory disease (AID). The cluding differential and platelet (PLT) diseases, children. identification of AIDs requires a care- count; routine blood chemistry, includ- ful evaluation of both history and clini- ing lactate dehydrogenase (LDH), bili- cal details that may reveal important rubin, and liver enzymes; urinalysis, clues to identify the correct aetiology. including microscopic examination; We also provide a comprehensive ac- chest radiograph; erythrocyte sedimen- count of specific signs and symptoms tation rate (ESR); antinuclear antibod- that could suggest possible diagnoses ies; rheumatoid factor; angiotensin and guide the work-up of FUO and converting enzyme; routine blood cul- non-genetic periodic fevers in children. tures (at least three) while not receiv- ing antibiotics; cytomegalovirus IgM Introduction antibodies or virus detection in blood; Fever of unknown origin (FUO) ac- heterophile antibody test in children Funding: This paper is part of a counts for around 3% of hospital ad- and young adults; tuberculin skin test; supplemental issue supported by an missions and has a high impact on computerised tomography (CT) of ab- unrestricted grant from Novartis Farma, health care systems (1, 2). Indeed, domen or radionuclide scan; HIV an- Italy through a service agreement with more than 200 different causes of FUO tibodies or virus detection assay; and, Health Publishing & Services Srl. Health have been reported (3). further evaluation of any abnormalities Publishing & Services Srl provide The first definition of FUO dates back detected by the above tests (6). editorial assistance. Article Processing to the early 1960’s, when it was defined Following on from this, a number of di- Charges were also funded by Novartis Farma, Italy. by Petersdorf and Beeson as a “Body agnostic algorithms have been proposed. temperature of more than 38.3°C on Notably, the inclusion of 18 fluorodeox- Competing interests: M. Cattalini received speaker’s fees and consultancy honoraria several occasions, lasting for more yglucose-positron emission tomography from AbbVie, Novartis and SOBI. All the than 3 weeks and no diagnosis after 18F-FDG PET among the investigations other authors declare no competing 1 week of hospitalisation” (4). Re- has improved and shortened the diag- interests. finements to the definition have since nostic work-up of FUO (7). S-10 Clinical and Experimental Rheumatology 2018 Fever of unknown origin / L. Attard et al. Case report: an adult patient lowed by normalisation of acute phase ography, and colonoscopy were nega- An Italian male patient aged 69 years reactants. However, due to a relapse of tive. Chest high-resolution CT showed old, with a mechanical aortic valve, was these parameters (PCT 62 mg/ml, CRP bilateral peripheral micronodules and admitted to the Internal Medicine ward 27 mg/dl, lactic acid 24 mg/dl, ferritin multiple mediastinal lymphadenopa- due to high fever (up to 39°C) and mi- 6921 ng/ml, LDH 1512 U/L) the pa- thies. The patient was initially treated grating arthralgia, which had started ten tient was switched to meropenem and with piperacillin-tazobactam without days prior. Before being admitted, he linezolid with apyrexia for 7 days. Fol- effect, and then, due to an impairment had been treated with clarithromycin, lowing this, the patient experienced a of acute phase reactants (PCT 65 mg/ which was stopped due to the occur- relapse of fever. Candida spp. was iso- dl), teicoplanin and fluconazole were rence of skin rash, and later with amox- lated in blood culture, and the patient added with resolution of fever. The pa- icillin-clavulanate, without resolution was treated with caspofungin. Due to tient was discharged after 30 days and of the fever. At admission he presented a recurrence of skin rash on the arms, referred to the Fever of Unknown Ori- with papular skin rash in the pretibial legs, and trunk, the patient underwent gin outpatient clinic, Infectious Dis- region, bilaterally. Blood investiga- skin biopsy, which raised the suspicion ease Unit. At that time he was apyretic; tions showed white blood cells (WBC) of psoriasis. He was then treated with he reported asthenia and marked loss of 15,600/mmc, PLT count 405,000/mmc, topical steroids with fast improvement body weight (10 kg over the previous 2 ESR 114 mm/h, C-reactive protein of the skin rash. At the same time, fever months). WBC were 7,490/mmc (Neu- (CRP) 29 mg/dl, beta-2 microglobulin and joint pain disappeared and blood trophils: 63%, Eosinophils 9.2%), ESR 7.8 mg/L, procalcitonin (PCT) 2.2 mg/ tests were normal. He was then dis- 92 mm/h, CRP 3.38 mg/dl, beta-2 mi- dl, LDH 894 U/L; Interferon-gamma charged after 35 days in a good clinical croglobulin 8 mg/L, interleukin-6 19.8 Release Assay (IGRA) test was in- condition with a diagnosis of recurrent ng/ml, serum amyloid A 5.23 mg/dl, determinate. Widal test, serology for infections due to the onset of psoriatic fibrinogen 405 mg/dl, LDH 525 U/L, Brucella and HIV, human herpesvirus arthritis. and ferritin 2,370 ng/ml. After 10 days (HHV)-8, cytomegalovirus (CMV), Five years later, the patient reported he reported a recurrence of high fever Epstein-Barr virus (EBV), hepatitis A to the Emergency Department due to and joint pain. According to his clini- virus, hepatitis B virus (HBV), hepatitis a recurrence of fever (up to 38°C), cal history and laboratory features, a C virus (HCV), enterovirus, parvovirus night sweats, loss of body weight, and diagnosis of Adult-onset Still’s disease B19, Dengue, Chikungunya, Trepone- arthralgia over the previous month. (AOSD) was formulated based on four ma, Francisella, Bartonella, Borrelia, Before reporting to hospital, he had major and three minor Yamaguchi cri- Rickettsia, Coxiella, Leishmania, Toxo- been treated with amoxicillin-clavu- teria. Antibodies to Strongyloides ster- plasma, Chlamydia, and Mycoplasma lanate for 6 days without benefit. He coralis were positive and he was treat- did not show any active infections. complained of a transient rash on the ed with oral ivermectin for 2 days be- Polymerase chain reaction (PCR) for back. WBC were 16,670/mmc (Neu- fore starting steroids. After the start of HCV, HBV, CMV, EBV, and HHV- trophils: 93%), CRP 5.93 mg/dl, LDH steroid treatment, the patient achieved 6 were negative. More than 10 blood 600 U/L; chest x-ray was negative. He complete recovery after a period of one cultures for bacteria and mycobacteria was admitted for further investigations: month. He did not show any febrile were negative. Chest x-ray, chest and blood tests showed WBC 20,000/mmc episodes nor other symptoms while on abdominal CT scan, transthoracic and (Neutrophils: 92%), haemoglobin 10.9 steroid treatment. transoesophageal echocardiography, g/dl, beta-2 microglobulin 6.8 mg/L, The diagnostic and therapeutic ap- and colonoscopy were all negative. PCT 1.9 mg/dl, ferritin 7,500 ng/ proaches carried out in this patient 18F-FDG PET showed multiple me- ml, and thyroid function was normal. were particularly aggressive as a blood diastinal and abdominal lymph nodes Two sets of blood cultures were nega- stream infection was suspected in con- uptake (SUV max 15), diffuse splenic tive. IGRA test was negative. Widal sideration of his aortic mechanic valve (SUV max 6.5), and diffuse bone up- test and serology for Brucella and and high values of PCT.
Load more

Recommended publications
  • 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).
    [Show full text]
  • Netherlands in Focus
    Talent in Banking 2015 The Netherlands in Focus UK Financial Services Insight Report contents The Netherlands in Focus • Key findings • Macroeconomic and industry context • Survey findings 2 © 2015 Deloitte LLP. All rights reserved. Key findings 3 © 2015 Deloitte LLP. All rights reserved. Attracting talent is difficult for Dutch banks because they are not seen as exciting, and because of the role banks played in the financial crisis • Banking is less popular among business students in the Netherlands than in all but five other countries surveyed, and its popularity has fallen significantly since the financial crisis • Banks do not feature in the top five most popular employers of Dutch banking students; among banking-inclined students, the three largest Dutch banks are the most popular • The top career goals of Dutch banking-inclined students are ‘to be competitively or intellectually challenged’ and ‘to be a leader or manager of people’ • Dutch banking-inclined students are much less concerned with being ‘creative/innovative’ than their business school peers • Dutch banking-inclined students want ‘leadership opportunities’ and leaders who will support and inspire them, but do not expect to find these attributes in the banking sector • Investment banking-inclined students have salary expectations that are significantly higher than the business student average • Banks in the Netherlands are failing to attract female business students; this is particularly true of investment banks 4 © 2015 Deloitte LLP. All rights reserved. Macroeconomic and industry context 5 © 2015 Deloitte LLP. All rights reserved. Youth unemployment in the Netherlands has almost doubled since the financial crisis, but is relatively low compared to other EMEA countries Overall and youth unemployment, the Netherlands, 2008-2014 15% 10% 5% 0% 2008 2009 2010 2011 2012 2013 2014 Overall Youth (Aged 15-24) 6 Source: OECD © 2015 Deloitte LLP.
    [Show full text]
  • The Labor Agreements Between UAW and the Big Three Automakers- Good Economics Or Bad Economics? John J
    Journal of Business & Economics Research – January, 2009 Volume 7, Number 1 The Labor Agreements Between UAW And The Big Three Automakers- Good Economics Or Bad Economics? John J. Lucas, Purdue University Calumet, USA Jonathan M. Furdek, Purdue University Calumet, USA ABSTRACT On October 10, 2007, the UAW membership ratified a landmark, 456-page labor agreement with General Motors. Following pattern bargaining, the UAW also reached agreement with Chrysler LLC and then Ford Motor Company. This paper will examine the major provisions of these groundbreaking labor agreements, including the creation of the Voluntary Employee Beneficiary Association (VEBA), the establishment of a two tier wage structure for newly hired workers, the job security provisions, the new wage package for hourly workers, and the shift to defined contribution plans for new hires. The paper will also provide an economic analysis of these labor agreements to consider both if the “Big Three” automakers can remain competitive in the global market and what will be their impact on the UAW and its membership. Keywords: UAW, 2007 Negotiations, Labor Contracts BACKGROUND he 2007 labor negotiations among the Big Three automakers (General Motors, Chrysler LLC, and Ford Motor) and the United Autoworkers (UAW) proved to be historic, as well as controversial as they sought mutually to agree upon labor contracts that would “usher in a new era for the auto Tindustry.” Both parties realized the significance of attaining these groundbreaking labor agreements, in order for the American auto industry to survive and compete successfully in the global economy. For the UAW, with its declining membership of approximately 520,000, that once topped 1.5 million members, a commitment from the Big Three automakers for product investments to protect jobs and a new health care trust fund were major goals.
    [Show full text]
  • Missouri Hospitalist Missouri Society
    MISSOURI HOSPITALIST MISSOURI SOCIETY HOSPITALIST Publisher: Issue 22 October 22, 2009 Division of General IM University of Missouri Hospitalist Update Columbia, Missouri Dealing with Hypertensive Urgencies Syed Ahsan, MD Editor: Robert Folzenlogen MD INTRODUCTION Patients presenting with severe hypertension can often be alarming for house officers and family members. Systolic blood pressures > 180 mm Hg, with or without a diastolic blood pressure >120, have been known to progress to hypertensive emer- Inside this issue: gencies. The majority of complications are related to end organ damage; this may include encephalopa- thy, blurred vision, chest pain, unstable angina, Hospitalist Update acute myocardial infarction and acute renal insuffi- ciency, with or without proteinuria. In the absence of these acute signs, the control of hypertensive urgency remains paramount but is not considered an emergency. Case of the Month The etiology of severe, asymptomatic hypertension is extremely important in defin- ing treatment strategies. The majority of these patients have a prolonged history of uncontrolled hypertension secondary to poor compliance or inadequate treatment From the Journals regimens. Guidelines are not entirely specific in the management of hypertensive ur- gency. ID Corner TREATMENT STRATEGY Based on the current literature, the following approach is recommended: Calendar 1. Confirm that the blood pressure is elevated. The reading should be re- peated in both upper extremities; the physician should ensure that the appropriate cuff size is used and that the readings are consistent. Comments 2. Goal for blood pressure reduction: the ideal goal is to reduce the systolic blood pressure by 20-25% and this should be done over a period of hours to days.
    [Show full text]
  • A Review of Undulant Fever : Particularly As to Its Incidence, Origin and Source of Infection
    University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1938 A Review of undulant fever : particularly as to its incidence, origin and source of infection Richard M. Still University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Still, Richard M., "A Review of undulant fever : particularly as to its incidence, origin and source of infection" (1938). MD Theses. 706. https://digitalcommons.unmc.edu/mdtheses/706 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. ·~· A REVIEW OF UNDULANT FEVER PARTICULARLY AS TO ITS INCIDENCE, ORIGIN AND SOURCE OF INFECTION RICHARD M. STILL SENIOR THESIS PRESENTED TO THE COLLEGE OF MEDICINE, UNIVERSITY OF NEBRASKA, OMAHA, NEBRASKA, 1958 SENIOR THESIS A REVIEW OF UNDULANT FEVER PARTICULARLY AS TO ITS;. INCIDENCE, ORIGIN .AND SOURCE OF INFECTION :trJ.:RODUCTION The motive for this paper is to review the observations, on Undul:ant Fever, of the various authors, as to the comps.rat!ve im- portance of' milk borne infection and infection by direct comtaC't.•.. The answer to this question should be :of some help in the diagnos- is ot Undulant Fever and it should also be of value where - question of the disease as an occupational entity is presented.
    [Show full text]
  • Adult Onset Still's Disease Accompanied by Acute Respiratory Distress Syndrome: a Case Report
    EXPERIMENTAL AND THERAPEUTIC MEDICINE 12: 1817-1821, 2015 Adult onset Still's disease accompanied by acute respiratory distress syndrome: A case report XIAO-TU XI1, MAO‑JIE WANG2, RUN‑YUE HUANG2 and BANG‑HAN DING1 1Emergency Department; 2Rheumatology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong 510006, P.R. China Received July 17, 2015; Accepted May 20, 2016 DOI: 10.3892/etm.2016.3512 Abstract. Adult onset Still's disease (AOSD) is a systemic vascular permeability and a loss of aerated lung tissue (8). inflammatory disorder characterized by rash, leukocytosis, ARDS occurs in 7.2‑38.9/100,000 individuals (9,10), and has fever and arthralgia/arthritis. The most common pulmo- a mortality rate of ~40% (11). Patient mortality varies based nary manifestations associated with AOSD are pulmonary on numerous factors, including age, etiology of the lung injury infiltrates and pleural effusion. The present study describes and non‑pulmonary organ dysfunction. The most common a 40‑year‑old male with AOSD who developed fever, sore risk factors for ARDS are pneumonia, sepsis, aspiration and throat and shortness of breath. Difficulty breathing promptly trauma (11). Multiple predisposing risk factors, in addition to developed, and the patient was diagnosed with acute respira- some secondary factors such as alcohol abuse and obesity, also tory distress syndrome (ARDS). The patient did not respond increase the risk (4). In addition to patient support provided by to antibiotics, including imipenem, vancomycin, fluconazole, improving oxygen delivery to the tissues and preventing multi- moxifloxacin, penicillin, doxycycline and meropenem, but was organ system failure, early recognition and correction of the sensitive to glucocorticoid treatment, including methylpred- underlying cause is important in ARDS treatment.
    [Show full text]
  • Malaria History
    This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site. Copyright 2006, The Johns Hopkins University and David Sullivan. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided “AS IS”; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed. Malariology Overview History, Lifecycle, Epidemiology, Pathology, and Control David Sullivan, MD Malaria History • 2700 BCE: The Nei Ching (Chinese Canon of Medicine) discussed malaria symptoms and the relationship between fevers and enlarged spleens. • 1550 BCE: The Ebers Papyrus mentions fevers, rigors, splenomegaly, and oil from Balantines tree as mosquito repellent. • 6th century BCE: Cuneiform tablets mention deadly malaria-like fevers affecting Mesopotamia. • Hippocrates from studies in Egypt was first to make connection between nearness of stagnant bodies of water and occurrence of fevers in local population. • Romans also associated marshes with fever and pioneered efforts to drain swamps. • Italian: “aria cattiva” = bad air; “mal aria” = bad air. • French: “paludisme” = rooted in swamp. Cure Before Etiology: Mid 17th Century - Three Theories • PC Garnham relates that following: An earthquake caused destruction in Loxa in which many cinchona trees collapsed and fell into small lake or pond and water became very bitter as to be almost undrinkable. Yet an Indian so thirsty with a violent fever quenched his thirst with this cinchona bark contaminated water and was better in a day or two.
    [Show full text]
  • Patterns of Proinflammatory Cytokines and Inhibitors During Typhoid Fever
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by RERO DOC Digital Library 1306 Patterns of Proinflammatory Cytokines and Inhibitors during Typhoid Fever Monique Keuter, Edi Dharmana, M. Hussein Gasem, University Hospital, Nijmegen. Netherlands; Diponegoro University, Johanna van der Ven-Jongekrijg, Semarang. Indonesia; F. Hoffman-Lakoche, Basel, Switzerland Robert Djokomoeljanto, Wil M. V. Dolmans, Pierre Demacker, Robert Sauerwein, Harald Gallati, and Jos W. M. van der Meer Cytokines and inhibitors in plasma were measured in 44 patients with typhoid fever. Ex vivo production of the cytokines was analyzed in a whole blood culture system with and without lipopolysaccharide (LPS). Acute phase circulating concentrations of cytokines (±SD) were as follows: interleukin (IL)-IP, <140 pg/ml.; tumor necrosis factor-a (TNFa), 130 ± 50 pg/mL; IL-6, 96 ± 131 pg/ml.; and IL-8, 278 ± 293 pg/ml., Circulating inhibitors were elevated in the acute phase: IL-l receptor antagonist (IL-IRA) was 2304 ± 1427 pg/ml, and soluble TNF receptors 55 and 75 were 4973 ± 2644 pgJmL and 22,865 ± 15,143 pgJmL, respectively. LPS­ stimulated production of cytokines was lower during the acute phase than during convalescence (mean values: IL-IP, 2547 vs. 6576 pg/ml.; TNFa, 2609 vs. 6338 pg/rnl.; IL-6, 2416 vs. 7713 pg/ml.), LPS-stimulated production orIL-iRA was higher in the acute than during the convales­ cent phase (5608 vs. 3977 pg/mL). Inhibited production of cytokines during the acute phase may bedue to a switch from a proinflammatory to an antiinflammatory mode. Typhoid fever is caused by the facultative intracellular tibodies to this cytokine are detrimental [11-16], In experi­ gram-negative bacillus Salmonella typhi and occasionally by mental Salmonella typhimurium infection in mice.
    [Show full text]
  • CD Alert Monthly Newsletter of National Centre for Disease Control, Directorate General of Health Services, Government of India
    CD Alert Monthly Newsletter of National Centre for Disease Control, Directorate General of Health Services, Government of India May - July 2009 Vol. 13 : No. 1 SCRUB TYPHUS & OTHER RICKETTSIOSES it lacks lipopolysaccharide and peptidoglycan RICKETTSIAL DISEASES and does not have an outer slime layer. It is These are the diseases caused by rickettsiae endowed with a major surface protein (56kDa) which are small, gram negative bacilli adapted and some minor surface protein (110, 80, 46, to obligate intracellular parasitism, and 43, 39, 35, 25 and 25kDa). There are transmitted by arthropod vectors. These considerable differences in virulence and organisms are primarily parasites of arthropods antigen composition among individual strains such as lice, fleas, ticks and mites, in which of O.tsutsugamushi. O.tsutsugamushi has they are found in the alimentary canal. In many serotypes (Karp, Gillian, Kato and vertebrates, including humans, they infect the Kawazaki). vascular endothelium and reticuloendothelial GLOBAL SCENARIO cells. Commonly known rickettsial disease is Scrub Typhus. Geographic distribution of the disease occurs within an area of about 13 million km2 including- The family Rickettsiaeceae currently comprises Afghanistan and Pakistan to the west; Russia of three genera – Rickettsia, Orientia and to the north; Korea and Japan to the northeast; Ehrlichia which appear to have descended Indonesia, Papua New Guinea, and northern from a common ancestor. Former members Australia to the south; and some smaller of the family, Coxiella burnetii, which causes islands in the western Pacific. It was Q fever and Rochalimaea quintana causing first observed in Japan where it was found to trench fever have been excluded because the be transmitted by mites.
    [Show full text]
  • 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
    [Show full text]
  • How I Manage the Febrile Returning Traveller*
    Proc. R. Coll. Physicians Edinb. 1998; 28: 24-33 HOW I MANAGE THE FEBRILE RETURNING TRAVELLER* D. Nathwani,† Dundee Teaching Hospitals NHS Trust, DD3 8EA Humanity has but three great enemies: fever, famine and war; of these by far the greatest, by far the most terrible, is fever. Sir William Osler Throughout the centuries, the clinical diagnosis has been made or strongly suggested by the history, the presence of helpful physical findings and the observation of the patient. Like Osler, physicians since antiquity have viewed fever, an important clinical finding, as an entity worthy of unremitting attention. An eighteenth century English diarist (Fanny Gurney, Celia Book IV, 1782) wrote that ‘travelling is the ruin of all happiness’. Fortunately, this rather gloomy outlook is no longer widely held, as illustrated by the massive increase in public spending on travel and escalation in air travel by UK residents. Between 1991 and 1995 there was a rise to 22.9 million UK residents travelling abroad (International Passenger Survey, Office for National Statistics) and a 12.5 million rise in visitors to the UK over a similar period. Although Spain and France remain the most popular destinations, increasing numbers of British people (approximately three million in 1996) are travelling to the tropics and subtropics. Fever is an important and common presentation of tropical disease and sometimes may be the only manifestation of serious illness. Indeed, 81% of travellers complaining of fever admitted to the Hospital for Tropical Diseases in London, in a period of six months had travelled to the tropics or subtropics (60% sub-Saharan Africa; 13% Indian sub-continent 8% South-East Asia).1 This suggests that both primary and secondary care physicians need to be familiar with the management of patients arriving at, or returning to, this country with a febrile illness.
    [Show full text]
  • 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.
    [Show full text]