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PubMedDate not supplied

[Results of the use, for a period of 3 years (1974-1977), in pilot districts, of the complex program of measures for prevention of streptococcal infections and their complications].

Starting with the year 1974 a total 11 pilot units have been organized, in as many counties in which a complex program of surveillance of streptococcal infections was applied, that had the following objectives: 1. Prevention and fight against acute streptococcal infection ; 2. Prevention of severe complications of acute rheumatic fever of rheumatic carditis and acute glomerulonephritis ; 3. Prevention of relapses of acute rheumatic fever. The establishment and verification of methods for clinical and laboratory diagnosis was followed, as well as of therapeutic techniques and dispensarization. The analysis of results obtained after the application for a period of 3 years of the program in high-risk collectivities, and in the conditions of an intensive circulation of some epidemic strains of streptococcus has shown the decrease each year of the incidence of scarlet fever, the increased efficiency of detection of acute non-eruptive (non-rash) streptococcal infections, as well as a significant decrease in the number of cases that developed a first attack of acute rheumatic fever and acute glomerulonephritis. A significant decrease was also obtained in the number of relapses and of severe evolution of rheumatic carditis, due to active detection, continuous evidence, prophylaxis and periodic control of cases with acute rheumatic fever.

Anti-Bacterial Agents↗
PubMed1997

Severe recurrent ureteral stricture: the combined use of an anterograde and retrograde approach in the prone split-leg position without X-rays.

We report on a 50-year-old woman first treated by us in 1990 for uroseptic fever. Urography showed occlusion of the terminal tract of the lower third of the left ureter. The patient was submitted to successful left ureteroneocystostomy (UNCS). Three months later, she had a relapse of uroseptic fever, and urography showed right ingravescent dilation and excellent functional activity of the left urinary tract. Right UNCS was performed. A further relapse on the right side was again treated with UNCS and psoas-hitch bladder, but both the dilation and the occlusion persisted. Considering the state of the patient, and in order to remove the right nephrostomy that had been applied in the meantime, and to reduce the state of inflammation in view of further surgery, it was decided to treat the right ureteral total stenosis with ureteroscopic resection through the ureter facilitated by an other luminous flexible ureteroscope inserted upstream via nephrostomy. This technique is based on concepts searching for stenotic ureteral zones in transplanted kidneys, with the help of an adequate luminous catheter. An X-ray follow-up 9 months later evidenced that the maneuver was totally successful.

Anastomosis, Surgical↗
PubMed2001

Treatment of cat-scratch disease.

Cat-scratch disease is an infection caused by Bartonella henselae, a fastidious gram-negative bacillus acquired from exposure to an infected kitten or cat. The most common manifestation of human disease is lymphadenitis. Atypical forms of infection include Parinaud oculoglandular syndrome, stellate neuroretinitis, persistent fever without localizing signs, hepatosplenic infection, encephalopathy, osteomyelitis, and endocarditis. Immunocompromised individuals with B. hensalae infection may develop bacillary angiomatosis, bacillary peliosis, and relapsing bacteremia with fever syndrome. The bacillus is susceptible to several antibacterial agents in vitro, including penicillins, cephalosporins, aminoglycosides, tetracyclines, macrolides, quinolones, trimethoprim and sulfamethoxazole, and rifampin. Greatest clinical efficacy has been observed following treatment with rifampin, ciprofloxacin, gentamicin, trimethoprim and sulfamethoxazole, clarithromycin, and azithromycin. In one placebo-controlled study, azithromycin therapy was associated with more rapid diminution in size of infected lymph nodes. The majority of cases of cat-scratch disease occurring in normal hosts do not require anti-infective therapy for resolution of infection.

Animals↗
PubMed2006

Weber-Christian disease presenting with intractable fever and periorbital swelling mimicking angioedema.

A 22-year-old male patient with Weber-Christian disease (WCD) presenting with periorbital swelling is a very rare occurrence. Lobular panniculitis in the periorbital and anterior tibial skin was diagnosed in this patient, based on the histological findings from biopsy specimens. The differential diagnosis was done before administering systemic corticosteroid. A dramatic response was achieved several days later, but relapse with intractable fever occurred 1 month later. The use of other immunosuppressive agents failed, and he died of septic shock 2 months later. The preceding infection may have been the immunopathologic factor in the development of WCD. Other effective treatments for WCD may be described in the future.

Adult↗
PubMed1978

Listeria cerebritis: relapse of infection in renal transplant patients.

In 3 cases of Listeria cerebritis, two of the patients had relapse with cerebritis after antimicrobial therapy for acute Listeria septicemia or meningitis. Each had received ten to 14 days of intravenous penicillin. Relapse occurred with fever and sudden focal cerebral dysfunction. Brain scans showed focal uptake; arteriograms and computerized tomography were normal. Cerebrospinal fluids were nondiagnostic; blood cultures yielded Listeria in two patients. Penicillin treatment for six weeks produced rapid clinical responses that were complete in one and minimal residual in two. Progress brain scans were normal. A relapse rate of 35% is reported in transplant patients with Listeria meningitis and/or bacteremia who are treated for less than three weeks; to our knowledge, cerebritis in such patients has not been reported previously. High-dose penicillin or ampicillin therapy for four to six weeks is recommended for Listeria infections in this select group.

Adult↗
PubMedDate not supplied

Q fever in infancy: a review of 18 cases.

Infection with Coxiella burnetti (Q fever) was diagnosed in 18 children younger than 3 years of age in The Netherlands during a 16-month period. The diagnosis was confirmed serologically by means of a complement-fixation test and immunofluorescence for IgM determination. A summary of the clinical, hematologic, serologic and epidemiologic features is given. Four children had relapsing episodes of fever during several months. The problem of childhood infection with C. burnetii, particularly in relation to the possibility of intrauterine infection or infection during birth and in the neonatal period, is discussed. In at least one child of this series, an infection by means of breast feeding was considered likely. Q fever is possibly underdiagnosed in children; it should be considered in children with fever of unknown origin.

Antibodies, Viral↗
PubMed1996

The identification of febrile, neutropenic children with neoplastic disease at low risk for bacteremia and complications of sepsis.

BACKGROUND: The management of pediatric oncology patients with fever and neutropenia assumes that all patients are at risk for bacteremia, and therefore generally involves hospitalization and broad-spectrum parenteral antibiotics for all patients. The determination of which patients are at low risk for having positive blood cultures and for developing complications related to bacteremia is of potential benefit. METHODS: The records of 161 pediatric patients with neoplastic disease hospitalized for 509 episodes of fever and neutropenia between January 1990 and June 1992 were retrospectively reviewed. Clinical features at initial presentation, clinical and microbiologic documentation of infection, and outcome were analyzed. RESULTS: The only presenting clinical features that correlated with an increased likelihood of having positive blood cultures were chills, hypotension, the requirement for fluid resuscitation (P < 0.001), or a diagnosis of leukemia or lymphoma (P < 0.041). Leukemia patients with relapse admitted for fever and neutropenia were no more likely to have positive blood cultures than those patients in remission. There were ten episodes of fever and neutropenia in which patients were transferred to the intensive care unit (ICU), and two sepsis related deaths. Nine episodes involving ICU management and both deaths were in patients who had persistent fever and an absolute neutrophil count (ANC) of less than 100 after 48 hours of hospitalization (n = 177). Patients with an ANC of less than 100 after 48 hours were twice as likely to have antibiotic changes, 15 times more likely to receive amphotericin B, and were hospitalized twice as long as patients with an ANC of 100 or higher after 48 hours. CONCLUSIONS: Children hospitalized for fever and neutropenia who have persistent fever and an ANC of less than 100 after 48 hours are at high risk for morbidity and are more likely to require antibiotic changes and antifungal therapy. Children who initially lack signs of sepsis, are afebrile, and have an ANC of 100 or higher after 48 hours are at low risk for complications and could be selectively discharged on antimicrobials after a 48-hour period of inpatient hospitalization.

Adolescent↗
PubMedDate not supplied

[Rheumatic fever--exacerbation or decline? Analysis of patients admitted to a medical service within a period of 20 years].

The authors revised 116 clinical files of patients admitted to a Medicine ward with Rheumatic Fever in the years 1959-63 and 1979-83, in order to detect a possible recrudescence of the disease. The following parameters were analysed: age, sex, length of hospital stay, clinical manifestations, ancillary exams, therapeutics and evolution. It was found an impressive decline in the incidence of the disease (90 cases vs 26) and also a very significant decrease of the period of hospitalization in the recent group of patients (p less than 0.0005); Carditis and relapses of Rheumatic Fever were more frequent in the old group of patients.

Adolescent↗
PubMed1978

Epidemiologic and clinical features of sporadic Salmonella enteric fever.

Twenty-seven cases of enteric fever were diagnosed between January 1961 and February 1977 at a medium-sized urban hospital. Nineteen of the patients had recently travelled abroad. Fever was the only constant finding, and four patients noted fever and headache as their only symptoms. Splenomegaly was present in 30% and rose spots in just 11%. Enteric fever was initially suspected in only 63% of cases, and a mean of 4.8 days elapsed after admission before specific therapy was instituted. Salmonella was cultured from blood samples in 19 of 24 patients and from stool specimens in 21 of 27, but was never isolated from the urine. Serum O agglutinins, while eventually present in 54% of the patients tested, did not help in establishing an early diagnosis. No deaths occurred, though two patients sustained relapses. Sporadic enteric fever is unlikely to be suspected unless associated with recent foreign travel, but is easily diagnosed by usual culture methods.

Adolescent↗
PubMed2002

Leflunomide induced fevers, thrombocytosis, and leukocytosis in a patient with relapsing polychondritis.

The most common adverse events reported with the use of leflunomide are hypertension, infections, alopecia, and various gastrointestinal complaints. No fatal adverse hematologic events have been reported in humans, although anemia and leukopenia have been described in animals receiving 20 mg/kg/day. We describe a patient with relapsing polychondritis, in whom treatment failure with glucocorticoids, methotrexate, hydroxychloroquine, and azathioprine led to the institution of therapy with leflunomide at a maintenance dose of 20 mg/day. Two months after the dose of leflunomide had been increased to 30 mg daily, the patient developed high fevers, photophobia, thrombocytosis, and leukocytosis that returned to normal following treatment with cholestyramine and discontinuation of leflunomide. Rechallenge with leflunomide was not attempted and the syndrome did not recur during 14 month followup.

Anti-Inflammatory Agents↗
PubMed1985

Cost-effective control of rheumatic fever in the community.

Rheumatic fever is declining rapidly in importance in the developed countries, but is still a major public health problem in the developing countries. Primary prevention techniques, consisting of the detection and antibiotic treatment of streptococcal infections of the pharynx, are both feasible and effective, but are also costly, as only 10-20% of all pharyngeal infections are due to the beta-hemolytic Streptococcus, and only a small proportion of those actually develop into rheumatic heart disease. A different concerted approach, which is both effective and economically entirely justifiable, is to use antibiotics as a prophylaxis to prevent secondary infection, i.e. relapses of rheumatic fever. A multi-centre study conducted by the WHO has shown that the cost of antibiotics used for secondary prevention was less than the savings resulting from the lower incidence and shorter hospital stays of recurrencies of rheumatic fever. Given economic restrictions, therefore, priority is given to organized and systematic secondary prevention.

Community Health Services↗
PubMed1994

Therapeutic efficacy and safety of pidotimod in the treatment of urinary tract infections in children.

The activity of pidotimod ((R)-3-[(S)-(5-oxo-2-pyrrolidinyl) carbonyl]-thiazolidine-4-carboxylic acid, PGT/1A, CAS 121808-62-6) was studied vs. placebo in a double-blind, randomized, multicentre trial, involving 60 pediatric patients with recurrent urinary tract infections. Recovery from acute events was quicker with pidotimod than with placebo (9.6 vs. 12.3 days). In treated patients antibiotic therapy was shorter (6.9 vs. 8.3 days) and main symptomatic parameters (body temperature, vesical tenesmus, stranguria, pollakiuria, total number of symptoms, total symptomatic intensity, rate of asymptomatic patients, haematuria, leukocyturia, positive urinary culture) receded quickly. In patients receiving the drug as well as in patients treated with placebo changes in laboratory parameters were observed, indicating recovery from the acute infectious disease. A significant trend to normalization of the immune response, expressed by chemotaxis and index of leukocyte phagocytosis, was found only in patients treated with pidotimod. After the acute episode a significant decrease of risk of relapses (69%) was observed in these patients. If a relapse occurs, the response of treated patients is quicker (duration of fever, total time of relapses) than for control patients. These findings allow to correlate the individual immune response activation to the resistance to recurrent infections and also to a better response to therapy if the disease occurs and becomes clinically relevant. No side effects were observed. Mild reactions (4 nausea/vomiting, 1 erythema) occurred only in 5 patients (2 pidotimod, 3 placebo) but were attributed to concomitant antibiotic therapy. No alterations of main laboratory parameters were found. These findings confirm the tolerability of the drug also in long-term treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Infective Agents, Urinary↗
PubMed1976

Cefazolin in the treatment of acute enteric fever.

Cefazolin was used in the treatment of nine patients with acute enteric fever proven by positive blood cultures. In seven patients the causative organism was Salmonella typhi and in two it was Salmonella paratyphi B. Minimal inhibitory and minimal bactericidal concentrations of cefazolin against the nine isolates ranged between 1.95 and 3.90 mug/ml. Cefazolin was administered either intramuscularly or intravenously in a daily dose of 3 to 6 g for 11 to 16 days. The mean peak serum antibiotic concentration after a 0.5-g intravenous injection was 64.4 mug/ml, and the mean trough concentration, 3 h later, was 12.7 mug/ml. The highest serum inhibitory dilution at peak level was frequently 1/64, and at trough level it was 1/16 to 1/32. The acute infection was satisfactorily controlled in all patients. Phlebitis, complicating intravenous therapy, in five out of eight patients, was the only side effect observed. Relapse of typhoid fever, as documented by positive blood culture, occurred in one patient 11 days after treatment course was completed. More extensive clinical studies are required before drawing any conclusions regarding the efficacy of cefazolin in acute enteric fever.

Adolescent↗
PubMedDate not supplied

[The characteristics of the immune response to the polysaccharide determinants of Streptococcus group A in rheumatism].

As shown in this study, the formation of antibodies, at least, to the determinants (DT) of polysaccharide of group A streptococcus (A-PS), common with epidermal antigens, occurs in rheumatic fever. Two DT include N-acetylglucosamine; DT common with epidermal basal cell antigen (DT-1) and DT common with antigen of the perinuclear zone of the cytoplasm of cells of differentiated layers (DT-2). Two other DT seem to contain only rhamnose; DT common with the cytoplasm of cells of differentiated layers (DT-3) and DT common with epidermal antigen, characteristic of the cytoplasm of cells of all epidermal layers (DT-4). Conclusion has been made that the presence of autoantibodies to epidermal basal cell antigens, common with DT-1 and DT-4 of A-PS, may serve as an additional indicator of the activity of the rheumatic process. Autoantibodies to cross-reacting DT-4 of A-PS are indicative of the chronization of the process with a tendency to relapses of rheumatic fever.

Acetylglucosamine↗
PubMed2002

Q fever endocarditis: over 14 years of surgical experience in a referral center for rickettsioses.

BACKGROUND AND AIM OF THE STUDY: Q fever endocarditis caused by Coxiella burnetii is the most important etiology of negative blood culture endocarditis. Without specific clinical findings, diagnosis is difficult and prevalence of this life-threatening disease is underestimated. METHODS: Q fever endocarditis was assessed in 19 patients (15 men, four women; age range: 36-79 years) by evaluating clinical and echocardiographic criteria and specific serology. All patients had evidence of pre-existing valvular disease, and 10 had a valvular prosthesis. Diagnosis was assessed in: the presence of unexplained fever (n = 5), heart failure with valvular dysfunction (n = 10), hemolysis (n = 1), glomerulonephritis (n = 1) and stroke (n = 2). A late diagnosis was made in eight patients, either during or after surgery. RESULTS: In all cases, usual blood cultures remained negative, despite specific serology being positive. Transthoracic and transesophageal echocardiography were conclusive in only six cases (four vegetations, two periannular abscesses). Surgery was indicated in 15 patients for heart failure or valvular dysfunction (n = 12), hemolysis (n = 1) and periannular abscess (n = 2). Intraoperative findings were suggestive of endocarditis in seven cases; valvular cultures were positive in 92% of cases. All patients were treated with combined doxycycline/ hydrochloroquine or quinolone, for a mean of 24 months (range: 6-60 months). Mean follow up was 40 months (range: 6-144 months). Two patients died from heart failure, one patient was lost to follow up, and 16 patients had no late relapses. CONCLUSION: Q fever is an underestimated cause of endocardititis, and early diagnosis is the key to good prognosis. The need for systematic serologic examination in case of valvular dysfunction, with or without endocarditis symptoms, is emphasized.

Adult↗
PubMed2004

Recurrence of Sydenham chorea: implications for pathogenesis.

BACKGROUND: Sydenham chorea (SC), a major sign of rheumatic fever (RF), is related to systemic streptococcal infection and is treated with antibiotics. Recurrence usually occurs within a short interval following the initial event and is considered part of RF. OBJECTIVE: To evaluate the rate, nature, and course of recurrent SC during an extended follow-up period. DESIGN: Prospective assessment of a cohort of patients with SC who were admitted between 1985 and 2002. SETTING: General community hospital. METHODS: Diagnosis of RF was based on the revised Jones criteria. Other causes of chorea were excluded. Recurrence was defined as the development of new signs, lasting more than 24 hours and separated by a minimum of 2 months from the previous episode. Patients were observed from 1 to 14 years following the initial SC episode and for at least 1 year after recurrence. At recurrence, patients were assessed for RF clinical and laboratory activity, including change in cardiac involvement. RESULTS: Twenty-four patients had SC. In 19 patients (79%), the chorea was associated with other RF signs, and 5 suffered from pure chorea. Ten patients (42%, 7 women) developed 11 recurrent episodes of chorea 3 months to 10 years after the initial episode. Association of recurrent chorea with RF could be suspected in only 6 episodes: cessation of prophylactic antibiotic treatment or poor compliance in 4 patients and rise in antistreptolysin O titers in 2. In an 18-year-old woman, chorea recurred during her first pregnancy. At recurrence, chorea was the sole rheumatic sign in all 9 patients who had 1 recurrent episode. In the patient with 2 recurrent episodes, mitral regurgitation developed into mitral stenosis. No statistical differences in previous RF activity and rheumatic cardiac involvement between patients with recurrent SC and patients with a single episode could be found. CONCLUSIONS: In a significant subgroup of patients, SC recurrence might not be a true relapse of rheumatic fever. It might represent either a primary underlying abnormality that renders patients susceptible to developing such a movement disorder or the outcome of permanent subclinical damage to the basal ganglia following the initial SC episode.

Adolescent↗
PubMed2002

Active infective endocarditis due to methicillin-resistant Staphylococcus aureus in the acute phase of infectious mononucleosis.

A 26-year-old male was treated for acute hepatitis due to Epstein-Barr virus and infectious mononucleosis in our hospital. At 2 weeks after admission, there was relapse with high fever. A blood culture detected methicillin-resistant Staphylococcus aureus. A two-dimensional echocardiogram revealed severe aortic regurgitation and vegetation on the left coronary cusp of the aortic valve. The diagnosis was active infective endocarditis due to methicillin-resistant Staphylococcus aureus in the acute phase of infectious mononucleosis. Following preoperative administration of vancomycin, the aortic valve was replaced with a Carbomedics prosthetic valve. The aortic valve was bicuspid, and the right cusp and non-coronary cusp were conjoined. As the focus of infection was localized to the left coronary cusp, the infected tissue was fully removed with resection of all the cusps. Although fever persisted long after the operation, the blood culture became negative for methicillin-resistant Staphylococcus aureus, and repeated echocardiograms including transesophageal echocardiogram showed no prosthetic valve infection. Vancomycin was administered until the C-reactive protein became negative at 45 days after the operation.

Acute-Phase Reaction↗
PubMed2004

[Autoimmune cholangitis with vasculitic ulcers, rheumatoid arthritis and IgA glomerulonephritis].

HISTORY AND ADMISSION FINDINGS: A 51-year-old woman was admitted because of relapsing episodes of fever and leg ulcers for 14 years. In addition, she had polyserositis, polyarthralgias and polyarthritides, renal failure with proteinuria and elevation of gamma-GT and alkaline phosphatase. The patient was in a reduced general condition and cachectic nutritional state. She had slight scleral icterus, the liver being palpable 5 cm under the costal margin, edema of the lower limbs and two ulcers at the right foot. INVESTIGATIONS: Laboratory examinations revealed leukocytosis, anemia, elevation of cholestasis and inflammation parameters as well as renal failure. During a 24 hour collection period, a significant proteinuria was demonstrated. Immunoserologically, an ANA titer of 1:100 and a positive rheumatoid factor were found, ANCAs and AMAs were negative. On ultrasound, both kidneys exhibited a blurred pelvic parenchymal border. Thyroid ultrasound demonstrated parenchymal changes consistent with Hashimoto's disease. Ultrasound of the wrist revealed extensive arthritis with tendovaginitis. A renal biopsy revealed mesangioproliferative glomerulonephritis. DIAGNOSIS, THERAPY AND CLINICAL COURSE: Due to serologically persistent cholestasis, a liver biopsy was performed which, together with negative AMAs, revealed the diagnosis of an autoimmune cholangitis (AIC; AMA-negative primary-biliary cirrhosis (PBC)). In addition, the patient presented with rheumatoid arthritis, polyserositis, IgA glomerulonephritis, vasculitic leg ulcers and Hashimoto's thyreoiditis which were interpreted as extra-hepatic manifestations of the AIC. After initiation of high dosage corticosteroid therapy, rapid healing of the leg ulcers occurred. Therapy of the AIC consisted in ursodeoxycholic acid. CONCLUSION: The multitude of associated immunological phenomena in this patient resulted in a delay of the diagnosis. A AIC/PBC, however, should, always be considered in case of cholestasis.

Adrenal Cortex Hormones↗