Diagnosis Of Febrile Patients Research Articles

Nasopharyngeal colonisation dynamics of bacterial pathogens in patients with fever in rural Burkina Faso: an observational study

BackgroundNasopharyngeal colonisation with clinically relevant bacterial pathogens is a risk factor for severe infections, such as pneumonia and bacteraemia. In this study, we investigated the determinants of nasopharyngeal carriage in febrile patients in rural Burkina Faso.MethodsFrom March 2016 to June 2017, we recruited 924 paediatric and adult patients presenting with fever, hypothermia or suspicion of severe infection to the Centre Medical avec Antenne Chirurgicale Saint Camille de Nanoro, Burkina Faso. We recorded a broad range of clinical data, collected nasopharyngeal swabs and tested them for the presence of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus and Klebsiella pneumoniae by quantitative polymerase chain reaction. Using logistic regression, we investigated the determinants of carriage and aimed to find correlations with clinical outcome.ResultsNasopharyngeal colonisation with S. pneumoniae, H. influenzae and M. catarrhalis was highly prevalent and strongly dependent on age and season. Females were less likely to be colonised with S. pneumoniae (OR 0.71, p = 0.022, 95% CI 0.53–0.95) and M. catarrhalis (OR 0.73, p = 0.044, 95% CI 0.54–0.99) than males. Colonisation rates were highest in the age groups < 1 year and 1–2 years of age and declined with increasing age. Colonisation also declined towards the end of the rainy season and rose again during the beginning of the dry season. K. pneumoniae prevalence was low and not significantly correlated with age or season. For S. pneumoniae and H. influenzae, we found a positive association between nasopharyngeal carriage and clinical pneumonia [OR 1.75, p = 0.008, 95% CI 1.16–2.63 (S. pneumoniae) and OR 1.90, p = 0.004, 95% CI 1.23–2.92 (H. influenzae)]. S. aureus carriage was correlated with mortality (OR 4.01, p < 0.001, 95% CI 2.06–7.83), independent of bacteraemia caused by this bacterium.ConclusionsAge, sex and season are important determinants of nasopharyngeal colonisation with S. pneumoniae, H. influenzae and M. catarrhalis in patients with fever in Burkina Faso. S. pneumoniae and H. influenzae carriage is associated with clinical pneumonia and S. aureus carriage is associated with mortality in patients with fever. These findings may help to understand the dynamics of colonisation and the associated transmission of these pathogens. Furthermore, understanding the determinants of nasopharyngeal colonisation and the association with disease could potentially improve the diagnosis of febrile patients.

Diagnostic Accuracy of Procalcitonin, Neutrophil-to-Lymphocyte Ratio, and C-Reactive Protein in Detection of Bacterial Infections and Prediction of Outcome in Nonneutropenic Febrile Patients with Lung Malignancy.

Background Procalcitonin (PCT), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) have emerged as important markers of inflammation, and these markers, especially PCT and CRP, have been studied in patients with neutropenia. This study was designed to evaluate their value in differentiating infectious fever from tumor fever (TF) and to investigate their role in assessing outcomes in nonneutropenic lung cancer patients (NNLCPs). Methods This retrospective clinical study included 588 febrile NNLCPs between January 2019 and December 2019. The levels of PCT, CRP, and conventional inflammatory markers, including white blood cells (WBC) and neutrophils (NEU), were measured. NLR was defined as the ratio of the absolute neutrophil count to the absolute lymphocyte count. Patients' clinical and bacteriological data were recorded. Results This study included 311 NNLCPs with bacterial infections and 277 with TF. Inflammatory markers such as PCT, CRP, WBC, and NEU levels and NLR were significantly higher in patients with bacterial infections than in those with TF (p < 0.0001). However, PCT level was the best predictor of bacterial infections, with an area under the curve (AUC) of 0.874, followed by CRP level (AUC = 0.855) and NLR (AUC = 0.792) (p < 0.0001). Additionally, PCT level was significantly elevated in patients with bacterial infections with progressive disease after radiotherapy and chemotherapy (p < 0.01). Conclusions The present study demonstrated the superiority of PCT over CRP and NLR in the diagnosis of febrile patients with bacterial infections. Additionally, PCT can be used to assess the clinical outcomes and cancer progression in NNLCPs.

Francisella tularensis as the cause of protracted fever

BackgroundTularemia, a re-emerging, potential life threatening infectious disease, can present itself with nonspecific clinical symptoms including fever, chills and malaise. Taking a detailed history of exposure and a highly raised index of clinical suspicion are necessary to take the appropriate diagnostic and therapeutic steps in this setting. Here, a case report of typhoid tularaemia is presented.Case presentationA 53-year old male forester and farmer with protracted fever, abdominal pain, diarrhoea and loss of weight, who experienced productive cough and a pulmonary infiltrate later in the course of disease, was admitted for further investigation. Tularaemia was suspected only owing to history and confirmed by serologic testing more than three weeks after the beginning of the symptoms. The initial antibiotic therapy with ceftriaxone/doxycycline was switched to ciprofloxacin, resulting in the resolution of fever and symptoms.ConclusionTularaemia has to be considered as a differential diagnosis in febrile patients, even more in cases with protracted fever. Since tularaemia is expanding geographically, involving more animal hosts and causing larger outbreaks, clinicians have to be aware of this potentially fatal disease.

Molecular diagnosis of autochthonous human anaplasmosis in Austria \u2013 an infectious diseases case report

BackgroundThe diagnosis of human anaplasmosis remains elusive and is probably often missed. This case report highlights the efficacy of molecular diagnostic techniques.Case presentationWe would like to report the case of a 74-year-old man who was admitted to hospital because of a high fever, marked chills, transient diplopic images and vertigo, 6 weeks after multiple tick bites. The laboratory results showed mild anemia, marked thrombocytopenia and leukopenia and a moderately elevated C-reactive protein. The initial serology seemed to indicate an active infection with Borrelia spp., and Anaplasma phagocytophilum was detected in peripheral blood by polymerase chain reaction (PCR) and subsequent sequencing. The patient received intravenous ceftriaxone for 14 days and oral doxycycline for 4 weeks and made a fast and complete recovery.ConclusionsWhile human anaplasmosis has been reported very rarely in Austria, it should be considered as a differential diagnosis in febrile patients with low leukocyte and platelet counts with elevated levels of C-reactive protein after exposure to tick bites. Molecular detection of A. phagocytophilum is the technique of choice allowing rapid and reliable diagnosis.

First detection of Borrelia miyamotoi in Ixodes ricinus ticks from northern Italy

BackgroundBorrelia miyamotoi is a spirochete transmitted by several ixodid tick species. It causes a relapsing fever in humans and is currently considered as an emerging pathogen. In Europe, B. miyamotoi seems to occur at low prevalence in Ixodes ricinus ticks but has a wide distribution. Here we report the first detection of B. miyamotoi in Ixodes ricinus ticks collected in two independent studies conducted in 2016 in the north-eastern and north-western Alps, Italy.ResultsThree out of 405 nymphs (0.74%) tested positive for Borrelia miyamotoi. In particular, B. miyamotoi was found in 2/365 nymphs in the western and in 1/40 nymphs in the eastern alpine area. These are the first findings of B. miyamotoi in Italy.ConclusionsExposure to B. miyamotoi and risk of human infection may occur through tick bites in northern Italy. Relapsing fever caused by Borrelia miyamotoi has not yet been reported in Italy, but misdiagnoses with tick-borne encephalitis, human granulocytic anaplasmosis or other relapsing fever can occur. Our findings suggest that B. miyamotoi should be considered in the differential diagnosis of febrile patients originating from Lyme borreliosis endemic regions. The distribution of this pathogen and its relevance to public health need further investigation.

The 2016-2017 Chikungunya Outbreak in Karachi.

Introduction: Chikungunya is an incipient disease, caused by Chikungunya virus (CHKV) that belongs to genus alphavirus of the family Togaviridae.Materials and Methods: In this study, during an outbreak of CHKV in Dec 2016 in Karachi, Pakistan, samples were collected from patients presenting with fever, tiredness and pain in muscles and joints. Total 126 sera were tested for the presence of Chikungunya infection through ELISA and Real-time Reverse Transcriptase PCR assay.Results and Discussion: This study showed that approx 79.4% samples were positive for CHKV. To our knowledge, this is the first reported outbreak from last decades in which the presence of CHKV is confirmed in Karachi while affecting such large no. of individuals.. Conclusion: CHKV diagnosis should be considered by the scientists and clinicians as a differential diagnosis in febrile patients, and appropriate control strategies must be adopted for its surveillance.

Zika virus-induced itching rash in a returning traveller from Brazil

• Zika virus infections are an important differential diagnosis in febrile patients returning from endemic areas.

Relapsing fever: an almost forgotten disease in focus again

Introduction | Relapsing fevers, transmitted by arthropods, are rarely encountered in Germany, thus they are often not considered as differential diagnosis in febrile patients. In the last months, more than fourty cases of louse-borne relapsing fever were diagnosed in asylum seekers in Germany. Some of the patients had to be admitted to intensive care units, one patient died despite therapy. Pathogen, disease and diagnosis | The causative agents are spirochetes of the genus borrelia, which can reach high densities in patient blood. Depending on the vector and the region, different species are prevalent worldwide. For diagnosis, appropriate techniques include direct detection by microscopy or PCR from EDTA-blood. Ordering such tests should not be delayed when there is suspicion for relapsing fever. Besides, malaria can also be excluded with microscopy of blood smears. Therapy | First-line antibiotics include tetracyclines and penicillin, acquired resistance has not yet been observed. Frequently patients develop a Jarisch-Herxheimer reaction shortly after initiation of therapy, requiring hospitalization or intensive care treatment. Managing the treatment exclusively in an outpatient setting is not recommended. Especially in migrants with febrile illness, relapsing fever is an important differential diagnosis.

Brucellosis serology as an alternative diagnostic test for patients with malaria-like symptoms

Background: In a low transmission zone for malaria, we explored the presence of brucellosis as an alternative diagnosis in febrile patients. Specifically, the objective of our study was to determine the proportion of patients presenting to the hospital with malaria-like febrile symptoms that were concurrently brucellosis sero-positive, and assess related risk factors.Methods: The study was done at the rural hospital in Endulen, in the Ngorongoro Conservation Area (NCA), Tanzania. Hospital patients were enrolled showing malaria-like febrile symptoms and were tested for malaria (microscopy) as well as brucellosis (agglutination test, plus commercial ELISAs for IgM and for IgG). Patient demographic characteristics and risk factors for brucellosis were determined using a questionnaire interview.Results: A total of 159 patients were enrolled, of which 57 were positive for malaria and 58 were positive by ELISA for brucellosis, with 54 (93%) of these brucellosis-positives solely positive for isotype IgG, 1 (1.7%) solely for isotype IgM, and 3 (5.2%) positive for both IgM and IgG. However, the brucellosis agglutination test was only positive in 9 of 159 samples. Co-infections of malaria and brucellosis occurred, but malaria disease status was not significantly correlated with brucellosis status. Patients serologically positive for brucellosis were more likely to have had contact with aborted animal materials (p=0.002).Conclusions: Brucellosis is a potentially missed diagnosis amongst pastoralists in rural Tanzania with malaria-like symptoms. However, concurrent and isotope-specific serology is integral to ensure detection and appropriate clinical management.

Ceftriaxone, ofloxacin or both in the treatment of enteric fever

Introduction: Enteric fever is a common diagnosis in febrile patients admitting to the hospital of Nepal. The treatment of enteric fever, though looks straightforward, in recent times has been complicated by emerging resistance to various antibiotics including fluoroquinolones and cephalosporins.Methods: This was a randomized clinical study done at Shree Birendra Hospital from January 2011 to December 2011. Patients with with high grade fever, headache, relative bradycardia, abdominal pain, diarrhoea or constipation with normal to low leukocyte count were clinically diagnosed as Enteric fever and were randomized to either ofloxacin or ceftriaxone group, both well accepted first line treatment for enteric fever and observed for at least five days before the addition of the second drug that is ceftriaxone in ofloxacin group and ofloxacin in ceftriaxonegroup and the response to the drug was noted in terms of defervescence of fever.Results: Total 50 patients were enrolled, 25 in each treatment group. After five days, six patients in Ceftriaxone group needed addition of Ofloxacin and two patients in Ofloxacin group needed Ceftriaxone. The average fever defervescence time in Ceftriaxone group was 3.88 days and in Ofloxacin group was 3.04 days. All patients were afebrile by 9 days of antibiotics.Conclusions: Fever defervescence time with Ofloxacin was lesser than ceftriaxone group and need of supplementary antibiotic is lesser in ofloxacine group. So, ofloxacin can be recommended as 1st line drug for enteric fever.Medical Journal of Shree Birendra Hospital; January-June 2013/vol.12/Issue1/37-40DOI: http://dx.doi.org/10.3126/mjsbh.v12i1.9092

Clinical and laboratory profile of enteric fever in children in northern India

The diagnosis of enteric fever poses several problems due to the non-specific and wide array of clinical features. A five-year retrospective study enrolling 136 culture-proven cases of enteric fever was undertaken in order to estimate the clinical and laboratory characteristics, fever clearance time and outcome. The common symptoms and signs were: fever, vomiting, cough, anorexia, diarrhoea, abdominal pain, hepatomegaly, splenomegaly and coated tongue. Enteric fever should be considered in the differential diagnosis of febrile patients with abdominal symptoms.

Severe pharyngitis in stockbreeders: an unusual presentation of brucellosis

Abstract Brucellosis is a known occupational hazard for shepherds, abattoir workers, veterinarians, dairy industry professionals and personnel in microbiological laboratories. Any organ may be affected by Brucella species but to date, severe manifestations in the pharynx have never been reported as the prevailing features of brucellosis. We report two cases in stockbreeders who presented with high-grade fever and severe exudative pharyngitis accompanied by severe odynophagia in the first and with high-grade fever and a history of relapsing tonsillitis in the second. We therefore recommend including brucellosis in the differential diagnosis of febrile patients suffering from unexplained pharyngitis or tonsillitis who belong to high-risk groups for contracting brucellosis.

The Rapid Manual Para Sight™-F Test for Diagnosing Plasmodium Falciparum Malaria in Saudi Arabia

Currently, about 1.6 million people live in areas of Saudi Arabia where malaria is transmitted. In the southwestern region of the Asir lowlands (Tihama), Plasmodium falciparum is the predominant species, accounting for over 90% of all malaria infections. 1 The peak of malaria transmission in the Asir lowlands is between October and April, and coincides with the rainy season (550 mm/year). In the malarious areas of Asir, two categories of population are at risk of contracting the infection: 1) permanent residents of the foothills and lowlands of Tihama and the coastal plain along the Red Sea; and 2) residents of the non-malarious areas in the highlands (Sarawat), who frequently travel for recreational activities to the endemic lowland areas during the transmission season. The latter group is especially prone to severe infection and a high degree of parasitemia, as they have little or no resistance to malaria. In the rural areas of Saudi Arabia, management of human malaria at the primary health care level is based on clinical diagnosis of febrile patients before institution of chloroquine therapy. The absence of specific diagnostic criteria and supportive laboratory confirmation of parasitemia mostly leads to inaccurate diagnosis and overtreatment. In regional referral hospitals, where appropriate facilities for better diagnosis and light microscopy are present, examination of blood slides for malaria is the cornerstone for early diagnosis and prompt treatment. However, the sensitivity of the standard thickblood examination and microscopy has many limitations. 2