1/112. pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography.PURPOSE: To obtain statistical data on the use of high-resolution computed tomography (HRCT) for early detection of pneumonia in febrile neutropenic patients with unknown focus of infection. MATERIALS AND methods: One hundred eighty-eight HRCT studies were performed prospectively in 112 neutropenic patients with fever of unknown origin persisting for more than 48 hours despite empiric antibiotic treatment. Fifty-four of these studies were performed in transplant recipients. All patients had normal chest roentgenograms. If pneumonia was detected by HRCT, guided bronchoalveolar lavage was recommended. Evidence of pneumonia on chest roentgenograms during follow-up and micro-organisms detected during follow-up were regarded as documentation of pneumonia. RESULTS: Of the 188 HRCT studies, 112 (60%) showed pneumonia and 76 were normal. documentation of pneumonia was possible in 61 cases by chest roentgenography or micro-organism detection (54%) (P < 10(-6)). Sensitivity of HRCT was 87% (88% in transplant recipients), specificity was 57% (67%), and the negative predictive value was 88% (97%). A time gain of 5 days was achieved by the additional use of HRCT compared to an exclusive use of chest roentgenography. CONCLUSION: The high frequency of inflammatory pulmonary disease after a suspicious HRCT scan (> 50%) proves that pneumonia is not excluded by a normal chest roentgenogram. Given the significantly longer duration of febrile episodes in transplant recipients, HRCT findings are particularly relevant in this subgroup. patients with normal HRCT scans, particularly transplant recipients, have a low risk of pneumonia during follow-up. All neutropenic patients with fever of unknown origin and normal chest roentgenograms should undergo HRCT.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/112. Disseminated Bartonella infection with granulomatous hepatitis in a liver transplant recipient.Disseminated infection with Bartonella spp with granulomatous hepatitis was diagnosed in a liver transplant recipient presenting with fever of unknown origin. Pathological findings on liver biopsy were atypical, with scant granulomas seen only after a second biopsy. The patient responded promptly to antibiotic therapy. Infections caused by Bartonella spp should be considered in transplant recipients with fever of unknown origin.- - - - - - - - - - ranking = 5keywords = infection (Clic here for more details about this article) |
3/112. Systemic bartonella henselae infection with hepatosplenic involvement.BACKGROUND: Systemic manifestations of bartonella henselae infection are rare in the immunocompetent host. The infection generally has initial symptoms of prolonged fever and multiple granulomatous lesions in liver and spleen. methods: Retrospective analysis of the records of all patients with hypoechogenic lesions in the liver and/or spleen diagnosed from 1990 through 1996 in three pediatric clinics in northern italy. RESULTS: Among the 13 patients reviewed, 9 had evidence of B. henselae infection and hepatosplenic involvement: five had prolonged and unexplained fever lasting from 3 to 16 weeks, and four had typical cat-scratch disease and peripheral lymphadenitis. All patients had increased sedimentation rate and normal aminotransferase serum activity. Five children had a liver biopsy, by laparotomy in three and by needle in two. In all, the predominant liver lesion was a necrotizing granuloma. All patients were treated with broad-spectrum antibiotics. Fever lasted from 3 to 16 weeks, and hepatic and splenic lesions resolved in all with residual splenic calcification in one. CONCLUSIONS: Systemic B. henselae infection represents an important cause of inflammatory hypoechogenic hepatosplenic lesions in children. serology provides rapid diagnosis, avoiding multiple and invasive investigations. Hepatosplenic involvement can be found even in children with typical cat-scratch disease without apparent systemic manifestations. The frequency of liver and/or splenic involvement in cat-scratch disease is probably underestimated.- - - - - - - - - - ranking = 8keywords = infection (Clic here for more details about this article) |
4/112. bacteroides fragilis bacteremia and infected aortic aneurysm presenting as fever of unknown origin: diagnostic delay without routine anaerobic blood cultures.We report the case of a 71-year-old male with bacteroides fragilis bactermia and infected aortic aneurysm that went undiagnosed, in part, because routine anaerobic blood cultures were not obtained. bacteremia caused by anaerobes has been reported to be declining, and recommendations to discontinue routine anaerobic blood cultures have been implemented in some hospitals. To our knowledge, this is the first report of an anaerobic bacteremia and infection that had a delay in diagnosis due to this change in blood-culturing protocol. The potential impact of deleting anaerobic blood cultures from routine protocols is discussed.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
5/112. Mycotic aneurysm of the ascending aorta following CABG.Mycotic aneurysm of the thoracic aorta is a rare and life threatening condition. Two patients are presented (both male, aged 66 and 59 years) in whom coronary artery bypass surgery was complicated by the development of a mycotic aneurysm. Fever preceded the radiological and echocardiographic signs of the aneurysm by at least several months in both cases. blood cultures were negative for one patient and the source of corynebacterium sp infection in the other was not determined for several months. Both patients died before surgery could correct the aneurysm.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
6/112. Intestinal tuberculosis presenting as fever of unknown origin in a heart transplant patient.patients undergoing transplantation have an increased risk of developing infections such as tuberculosis, pneumocystis carinii pneumonia, candida infections or cytomegalovirus infections because of their immunosuppressive therapy with cyclosporin A, azathioprine and steroids. Mycobacterial infection is well recognized as a complication in the immunocompromised host but diagnosis and therapy are very difficult.- - - - - - - - - - ranking = 4keywords = infection (Clic here for more details about this article) |
7/112. Recurring febrile illness in a slaughterhouse worker.A slaughterhouse worker presented with fever and a pleuropericardial effusion. Conventional microbiology failed to identify the responsible organism. However, dna sequencing definitively identified campylobacter fetus ssp fetus, which is rare in immunocompetent individuals. Prolonged treatment was required to eradicate the infection.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
8/112. A case of fever of unknown origin with severe stomatitis in renal transplant recipient resulting in graft loss.We present a case of fever of unknown origin and life-threatening stomatitis developed about 60 months after renal transplantation. He was 15 yr old at the transplantation. Bacterial, fungal, and viral infections were not evident. Fever and stomatitis were resistant to acyclovir and to any anti-bacterial or anti-fungal treatment. Graft biopsy revealed a small focus of acute vascular rejection, but the findings were not severe enough to be an etiology of the fever in this case. The administration of cyclosporine (CYA) was stopped 19 d before graftectomy, but the clinical picture was unchanged. Fever and stomatitis was resolved immediately after graftectomy and the discontinuation of immunosuppressants such as mizoribine (MZ) and prednisolone. Pathological changes of the graft included chronic transplant glomerulopathy, acute glomerulitis, and lymphocyte infiltration in peritubular capillaries. Thus we suppose that immunosuppressants were the cause of both fever and stomatitis in this case. We speculate that a fever in this case might be due to the immunosuppressant itself, i.e., CYA or MZ, or viral infection probably herpes-simplex virus infection. It is probably the immunosuppressive state per se that may cause the resistance of his muco-cutaneous lesion to anti-viral agent.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
9/112. The shampoo clue: two cases of infection of a ventriculoatrial shunt.Despite the use of sophisticated tools, infections of implanted devices may be difficult to diagnose. Two cases of infections of ventriculoatrial shunts, which demonstrate the eminent importance of meticulously taking history, are reported and discussed.- - - - - - - - - - ranking = 6keywords = infection (Clic here for more details about this article) |
10/112. peptostreptococcus asaccharolyticus renal abscess: a rare cause of fever of unknown origin.Renal abscess is uncommon in pediatrics and is rarely a cause of fever of unknown origin. We recently cared for a patient who presented with a 3-week history of fever. An indium scan ultimately led to the diagnosis of a renal abscess. Aspiration yielded peptostreptococcus asaccharolyticus. This unusual case prompted a review of the clinical and microbiologic features of renal abscess in pediatric patients at our hospital over the past 10 years. Seven additional patients with a discharge diagnosis of renal abscess were identified. Only 2 of the patients had identifiable risk factors (diabetes mellitus and polycystic kidneys). staphylococcus aureus or enterobacteriaceae were responsible for most infections, consistent with hematogenous and urinary tract sources, respectively. No other cases of anaerobic abscess were identified. This case highlights the importance of considering a renal abscess in the differential diagnosis of fever of unknown origin and of processing specimens for both aerobic and anaerobic organisms.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
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