Utility of Procalcitonin as an Early Diagnostic Marker of Bacteremia in Patients with Acute Fever

PURPOSE: Procalcitonin (PCT) is a current, frequently used marker for severe bacterial infection. The aim of this study was to assess the ability of PCT levels to differentiate bacteremic from nonbacteremic patients with fever. We assessed whether PCT level could be used to accurately rule out a diagnosis of bacteremia. MATERIALS AND METHODS: Serum samples and blood culture were obtained from patients with fever between August 2008 and April 2009. PCT was analyzed using a VIDAS(R) B.R.A.H.M.S PCT assay. We reviewed the final diagnosis and patient histories, including clinical presentation and antibiotic treatment. RESULTS: A total of 300 patients with fevers were enrolled in this study: 58 with bacteremia (positive blood culture) (group I); 137 with local infection (group II); 90 with other diseases (group III); and 15 with fevers of unknown origin (group IV). PCT levels were significantly higher in patients with bacteremia than in those with non-bacteremia (11.9 +/- 25.1 and 2.5 +/- 14.7 ng/mL, respectively, p < 0.001). The sensitivity and specificity were 74.2% and 70.1%, respectively, at a cut-off value of 0.5 ng/mL. A serum PCT level of < 0.4 ng/mL accurately rules out diagnosis of bacteremia. CONCLUSION: In febrile patients, elevated PCT may help predict bacteremia; furthermore, low PCT levels were helpful for ruling out bacteremia as a diagnosis. Therefore, PCT assessment could help physicians limit the number of prescriptions for antibiotics.

Etiology of obscure fever in children at a university hospital in northeast Thailand.

Obscure fever is not an uncommon problem in Thailand. We studied 25 children with obscure fever admitted to Srinagarind (university) Hospital in Northeast Thailand. The etiology was identified in 52% of the cases: dengue (40%), leptospirosis (8%), and micrococcus septicemia (4%). Two cases with primary dengue infection developed dengue shock syndrome. The case with leptospirosis developed infection-associated, hemophagocytic syndrome. We found no cases of Japanese encephalitis, scrub typhus or murine typhus.

Hyperferritinemia and Pyrexia of Unknown Origin

By the time a patient is formally categorized as having 'Pyrexia of Unknown Origin', a battery of tests have been performed and many physicians have run out of differential diagnoses. Adult Still's Disease is considered a rheumatologic disorder and is, therefore, not considered if the patient does not have joint symptoms. We present the case of such a patient who presented with high spiking fever, and review how we gained confidence in establishing the diagnosis

Bacteremia and bacterial infections in highly febrile children without apparent focus.

To find the incidence of bacteremia and serious bacterial infections in febrile children without an apparent focus of infection, we prospectively studied 100 febrile children aged 1 month-3 years with a rectal temperature > or = 39 degrees C. Ten children had a blood culture positive bacteremia and nine had serology positive for bacteremia; 6 had urinary tract infection, 5 otitis media and 8 meningitis. A diagnosis of non bacterial illness was made in 62 patients. Staphylococcus aureus was the most common bacteriologic isolate on blood culture (five) and by serology (eight). TLC > or = 15,000/cu mm m-ESR > or = 25 mm and temperature > or = 39 degrees C had high specificity (95-100%) but low sensitivity for diagnosis of bacteremia.

Fiebre de origen desconocido: diagnóstico médico y tratamiento homeopático / Fever of unknown origin: medical diagnosis and homeopathic treatment

Uno de los dasafíos más difíciles que nos plantea la energía vital a los homeópatas, es cuando manifiesta su desequilibrio como síndrome febril prolongado de diagnóstico incierto. Las enfermedades responsables de la fiebre de origen desconocido (FOD) han ido variando para introducirse, cada vez con más frecuencia, las neoplasias y las enfermedades del colágeno. Sin embargo, se ha demostrado repetidamente que la FOD, es producida generalmente por enfermedades muy comunes y que las patologías exóticas o infrecuentes constituyen una pequeña proporción. Las infecciones representan en promedio el 40 por ciento de las causas de FOD, destacándose la tuberculosis como más frecuente. Las neoplasias constituyen alrededor de un 30 por ciento de los casos, especialmente linfomas, carcinoma renal, mixoma auricular, hepatoma y carcinoma del tubo digestivo. A las enfermedades del colágeno corresponde un 15 por ciento de los casos FOD, sobre todo LES y AR en su variedad llamada enfermedad de Still. El porcentaje restante tiene etiología diversa. Un 8 por ciento de los casos quedan sin diagnóstico. En el presente trabajo se propone una estrategia para el diagnóstico médico de la FOD y una revisión de las principales modalidades que el síndrome febril presenta en el Repertorio