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1.
Diagn Microbiol Infect Dis ; 101(1): 115433, 2021 Sep.
Article in English | MEDLINE | ID: mdl-34139401

ABSTRACT

Enterococcus faecalis can cause infective endocarditis and other complicated infections. We prospectively investigate the incidence of persistent bacteremia with E. faecalis. Of 50 episodes with monomicrobial E. faecalis bacteremia the control blood culture after 48 to 72 hours was positive in 5 episodes (10%) of which 4 had a complicated focal infection.


Subject(s)
Bacteremia/diagnosis , Blood Culture , Enterococcus faecalis/isolation & purification , Gram-Positive Bacterial Infections/diagnosis , Aged , Aged, 80 and over , Bacteremia/epidemiology , Bacteremia/microbiology , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/epidemiology , Endocarditis, Bacterial/microbiology , Female , Focal Infection/diagnosis , Focal Infection/epidemiology , Focal Infection/microbiology , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/microbiology , Humans , Incidence , Male , Prospective Studies
2.
An. pediatr. (2003. Ed. impr.) ; 93(2): 77-83, ago. 2020. tab, graf
Article in Spanish | IBECS | ID: ibc-201749

ABSTRACT

INTRODUCCIÓN: La nefritis focal bacteriana aguda es una infección intersticial bacteriana, localizada en el parénquima renal, que entraña mayor gravedad que la pielonefritis aguda. El objetivo del estudio es el análisis de factores predictivos que permitan su diagnóstico precoz, fundamental para un adecuado abordaje terapéutico. PACIENTES Y MÉTODOS: Estudio multicéntrico de casos y control retrospectivo. Centros participantes: hospitales de Castellón y Valencia. Periodo de estudio: 2010-2018. Casos: nefritis focal bacteriana. Controles: pielonefritis aguda. RESULTADOS: Se incluyó a un total de 158 pacientes (1:1). La mediana de edad de los casos fue 2 años. El 75% de sexo femenino. No existieron diferencias en la presentación clínica. En el análisis univariante la nefritis focal se relacionó con malformaciones del tracto urinario, bacteriemia, recuento de neutrófilos y la procalcitonina, así como las convulsiones febriles en el límite de la significación. Valores de procalcitonina ≥ 2 ng/ml tiene una OR de 4,9 (IC del 95: 1,77-13,85) de presentar nefritis focal. En el análisis multivariante las malformaciones urológicas mantuvieron la significación estadística y la procalcitonina en el límite de la significación. CONCLUSIONES: Las malformaciones del tracto urinario predisponen al desarrollo de nefritis focal bacteriana. Ante pacientes con infección del tracto urinario y factores predictivos de nefritis focal bacteriana aguda, sería recomendable la realización de una ecografía Doppler renal en fase aguda para un diagnóstico y un tratamiento adecuado


INTRODUCTION: Acute focal bacterial nephritis is an interstitial bacterial infection, localised in the renal parenchyma, which can be more serious than acute pyelonephritis. The aim of this study is the analysis of predictive factors that may lead to its early diagnosis, which is essential for an adequate therapeutic approach. PATIENTS AND METHODS: A retrospective, multicentre case and control study. The participant centres were hospitals in Castellon and Valencia. The study period was 2010-2018, with the cases being patients with focal bacterial nephritis and the patients with pyelonephritis as controls. RESULTS: A total of 158 (1:1) patients were included. The median age of the cases was 2 years and there were 75% females. There were no differences in the clinical presentation. In the univariate analysis, focal nephritis was associated with malformations of the urinary tract, bacteraemia, the neutrophil count, and procalcitonin, as well as febrile convulsions of borderline significance. Procalcitonin values ≥ 2 ng/ml had an OR of 4.9 (95% CI; 1.77-13.85) of presenting with focal nephritis. In the multivariate analysis, the urological malformations still maintained statistical significance and borderline significance for procalcitonin. CONCLUSIONS: The urinary tract malformations predispose the development of focal bacterial nephritis. In patients with a urinary tract infection and predictive factors of acute focal bacterial nephritis it would be worthwhile performing a renal Doppler ultrasound in the acute phase for its appropriate diagnosis and treatment


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Bacterial Infections/diagnosis , Nephritis/diagnosis , Pyelonephritis/diagnosis , Acute Disease , Bacterial Infections/microbiology , Biomarkers/metabolism , Case-Control Studies , Nephritis/microbiology , Focal Infection/diagnosis , Retrospective Studies , Urinary Tract/abnormalities , Urinary Tract Infections/complications
3.
An Pediatr (Engl Ed) ; 93(2): 77-83, 2020 Aug.
Article in Spanish | MEDLINE | ID: mdl-32205055

ABSTRACT

INTRODUCTION: Acute focal bacterial nephritis is an interstitial bacterial infection, localised in the renal parenchyma, which can be more serious than acute pyelonephritis. The aim of this study is the analysis of predictive factors that may lead to its early diagnosis, which is essential for an adequate therapeutic approach. PATIENTS AND METHODS: A retrospective, multicentre case and control study. The participant centres were hospitals in Castellon and Valencia. The study period was 2010-2018, with the cases being patients with focal bacterial nephritis and the patients with pyelonephritis as controls. RESULTS: A total of 158 (1:1) patients were included. The median age of the cases was 2 years and there were 75% females. There were no differences in the clinical presentation. In the univariate analysis, focal nephritis was associated with malformations of the urinary tract, bacteraemia, the neutrophil count, and procalcitonin, as well as febrile convulsions of borderline significance. Procalcitonin values ≥2 ng/ml had an OR of 4.9 (95%CI; 1.77-13.85) of presenting with focal nephritis. In the multivariate analysis, the urological malformations still maintained statistical significance and borderline significance for procalcitonin. CONCLUSIONS: The urinary tract malformations predispose the development of focal bacterial nephritis. In patients with a urinary tract infection and predictive factors of acute focal bacterial nephritis it would be worthwhile performing a renal Doppler ultrasound in the acute phase for its appropriate diagnosis and treatment.


Subject(s)
Bacterial Infections/diagnosis , Nephritis/diagnosis , Pyelonephritis/diagnosis , Acute Disease , Adolescent , Bacterial Infections/microbiology , Biomarkers/metabolism , Case-Control Studies , Child , Child, Preschool , Female , Focal Infection/diagnosis , Humans , Infant , Male , Nephritis/microbiology , Retrospective Studies , Urinary Tract/abnormalities , Urinary Tract Infections/complications
4.
J Infect ; 79(5): 419-425, 2019 11.
Article in English | MEDLINE | ID: mdl-31442461

ABSTRACT

OBJECTIVES: Microbiological diagnosis is essential during clinical management of focal infections. Metagenomic next generation sequencing (mNGS) has been reported as a promising diagnostic tool in infectious diseases. However, little is known about the clinical utility of mNGS in focal infections. METHODS: We conducted a single-center retrospective study to investigate impact of mNGS on focal infection diagnosis and compared it with conventional methods, including culture, pathological examination, Xpert MTB/RIF, etc. 98 suspected focal infections cases were enrolled, and medical records were reviewed to determine their rates of detection, time-to-identification, and clinical outcomes. RESULTS: mNGS showed a satisfying diagnostic positive percent agreement of 86.30% (95% CI: 75.79-92.88%) in a variety of tissues, compared to 45.21% (95% CI: 33.68-57.24%) for culture and 57.53% (95% CI: 45.43-68.84%)f for conventional methods (p < 0.0125), and detected an extra 34 pathogenic microorganisms. Time requirement for pathogen identification using mNGS ranges from 31 h to 55 h, which showed an advantage over culture. (82.36 h; 95%CI: 65.83, 98.89; P < 0.05) CONCLUSIONS: mNGS showed promising potential in pathogenic diagnosis during focal infections and might enable clinicians to make more timely and targeted therapeutic decisions.


Subject(s)
Focal Infection/diagnosis , High-Throughput Nucleotide Sequencing/methods , Metagenomics/methods , Molecular Diagnostic Techniques/methods , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Treatment Outcome , Young Adult
6.
Respirology ; 21(5): 898-904, 2016 07.
Article in English | MEDLINE | ID: mdl-27028604

ABSTRACT

BACKGROUND AND OBJECTIVE: Sepsis is a leading cause of acute lung injury (ALI); however, the characteristics and outcome of sepsis-associated ALI are poorly understood. We aimed to elucidate factors that predict patient outcome in sepsis-associated ALI. METHODS: Secondary analysis of a multicenter, prospective, observational study was performed. RESULTS: Among 624 patients with severe sepsis and septic shock, 251 (40.2%) fulfilled the definition of American-European Consensus Conference definition of ALI. All-cause 28-day and in-hospital mortalities were 30.7% and 38.6%, respectively. More than 40% of ALI patients had neurological, cardiovascular and haematological dysfunctions or disseminated intravascular coagulation, all of which were associated with higher mortality. We report a significant correlation between infection site and mortality in patients with ALI, but not in those without ALI. The proportion of ALI was significantly higher in pulmonary sepsis; further, a complication of ALI was associated with higher mortality in sepsis from pulmonary and other sources, but not in abdominal sepsis. Among the other sepsis sites, urinary tract, central nervous system, catheter-related and undetermined foci of infection had worse outcomes when associated with ALI. None of the individual severe sepsis bundles, including fluid resuscitation and early antibiotic administration, correlated with mortality. Compliance with a set of sepsis management bundles was associated with better outcomes. CONCLUSION: In severe sepsis and septic shock, the proportion and effect on outcome was not uniform among infection sites. The infection site was predictive of outcome in patients with ALI but not in those without ALI.


Subject(s)
Acute Lung Injury , Focal Infection , Lung Diseases , Sepsis , Shock, Septic , Acute Lung Injury/diagnosis , Acute Lung Injury/etiology , Acute Lung Injury/mortality , Causality , Disease Management , Female , Focal Infection/complications , Focal Infection/diagnosis , Hospital Mortality , Humans , Japan/epidemiology , Lung Diseases/complications , Lung Diseases/diagnosis , Male , Middle Aged , Multiple Organ Failure/etiology , Multiple Organ Failure/mortality , Outcome and Process Assessment, Health Care , Prognosis , Prospective Studies , Sepsis/complications , Sepsis/epidemiology , Sepsis/therapy , Shock, Septic/complications , Shock, Septic/epidemiology , Shock, Septic/therapy
7.
Acta Clin Croat ; 50(1): 113-4, 2011 Mar.
Article in English | MEDLINE | ID: mdl-22034791

ABSTRACT

Focal bacterial nephritis is a symptom associated with inflammation of the kidneys. It may occur in children, usually indicating abnormal urinary tract development. In adults, urinary tract infection is generally caused by gram-negative bacteria, with Escherichia (E.) coli accounting for 80% of all infections. This case report describes a female patient in whom E. coli urinary infection caused, via ascending route, focal bacterial nephritis masquerading as renal cell carcinoma.


Subject(s)
Carcinoma, Renal Cell/diagnostic imaging , Escherichia coli Infections/diagnostic imaging , Focal Infection/diagnostic imaging , Kidney Neoplasms/diagnostic imaging , Nephritis/diagnostic imaging , Carcinoma, Renal Cell/diagnosis , Diagnosis, Differential , Escherichia coli Infections/diagnosis , Female , Focal Infection/diagnosis , Humans , Kidney Neoplasms/diagnosis , Magnetic Resonance Imaging , Middle Aged , Nephritis/diagnosis , Ultrasonography
8.
Rev Stomatol Chir Maxillofac ; 112(6): 353-9, 2011 Dec.
Article in French | MEDLINE | ID: mdl-22093766

ABSTRACT

Focal infection of oral origin means that an oral infectious focus may have widespread effects. This concept remains controversial since it is difficult to prove the oral origin of germs responsible for an extra-oral infection. Experiments on animal models and clinical studies suggested several physiopathological mechanisms: bacteremia, toxinic and immunological mechanisms. Various operations induce the passage of bacterial flora (transcytosis) and its toxins into the bloodstream: oral care, chewing, or tooth brushing. Bacteremia is worsened by poor oral hygiene or an infection. The germs are usually destroyed by the host's reticuloendothelial system in a few minutes, but the presence of a valvular disease or a weak immune system favors focal infection. Besides infectious endocarditis, this may concern cardiovascular diseases, lung infections, prematurity and hypotrophy, diabetes, prosthetic infections, cerebral abscesses, etc. This update is based on literature review, selected according to its high level of scientific proof, as well as on a selected choice of consensus conferences. The current recommendation is to limit antibiotic prophylaxis to the high bacteremia risk procedures and to patients highly at risk of developing a focal infection.


Subject(s)
Focal Infection/complications , Mouth Diseases/complications , Stomatognathic Diseases/complications , Animals , Antibiotic Prophylaxis/methods , Bacteremia/prevention & control , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Endocarditis, Bacterial/prevention & control , Focal Infection/diagnosis , Focal Infection/epidemiology , Focal Infection/therapy , Humans , Mouth Diseases/diagnosis , Mouth Diseases/epidemiology , Mouth Diseases/therapy , Oral Hygiene/adverse effects , Prosthesis-Related Infections/complications , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/therapy , Stomatognathic Diseases/diagnosis , Stomatognathic Diseases/epidemiology , Stomatognathic Diseases/therapy
9.
Adv Otorhinolaryngol ; 72: 79-82, 2011.
Article in English | MEDLINE | ID: mdl-21865696

ABSTRACT

OBJECTIVE: The clinical manifestation of reactive arthritis (ReA ) induced by tonsillitis is demonstrated. METHODS: Medical records of 21 patients with ReA induced by tonsillitis were analyzed. RESULTS: Nine male and 12 female patients were recorded. The mean age was 31.7 years ranging from 20 to 51 years. The mean duration of arthritis was 29.8 months (2 weeks to 10 years). Acute or recurrent origoarthritis involved in ankle, knee and sternoclavicular joints associated with Achilles tendon enthesitis were demonstrated. Thirteen of 21 (62%) patients were demonstrated positive for ASO and/or ASK. Group A streptococcus was demonstrated in 12 of 21 (57.1%) patients and other bacteria were demonstrated by culture of tonsillar swab or from resected tonsillar microabscess. No bacteria was demonstrated in synovial fluid from 3 patients. Rheumatoid factor was demonstrated only in 2 of 21 patients. HLA-B39 and BW61 (B40) were significantly demonstrated in 5 and 7 patients (p=0.0004, 0.0006, respectively) compared with those of healthy controls. All patients were treated with antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). Eight of 21 patients underwent tonsillectomy. Arthritis ceased after the treatments and no recurrence was found. DISCUSSION: Sterile inflammatory arthritis induced by tonsillitis was cured by resection of the microabscess in the tonsils. Therefore, ReA induced by tonsillitis is one form of 'focal infection'.


Subject(s)
Arthritis, Reactive/etiology , Focal Infection/complications , Palatine Tonsil/microbiology , Streptococcal Infections/complications , Streptococcus pyogenes/isolation & purification , Tonsillitis/complications , Adult , Arthritis, Reactive/diagnosis , Arthritis, Reactive/immunology , Diagnosis, Differential , Female , Focal Infection/diagnosis , Focal Infection/microbiology , Follow-Up Studies , HLA Antigens/immunology , Humans , Male , Middle Aged , Palatine Tonsil/immunology , Prohibitins , Recurrence , Streptococcal Infections/diagnosis , Streptococcal Infections/microbiology , Time Factors , Tonsillitis/diagnosis , Tonsillitis/microbiology , Young Adult
10.
J Hosp Med ; 5(2): 76-82, 2010 Feb.
Article in English | MEDLINE | ID: mdl-20104632

ABSTRACT

BACKGROUND: Well-appearing young infants with focal bacterial infections present to the emergency department (ED) and are often admitted for a sepsis evaluation of blood, urine, and spinal fluid. However, the risk of concomitant systemic infections (CSI) in this population is not well reported, specifically comparing febrile to afebrile infants. We hypothesized that afebrile, well-appearing infants under two months of age with a defined focal bacterial infection on exam have a very low risk of CSI. METHODS: This retrospective study was conducted at an urban, academic, tertiary care pediatric hospital ED on patients seen from January 2000-December 2005. Eligible infants were less than 60 days of age, well-appearing on exam, and with normal-for-age vital signs who presented with a focal bacterial infection on exam. Exclusion criteria included immunodeficiency, indwelling catheter, previous admission for bacterial infection, or current use of systemic antibiotics. Main study outcome was risk of CSI in febrile and afebrile groups. RESULTS: One hundred ninety seven patients were included in the study population. Of these, 39 were febrile and 158 were afebrile. Four patients had a documented CSI: one case of S. pneumoniae bacteremia and three cases of E. coli urinary tract infection. Of these 4 infants, 3 were febrile (7.7% CSI risk) and 1 was afebrile (0.6%). Febrile infants had a significantly higher risk of CSI (OR 13.1, 95% CI 1.3, 129.5). CONCLUSIONS: CSI is very uncommon in afebrile, well-appearing infants under 60 days of age with a focal bacterial infection.


Subject(s)
Focal Infection/diagnosis , Focal Infection/drug therapy , Outcome Assessment, Health Care , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapy , Escherichia coli/isolation & purification , Female , Focal Infection/epidemiology , Health Resources/statistics & numerical data , Humans , Infant , Infant, Newborn , Male , Medical Audit , Ohio/epidemiology , Pneumococcal Infections/diagnosis , Pneumococcal Infections/epidemiology , Retrospective Studies , Streptococcal Infections/diagnosis , Streptococcus agalactiae/isolation & purification , Streptococcus pneumoniae/isolation & purification , Urinary Tract Infections/epidemiology , Urinary Tract Infections/urine
11.
Pesqui. bras. odontopediatria clín. integr ; 9(3): 309-311, set.-dez. 2009.
Article in Portuguese | LILACS, BBO - Dentistry | ID: biblio-873930

ABSTRACT

Objective: To investigate the association between periodontaldisease and pre-eclampsia. Methods: A method preliminary study was carried out on 25 pre-eclamptic women and 25 normotensive healthy, normotensive pregnant, women. The clinical parameters and missing teeth were determined. Data were analyzed by using SPSS version 7. Results: The mean pocket depth and missing teeth (periodontal disease characteristics) for pre-eclampsia patients were not significant as ompared those of normotensive. Conclusion: The present study shows that maternal periodontal disease during pregnancy is not associated with increased risk for development of pre-eclampsia. The nature of both preeclampsia and periodontitis is multi factorial, and caution should be exercised when implicating periodontal disease in causation of pre eclampsia.


Objetivo: Investigar a associação entre doença periodontal e pré eclâmpsia. Método: O estudo foi desenvolvido em 25 mulheres pré eclâmpticas e em 25 mulheres grávidas normotensas, saudáveis. Avaliou-se alguns parâmetros clínicos e a perda dentária. Os dados foram analisados por meio do SPSS versão 7. Resultados: A profundidade média da bolsa periodontal e perda dentária (características da doença periodontal) nas pacientes pré-eclâmpitcas não foi estatisticamente significante quando comparadas as gestantes normotensas. Conclusão: Este estudo mostrou que a doença periodontal durante a gravidez não está associada com o aumento no risco para o desenvolvimento de pré eclâmpsia. A etiologia de ambas as patologias - pré-eclâmpsia e periodontite é multifatorial e deve-se ter cautela ao se relacionar a doença periodontal como causa da pré-eclâmpsia.


Subject(s)
Humans , Female , Adult , Periodontal Diseases/etiology , Periodontal Diseases/pathology , Focal Infection/diagnosis , Focal Infection/pathology , Periodontitis , Pre-Eclampsia/diagnosis , Pre-Eclampsia/etiology , Tooth Loss , Data Interpretation, Statistical
13.
Ann Dermatol Venereol ; 134(11): 851-4, 2007 Nov.
Article in French | MEDLINE | ID: mdl-18033066

ABSTRACT

BACKGROUND: Skin signs is associated with Aspergillus are rare and are seen principally in immunodepressed patients. Distinction is generally made between primary skin aspergillosis, caused by direct cutaneous inoculation with the offending organism, and secondary skin aspergillosis, associated with peripheral emboli from an area of chronic pulmonary or sinus mycetoma. There have been rare reports of indirect satellite skin signs resulting from Aspergillus infection, and below we present such a case. PATIENTS AND METHODS: A 40 year-old immunocompetent man consulted for erysipeloid plaques on the lower limbs recurring over a period of seven months. X-rays and CAT scans of the sinus demonstrated asymptomatic axillary sinusitis probably caused by Aspergillus. The diagnosis was confirmed by surgery, which resulted in cure without additional antifungal treatment. The inflammatory syndrome subsided and after 15 months, there was no recurrence of lesions. DISCUSSION: The absence of relapse following treatment of the focus of aspergillosis forms a major argument in favour of a causal relationship between the erysipeloid dermatitis and the sinus mycotic infection. The hypothesis of a septic embologenic mechanism within the sinus was abandoned in favour of a mechanism similar to streptococcal nodular erythema, seen in diseases involving immune complexes, possibly caused by allergy to Aspergillus proteins. This case history demonstrates the existence of satellite skin signs of Aspergillus infection indicative of neither primary nor secondary aspergillosis.


Subject(s)
Aspergillosis/diagnosis , Erysipelas/diagnosis , Leg Dermatoses/microbiology , Maxillary Sinusitis/microbiology , Diagnosis, Differential , Endoscopy , Focal Infection/diagnosis , Humans , Male , Microsurgery , Middle Aged , Recurrence
14.
Isr Med Assoc J ; 9(10): 729-31, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17987762

ABSTRACT

BACKGROUND: Acute focal nephritis is an inflammatory process of the renal parenchyma affecting principally the cortex of the kidney. It is considered a midpoint in the spectrum of upper urinary tract infections, ranging from uncomplicated pyelonephritis to intrarenal abscesses. Until recently the hyperechoic sonographic appearance of this lesion was considered uncommon. OBJECTIVES: To determine the relative prevalence of hyperechoic and hypoechoic sonographic appearance of focal renal lesions in patients with the clinical diagnosis of acute pyelonephritis and to correlate the findings with those of the color Doppler examinations. METHODS: We reviewed the sonograms of 367 patients hospitalized with the clinical diagnosis of acute pyelonephritis. The sonograms were reviewed for acute renal inflammatory changes. When a focal lesion was detected, we noted the echogenicity, side, form, location and color Doppler characteristics. RESULTS: Abnormal sonographic findings related to the infection were found in 78 cases. In 52 patients a focal lesion was diagnosed. Forty-seven focal lesions appeared hyperechoic related to the adjacent parenchyma. These lesions were more frequently located at the upper pole and were wedge-shaped in most of the cases. The areas appeared hypo/avascular on the color Doppler examination. CONCLUSIONS: Our data suggest that the most common appearance of acute focal nephritis is an area of increased echogenicity in the parenchyma of the affected kidney.


Subject(s)
Focal Infection/diagnostic imaging , Kidney/pathology , Pyelonephritis/diagnostic imaging , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Focal Infection/diagnosis , Focal Infection/pathology , Humans , Infant , Israel , Kidney/diagnostic imaging , Male , Middle Aged , Pyelonephritis/diagnosis , Pyelonephritis/pathology , Ultrasonography, Doppler, Color
16.
J Intern Med ; 261(1): 91-100, 2007 Jan.
Article in English | MEDLINE | ID: mdl-17222172

ABSTRACT

BACKGROUND: Nontyphoid Salmonella (NTS) isolates lead to not only self-limited, acute gastrointestinal infections, but also bacteraemia with or without extraintestinal focal infections (EFIs). The risk factors associated with EFIs in adults with NTS bacteraemia were not clearly elucidated. METHODS: In a medical center in southern Taiwan, patients aged > or = 18 years with NTS bacteraemia between January 1999 and June 2005 were included for analysis. RESULTS: Of 129 patients, 51 (39.5%) were complicated with EFIs. The most common EFI was mycotic aneurysm, followed by pleuropulmonary infections and spinal osteomyelitis. Compared to patients with primary bacteraemia, those with EFIs had higher leucocyte counts (P = 0.004) and higher serum levels of C-reactive protein (P < 0.0001). The development of EFIs was associated with a higher mortality, more severe septic manifestations, longer hospital stays and duration of antimicrobial therapy. Univariate analysis revealed that diabetes mellitus (P = 0.02), hypertension (P = 0.02) and chronic lung disease (P = 0.006) were significantly associated with EFIs. However, patients with malignancy (P = 0.01) and immunosuppressive therapy (P = 0.03) were less likely to develop EFIs. On the basis of multivariate analysis, an independent factor for the occurrence of EFIs was age [adjusted odds ratio (aOR) 1.05; 95% confidence interval (CI) 1.02-1.07; P < 0.0001], whilst malignancy was negatively associated with EFIs (aOR 0.16; 95% CI 0.14-0.78; P = 0.01). CONCLUSION: Amongst patients with NTS bacteraemia, EFIs often occurred in the aged, and were associated with a higher mortality and morbidity. Recognition of specific host factors is essential for identification of EFIs which often demand early surgical interventions and prolonged antimicrobial therapy.


Subject(s)
Focal Infection/diagnosis , Salmonella Infections/diagnosis , Adult , Aged , Aneurysm, Infected/diagnosis , Aneurysm, Infected/drug therapy , Aneurysm, Infected/mortality , Anti-Bacterial Agents/therapeutic use , Bacteremia/diagnosis , Bacteremia/drug therapy , Bacteremia/mortality , Drug Resistance, Bacterial , Epidemiologic Methods , Female , Fever/microbiology , Focal Infection/drug therapy , Focal Infection/mortality , Humans , Lung Diseases/diagnosis , Lung Diseases/drug therapy , Lung Diseases/mortality , Male , Middle Aged , Osteomyelitis/diagnosis , Osteomyelitis/drug therapy , Osteomyelitis/mortality , Salmonella Infections/drug therapy , Salmonella Infections/mortality , Shock, Septic/diagnosis , Taiwan/epidemiology , Treatment Outcome
17.
Rev Med Liege ; 59(1): 16-8, 2004 Jan.
Article in French | MEDLINE | ID: mdl-15035538

ABSTRACT

Focal acute bacterial nephritis (lobar nephronia) is a localized bacterial infection of the kidney that has rarely been described in childhood. It is frequently associated to urinary tract anomalies and malformations and its diagnosis is based upon renal ultrasonography and computed tomography. In this article, we report a case in an 8 year old boy admitted to hospital in a septic state.


Subject(s)
Bacterial Infections/diagnosis , Focal Infection/diagnosis , Nephritis/diagnosis , Abdominal Pain/microbiology , Acute Disease , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Bacterial Infections/etiology , Child , Diagnosis, Differential , Fever/microbiology , Focal Infection/drug therapy , Focal Infection/etiology , Headache/microbiology , Humans , Male , Nephritis/drug therapy , Nephritis/etiology , Tomography, X-Ray Computed , Ureter/abnormalities , Ureter/surgery , Ureteroscopy , Urodynamics , Urography , Vomiting/microbiology
18.
Eur J Nucl Med Mol Imaging ; 31(1): 29-37, 2004 Jan.
Article in English | MEDLINE | ID: mdl-14551752

ABSTRACT

Fever of unknown origin (FUO) and suspected focal infection or inflammation are challenging medical problems. The aim of this study was to assess the value of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) in patients with FUO and patients with suspected focal infection or inflammation. All FDG PET scans ordered because of FUO or suspected focal infection or inflammation in the last 4 years were reviewed. These results were compared with the final diagnosis. Thirty-five FDG PET scans were performed in 35 patients with FUO. A final diagnosis was established in 19 patients (54%). Of the total number of scans, 37% were clinically helpful. The positive predictive value of FDG PET in these patients was 87% and the negative predictive value was 95%. Fifty-five FDG PET scans were performed in 48 patients with suspected focal infection or inflammation. A final diagnosis was established in 38 patients (82%). Of the total number of scans, 65% were clinically helpful. The positive predictive value of FDG PET in these 55 episodes of suspected infection or inflammation was 95% and the negative predictive value was 100%. It is concluded that FDG PET appears to be a valuable imaging technique in the evaluation of FUO and suspected focal infection or inflammation. Furthermore, FDG PET could become a useful tool for evaluating the effect of treatment of infectious and inflammatory processes that cannot reliably be visualised by conventional techniques. However, to assess the additional diagnostic value of this technique, prospective studies of FDG PET as part of a structured diagnostic protocol are warranted.


Subject(s)
Fever of Unknown Origin/diagnostic imaging , Fluorodeoxyglucose F18 , Focal Infection/diagnostic imaging , Inflammation/diagnostic imaging , Tomography, Emission-Computed/methods , Adolescent , Adult , Aged , Aged, 80 and over , False Negative Reactions , False Positive Reactions , Female , Fever of Unknown Origin/diagnosis , Focal Infection/diagnosis , Humans , Inflammation/diagnosis , Male , Middle Aged , Radiopharmaceuticals , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity
20.
Lancet ; 360(9347): 1795, 2002 Nov 30.
Article in English | MEDLINE | ID: mdl-12480473
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