RESUMO
A 63-year-old woman presented with fever, tachycardia and tachypnoea, with right sided chest and hypochondrial pain. Chest radiograph showed right basal consolidation and she was treated for community acquired pneumonia with intravenous antibiotics. Subsequent clinical deterioration in presence of a previous history of complicated diverticulitis, persistent right hypochondrial pain and deranged liver function tests prompted further investigations that confirmed presence of a large pyogenic liver abscess. Following appropriate antibiotic treatment and image guided drainage of the abscess, the patient made a complete recovery. This case illustrates the importance of considering a subdiaphragmatic source of sepsis even in the presence of chest radiographic abnormalities, when a patient fails to respond to initial treatment for pneumonia.
Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/terapia , Drenagem , Abscesso Hepático/terapia , Pneumonia/terapia , Dor Abdominal/microbiologia , Bacteriemia/diagnóstico por imagem , Bacteriemia/microbiologia , Infecções Comunitárias Adquiridas/complicações , Diagnóstico Diferencial , Drenagem/métodos , Feminino , Febre/microbiologia , Humanos , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/microbiologia , Pessoa de Meia-Idade , Pneumonia/diagnóstico por imagem , Radiografia Intervencionista/métodos , Taquicardia/microbiologia , Taquipneia/microbiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Newborns and young infants suffer high rates of infections in South Asia and sub-Saharan Africa. Timely access to appropriate antibiotic therapy is essential for reducing mortality. In an effort to develop community case management guidelines for young infants, 0-59 days old, with clinically diagnosed severe infections, or with fast breathing, 4 trials of simplified antibiotic therapy delivered in primary care clinics (Pakistan, Democratic Republic of Congo, Kenya and Nigeria) or at home (Bangladesh and Nigeria) are being conducted. METHODS: This article describes the scientific rationale for these trials, which share major elements of trial design. All the trials are in settings of high neonatal mortality, where hospitalization is not feasible or frequently refused. All use procaine penicillin and gentamicin intramuscular injections for 7 days as reference therapy and compare this to various experimental arms utilizing comparatively simpler combination regimens with fewer injections and oral amoxicillin. CONCLUSION: The results of these trials will inform World Health Organization policy regarding community case management of young infants with clinical severe infections or with fast breathing.
