RESUMEN
OBJECTIVE: We standardized the RT-PCR panviral CSF and determined its applicability in detecting acute enterovirus infection in the central nervous system in children under 15 years. MATERIAL AND METHODS: RT-PCR was performed directly in CSF samples of 10 pediatric patients with suspected CNS infection and 9, with different conditions of the central nervous system. RESULTS: 80% (8/10) of RT-PCR samples were positive for enterovirus in patients with suspected CNS infection and no sample was positive in patients with different ailments. CONCLUSIONS: Since enteroviruses are among the main etiologies of pediatric encephalitis, RT-PCR could be particularly useful for rapid detection in CSF.
Asunto(s)
Encefalitis Viral/líquido cefalorraquídeo , Infecciones por Enterovirus/líquido cefalorraquídeo , Meningitis Aséptica/líquido cefalorraquídeo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/normas , Enfermedad Aguda , Líquido Cefalorraquídeo/química , Líquido Cefalorraquídeo/virología , Niño , Trastornos de la Conducta Infantil/líquido cefalorraquídeo , Trastornos de la Conducta Infantil/etiología , Preescolar , Trastornos de la Conciencia/líquido cefalorraquídeo , Trastornos de la Conciencia/etiología , Encefalitis Viral/diagnóstico , Encefalitis Viral/virología , Infecciones por Enterovirus/diagnóstico , Infecciones por Enterovirus/virología , Femenino , Fiebre de Origen Desconocido/líquido cefalorraquídeo , Fiebre de Origen Desconocido/etiología , Humanos , Lactante , Masculino , Meningitis Aséptica/diagnóstico , Meningitis Aséptica/virología , Proyectos Piloto , ARN Viral/líquido cefalorraquídeo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Convulsiones/líquido cefalorraquídeo , Convulsiones/etiologíaRESUMEN
OBJECTIVES: Guidelines for the management of febrile infants aged 30 to 90 days presenting to the emergency department (ED) suggest that a lumbar puncture (LP) should be performed routinely if a positive urinalysis is found during initial investigations. The aim of our study was to assess the necessity of routine LPs in infants aged 30 to 90 days presenting to the ED for a fever without source but are found to have a positive urine analysis. METHODS: We retrospectively reviewed the records of all infants aged 30 to 90 days, presenting to the Montreal Children's Hospital ED from October 2001 to August 2005 who underwent an LP for bacterial culture, in addition to urinalysis and blood and urine cultures. Descriptive statistics and their corresponding confidence intervals were used. RESULTS: Overall, 392 infants were identified using the microbiology laboratory database. Fifty-seven patients had an abnormal urinalysis. Of these, 1 infant (71 days old) had an Escherichia coli urinary tract infection, bacteremia, and meningitis. This patient, however, was not well on history, and the peripheral white blood cell count was low at 2.9 × 109/L. Thus, the negative predictive value of an abnormal urinalysis for meningitis was 98.2%. CONCLUSIONS: Routine LPs are not required in infants (30-90 days) presenting to the ED with a fever and a positive urinalysis if they are considered at low risk for serious bacterial infection based on clinical and laboratory criteria. However, we recommend that judicious clinical judgment be used; in doubt, an LP should be performed before empiric antibiotic therapy is begun.
Asunto(s)
Fiebre de Origen Desconocido/etiología , Meningitis Bacterianas/diagnóstico , Punción Espinal/estadística & datos numéricos , Procedimientos Innecesarios , Urinálisis , Infecciones Urinarias/epidemiología , Bacteriemia/complicaciones , Bacteriemia/epidemiología , Bacteriemia/microbiología , Comorbilidad , Pruebas Diagnósticas de Rutina/normas , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Femenino , Fiebre de Origen Desconocido/sangre , Fiebre de Origen Desconocido/líquido cefalorraquídeo , Fiebre de Origen Desconocido/orina , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/epidemiología , Guías de Práctica Clínica como Asunto , Quebec/epidemiología , Estudios Retrospectivos , Riesgo , Infecciones Urinarias/complicaciones , Infecciones Urinarias/microbiologíaRESUMEN
UNLABELLED: Lumbar puncture to detect bacterial meningitis is a recommended screening procedure to be performed in febrile newborn infants at admission to hospital. OBJECTIVE: To evaluate the usefulness of this procedure performed at admission and eventually, in a second look if clinically justified. PATIENTS AND METHOD: There were studied 1,841 febrile newborns consulting at the Emergency Department from January 1992 to December 2000 without source. All of them underwent a sepsis workup. The rate of meningitis incidence was calculated, and we analyzed the frequency of meningitis diagnosed in the initial evaluation and reappraisal. RESULTS: There were 206 febrile patients with diagnosis of meningitis for an incidence of 11.2%, which 20 were bacterial (1.1%) and 186 aseptic meningitis (10.1%). In the initial evaluation 155 patients were diagnosed with meningitis (155/ 1.774 = 8.7%) and in reappraisal (mean 39,5 +/- 25,2 hours after) there were diagnosed another 51 cases (51/ 135 = 37.8%). CONCLUSIONS: The meningitis was a common diagnosis in febrile newborns without source, with prevalence of aseptic meningitis. In almost 25% of cases we reached to this diagnosis by means of performing lumbar puncture after a reappraisal.
Asunto(s)
Fiebre de Origen Desconocido/líquido cefalorraquídeo , Meningitis Aséptica/líquido cefalorraquídeo , Meningitis Bacterianas/líquido cefalorraquídeo , Punción Espinal , Chile , Femenino , Fiebre de Origen Desconocido/etiología , Humanos , Lactante , Recién Nacido , Masculino , Meningitis Aséptica/complicaciones , Meningitis Aséptica/diagnóstico , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/diagnóstico , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
La evaluación del RN febril incluye efectuar una punción lumbar para detectar un foco meníngeo. Objetivo: Evaluar la utilidad de este procedimiento al ingreso del paciente al hospital y, eventualmente, en una segunda instancia si se justifica clínicamente. Pacientes y Método: Estudiamos 1.841 recién nacidos febriles sin signos de focalización que consultaron en la Unidad de Emergencia entre enero 1992 y diciembre 2000. Todos se sometieron a una evaluación para pesquisa de sepsis. Calculamos la tasa de incidencia de meningitis, y analizamos la frecuencia de meningitis diagnosticada en la evaluación inicial y en una re-evaluación. Resultados: Hubo 206 pacientes con diagnóstico de meningitis (incidencia de 11,2 por ciento), de las cuales 20 fueron bacterianas (1,1 por ciento) y 186 meningitis asépticas (10,1 por ciento). En la evaluación inicial se detectaron 155 pacientes con meningitis (155/ 1.774 = 8,7 por ciento) y en la reevaluación (media de 39,5 ± 25,2 horas más tarde) se diagnosticaron 51 casos más (51/ 135 = 37,8 por ciento). Conclusiones: La meningitis fue un diagnóstico frecuente en recién nacidos febriles sin signos de focalización, predominando la meningitis aséptica. En casi 25 por ciento de los casos se llegó a este diagnóstico mediante la ejecución de la punción lumbar al ser re-evaluados(AU)
Lumbar puncture to detect bacterial meningitis is a recommended screening procedure to be performed in febrile newborn infants at admission to hospital. Objective: To evaluate the usefulness of this procedure performed at admission and eventually, in a second look if clinically justified. Patients and method: There were studied 1,841 febrile newborns consulting at the Emergency Department from January 1992 to December 2000 without source. All of them underwent a sepsis workup. The rate of meningitis incidence was calculated, and we analyzed the frequency of meningitis diagnosed in the initial evaluation and reappraisal. Results: There were 206 febrile patients with diagnosis of meningitis for an incidence of 11.2 percent, which 20 were bacterial (1.1percent) and 186 aseptic meningitis (10.1 percent). In the initial evaluation 155 patients were diagnosed with meningitis (155/ 1.774 = 8.7 percent) and in reappraisal (mean 39,5 ± 25,2 hours after) there were diagnosed another 51 cases (51/ 135 = 37.8 percent). Conclusions: The meningitis was a common diagnosis in febrile newborns without source, with prevalence of aseptic meningitis. In almost 25percent of cases we reached to this diagnosis by means of performing lumbar puncture after a reappraisal(AU)
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Fiebre de Origen Desconocido/líquido cefalorraquídeo , Fiebre de Origen Desconocido/etiología , Meningitis Aséptica/líquido cefalorraquídeo , Meningitis Aséptica/complicaciones , Meningitis Bacterianas/líquido cefalorraquídeo , Punción EspinalRESUMEN
La evaluación del RN febril incluye efectuar una punción lumbar para detectar un foco meníngeo. Objetivo: Evaluar la utilidad de este procedimiento al ingreso del paciente al hospital y, eventualmente, en una segunda instancia si se justifica clínicamente. Pacientes y Método: Estudiamos 1.841 recién nacidos febriles sin signos de focalización que consultaron en la Unidad de Emergencia entre enero 1992 y diciembre 2000. Todos se sometieron a una evaluación para pesquisa de sepsis. Calculamos la tasa de incidencia de meningitis, y analizamos la frecuencia de meningitis diagnosticada en la evaluación inicial y en una re-evaluación. Resultados: Hubo 206 pacientes con diagnóstico de meningitis (incidencia de 11,2 por ciento), de las cuales 20 fueron bacterianas (1,1 por ciento) y 186 meningitis asépticas (10,1 por ciento). En la evaluación inicial se detectaron 155 pacientes con meningitis (155/ 1.774 = 8,7 por ciento) y en la reevaluación (media de 39,5 ± 25,2 horas más tarde) se diagnosticaron 51 casos más (51/ 135 = 37,8 por ciento). Conclusiones: La meningitis fue un diagnóstico frecuente en recién nacidos febriles sin signos de focalización, predominando la meningitis aséptica. En casi 25 por ciento de los casos se llegó a este diagnóstico mediante la ejecución de la punción lumbar al ser re-evaluados.
Lumbar puncture to detect bacterial meningitis is a recommended screening procedure to be performed in febrile newborn infants at admission to hospital. Objective: To evaluate the usefulness of this procedure performed at admission and eventually, in a second look if clinically justified. Patients and method: There were studied 1,841 febrile newborns consulting at the Emergency Department from January 1992 to December 2000 without source. All of them underwent a sepsis workup. The rate of meningitis incidence was calculated, and we analyzed the frequency of meningitis diagnosed in the initial evaluation and reappraisal. Results: There were 206 febrile patients with diagnosis of meningitis for an incidence of 11.2 percent, which 20 were bacterial (1.1 percent) and 186 aseptic meningitis (10.1 percent). In the initial evaluation 155 patients were diagnosed with meningitis (155/ 1.774 = 8.7 percent) and in reappraisal (mean 39,5 ± 25,2 hours after) there were diagnosed another 51 cases (51/ 135 = 37.8 percent). Conclusions: The meningitis was a common diagnosis in febrile newborns without source, with prevalence of aseptic meningitis. In almost 25 percent of cases we reached to this diagnosis by means of performing lumbar puncture after a reappraisal.
Asunto(s)
Femenino , Humanos , Lactante , Recién Nacido , Masculino , Fiebre de Origen Desconocido/líquido cefalorraquídeo , Meningitis Aséptica/líquido cefalorraquídeo , Meningitis Bacterianas/líquido cefalorraquídeo , Punción Espinal , Chile , Fiebre de Origen Desconocido/etiología , Meningitis Aséptica/complicaciones , Meningitis Aséptica/diagnóstico , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/diagnóstico , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Currently, malignancies are more common than infections as a cause of fever of unknown origin (FUO) in adults. Many malignant disorders are associated with fever, which may either be of the hectic-septic variety resembling an infectious disease or prolonged and low-grade. Neoplasms with either kind of fever may present as an FUO. The malignancies usually associated with fever are lymphoreticular malignancies involving the blood, liver, spleen, or bone marrow. Most malignancies do not have fever, e.g., chronic lymphatic leukemia (CLL), as part of their clinical presentation. We present a case of long-standing CLL in an elderly woman who presented with an FUO. Initially, it was thought that her FUO was caused by CLL or a CLL-related opportunistic infection. The naprosyn test was used in this patient with CLL and FUO to differentiate a malignant from an infectious etiology. Her response to naprosyn indicated that the etiology of her FUO was neoplastic rather than infectious. The absence of tonsillar enlargement and peripheral adenopathy, as well as the presence of fever, argued against CLL as the cause of her fever. Computed axial tomography scans showed central adenopathy in addition to splenomegaly. The presence of fever, splenomegaly, and central adenopathy indicated that the cause of her FUO was a lymphoma (Richter's transformation) and not CLL.
Asunto(s)
Fiebre de Origen Desconocido/etiología , Leucemia Linfocítica Crónica de Células B/diagnóstico , Linfoma/diagnóstico , Anciano de 80 o más Años , Líquido Cefalorraquídeo/citología , Diagnóstico Diferencial , Femenino , Fiebre de Origen Desconocido/líquido cefalorraquídeo , Fiebre de Origen Desconocido/diagnóstico , Humanos , Leucemia Linfocítica Crónica de Células B/complicaciones , Linfoma/complicaciones , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
A polymerase chain reaction kit (AMPLICOR EV) for the detection of enteroviruses (EV-PCR) in the cerebrospinal fluid (CSF) was evaluated in clinical conditions in a prospective blinded-intention study. Forty-three children (mean age 2.7 years) hospitalized for suspected meningitis or fever of unclear etiology were enrolled. EV-PCR was performed on a daily basis. Results were available in less than 2 days in 72% of cases. EV-PCR was positive in nine (21%) children, including three infants without CSF pleocytosis. Knowing their EV-PCR result would have allowed a saving of 18 hospital days and 12 days of antibiotic therapy. The EV-PCR in the CSF can thus be practically useful for children hospitalized for meningitis or fever if available on-site on a daily basis.
Asunto(s)
Infecciones por Enterovirus/líquido cefalorraquídeo , Reacción en Cadena de la Polimerasa/métodos , Adolescente , Líquido Cefalorraquídeo/virología , Niño , Preescolar , Diagnóstico Diferencial , Estudios de Evaluación como Asunto , Femenino , Fiebre de Origen Desconocido/líquido cefalorraquídeo , Fiebre de Origen Desconocido/microbiología , Humanos , Lactante , Recién Nacido , Tiempo de Internación , Masculino , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/microbiología , Estudios ProspectivosRESUMEN
OBJECTIVE: To investigate the viral aetiology in cerebral spinal fluid (Csf) from 580 cases of CNS infection or FUO in Yuedong district from 1990 to 1997. METHODS: Virus isolation was done with Hep-2 and BHK-21 cells. RESULTS: 21 virus types of 5 kinds of viruses were isolated from 113 samples (19.5%). Clinically diagnosed diseases included viral encephalitis 17.8% (43/242), intracranial infection 20.2% (47/233), paralytic diseases 24.3% (9/37), FUO 37.5% (9/24), convulsion 16.0% (4/25), Guillain-Barre syndrome 5.3% (1/19). Virus infection included 11 cases of Poliovirus (constitutional ratio 0.0973, including 1 Polio-I, 8 Polio-II, 2 Polio-III); 54 cases of Coxsackie virus (0.477 9, including 11 CoxA24, 10 CoxBl, 2 Cox134, 3 CoxB5); 15 cases of ECHO virus (0.1327, including 4 ECHO-24, 3 ECRO-7, 2 ECHO-12 and each one of ECHO-3, 11,14,15,27,32); 25 cases of Enterovirus (0.2213, including 14 EV-70, 11 EV-71); 8 cases of Adenovirus (0.070 8, including 3 Adv-2, 3 Adv-3 and 2 Adv7). Results of different age groups indicated there was significant difference (P < 0.05) in virus detection rate in two age groups. Virus positive rates in different years were 1990-1991 14.2% (15/106), 1992-1993 14.1%(23/163), 1994-1995 26.1% (36/138), 1996-1997 22.5% (39/173), that showed a significant difference (P <0.05). CONCLUSIONS: Virus infection rate of CNS diseases and FUO showed an a ascending trend, and the different virus types and kinds were isolated in different periods.