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Febrile patient in icu

Gregory M Taylor, David V Hess
Fournier's gangrene, a rare polymicrobial infection that affects the genitals and perineum, can present as an insidious onset to a rapid and fulminant course. Early recognition, diagnosis, initiation of broad-spectrum antibiotics and prompt surgical treatment remain the foundation of management. If treatment is not initiated aggressively, the patient will likely rapidly deteriorate, leading to organ failure and death. We present the case of a 58-year-old diabetic female presenting febrile, hypoxic, with severe respiratory distress and evidence of septic shock, found to have necrotizing fasciitis of the entire right hemi-pelvis...
February 2018: Oxford Medical Case Reports
Lenaïg Le Clech, Jean-Philippe Talarmin, Marie-Anne Couturier, Jean-Christophe Ianotto, Christophe Nicol, Ronan Le Calloch, Stéphanie Dos Santos, Pascal Hutin, Didier Tandé, Virginie Cogulet, Christian Berthou, Gaëlle Guillerm
INTRODUCTION: Immediate empirical antibiotic therapy is mandatory in febrile chemotherapy-induced neutropenia, but its optimal duration is unclear, especially in patients with fever of unknown origin (FUO). OBJECTIVES: The primary objective of this 20-month prospective observational study was to evaluate the feasibility and safety of short-term antibiotic treatment in afebrile or febrile patients exhibiting FUO, irrespective of their neutrophil count. The secondary objective was to describe the epidemiology of all episodes of febrile neutropenia...
February 16, 2018: Infectious Diseases
Norberto Giglio, Homero Monsanto, Emmanouil Rampakakis, H Keri Yang, Barbara J Kuter, Lara J Wolfson
INTRODUCTION: In Argentina, varicella vaccination was included in the national schedule for mandatory immunizations in 2015. The vaccine has been shown to substantially reduce the morbidity and mortality associated with the virus. The purpose of this study was to evaluate the clinical and economic burden associated with varicella in Argentina prior to vaccine introduction. METHODS: This was a multicenter, retrospective chart review study among patients aged 1-12 years with a primary varicella diagnosis in 2009-2014 in Argentina...
January 22, 2018: Journal of Medical Economics
Divya Khurana, Shilpa A Deoke
Background: Thrombocytopenia, being among the most common laboratory abnormality, found in Intensive Care Unit (ICU) patients is commonly associated with sepsis and disseminated intravascular coagulation. Declining platelet counts are associated with higher mortality rates. Thus, thrombocytopenia can be used as a prognostic marker in critically ill patients. Methodology: A prospective observational study was conducted on patients fulfilling the inclusion criteria and were evaluated for complete medical history, clinical, and laboratorial examination...
December 2017: Indian Journal of Critical Care Medicine
Dorothea Hellmich, Katja E Wartenberg, Stephan Zierz, Tobias J Mueller
BACKGROUND: Foodborne botulism is a life-threatening, rapidly progressive disease. It has an incidence of less than 10 cases per year in Germany and mostly affects several previously healthy people at the same time. The only specific treatment is the administration of botulism antitoxin. According to the German guidelines administration of antitoxin is recommended only in the first 24 hours after oral ingestion of the toxin. CASE PRESENTATION: A 47-year-old white woman and her 51-year-old white husband presented with paralysis of multiple cranial nerves and rapidly descending paralysis approximately 72 hours after ingestion of home-canned beans...
January 4, 2018: Journal of Medical Case Reports
Julia Cupp, Eva Culakova, Marek S Poniewierski, David C Dale, Gary H Lyman, Jeffrey Crawford
Lung cancer, compared with other solid tumors, is associated with high mortality rates from febrile neutropenia. The risk factors associated with in-hospital mortality were identified and compared for patients with lung cancer and patients with other solid tumors. Hospitalization data from the University Health Consortium database inclusive of 2004 to 2012 were analyzed. The study population included all adult patients with solid tumors who developed neutropenia. Cancer type, the presence of neutropenia, and further subgroups were determined using International Classification of Diseases, 9th revision, Clinical Modification codes...
October 28, 2017: Clinical Lung Cancer
A Sedhain, G R Bhattarai
Renal involvement and acute kidney injury (AKI) are common clinical manifestations seen in scrub typhus, a vector-borne tropical disease. There are no data on renal manifestation in scrub typhus in Nepal. We conducted a prospective study to analyze the incidence, urinary abnormalities, course, severity, outcome, and the predictors of AKI in patients with scrub typhus during a major outbreak in Central Nepal. Total 1398 patients admitted with acute febrile illness were subjected for Scrub Typhus Detect™ Immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) test, of which 502 (35...
November 2017: Indian Journal of Nephrology
Manal Abouelkheir, Sarah Alsubaie
BACKGROUND: Vancomycin is very commonly used in combination with piperacillin-tazobactam (PTZ) as the initial empiric treatment for moderate-severe infection, whenever coverage for both methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa is required. The combination of vancomycin and PTZ in adults has recently been reported to significantly increase the risk of acute kidney injury (AKI) relative to vancomycin monotherapy; such reports in pediatrics, however, are sparse...
February 2018: Pediatrics International: Official Journal of the Japan Pediatric Society
Shin Ahn, Terry W Rice, Sai-Ching J Yeung, Tim Cooksley
PURPOSE: Patients with febrile neutropenia are a heterogeneous group with a minority developing serious medical complications. Outpatient management of low-risk febrile neutropenia has been shown to be safe and cost-effective. Scoring systems, such as the Multinational Association for Supportive Care in Cancer (MASCC) score and Clinical Index of Stable Febrile Neutropenia (CISNE), have been developed and validated to identify low-risk patients. We aimed to compare the performance of these two scores in identifying low-risk febrile neutropenic patients...
November 22, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Hector Gorbea, Enid J Garcia-Rivera, Hilda Torres, Olga D Lorenzi, Aidsa Rivera, Renee L Galloway, Tyler M Sharp
Leptospirosis is an emerging bacterial zoonosis that is endemic but underrecognized throughout the tropics. Through prospective surveillance for acute febrile illness (AFI) among patients who presented to the emergency department of a hospital located in an urban region of Puerto Rico, four patients with laboratory-confirmed leptospirosis were identified. All patients had signs and symptoms of AFI, including fever, headache, and dehydration. Three patients had leukocytosis with thrombocytopenia and were admitted to the hospital...
November 6, 2017: American Journal of Tropical Medicine and Hygiene
Juan Ignacio Silesky Jiménez, Jorge Luis Hidalgo Marroquin, Guy A Richards, Pravin Amin
Leptospirosis is a zoonosis caused by a gram negative aerobic spirochete of the genus Leptospira. It is acquired by contact with urine or reproductive fluids from infected animals, or by inoculation from contaminated water or soil. The disease has a global distribution, mainly in tropical and subtropical regions that have a humid, rainy climate and is also common in travelers returning from these regions. Clinical suspicion is critical for the diagnosis and it should be included in the differential diagnosis of any patient with a febrile hepatorenal syndrome in, or returning from endemic regions...
November 9, 2017: Journal of Critical Care
Joel D Hudgins, Vera Goldberg, Gillian L Fell, Mark Puder, Matthew A Eisenberg
BACKGROUND: Children with intestinal failure (IF) on parenteral nutrition (PN) are at high risk for bacteremia, and delays in antibiotic administration have been associated with increased morbidity and mortality. We designed an emergency department (ED) quality improvement (QI) initiative to reduce time to administration of intravenous antibiotics in febrile children with IF on PN. METHODS: Our aim was to decrease the mean time for febrile children with IF on PN to receive intravenous antibiotics by 50% to <60 minutes over a 12-month period...
November 2017: Pediatrics
Amrita D Singh, Sapna Parmar, Khilna Patel, Shreya Shah, Tsiporah Shore, Usama Gergis, Sebastian Mayer, Adrienne Phillips, Jing-Mei Hsu, Ruben Niesvizky, Tomer M Mark, Roger Pearse, Adriana Rossi, Koen van Besien
Administration of granulocyte colony-stimulating factor (G-CSF) after autologous peripheral blood stem cell transplantation (PBSCT) is generally recommended to reduce the duration of severe neutropenia; however, data regarding the optimal timing of G-CSFs post-transplantation are limited and conflicting. This retrospective study was performed at NewYork-Presbyterian/Weill Cornell Medical Center between November 5, 2013, and August 9, 2016, of adult inpatient autologous PBSCT recipients who received G-CSF empirically starting on day +5 (early) versus on those who received G-CSF on day +12 only if absolute neutrophil count (ANC) was <0...
February 2018: Biology of Blood and Marrow Transplantation
Maria Escobar, Albaro J Nieto, Sara Loaiza-Osorio, Juan S Barona, Fernando Rosso
In 2015 in Colombia, 60 pregnant women were hospitalized with chikungunya virus infections confirmed by reverse transcription PCR. Nine of these women required admission to the intensive care unit because of sepsis with hypoperfusion and organ dysfunction; these women met the criteria for severe acute maternal morbidity. No deaths occurred. Fifteen women delivered during acute infection; some received tocolytics to delay delivery until after the febrile episode and prevent possible vertical transmission. As recommended by a pediatric neonatologist, 12 neonates were hospitalized to rule out vertical transmission; no clinical findings suggestive of neonatal chikungunya virus infection were observed...
November 2017: Emerging Infectious Diseases
Christopher A Mecoli, Arash H Lahouti, Robert A Brodsky, Andrew L Mammen, Lisa Christopher-Stine
OBJECTIVE: To describe the experience managing treatment-refractory immune-mediated necrotizing myopathies (IMNM) with high-dose cyclophosphamide (HiCy) therapy. METHODS: Five patients with severe refractory IMNM who were treated with HiCy without stem cell rescue were identified. Their medical records were reviewed to assess demographic, clinical, and histologic characteristics as well as response to therapy. RESULTS: Three patients with anti-signal recognition particle (SRP) and 2 patients with anti-HMG-CoA reductase autoantibodies were included...
September 2017: Neurology® Neuroimmunology & Neuroinflammation
Emmanuel Andrès, Rachel Mourot-Cottet, Frédéric Maloisel, Olivier Keller, Thomas Vogel, François Séverac, Martine Tebacher, Jacques-Eric Gottenberg, Jean-Christophe Weber, Georges Kaltenbach, Bernard Goichot, Jean Sibilia, Anne-Sophie Korganow, Raoul Herbrecht
BACKGROUND: Despite major advances in its prevention and treatment, febrile neutropenia remains a most concerning complication of cancer chemotherapy. Outside the oncology setting, however, only few data are currently available on febrile neutropenia related to non-chemotherapy drugs. We report here data on 76 patients with febrile neutropenia related to non-chemotherapy drugs, followed up in a referral center within a university hospital. PATIENTS AND METHODS: Data from 76 patients with idiosyncratic drug-induced febrile neutropenia were retrospectively reviewed...
September 26, 2017: Journal of Clinical Medicine
Kellie J Goodlet, David P Nicolau, Michael D Nailor
Guidelines for the treatment of sepsis, febrile neutropenia, and hospital-acquired pneumonia caused by Pseudomonas aeruginosa include empirical regimens incorporating two antibiotics from different classes with activity against P. aeruginosa for select at-risk patients to increase the likelihood that the organism will be susceptible to at least one agent. The activity against P. aeruginosa and the rates of cross-resistance of ceftolozane-tazobactam were compared to those of the β-lactam comparators cefepime, ceftazidime, piperacillin-tazobactam, and meropenem alone and cumulatively with ciprofloxacin or tobramycin...
December 2017: Antimicrobial Agents and Chemotherapy
Andrew C Elton, James Levin, Matthew P Lazio
Salmonella meningitis is a rare manifestation of meningitis typically presenting in neonates and the elderly. This infection typically associates with foodborne outbreaks in developing nations and AIDS-endemic regions. We report a case of a 19-year-old male presenting with altered mental status after 3-day absence from work at a Wisconsin tourist area. He was febrile, tachycardic, and tachypneic with a GCS of 8. The patient was intubated and a presumptive diagnosis of meningitis was made. Treatment was initiated with ceftriaxone, vancomycin, acyclovir, dexamethasone, and fluid resuscitation...
2017: Case Reports in Infectious Diseases
Marta Zawadzka, Marta Szmuda, Maria Mazurkiewicz-Bełdzińska
Fever is a common symptom in the Intensive Care Unit. At least half of febrile episodes are caused by infection. Excluding infectious etiology and other non-infectious causes of fever, especially in patients with central nervous system (CNS) disorders, attention should be paid to disturbances of thermoregulatory centre. In particular, subarachnoid haemorrhage, cerebral trauma, along with ischaemic or haemorrhagic stroke are strongly associated with the development of central fever. Proper, speedy diagnosis of the cause of fever makes it possible to implement preventive measures against the harmful effects of hyperthermia on the CNS and to avoid the consequences of inappropriate treatment...
2017: Anaesthesiology Intensive Therapy
Fatehi Elzein, Nazik Mohammed, Najoud Ali, Abdelkarim Bahloul, Abeer Albadani, Nisreen Alsherbeeni
Pulmonary complications, including acute respiratory distress syndrome (ARDS), are well described in P. falciparum (PF) and to a lesser extent in other malaria species. In non-endemic areas, malaria diagnosis may be overlooked; if a thorough travel history is not obtained on all patients with acute febrile illness. Three patients with malaria associated respiratory distress were admitted to our intensive care unit. The diagnosis was delayed; however, all patients received artesunate and intensive therapy with a satisfactory outcome...
2017: Respiratory Medicine Case Reports
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