Infektionen als Ursache für Fieber unklarer Genese

2017 ◽  
Vol 142 (13) ◽  
pp. 951-960
Author(s):  
Bernd Salzberger ◽  
Gabriele Birkenfeld ◽  
Michael Iberer ◽  
Florian Hitzenbichler
Keyword(s):  
Intensive Care ◽  
Data Transfer ◽  
Unknown Origin ◽  
Clinical Problem ◽  
Bacterial Endocarditis ◽  
Diagnostic Methods ◽  
Subacute Bacterial Endocarditis ◽  
Fieber Unklarer Genese ◽  
Pet Ct ◽  
Diagnostic Indicator

AbstractFever of unexplained (or unknown) origin (FUO) remains a relevant clinical problem even with modern diagnostic methods. In addition to the classical definition, new categories of FUO describe different clinical situations: nosocomial FUO, FUO in neutropenic/immundeficient patients and FUO in patients with HIV-infection. The new categories are defined by much shorter duration of fever, i. e. mostly three days. Each category of FUO shows a different spectrum of infectious diseases. Often, subacute bacterial endocarditis is very difficult to verify. In many cases, patients in intensive care suffer from FUO caused by reactivation of CMV. In patients with HIV the most important diagnostic indicator concerning the origin of infection is the degree of immundeficiency. Biological and nuclear medical (PET-CT) verification procedures have been established in diagnostics. A national or international register should be created with the purpose of data transfer and validation of strategies concerning the treatment of FUO.

The role of FDG PET/CT discovering the cause of fever of unknown origin

2012 ◽  
Vol 153 (6) ◽  
pp. 227-231
Author(s):  
Bernadett Szűcs ◽  
Edit Nagy ◽  
Stefan Talev ◽  
Ildikó Garai ◽  
László Galuska
Keyword(s):  
Case Report ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Diagnostic Procedures ◽  
Clinical Problem ◽  
Diagnostic Techniques ◽  
Diagnostic Methods ◽  
Pet Ct ◽  
Fdg Pet Ct

The fever of unknown origin from time to time constitutes a serious clinical problem and nearly all diagnostic methods are involved to discover urgently its cause. According to literature data 18F-fluoro-deoxyglucose PET/CT was successful in 25-70% of cases even in patients without any positive findings with conventional diagnostic techniques. The Hungarian National Health Fund does not include fever of unknown origin in the list of reimbursed 18F-fluoro-deoxyglucose PET/CT indications. The authors try to illustrate the clinical problem with this case report. Fever of unknown origin persisted in a patient for a year, but conventional diagnostic procedures were unsuccessful to find the cause of the fever. Finally, 18F-fluoro-deoxyglucose PET/CT indicated a metabolically active focus between the pancreas tail and the spleen. After a long-lasting antibiotic therapy the patient became symptomfree. Orv. Hetil., 2012, 153, 227–231.

scholarly journals FDG-PET/CT in intensive care patients with bloodstream infection

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Jordy P. Pijl ◽  
Mark Londema ◽  
Thomas C. Kwee ◽  
Maarten W. N. Nijsten ◽  
Riemer H. J. A. Slart ◽  
...  
Keyword(s):  
Intensive Care ◽  
Image Quality ◽  
Fdg Pet ◽  
Diagnostic Yield ◽  
Unknown Origin ◽  
Intensive Care Patients ◽  
Pet Ct ◽  
Infection Focus ◽  
Focus Of Infection ◽  
Fdg Pet Ct

Abstract Background 2-Deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) is an advanced imaging technique that can be used to examine the whole body for an infection focus in a single examination in patients with bloodstream infection (BSI) of unknown origin. However, literature on the use of this technique in intensive care patients is scarce. The purpose of this study was to evaluate the diagnostic yield of FDG-PET/CT in intensive care patients with BSI. Methods In this retrospective cohort study, all intensive care patients from our Dutch university medical center who had culture-proven BSI between 2010 and 2020 and underwent FDG-PET/CT to find the focus of infection were included. Diagnostic performance was calculated and logistic regression analysis was performed to evaluate the association between FDG-PET/CT outcome and C-reactive protein level (CRP), leukocyte count, duration of antibiotic treatment, duration of ICU stay, quality of FDG-PET/CT, and dependency on mechanical ventilation. In addition, the impact of FDG-PET/CT on clinical treatment was evaluated. Results 30 intensive care patients with BSI were included. In 21 patients, an infection focus was found on FDG-PET/CT which led to changes in clinical management in 14 patients. FDG-PET/CT achieved a sensitivity of 90.9% and specificity of 87.5% for identifying the focus of infection. Poor quality of the FDG-PET images significantly decreased the likelihood of finding an infection focus as compared to reasonable or good image quality (OR 0.16, P = 0.034). No other variables were significantly associated with FDG-PET/CT outcome. No adverse events during the FDG-PET/CT procedure were reported. Conclusion FDG-PET/CT has a high diagnostic yield for detecting the infection focus in patients with BSI admitted to intensive care. Poor PET image quality was significantly associated with a decreased likelihood of finding the infection focus in patients with BSI. This could be improved by adequate dietary preparation and cessation of intravenous glucose and glucose-regulating drugs. Recent advances in PET/CT technology enable higher image quality with shorter imaging time and may contribute to routinely performing FDG-PET/CT in intensive care patients with BSI of unknown origin.

scholarly journals FDG-PET or PET/CT in Fever of Unknown Origin: The Diagnostic Role of Underlying Primary Disease

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Nurhan Ergül ◽  
Tevfik Fikret Çermik
Keyword(s):  
Fdg Pet ◽  
Fever Of Unknown Origin ◽  
Inflammatory Diseases ◽  
Unknown Origin ◽  
Structural Analog ◽  
Diagnostic Methods ◽  
Pet Ct ◽  
Diagnostic Role ◽  
The Impact

Fever of unknown origin (FUO) is generally defined as a fever greater than 38.3°C on several occasions during a period longer than 3 weeks for which the etiology behind cannot be diagnosed at the end of at least 1 week hospital stay. Conventional diagnostic methods are still not adequate to reveal underlying reason in approximately 50% of patients with FUO. In patients with certain diagnosis, three major categories are infections, malignancies, and noninfectious inflammatory diseases. Fluoro-18-fluoro-2-deoxy-D:-glucose (FDG) is a structural analog of 2-deoxyglucose and accumulates in malignant tissues but also at sites of infection and inflammation. For this reason, FDG PET or PET/CT has great advantage in understanding of underlying pathology in assessment of FUO. However, till today, there are limited studies about the role of FDG PET or PET/CT in evaluation of FUO. In this paper, the impact of FDG PET or PET/CT in the diagnostic work-up of FUO is described by data obtained from literature review.

Skin Manifestations in Subacute Bacterial Endocarditis

1980 ◽  
Vol 42 (3) ◽  
pp. 398-402
Author(s):  
Yoshiko HITAKA ◽  
Tsuguo HAMAGUCHI ◽  
Tokuji KONISHI
Keyword(s):  
Bacterial Endocarditis ◽  
Subacute Bacterial Endocarditis ◽  
Skin Manifestations

scholarly journals Prevalence and Carbapenem Resistance of Acinetobacter baumannii and Other Than A. baumannii Isolates From Intensive Care Units (ICUs) and non-ICUs

2020 ◽  
Vol 41 (S1) ◽  
pp. s356-s357
Author(s):  
Tomasz Kasperski ◽  
Biophage Pharma S.A. Kraków ◽  
Agnieszka Chmielarczyk ◽  
Monika Pomorska-Wesolowska ◽  
Dorota Romaniszyn ◽  
...  
Keyword(s):  
Intensive Care ◽  
Inhibitory Concentration ◽  
Carbapenem Resistance ◽  
Diagnostic Methods ◽  
Clinical Settings ◽  
Gram Negative Bacteria ◽  
Carbapenem Resistant ◽  
Therapeutic Problem ◽  
Hospital Associated Infections ◽  
Very High

Background:Acinetobacter spp are gram-negative bacteria that have emerged as a leading cause of hospital-associated infections, most often in the intensive care unit (ICU) setting. This is particularly important in Poland, where the prevalence of A. baumannii in various types of infections, including bloodstream infection (BSI), pneumonia, skin and soft-tissue infection (SSTI), and urinary tract infection (UTI) is higher than in neighboring countries. Recently, other Acinetobacter spp, including A. lwoffii or A. ursingii, have been found to be clinically relevant. In Poland, we have also observed a very rapid increase in antimicrobial resistance, significantly faster for A. baumannii than for other nosocomial pathogens. Methods: A study was conducted in 12 southern Polish hospitals, including 3 ICUs, from January 1 to December 31, 2018. Only adult hospitalized patients were included. Strains were identified using the MALDI-TOF method. Carbapenem resistance was determined using the minimum inhibitory concentration (MIC). Results: During the study, 194 strains belonging to the Acinetobacter genus were isolated. A. baumannii was the dominant species, 88.1% (n = 171), and 23 isolates (11.9%) were other Acinetobacter spp: A. ursingii (n = 5), A. lwofii (n = 4), A. haemolyticus (n = 4), A. junii (n = 3), A. radioresistens (n = 2), A. bereziniae (n = 2), and A. johnsonii (n = 2). Moreover, 15 Acinetobacter strains were collected from ICUs. The most Acinetobacter strains were isolated from SSTIs (n = 115) from non-ICU settings. Non–A. baumannii strains were also most frequently isolated from SSTIs; they constituted 11.3% of all Acinetobacter strains from this type of infection (n = 13). The total Acinetobacter prevalence was 2.6%, whereas the prevalence in the ICU setting was 7%. Acinetobacter prevalence in SSTIs was 10.4%. In pneumonia, Acinetobacter prevalence was 18.6% for ICUs (n = 13) and 2.7% for non-ICUs (n = 46). Strains from UTIs were isolated only with the non-ICU setting, and their prevalence was 0.7% (n = 14). More than half of the tested strains (52.1%) were resistant to carbapenems, but all non–A. baumannii strains were susceptible. The highest resistance to carbapenems was among strains from pneumonia cases in ICUs (58.3%) and resistance among all strains isolated from ICU was 50%. However, even higher resistance was noted among SSTI strains from non-ICUs (61.7%). Conclusions: Increasingly, more than A. baumannii, other species among Acinetobacter strains are isolated from patients hospitalized in Polish hospitals. To assess the significance of non–A. baumannii spp in clinical settings, precise species identification is needed. Therefore, the diagnostic methods used must be improved. Carbapenem-resistant A. baumannii infections are the biggest problem in pneumonia patients in ICUs and in SSTI patients in other hospital departments. Carbapenem resistance occurs in a very high percentage of A. baumannii strains; among non–A. baumannii strains it is not yet a therapeutic problem.Funding: NoneDisclosures: None

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