scholarly journals Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Susanna Esposito ◽  
Victoria Elisa Rinaldi ◽  
Alberto Argentiero ◽  
Edoardo Farinelli ◽  
Marta Cofini ◽  
...  
Keyword(s):  
At Risk ◽  
Bacterial Infection ◽  
Bacterial Infections ◽  
Laboratory Data ◽  
Unknown Origin ◽  
Clinical Findings ◽  
Reactive Protein ◽  
Young Infants ◽  
High Risk Infants ◽  
The Impact

Introduction. Among neonates and infants <3 months of age with fever without a source (FWS), 5% to 15% of cases are patients with fever caused by a serious bacterial infection (SBI). To favour the differentiation between low- and high-risk infants, several algorithms based on analytical and clinical parameters have been developed. The aim of this review is to describe the management of young infants with FWS and to discuss the impact of recent knowledge regarding FWS management on clinical practice. Materials and Methods. PubMed was used to search for all of the studies published over the last 35 years using the keywords: “fever without source” or “fever of unknown origin” or “meningitis” or “sepsis” or “urinary tract infection” and “neonate” or “newborn” or “infant <90 days of life” or “infant <3 months”. Results and Discussion. The selection of neonates and young infants who are <3 months old with FWS who are at risk for SBI remains a problem without a definitive solution. The old Rochester criteria remain effective for identifying young infants between 29 and 60 days old who do not have severe bacterial infections (SBIs). However, the addition of laboratory tests such as C-reactive protein (CRP) and procalcitonin (PCT) can significantly improve the identification of children with SBI. The approach in evaluating neonates is significantly more complicated, as their risk of SBIs, including bacteremia and meningitis, remains relevant and none of the suggested approaches can reduce the risk of dramatic mistakes. In both groups, the best antibiotic must be carefully selected considering the clinical findings, the laboratory data, the changing epidemiology, and increasing antibiotic resistance of the most common infectious bacteria.

scholarly journals Thrombocytosis as a Predictor of Serious Bacterial Infection in Febrile Infants

2019 ◽  
Vol 16 (41) ◽  
pp. 401-404
Author(s):  
Deepak Mishra ◽  
Amit Kumar Das ◽  
Ram Hari Chapagain ◽  
Nitu Kumari Jha ◽  
Ganesh Kumar Rai
Keyword(s):  
Bacterial Infection ◽  
Bacterial Infections ◽  
Diagnostic Marker ◽  
Common Finding ◽  
P Value ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Young Infants

Background: Most of the febrile infants <90 days old will have no more than a mild viral infection but there is a substantial minority that will be diagnosed as having serious bacterial infection at a reported prevalence of 10–14%. A simple, readily available, inexpensive diagnostic marker that yields results quickly and also accurately identifies bacterial infections in febrile infants would be of great value in management of these infants. This study aims to assess the role of thrombocytosis in predicting serious bacterial infection in young febrile infants beyond neonatal period.Methods: A hospital based cross-sectional observational study was conducted from May 2016 to April 2017 on 76 febrile infants of age group 29-90 days in Kanti Children’s Hospital.Results: The incidence of serious bacterial infection was found 43 (56.6%). Thrombocytosis, elevated C-reactive protein and pyuria were significantly higher in serious bacterial infection cases (p value <0.05). Thrombocytosis alone had the sensitivity of only 53.5%, but had specificity of 90.9%. Elevated C-reactive protein had the best sensitivity (81.4%). Combination of leukocytosis, elevated C-reactive protein, pyuria and thrombocytosis had better sensitivity (93.0%) than these parameters alone. The overall ability of platelet count to identify infants with SBI was only moderate (AUC: 0.722). Elevated C-reactive protein was found to have better ability to identify infants with serious bacterial infection (AUC: 0.846).Conclusions: Thrombocytosis is a common finding in young infants diagnosed with serious bacterial infection. It has however, moderate ability in identifying infants with serious bacterial infection. Combining thrombocytosis with elevated C-reactive protein, leukocytosis and pyuria has better sensitivity in diagnosing serious bacterial infection than these individual parameters alone. Hence, combining these parameters may help in early prediction of febrile young infants at risk of serious bacterial infection.Keywords: Febrile young infants; serious bacterial infection; thrombocytosis.

scholarly journals The impact of Temporal Artery Biopsy for the diagnosis of Giant Cell Arteritis in clinical practice in a tertiary University Hospital

2019 ◽  
Author(s):  
E Kaltsonoudis ◽  
E Pelechas ◽  
A Papoudou-Bai ◽  
E.T. Markatseli ◽  
M Elisaf ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Laboratory Data ◽  
Unknown Origin ◽  
Temporal Artery ◽  
University Hospital ◽  
Temporal Artery Biopsy ◽  
Acute Phase Reactants ◽  
Anemia Of Chronic Disease ◽  
The Impact

ABSTRACTBackgroundTemporal artery biopsy (TAB) is useful in assisting with giant cell arteritis (GCA) diagnosis but lacks sensitivity. The aim of our study was to assess the diagnostic impact of TAB histology in patients with suspected GCA on hospital admission.MethodsA prospectively maintained database was queried for all TABs performed between 1-1-2000 until 31-12-2017 at the University Hospital of Ioannina. Thus, inclusion criteria were made on the grounds of every patient that underwent a TAB during the above-mentioned period, regardless of demographic, clinical and laboratory data.ResultsTwo hundred forty-five TABs were included (149 females and 96 males), with a mean age of 64.5 (±3.5) years. The mean symptoms duration until admission to the hospital was 8.6 (±1.3) weeks and all had elevated acute phase reactants on admission. The reasons of admission were fever of unknown origin (FUO) in 114 (46.5%) patients, symptoms of polymyalgia rheumatica (PMR) in 84 (34.3%), new headache in 33 (13.5%), anemia of chronic disease (ACD) in 8 (3.32%) and eye disturbances in 6 (2.5%) patients. Positive results were found in 49 (20%) TABs. More specifically, in 14% of patients with FUO, 21% in those with PMR, while in patients with a new headache the percentage was 27%. Finally, 5 out of 6 (83.3%) of patients with ocular symptoms and only one (12.5%) of those suffering from ACD. Visual manifestations and FUO are correlated with a positive TAB.ConclusionIt seems that TAB is useful in assisting with GCA diagnosis, but lacks sensitivity.

Utility of a Simple Scoring System in Differentiating Bacterial Infections in Cases of Fever of Unknown Origin

2020 ◽  
Vol 71 (Supplement_4) ◽  
pp. S409-S415
Author(s):  
Teng Xu ◽  
Li Wang ◽  
Shi Wu ◽  
Fenfen Zhou ◽  
Haihui Huang
Keyword(s):  
Bacterial Infection ◽  
Roc Curve ◽  
Scoring System ◽  
Inflammatory Markers ◽  
Retrospective Cohort ◽  
Bacterial Infections ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Neutrophil Percentage ◽  
Serum Inflammatory Markers

Abstract Background Infectious disease is the leading cause of fever of unknown origin (FUO). Serum inflammatory markers historically used to diagnose bacterial infection have sufficient diagnostic sensitivity but low specificity. This study aimed to develop a simple scoring system for differentiating bacterial infections from other causes of early-stage FUO. Methods This study included a retrospective cohort of patients presenting with FUO at the Huashan Hospital (January 2014 to June 2017). The diagnostic utility of serum inflammatory markers for bacterial infection was evaluated using the receiver operating characteristic (ROC) curve analysis. Relevant markers were subsequently measured prospectively in a separate cohort of FUO patients (December 2017 to May 2019). A scoring system was based on inflammatory markers and other test results. Results Bacterial infection was identified in 34% of patients in the retrospective cohort. The area under the ROC curve (AUC) was 0.644 (95% confidence interval [CI], .595–.693) for C-reactive protein, 0.624 (95% CI, .573–.675) for procalcitonin, and 0.646 (95% CI, .595–.697) for serum ferritin (SF) in diagnosing bacterial infection. Bacterial infection was found in 29% of cases in the prospective cohort. A model based on serum amyloid A (SAA) and SF levels and neutrophil percentage yielded an AUC of 0.775 (95% CI, .695–.854). Validation analysis indicated lower probability (&lt;15%) of bacterial infection for patients with a score &lt;16.5 points. Conclusions A scoring system based on SAA and SF levels and neutrophil percentage can help distinguish bacterial infection from other causes of FUO, potentially reducing antibiotic use.

scholarly journals Thrombocytosis as an additional predictor of serious bacterial infection in febrile young infants

2017 ◽  
Vol 4 (3) ◽  
pp. 1027
Author(s):  
Merin Eapen ◽  
Sreelatha P. R. ◽  
Jayakumar C.
Keyword(s):  
Platelet Count ◽  
Bacterial Infection ◽  
Soft Tissues ◽  
Early Recognition ◽  
Tertiary Care ◽  
White Blood Cells ◽  
C Reactive Protein ◽  
High Power Field ◽  
Reactive Protein ◽  
Young Infants

Background: To estimate the incidence of Reactive Thrombocytosis among febrile young infants and to assess the utility of platelet count as a potential predictor of Serious bacterial infection (SBI).Methods: This study was conducted as a prospective study between January 2014 to September 2015 at the tertiary care pediatric unit, Alappuzha, India. The participants were all infants 30 to 89 days of age, admitted with rectal temperature >38°C. The results of the sepsis evaluation on admission were recorded. SBI included cases of occult bacteremia, urinary tract infection, bacterial meningitis, pneumonia, bacterial gastroenteritis and infections of the soft tissues and bones.Results: Of the 120 infants studied, 24 (28%) had SBI. Platelet count was significantly higher in infants with SBI compared to those without {Platelet count ≥ 4.5lakhs /mm3 in SBI (70.3%) vs. Non SBI (30.2%). Mean platelet count 4.82±1.4 in SBI vs. 3.9±1.2 in non SBI which was statistically significant (p<0.05). Thrombocytosis had moderate ability in predicting SBI (Area under curve area under the curve: 0.720). The combination of platelet count ≥450,000/mm3, WBC ≥15,000/mm3, C-reactive protein ≥1 mg/dl, pyuria ≥5 White blood cells (WBC) per High power field (HPF) and erythrocyte sedimentation rate (ESR) >30mm/hr resulted in identification of all infants with SBI.Conclusions: Thrombocytosis in combination with leukocytosis, elevated C-reactive protein, ESR, and pyuria, may help in early recognition of febrile young infants at risk for SBI. 

scholarly journals C-Reactive Protein Is an Independent Predictor of 30-Day Bacterial Infection Post-Liver Transplantation

Biomolecules ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1195
Author(s):  
Jiong Yu ◽  
Xiaowei Shi ◽  
Jing Ma ◽  
Ronggao Chen ◽  
Siyi Dong ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Bacterial Infection ◽  
Systemic Inflammation ◽  
Bacterial Infections ◽  
Cox Regression ◽  
Prognostic Models ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Clinically Significant ◽  
The Relationship

The relationship between aseptic systemic inflammation and postoperative bacterial infection is unclear. We investigated the correlation of systemic inflammation biomarkers with 30-day clinically significant bacterial infections (CSI) after liver transplantation (LT). This retrospective study enrolled 940 patients who received LT and were followed for 30 days. The primary end point was 30-day CSI events. The cohort was divided into exploratory (n = 508) and validation (n = 432) sets according to different centers. Area under the receiver operated characteristic (AUROC) and Cox regression models were fitted to study the association between baseline systemic inflammation levels and CSI after LT. A total of 255 bacterial infectious events in 209 recipients occurred. Among systemic inflammation parameters, baseline C-reactive protein (CRP) was independently associated with 30-day CSI in the exploratory group. The combination of CRP and organ failure number showed a good discrimination for 30-day CSI (AUROC = 0.80, 95% CI, 0.76–0.84) and the results were confirmed in an external verification group. Additionally, CRP levels were correlated with bacterial product lipopolysaccharide. In conclusion, our study suggests that pre-transplantation CRP is independent of other prognostic factors for 30-day CSI post-LT, and can be integrated into tools for assessing the risk of bacterial infection post-LT or as a component of prognostic models.

scholarly journals Type I Interferon in Children with Viral or Bacterial Infections

2020 ◽  
Vol 66 (6) ◽  
pp. 802-808 ◽  
Author(s):  
Sophie Trouillet-Assant ◽  
Sébastien Viel ◽  
Antoine Ouziel ◽  
Lucille Boisselier ◽  
Philippe Rebaud ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Type I Interferon ◽  
Area Under The Curve ◽  
Pediatric Emergency ◽  
Type I ◽  
Discriminative Performance ◽  
Antibiotic Overuse ◽  
Reactive Protein

Abstract Background Fever is one of the leading causes of consultation in the pediatric emergency department for patients under the age of 3 years. Distinguishing between bacterial and viral infections etiologies in febrile patients remains challenging. We hypothesized that specific host biomarkers for viral infections, such as type I-interferon (IFN), could help clinicians’ decisions and limit antibiotic overuse. Methods Paxgene tubes and serum were collected from febrile children (n = 101), age from 7 days to 36 months, with proven viral or bacterial infections, being treated at pediatric emergency departments in France. We assessed the performance of an IFN signature, which was based on quantification of expression of IFN-stimulated genes using the Nanostring® technology and plasma IFN-α quantified by digital ELISA technology. Results Serum concentrations of IFN-α were below the quantification threshold (30 fg/mL) for 2% (1/46) of children with proven viral infections and for 71% (39/55) of children with bacterial infections (P &lt; 0.001). IFN-α concentrations and IFN score were significantly higher in viral compared to bacterial infection (P &lt; 0.001). There was a strong correlation between serum IFN-α concentrations and IFN score (p-pearson = 0.83). Both serum IFN-α concentration and IFN score robustly discriminated (Area Under the Curve &gt;0.91 for both) between viral and bacterial infection in febrile children, compared to C-reactive protein (0.83). Conclusions IFN-α is increased in blood of febrile infants with viral infections. The discriminative performance of IFN-α femtomolar concentrations as well as blood transcriptional signatures could show a diagnostic benefit and potentially limit antibiotic overuse. Clinical Trials Registration clinicaltrials.gov (NCT03163628).

Diagnosis of Anastomotic Leak

2021 ◽  
Vol 34 (06) ◽  
pp. 391-399
Author(s):  
Paul T. Hernandez ◽  
Raj M. Paspulati ◽  
Skandan Shanmugan
Keyword(s):  
Anastomotic Leak ◽  
Surgical Intervention ◽  
Laboratory Data ◽  
Water Soluble ◽  
Contrast Study ◽  
Anastomotic Leaks ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Water Soluble Contrast ◽  
The Impact

AbstractAnastomotic leaks after colorectal surgery is associated with increased morbidity and mortality. Understanding the impact of anastomotic leaks and their risk factors can help the surgeon avoid any modifiable pitfalls. The diagnosis of an anastomotic leak can be elusive but can be discerned by the patient's global clinical assessment, adjunctive laboratory data and radiological assessment. The use of inflammatory markers such as C-Reactive Protein and Procalcitonin have recently gained traction as harbingers for a leak. A CT scan and/or a water soluble contrast study can further elucidate the location and severity of a leak. Further intervention is then individualized on the spectrum of simple observation with resolution or surgical intervention.

The Innate Immune System Favors Emergency Monopoiesis at the Expense of DC Differentiation to Control Bacterial Infections

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2722-2722
Author(s):  
Kristin Bieber ◽  
Karina A. Pasquevich ◽  
Manina Günter ◽  
Matthias Grauer ◽  
Oliver Pötz ◽  
...  
Keyword(s):  
Immune System ◽  
Bacterial Infection ◽  
Bacterial Infections ◽  
Conflicts Of Interest ◽  
Bacterial Load ◽  
Innate Immune ◽  
General Response ◽  
The Impact ◽  
Myeloid Progenitors

Abstract Dendritic cells (DCs) are critical in host defense against infection, bridging the innate and adaptive immune system. Patients with sepsis display reduced circulating and splenic DCs and impaired DC function that may contribute to prolonged immune suppression and exacerbation of infection. However, the mechanisms of pathogen-induced DC depletion remain poorly understood. Here, a mouse model of systemic bacterial infection was employed to analyze the impact of different bacterial pathogens on DC development in vivo. We found that the numbers of bone marrow (BM) hematopoietic progenitors committed to the DC lineages were reduced following systemic infection with different Gram-positive and Gram-negative bacteria. In parallel, a TLR4-dependent increase of committed monocyte progenitors in the BM as well as mature monocytes in the spleen was observed. In line, adoptively transferred FLT3+ myeloid progenitors (MPs) developed preferentially to monocytes at the expense of DCs in infected animals. Analyses performed on mixed BM chimeras suggested that both the reduction of DC progenitors and the induction of monopoiesis following infection were dependent on extrinsic TLR4 signaling driving the secretion of IFN-g regulated chemokines. Consistently, these effects were completely abrogated by suppression of IFN-g signaling. Elevated monocyte numbers in the spleen triggered by infection were due to a CCR2-dependent egress from the BM. In CCR2-deficient mice, in which monocytosis reportedly is abrogated, we observed a significantly increased bacterial load in the spleen and a reduced survival rate, highlighting the importance of monocytes for bacterial clearance. Together, our data provide evidence for a general response of myeloid progenitors upon bacterial infection to enhance monocyte production, thereby increasing the availability of innate immune cells as a first line of defense against invading pathogens. Concomitantly the development of DCs is impaired, which may be responsible for transient immunosuppression in e.g. bacterial sepsis. Disclosures No relevant conflicts of interest to declare.

scholarly journals C-Reactive Protein Level May Predict the Risk of COVID-19 Aggravation

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Guyi Wang ◽  
Chenfang Wu ◽  
Quan Zhang ◽  
Fang Wu ◽  
Bo Yu ◽  
...  
Keyword(s):  
Early Stage ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Area Under The Curve ◽  
Threshold Value ◽  
Clinical Findings ◽  
Optimal Threshold ◽  
C Reactive Protein ◽  
Related Factors ◽  
Reactive Protein

Abstract Background Clinical findings indicated that a fraction of coronavirus disease 2019 (COVID-19) patients diagnosed as mild early may progress to severe cases. However, it is difficult to distinguish these patients in the early stage. The present study aimed to describe the clinical characteristics of these patients, analyze related factors, and explore predictive markers of the disease aggravation. Methods Clinical and laboratory data of nonsevere adult COVID-19 patients in Changsha, China, were collected and analyzed on admission. A logistic regression model was adopted to analyze the association between the disease aggravation and related factors. The receiver operating characteristic curve (ROC) was utilized to analyze the prognostic ability of C-reactive protein (CRP). Results About 7.7% (16/209) of nonsevere adult COVID-19 patients progressed to severe cases after admission. Compared with nonsevere patients, the aggravated patients had much higher levels of CRP (median [range], 43.8 [12.3–101.9] mg/L vs 12.1 [0.1–91.4] mg/L; P = .000). A regression analysis showed that CRP was significantly associated with aggravation of nonsevere COVID-19 patients, with an area under the curve of 0.844 (95% confidence interval, 0.761–0.926) and an optimal threshold value of 26.9 mg/L. Conclusions CRP could be a valuable marker to anticipate the possibility of aggravation of nonsevere adult COVID-19 patients, with an optimal threshold value of 26.9 mg/L.

scholarly journals Cytokines and Chemokines as Biomarkers of Community-Acquired Bacterial Infection

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Michal Holub ◽  
David A. Lawrence ◽  
Nancy Andersen ◽  
Alžběta Davidová ◽  
Ondřej Beran ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Elevated Serum ◽  
Serum Concentrations ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Cytokines And Chemokines ◽  
Luminex Technology ◽  
Limited Usefulness

Routinely used biomarkers of bacterial etiology of infection, such as C-reactive protein and procalcitonin, have limited usefulness for evaluation of infections since their expression is enhanced by a number of different conditions. Therefore, several inflammatory cytokines and chemokines were analyzed with sera from patients hospitalized for moderate bacterial and viral infectious diseases. In total, 57 subjects were enrolled: 21 patients with community-acquired bacterial infections, 26 patients with viral infections, and 10 healthy subjects (control cohorts). The laboratory analyses were performed using Luminex technology, and the following molecules were examined: IL-1Ra, IL-2, IL-4, IL-6, IL-8, TNF-α, INF-γ, MIP-1β, and MCP-1. Bacterial etiology of infection was associated with significantly (P<0.001) elevated serum concentrations of IL-1Ra, IL-2, IL-6, and TNF-αin comparison to levels observed in the sera of patients with viral infections. In the patients with bacterial infections, IL-1Ra and IL-8 demonstrated positive correlation with C-reactive protein, whereas, IL-1Ra, TNF-α, and MCP-1 correlated with procalcitonin. Furthermore, elevated levels of IL-1Ra, IL-6, and TNF-αdecreased within 3 days of antibiotic therapy to levels observed in control subjects. The results show IL-1Ra as a potential useful biomarker of community-acquired bacterial infection.

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