scholarly journals Two Important Issues in Subacute Thyroiditis Management: Delayed Diagnosis and Inappropriate Use of Antibiotics

2021 ◽  
pp. 1-7
Author(s):  
Hayri Bostan ◽  
Muhammed Erkam Sencar ◽  
Murat Calapkulu ◽  
Sema Hepsen ◽  
Hakan Duger ◽  
...  
Keyword(s):  
Neck Pain ◽  
Median Time ◽  
Delayed Diagnosis ◽  
Antibiotic Use ◽  
Subacute Thyroiditis ◽  
Family Doctors ◽  
Antibiotic Overuse ◽  
Inappropriate Use ◽  
Laboratory Test Results ◽  
History Of

Background: Subacute thyroiditis (SAT) is a rare inflammatory disease of the thyroid gland. It has been noticed that patients with a diagnosis of SAT visit more other clinics and receive antibiotics unnecessarily. Therefore, the aim of this study was to reveal the degree of delay in the diagnosis of SAT, prediagnosis antibiotic use rates, and the awareness of clinics for the diagnosis of SAT. Methods: A total of 121 patients with SAT were enrolled in the study. A retrospective analysis was made of the history of patient symptoms during the diagnosis, which physicians they visited, antibiotic use, laboratory test results, and ultrasonographic findings. Results: The median age of the patients was 41 years. Neck pain radiating to the jaw/ear was seen in most patients (71.1%). The median time from symptom onset to a diagnosis of SAT was 23 days (range, 6–70 days). Antibiotics were erroneously prescribed to 71 patients (58.7%) before the diagnosis. The median time to diagnosis was 28 days in patients using antibiotics and 20 days in the group not using antibiotics (p < 0.001). Two or more physicians had been visited before SAT diagnosis by 89 (73.6%) patients, and more antibiotics were prescribed to these patients than the group who visited fewer physicians (p < 0.05). The frequency of prescribing antibiotics by physicians was 73.7% by emergency physicians, 53.1% by family doctors, 51.1% by ENT specialists, and 35.4% by internal medicine specialists. Conclusion: The diagnosis of SAT is often delayed, and misdiagnosis leads to erroneous antibiotic overuse. Physicians should increase their awareness of the diagnosis of SAT in patients with neck pain.

Time-Lag Between Symptom Onset and Diagnosis of Subacute Thyroiditis – How to Avoid the Delay of Diagnosis and Unnecessary Overuse of Antibiotics

2019 ◽  
Vol 52 (01) ◽  
pp. 32-38 ◽  
Author(s):  
Magdalena Stasiak ◽  
Renata Michalak ◽  
Bartłomiej Stasiak ◽  
Andrzej Lewiński
Keyword(s):  
Antibiotic Treatment ◽  
Clinical Symptoms ◽  
Time Lag ◽  
Delayed Diagnosis ◽  
Simple Algorithm ◽  
Antibiotic Use ◽  
Treated Group ◽  
Subacute Thyroiditis ◽  
Reactive Protein ◽  
Laboratory Test Results

AbstractClinical symptoms of subacute thyroiditis (SAT) may be misleading and the proper diagnosis is significantly delayed, and many unnecessary therapeutic methods are used, including application of antibiotics. The purpose of the study is to analyze the reasons and frequency of delayed SAT diagnosis and unnecessary antibiotic treatment and to propose a simple algorithm to facilitate the diagnosis and prevent antibiotic abuse. Sixty-four SAT patients were divided into groups depending on the period of time from the first symptoms of SAT to diagnosis and on the unnecessary use of antibiotics. Data from medical history and laboratory test results were analyzed for individual groups to determine the reasons for delayed diagnosis and incorrect treatment. In 73% of patients, the diagnosis was delayed from over two weeks up to six months. Among 62 patients who provided data on antibiotic use, 29 (46.77%) were treated with one or more antibiotics due to SAT symptoms. Fever, preceding infection, increased C-reactive protein (CRP), and WBC were characteristic for the antibiotic treated group. Fever, preceding infection, increased CRP and WBC are typical for both SAT and infection and are the main symptoms leading to misdiagnosis and unnecessary antibiotic treatment in SAT. Thus, in all patients with neck pain or other SAT-like symptoms, thorough clinical examination of the neck is mandatory. When firm and/or tender thyroid nodule/goitre is present and erythrocyte sedimentation rate /CRP is increased, patient should be promptly referred to an endocrinologist, and antibiotics are not recommended.

scholarly journals Nocardia Arthritidis Keratitis: Case Report and Review of the Literature

2017 ◽  
Vol 9 (1) ◽  
pp. 91-94 ◽  
Author(s):  
Andrew Gieger ◽  
Stephen Waller ◽  
Joseph Pasternak
Keyword(s):  
Delayed Diagnosis ◽  
Light Sensitivity ◽  
Treatment Withdrawal ◽  
Delayed Treatment ◽  
Inappropriate Use ◽  
Increased Risk ◽  
Prolonged Recovery ◽  
History Of ◽  
Withdrawal Of Therapy

Introduction: Keratitis due to Nocardia infection is not commonly encountered in clinical practice and may therefore be mistaken for fungal or viral keratitis leading to delayed treatment and increased risk of permanent visual impairment. Case: An otherwise healthy 27 years old Caucasian Active Duty military member presented to the clinic with three days of light sensitivity and irritation of his right eye. He carried a history of PRK in both eyes six years prior and admitted to recent contact lens overuse. With empiric treatment for typical bacterial keratitis including corticosteroids, his condition worsened on close follow-up. While awaiting cultures, a shift to fortified topical antibiotics tobramycin, moxifloxacin and ciprofloxacin showed improvement with closure of the epithelial defect. Ulcerative relapse occurred with withdrawal of therapy. Culture proven Nocardia arthritidis prompted successful treatment with topical antibiotic amikacin. On follow-up at three months, the patient was doing well with a small peripheral anterior stromal scar without permanent visual sequelae. Visual acuity returned to baseline of 20/20 in the affected eye. Conclusion: Keratitis caused by Nocardia species, including arthritidis, responds well to amikacin. Late diagnosis and early treatment withdrawal may lead to a prolonged recovery. Current literature indicates that corticosteroids may be harmful in the treatment of Nocardia keratitis. Increased awareness of Nocardia as an ocular pathogen has the potential to reduce unnecessary morbidity related to delayed diagnosis, inadequate therapy and inappropriate use of corticosteroids. 

Delayed diagnosis of an upper cervical epidural abscess masked due to crowned dens syndrome

2020 ◽  
Vol 13 (5) ◽  
pp. e235126
Author(s):  
Hiroshi Sugimoto ◽  
Takuji Hayashi ◽  
Shun Nakadomari ◽  
Keisuke Sugimoto
Keyword(s):  
Neck Pain ◽  
Epidural Abscess ◽  
Delayed Diagnosis ◽  
Atlantoaxial Joint ◽  
Stiff Neck ◽  
Contrast Enhanced Ct ◽  
Crowned Dens Syndrome ◽  
Old Japanese ◽  
Upper Cervical ◽  
History Of

An 87-year-old Japanese man presented to our hospital with a 5-day history of fever and neck pain. On physical examination, his stiff neck indicated restricted movement, especially on rotation. CT of the head revealed calcification of the atlantoaxial joint consistent with crowned dens syndrome, and celecoxib was started. Four days later, he returned to our emergency department as his neck pain and fever had not improved. Pneumonia and a urinary tract infection were suspected. The day following admission, blood culture results were positive for methicillin-resistant Staphylococcus aureus. A contrast-enhanced CT revealed an upper cervical epidural abscess at the level of C1–C2. He was discharged following 8 weeks of antibiotic treatment.

scholarly journals 721. Effect of Gastrointestinal Pathogen Panel (GIP) in Antibiotic Management

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S411-S411
Author(s):  
Christopher F Saling ◽  
Maria T Seville ◽  
Roberto L Patron
Keyword(s):  
Escherichia Coli ◽  
High Sensitivity ◽  
Antibiotic Use ◽  
Turnaround Time ◽  
Enterotoxigenic Escherichia Coli ◽  
Antibiotic Overuse ◽  
Panel Testing ◽  
Clostridioides Difficile ◽  
Antibiotic Management ◽  
History Of

Abstract Background GIP offers detection via PCR for a wide array of common microbes associated with diarrheal illness. Its rapid turnaround time and high sensitivity has made GIP testing commonplace for the evaluation of diarrhea. The purpose of this study is to determine if GIP influences antibiotic management in patients hospitalized with diarrhea. Methods Fifty patients hospitalized at Mayo Clinic Arizona between July and December 2019 who underwent BioFire® FilmArray™ GI PCR Panel testing were randomly selected. Medical records were reviewed to capture gender, age, immunocompromised state, antibiotic use within 30 days, prior hospitalization within 3 months, history of Clostridioides difficile infection, time from admission to testing and GIP results, and to determine if GIP results directly contributed towards antibiotic management. This study was exempt from Institutional Review Board approval. Results Twenty-six patients were male and twenty-four were female. The average age was 61.7 years. Thirty-four patients (68%) were immunocompromised. Forty-one GIPs were ordered within 24 hours of admission. Twenty-two patients (44%) had a positive GIP result; five were positive for 2 concurrent organisms. C. difficile was the most commonly detected organism, found in 16/24 (66.7%) positive tests. Eleven patients (68.8%) with C. difficile had a recent hospitalization, antibiotics within 30 days, or a history of C. difficile infection. There were 3 cases of Enteropathogenic Escherichia coli, 2 of Enterotoxigenic Escherichia coli, 2 of adenovirus, 2 of norovirus, 1 of rotavirus, and 1 of Vibrio cholerae. Excluding C. difficile positive patients, GIP testing contributed in changing antibiotic management in 3/50 (6%) patients tested. One patient had antibiotics stopped, one received correct antibiotics, and one received inappropriate antimicrobial therapy. Conclusion These results suggest that except in the setting of C. difficile infection, GIP has little utility in guiding antimicrobial management, even in the immunocompromised patient. GIP testing is expensive and it may be more resourceful to screen patients hospitalized with diarrhea for C. difficile alone, especially in those with risk factors for C. difficile infection. Furthermore, GIP testing can lead to antibiotic overuse. Disclosures All Authors: No reported disclosures

scholarly journals Subacute Thyroiditis in COVID-19 Patients

2021 ◽  
pp. 014556132110121
Author(s):  
Ali Seyed Resuli ◽  
Muzaffer Bezgal
Keyword(s):  
Neck Pain ◽  
Previous History ◽  
Endocrine System ◽  
Signs And Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Subacute Thyroiditis ◽  
Viral Respiratory Tract Infection ◽  
History Of ◽  
Viral Respiratory

Objective: As a result of the COVID-19 pandemic that occurred in the last year, it has been revealed that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) does not only cause viral respiratory tract infection but can also affect many organs in the short or long term. In our study, we aimed to reveal that COVID-19 infection affects the endocrine system and triggers subacute thyroiditis (SAT) in the acute period. Material and Method: In our retrospective study, the ear-nose-throat examination, internal diseases consultation (investigation of COVID-19 symptoms and polymerase chain reaction [PCR] test), routine blood tests, T3, T4, thyroid-stimulating hormone, antithyroglobulin (anti-TG), antithyroid peroxidase (anti-TPO), thyroid scintigraphy, and thyroid ultrasonography results of 5 patients who applied to the otorhinolaryngology clinic due to complaints of neck pain and odynophagia between April 2020 and February 2021 were examined. Findings: All 5 patients were female patients (30.4 years) with odynophagia and pain in the front lower region of the neck. These patients had no previous history of thyroiditis. COVID-19 PCR tests of the patients diagnosed with SAT were positive, and there were no typical COVID-19 signs and symptoms except odynophagia and neck pain. Result: It comes in view that SARS-COV-2 affects thyroid functions and causes SAT and the main symptoms in patients are pain in the neck and odynophagia.

scholarly journals Three Cases of Subacute Thyroiditis Following SARS-CoV-2 Vaccine: Post-vaccination ASIA Syndrome

2021 ◽  
Author(s):  
Burçin Gönül İremli ◽  
Süleyman Nahit Şendur ◽  
Uğur Ünlütürk
Keyword(s):  
Clinical Laboratory ◽  
Previous History ◽  
Subacute Thyroiditis ◽  
Imaging Features ◽  
Upper Respiratory Tract ◽  
Post Vaccination ◽  
Laboratory Test Results ◽  
History Of ◽  
Asia Syndrome ◽  
Inflammatory Syndrome

Abstract Context Autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome) can be seen as a post-vaccination phenomenon that occurs after exposure to adjuvants in vaccines that increase the immune responses. There is very limited data regarding ASIA syndrome following SARS-CoV-2 vaccines. Objectives This work aims to report cases of subacute thyroiditis related to the SARS-CoV-2 vaccine. Methods We describe the clinical, laboratory, and imaging features of three cases of subacute thyroiditis after inactivated SARS-CoV-2 vaccine (CoronaVac®). Three female healthcare workers have applied to our clinic with anterior neck pain and fatigue four to seven days after SARS-CoV-2 vaccination. Two of them were in the breastfeeding period. They were negative for thyroid antibodies, and there was no previous history of thyroid disease or upper respiratory tract infection, or COVID-19. Laboratory test results and imaging findings were consistent with subacute thyroiditis. Results SARS-CoV-2 vaccination can lead to subacute thyroiditis as a phenomenon of ASIA syndrome. Subacute thyroiditis may develop within a few days after the SARS-CoV-2 vaccination. Being in the postpartum period may be a facilitating factor for the development of ASIA syndrome after the SARS-CoV-2 vaccination. Conclusions This is the first report of subacute thyroiditis as a phenomenon of ASIA syndrome after inactivated COVID-19 vaccination. Clinicians should be aware that subacute thyroiditis may develop as a manifestation of ASIA syndrome after the inactive SARS-CoV-2 vaccine.

Refractory Ascites as the Only Presenting Symptom of Chronic Calcified Constrictive Pericarditis: A Diagnostic Challenge

2014 ◽  
Vol 17 (1) ◽  
pp. 42
Author(s):  
Shi-Min Yuan
Keyword(s):  
Computed Tomography ◽  
Liver Cirrhosis ◽  
Female Patient ◽  
Constrictive Pericarditis ◽  
Delayed Diagnosis ◽  
Young Female ◽  
Refractory Ascites ◽  
Diagnostic Challenge ◽  
Massive Ascites ◽  
History Of

Extracardiac manifestations of constrictive pericarditis, such as massive ascites and liver cirrhosis, often cover the true situation and lead to a delayed diagnosis. A young female patient was referred to this hospital due to a 4-year history of refractory ascites as the only presenting symptom. A diagnosis of chronic calcified constrictive pericarditis was eventually established based on echocardiography, ultrasonography, and computed tomography. Cardiac catheterization was not performed. Pericardiectomy led to relief of her ascites. Refractory ascites warrants thorough investigation for constrictive pericarditis.

Gestational diabetes mellitus: are mothers being followed-up? A retrospective study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697469
Author(s):  
Rebecca Ward ◽  
Fahmy W Hanna ◽  
Ann Shelley-Hitchen ◽  
Ellen Hodgson ◽  
Adrian Heald ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Median Time ◽  
Post Partum ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Tertiary Referral Centre ◽  
Alternative Approach ◽  
Nice Guidance ◽  
History Of

BackgroundWomen with gestational diabetes (GDM) have an elevated risk of developing type 2 diabetes (T2DM). NICE Guidance recommends women who develop GDM are screened 6 weeks post-partum and annually thereafter.AimTo evaluate conformity to guidance of screening in women with GDM by 6-week post-partum fasting plasma glucose (FPG) and annual FPG and determine time between delivery and development of T2DM.MethodRecords at a tertiary referral centre were used to identify women (n = 54) diagnosed with GDM by antenatal oral glucose tolerance test between July 1999 and January 2007. Data from laboratory records were used to collect investigations of glycaemic status during the follow-up period (median follow-up 12.4 years, range 9.5–17.1 years).ResultsOf 252 women, 102 (40.2%) did not have a FPG at 6 weeks (+/−2 weeks). Of these, median time to first test was 1.2 years (range 0.04–10.8 years), with only 43.1% followed-up within 1 year. In those who had a 6-week FPG, 17 (11.3%) women had no further tests. A total of 84 (33% of those with gestational diabetes in the index pregnancy) women were diagnosed with T2DM; median time from delivery to diagnosis was 5.2 years (range 0.35–15.95). We found the only significant factor for a follow-up test at 1-year post-partum was the use of insulin.ConclusionOur data suggest an alternative approach is needed for monitoring women with a history of GDM. This needs to be appropriate for a generally healthy group in which traditional screening mechanisms may not be adequate or sufficient.

scholarly journals Bloodstream infection with Acinetobacter baumanii in a Plasmodium falciparum positive infant: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Charity Wiafe Akenten ◽  
Kennedy Gyau Boahen ◽  
Kwadwo Sarfo Marfo ◽  
Nimako Sarpong ◽  
Denise Dekker ◽  
...  
Keyword(s):  
Case Report ◽  
Bacterial Infections ◽  
Treatment Options ◽  
Female Child ◽  
Correct Choice ◽  
Blood Cultures ◽  
Microbial Culture ◽  
Acinetobacter Baumanii ◽  
Inappropriate Use ◽  
History Of

Abstract Background The increasing incidence of multi-antibiotic-resistant bacterial infections, coupled with the risk of co-infections in malaria-endemic regions, complicates accurate diagnosis and prolongs hospitalization, thereby increasing the total cost of illness. Further, there are challenges in making the correct choice of antibiotic treatment and duration, precipitated by a lack of access to microbial culture facilities in many hospitals in Ghana. The aim of this case report is to highlight the need for blood cultures or alternative rapid tests to be performed routinely in malaria patients, to diagnose co-infections with bacteria, especially when symptoms persist after antimalarial treatment. Case presentation A 6-month old black female child presented to the Agogo Presbyterian Hospital with fever, diarrhea, and a 3-day history of cough. A rapid diagnostic test for malaria and Malaria microscopy was positive for P. falciparum with a parasitemia of 224 parasites/μl. The patient was treated with Intravenous Artesunate, parental antibiotics (cefuroxime and gentamicin) and oral dispersible zinc tablets in addition to intravenous fluids. Blood culture yielded Acinetobacter baumanii, which was resistant to all of the third-generation antibiotics included in the susceptibility test conducted, but sensitive to ciprofloxacin and gentamicin. After augmenting treatment with intravenous ciprofloxacin, all symptoms resolved. Conclusion Even though this study cannot confirm whether the bacterial infection was nosocomial or otherwise, the case highlights the necessity to test malaria patients for possible co-infections, especially when fever persists after parasites have been cleared from the bloodstream. Bacterial blood cultures and antimicrobial susceptibility testing should be routinely performed to guide treatment options for febril illnesses in Ghana in order to reduce inappropriate use of broad-spectrum antibiotics and limit the development of antimicrobial resistance.

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