scholarly journals Delayed diagnosis of extrapulmonary tuberculosis presenting as fever of unknown origin in an intermediate-burden country

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Jeong-Han Kim ◽  
Eu Suk Kim ◽  
Kang-Il Jun ◽  
Hyun gul Jung ◽  
Ji Hwan Bang ◽  
...  
Keyword(s):  
Fever Of Unknown Origin ◽  
Extrapulmonary Tuberculosis ◽  
Delayed Diagnosis ◽  
Unknown Origin

scholarly journals DELAYED DIAGNOSIS OF EXTRAPULMONARY TUBERCULOSIS PRESENTING AS FEVER OF UNKNOWN ORIGIN IN BIHAR

2020 ◽  
pp. 12-15
Author(s):  
Sant Kumar ◽  
Prabhat Kumar Sinha ◽  
Debarshi Jana
Keyword(s):  
Fever Of Unknown Origin ◽  
Comprehensive Evaluation ◽  
Imaging Finding ◽  
Extrapulmonary Tuberculosis ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Unknown Origin ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Atypical Presentations

Background: Tuberculosis (TB), especially extrapulmonary tuberculosis (EPTB), is an important cause of fever of unknown origin (FUO) in Bihar. Little information is known about patients with EPTB with clinical features presenting as FUO and about the factor of delaying the diagnosis. Material and Methods: We retrospectively analyzed EPTB patients at DMCH, Laheriasarai, Bihar, who were referred with FUO fromMithilanchal area around like; Darbhanga, Madhubani, Samsatipur and other places. The subjects were assigned to groups of early diagnosis and delayed diagnosis within3 days of an initial comprehensive evaluation from the referral. Clinical and laboratory variables were compared between the groups. Results: A total of 95 patients with febrile EPTB were included. Localizing symptoms and/or signs suggestive of anatomy were identified in 62.1% of the patients. Concurrent lung involvement by TB was presented by 49.5% (47/95) of the patients, and only 23.4% of them showed typical findings of pulmonary TB on simple chest X-ray. Most of the patients showed abnormal lesions on cross-sectional CT (98.9%) and MRI (100%). The clinical variables and blood test results of patients were not significantly different between the two groups. The less typical imaging finding of EPTB on CT (38.5% vs. 79.0%) and MRI (37.5% vs. 79.0%) in the delayed diagnosis group was a risk factor for delayed diagnosis. Conclusion: Febrile EPTB referred as FUO showed nonspecific clinical manifestations. The active application of cross-sectional imaging tests according to clinical clues or randomly in the absence of local manifestations, combined with invasive diagnostic approaches even for atypical presentations may lead to an earlier diagnosis of febrile EPTB.

scholarly journals Delayed Diagnosis of Biopsy-Negative Giant Cell Arteritis Presenting as Fever of Unknown Origin

2009 ◽  
Vol 24 (4) ◽  
pp. 532-536 ◽  
Author(s):  
Valentin S. Schäfer ◽  
Kenneth J. Warrington ◽  
Eric E. Williamson ◽  
Tanaz A. Kermani
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Fever Of Unknown Origin ◽  
Delayed Diagnosis ◽  
Unknown Origin

scholarly journals 18F-FDG PET/CT contribution to tuberculous vertebral osteomyelitis diagnosis: a case report

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Katerina Manika ◽  
Maria Kipourou ◽  
Stamata Georga ◽  
Eleni Faniadou ◽  
Georgios Pilianidis ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Fever Of Unknown Origin ◽  
Extrapulmonary Tuberculosis ◽  
Vertebral Osteomyelitis ◽  
Unknown Origin ◽  
Future Perspectives ◽  
Valuable Contribution ◽  
Delay In Diagnosis ◽  
Pet Ct ◽  
Fdg Pet Ct

ABSTRACT Tuberculous vertebral osteomyelitis (TVO) is an extrapulmonary tuberculosis form characterized by difficulty and delay in diagnosis. PET/CT is a valuable, well-established tool in the diagnostic workup of cancer and fever of unknown origin, which is increasingly appreciated in the management of infectious diseases. We report a TVO case where PET/CT had a valuable contribution towards diagnosis and monitoring of treatment response, highlighting its advantages and future perspectives when dealing with infectious diseases.

O45 Importance of extrapulmonary tuberculosis during evaluations of patients with fever of unknown origin

2009 ◽  
Vol 34 ◽  
pp. S16
Author(s):  
M. Pelemiš ◽  
G. Stevanovic ◽  
M. Pavlovic ◽  
S. Nikolic ◽  
L. Lavadinovic ◽  
...  
Keyword(s):  
Fever Of Unknown Origin ◽  
Extrapulmonary Tuberculosis ◽  
Unknown Origin

scholarly journals Tuberculosis in the Bone Marrow: A Case Report

2019 ◽  
Vol 42 (1) ◽  
pp. 65-70
Author(s):  
Lickhasit Saenglootong ◽  
Somchai Insiripong
Keyword(s):  
Bone Marrow ◽  
Fever Of Unknown Origin ◽  
Extrapulmonary Tuberculosis ◽  
Bone Marrow Involvement ◽  
Unknown Origin ◽  
Immunosuppressant Therapy ◽  
Thai Woman ◽  
Immunodeficiency Virus ◽  
Common Risk Factors ◽  
The Common

Mycobacterium tuberculosis of bone marrow that is considered one of the rare extrapulmonary tuberculosis (TB). Herein we report one case of tuberculosis of the bone marrow. A 82-year-old Thai woman presented with fever, fatigue, and weight loss of 4 kg in one month. The physical examination revealed only pallor and the ejection murmur at the upper parasternal border. Her chest film was unremarkable but the computed tomography of the chest revealed the reticular infiltration at both lower lungs and multiple small mediastinal lymphadenopathies. Although her blood smear did not show the leukoerythroblastic blood picture with the tear drop red blood cells (RBCs) or pancytopenia, her bone marrow biopsy showed a few granulomas with positive acid fast bacilli (AFB). The common risk factors such as diabetes, human immunodeficiency virus (HIV) infection, low CD4 counts, chronic kidney disease, malnutrition, and immunosuppressant therapy which might contribute her to be vulnerable to TB, were not found. The definite diagnosis was TB in the bone marrow and she clinically responded well to the 4-drug antituberculous regimen. Our case suggests that even though the leukoerythroblastosis with the tear drop RBCs or pancytopenia, the clues of the bone marrow involvement, is not found, the study of the bone marrow should not be precluded from the plan of the investigations for the diagnosis in a case of fever of unknown origin.

Patients with fever of unknown origin (FUO): diagnosis by nuclear medicine imaging

2001 ◽  
Vol 40 (03) ◽  
pp. 59-70 ◽  
Author(s):  
W. Becker ◽  
J. Meiler
Keyword(s):  
Nuclear Medicine ◽  
Fever Of Unknown Origin ◽  
Tumor Imaging ◽  
White Blood Cells ◽  
Unknown Origin ◽  
Final Diagnosis ◽  
Recurrent Fever ◽  
Nuclear Medicine Imaging

SummaryFever of unknown origin (FUO) in immunocompetent and non neutropenic patients is defined as recurrent fever of 38,3° C or greater, lasting 2-3 weeks or longer, and undiagnosed after 1 week of appropriate evaluation. The underlying diseases of FUO are numerous and infection accounts for only 20-40% of them. The majority of FUO-patients have autoimmunity and collagen vascular disease and neoplasm, which are responsible for about 50-60% of all cases. In this respect FOU in its classical definition is clearly separated from postoperative and neutropenic fever where inflammation and infection are more common. Although methods that use in-vitro or in-vivo labeled white blood cells (WBCs) have a high diagnostic accuracy in the detection and exclusion of granulocytic pathology, they are only of limited value in FUO-patients in establishing the final diagnosis due to the low prevalence of purulent processes in this collective. WBCs are more suited in evaluation of the focus in occult sepsis. Ga-67 citrate is the only commercially available gamma emitter which images acute, chronic, granulomatous and autoimmune inflammation and also various malignant diseases. Therefore Ga-67 citrate is currently considered to be the tracer of choice in the diagnostic work-up of FUO. The number of Ga-67-scans contributing to the final diagnosis was found to be higher outside Germany than it has been reported for labeled WBCs. F-l 8-2’-deoxy-2-fluoro-D-glucose (FDG) has been used extensively for tumor imaging with PET. Inflammatory processes accumulate the tracer by similar mechanisms. First results of FDG imaging demonstrated, that FDG may be superior to other nuclear medicine imaging modalities which may be explained by the preferable tracer kinetics of the small F-l 8-FDG molecule and by a better spatial resolution of coincidence imaging in comparison to a conventional gamma camera.

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