APPENDECTOMY IN CHILDREN WITH ACUTE RHEUMATIC FEVER

PEDIATRICS ◽  
1969 ◽  
Vol 43 (4) ◽  
pp. 573-577
Author(s):  
Jer-Shoung Lin ◽  
Ramon Rodriguez-Torres
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Laboratory Data ◽  
Initial Symptom ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
The Right

Clinical and laboratory data on five patients with appendectomy, later proved to have acute rheumatic fever, are presented in detail. The findings indicate that abdominal pain simulating acute appendicitis can be presented as the only initial symptom in acute rheumatic fever. Awareness and knowledge of the presence of clues-high fever, rapid sedimentation rate, prolonged P-R interval, and 4 plus C-reactive protein-usually help to make the differential diagnosis. However, if doubt remains, the right approach is to go ahead with surgery since these patients tolerate anesthesia and laparotomy very well.

Are there any novel markers in acute rheumatic fever: neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio

2020 ◽  
Vol 30 (5) ◽  
pp. 717-721
Author(s):  
Dilek Giray ◽  
Olgu Hallioglu
Keyword(s):  
Heart Disease ◽  
Rheumatic Fever ◽  
Sedimentation Rate ◽  
Acute Rheumatic Fever ◽  
Cardiac Involvement ◽  
C Reactive Protein ◽  
Lymphocyte Ratio ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Rheumatic Heart

AbstractObjective:The aim of this study was to investigate the relationship between C-reactive protein and erythrocyte sedimentation rate and neutrophil-to-lymphocyte, platelet-to-lymphocyte, and monocyte-to-lymphocyte ratios in acute rheumatic fever in children.Method:In this retrospective study, 182 patients with acute rheumatic fever and 173 controls were included. Complete blood count parameters, and neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios were recorded for all the patients underwent transthoracic echocardiography.Results:Neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios were significantly higher in patients with rheumatic heart disease than patients without cardiac involvement (p < 0.05). C-reactive protein and erythrocyte sedimentation rate levels were found to have a positive correlation with neutrophil-to-lymphocyte (r = 0.228, p = 0.001; r = 0.355, p = 0.001), platelet-to-lymphocyte (r = 0.227, p = 0.01; r = 0.149, p = 0.005), and monocyte-to-lymphocyte ratios (r = 0.117, p = 0.005; r = 0.107, p = 0.044). Cardiac involvement was present in 152 (83.5%) of the patients. Neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios were significantly higher in patients with rheumatic heart disease than patients without cardiac involvement (p < 0.05). Patients with carditis were grouped according to mitral, aortic, or both valve involvement but there was no significant difference between the groups with respect to neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios. In addition, neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios were significantly higher in patients with Sydenham’s chorea than without chorea (p < 0.05).Conclusion:Neutrophil-to-lymphocyte, platelet-to-lymphocyte, and monocyte-to-lymphocyte ratios may help make the diagnosis of acute rheumatic fever and its prognosis by serial measurements in follow-up but none of them tell us the severity of carditis. Also, this is the first study showing the positive correlation between Sydenham’s chorea and neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios. Further studies are needed to confirm this hypothesis, as this is the first study in the literature on this topic.

scholarly journals Uncommon Differential Diagnosis of Acute Right-sided Abdominal Pain – Case Report

2019 ◽  
Vol 4 (1) ◽  
pp. 33-36
Author(s):  
Cédric Kwizera ◽  
Benedikt Wagner ◽  
Johannes B. Wagner ◽  
Călin Molnar
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Fragile X ◽  
Pleural Empyema ◽  
Blind Ending ◽  
Rare Differential Diagnosis ◽  
Mentally Impaired ◽  
The Right ◽  
Tract Infections

Abstract The appendix is a worm-like, blind-ending tube, with its base on the caecum and its tip in multiple locations. Against all odds, it plays a key role in the digestive immune system and appendectomy should therefore be cautiously considered and indicated. We report the case of a 45-year-old male with a known history of Fragile-X syndrome who presented to the emergency department with intense abdominal pain and was suspected of acute appendicitis, after a positive Dieulafoy’s triad was confirmed. The laparoscopic exploration showed no signs of inflammation of the appendix; nonetheless, its removal was carried out. Rising inflammatory laboratory parameters led to a focused identification of a pleural empyema due to a tooth inlay aspiration. Our objective is to emphasize the importance of a thorough anamnesis, even in cases of mentally impaired patients, as well as to highlight a rare differential diagnosis for appendicitis. Acute appendicitis is an emergency condition that requires a thorough assessment and appropriate therapy. Clinical examinations are important, but in this particular case, imaging methods had a much more important role in establishing the right treatment approach. Furthermore, the signs of acute appendicitis are mimicked by several medical conditions including respiratory tract infections.

scholarly journals Pictorial quiz: A 2-year-old boy with abdominal pain

2019 ◽  
Vol 26 (5) ◽  
pp. 314-316
Author(s):  
Hsin-Ju Huang ◽  
Ming-Jen Tsai
Keyword(s):  
Abdominal Pain ◽  
Pediatric Emergency ◽  
C Reactive Protein ◽  
X Ray ◽  
High Attenuation ◽  
Reactive Protein ◽  
Calcified Lesion ◽  
Coffee Ground ◽  
Atypical Presentations ◽  
The Right

A 2-year-old boy presented with abdominal pain and non-coffee-ground emesis for 1 day. He was afebrile and without decreased activity. Examination showed lower abdominal tenderness, but psoas and obturator signs were negative. Laboratory test showed mildly elevated C-reactive protein (1.321 mg/dL) without leukocytosis. An abdominal X-ray revealed a high-attenuation-calcified lesion near the right sacroiliac joint which was highly suspected as an appendicolith. Subsequent abdominal computed tomography proved an appendicitis with appendicolith inside. He underwent laparoscopic appendectomy and was discharged uneventfully 4 days later. Acute appendicitis is a commonly misdiagnosed pediatric emergency because of the atypical presentations. Appendicoliths are presented in more than half of pediatric appendicitis and are highly associated with perforation. Surgery is recommended instead of antibiotics therapy alone to manage appendicolith-related appendicitis. A careful interpretation of the plain abdominal films and keeping a high suspicion are vital to early diagnosis of this disease.

scholarly journals White Cell Count and C-Reactive Protein Measurement in Patients with Possible Appendicitis

2009 ◽  
Vol 91 (2) ◽  
pp. 113-115 ◽  
Author(s):  
Anshuman Sengupta ◽  
George Bax ◽  
Simon Paterson-Brown
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Cell Count ◽  
White Cell Count ◽  
Lower Abdominal Pain ◽  
White Cell ◽  
C Reactive Protein ◽  
Economic Implications ◽  
Suspected Appendicitis ◽  
Reactive Protein

INTRODUCTION Clinical assessment outweighs the use of investigations in the diagnosis of acute appendicitis. Nevertheless, white cell count (WCC) and C-reactive protein (CRP) are regularly measured in patients with suspected appendicitis. The aim of this study was to assess the utility of these markers in patients presenting with acute lower abdominal pain. PATIENTS AND METHODS WCC and CRP were measured prospectively in 98 patients presenting with lower abdominal pain, and the results were correlated with each patient's outcome. RESULTS No patients with WCC and CRP both in the normal range had acute appendicitis. Raised WCC and CRP were poor positive predictors of appendicitis, both alone and in combination, and correlated poorly with the development of complications. CONCLUSIONS This result may have important clinical and economic implications. We suggest that patients experiencing lower abdominal pain, with normal WCC and CRP values, are unlikely to have acute appendicitis and can be safely sent home.

scholarly journals Laboratory Tests in Addition to the Alvarado Score in the Management of Acute Appendicitis in School-Age Children

2019 ◽  
Vol 73 (4) ◽  
pp. 379-386
Author(s):  
Astra Zviedre ◽  
Arnis Eņģelis ◽  
Pēteris Tretjakovs ◽  
Irisa Zīle ◽  
Aigars Pētersons
Keyword(s):  
Differential Diagnosis ◽  
Acute Appendicitis ◽  
Laboratory Tests ◽  
School Age Children ◽  
School Age ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Reactive Protein ◽  
Serum Cytokines ◽  
Tnf Α

Abstract The aim of the study was to determine whether the Alvarado score (AS) together with laboratory tests could be used to distinguish patients with acute appendicitis (AA) from acute mesenteric lymphadenitis (AML). Fifty-seven patients (7–18 years) with suspected AA were included in the prospective study (October 2010 – October 2013). Thirty-one patients underwent surgery for AA and 26 were not treated surgically and were diagnosed AML on ultrasonography. AS, white blood cell count (WBC), C – reactive protein (CRP) and serum cytokines (EGF, IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, TNF-α) were obtained on admission and were compared between groups. Mean age of the 57 patients was 12.9 (SD 3.2). Accuracy (AR) for AS ≥ 7 alone was 73.7% for AA. Modified AS with certain serum cytokines seemed to be a reliable tool for initial differential diagnosis between AA and AML in school-age children. Based on these results, AS ≥ 7, WBC ≥ 10.7 × 103/µL and serum IL-6 ≥ 4.3 pg/mL assessed altogether will yield more sensitivity for AA. Also for further advanced diagnostics, we propose to take into account the serum IL-6, IL-8, MCP-1, CRP cut-off levels in the differential diagnosis between complicated and uncomplicated AA to decide whether the treatment should be conservative or surgical.

scholarly journals Lymphocytes binding C-reactive protein during acute rheumatic fever.

1978 ◽  
Vol 61 (5) ◽  
pp. 1384-1393 ◽  
Author(s):  
R C Williams ◽  
K A Kilpatrick ◽  
M Kassaby ◽  
Z H Abdin
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
C Reactive Protein ◽  
Reactive Protein

scholarly journals CLINICOPATHOLOGICAL STUDY OF ACUTE APPEDDICITIS WITH SPECIAL REFERENCE TO THE ROLE OF WBC COUNT, C-REACTIVE PROTEIN (CRP), USG AND ALVARADO SCORE IN DIAGNOSIS

2020 ◽  
pp. 59-61
Author(s):  
Md. Mushir Reyaz ◽  
Kumari Pallavi ◽  
C. M. Narayan ◽  
Debarshi Jana
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Scoring System ◽  
Iliac Fossa ◽  
The Other ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Reactive Protein ◽  
Right Iliac Fossa Pain ◽  
Wbc Count

Background: Acute appendicitis is one of the commonest surgical emergencies in all ages. Diagnosis is mainly clinical, delay in diagnosis definitely increases the morbidity, mortality and cost of treatment, more aggressive surgical approach has resulted in increased white appendectomies. Methods: A total 140 cases hospitalized with abdominal pain, suggestive of acute appendicitis on the basis of WBC count, C-Reactive protein (CRP), USG and Alvarado scoring system and were subsequently operated, were included in the present study in our institute. Results: Males belonging to young age group of 21-30 were most commonly affected. Abdominal pain was seen in 100% of patients.Most of the patients of acute appendicitis presented with more than one of above symptoms. The most common presenting symptom was right iliac fossa pain affecting 96.19% of cases (migratory 62.86% and non-migratory 33.33%), followed by anorexia (78.10%) and nausea (66.67%). The other symptoms were fever (65.71%), vomiting (46.67%), constipation (28.57%), right sided flank pain (22.86%), dysurea (19.05%), suprapubic pain (15.24%), diarrhoea (14.29%) and generalized abdominal pain (13.33%) in decreasing order of frequency. Right iliac fossa pain was the most common presentation in non-appendicitis group, followed by anorexia. There was no significant difference in symptoms among these two groups.In this study 54.29% of patients with acute appendicitis had Alvarado score between 7 – 8 and 34.29% of patients with acute appendicitis had Alvarado score between 9 – 10. On the other hand majority of the patients of non-appendicitis group had a score below 7. Conclusions: Young males are most commonly affected almost always presents with abdominal pain. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy.

scholarly journals Antistreptolysin O titer and C-reactive protein levels in pediatric patients of acute rheumatic fever.

2020 ◽  
Vol 27 (07) ◽  
pp. 1335-1339
Author(s):  
Sana Zainab ◽  
Nida Saleem ◽  
Adil Manzoor ◽  
Saba Khaliq ◽  
Anum Wasim ◽  
...  
Keyword(s):  
Child Health ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Clinical Manifestations ◽  
Sampling Technique ◽  
Serum Levels ◽  
Descriptive Study ◽  
P Value ◽  
C Reactive Protein ◽  
Reactive Protein

Objectives: To determine serum levels of antistreptolysin O titre (ASOT) and C-reactive protein (CRP) and their association with clinical manifestations of Acute rheumatic fever (ARF). Study Design: Descriptive study. Setting: Department of Diagnostic Immunology and Serology, Children’s Hospital and Institute of Child Health, Lahore. Period: Jan 2015 to Jan 2016. Material & Methods: Fifty clinically confirmed patients of ARF were included in this descriptive study. The samples were taken from Children hospital and Institute of child health Lahore after written informed consent. The sampling technique was convenient sampling. Results: Out of 50 enrolled patients, males were 32(64%) and women 18(36%). Only 5(10%) patients had normal ASOT levels, 20(40%) patients were with borderline ASOT, and 25(50%) patients had titres above 200 IU/ml. There was no significant association of ASOT with gender, age and arthralgia with p-value = 0.060, 0.875 and 0.473, respectively. However, a significant association was found in ASOT with carditis and C-reactive protein (p-value = 0.028 and 0.014, respectively). Only 3 (6%) patients had CRP levels below 6mg/l, whereas 43 (86%) patients were with CRP levels above 6. Only 4(8%) patients had borderline value of CRP titer. There was no significant association between C-reactive protein with gender, age and arthralgia (p-value = 0.148, 0.184 and 0.574, respectively). Moreover, there was a significant association between C-reactive protein with carditis and AOST (p-value = 0.020 and 0.014, respectively). Conclusion: ASOT and CRP are important laboratory parameters reflecting undergoing infection (mainly caused by Streptococcus pyogenes A) and inflammation in patients of ARF. Rising levels of ASOT and CRP in ARF patients might be used as an indicator of involvement of heart tissues and therefore can be used to monitor transition of rheumatic carditis into Rheumatic heart disease.

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