scholarly journals Prolonged subfebrile condition, pyretic fever and febrile attacks of unknown genesis: new approach to diagnosis and treatment. Part 1. Clinical picture

2021 ◽  
Vol 9 (4) ◽  
pp. 6-14
Author(s):  
I.S. Markov ◽  
A.I. Markov
Keyword(s):  
Bacterial Infection ◽  
Temperature Regime ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Unknown Origin ◽  
Chronic Pyelonephritis ◽  
Low Grade ◽  
Bacteriological Examination ◽  
Short Term ◽  
Pathological Conditions

Background. The study was aimed to establish the true etiological cause of such pathological conditions as prolonged low-grade fever, fever of unknown genesis, and cases of rapid short-term febrile increase of temperature of unknown origin. Materials and methods. The design of the study was clinical-diagnostic and included the search for ways to diagnose and treat such pathological conditions as prolonged subfebrile fever, fever of unknown genesis, and cases of rapid short-term febrile increase of temperature of unknown origin. The studies were prospective-retrospective and were longitudinal with long-term periodic follow-up of a certain part of the same patients during 1–10 years after diagnosis of CBIS (chronic bacterial intoxication syndrome) and appropriate treatment. According to the effectiveness of the obtained results, the study was direct, because it undoubtedly led to the recovery of the patient with the improvement of his/her state and life. All patients (infants and adults aged till 80 years) who went to the hospital during 2009–2020 with complaints about violation of the temperature regime (subfebrile or febrile increase). Results. During 2009–2020, 3999 patients (adults — 2047/3999, 51.2 %, children — 1952/3999, 48.8 %) with a fever of unknown origin, namely 1578/2047 (77.1 %) adults and 1206/1952 (61.8 %) children with prolonged subfebrile fever, 70/2047 (3.4 %) and 25/1952 (1.3 %), respectively — with febrile fever and 399/2047 (19.5 %) and 721/1952 (36.9 %) — with febrile attacks (FA), were observed by the authors. In all 3999 (100 %) patients, there was detected a focus of chronic bacterial infection in the kidneys. Herewith in more than 2/3 cases (2780/3999 patients, 69.5 %), there was diagnosed the locally asymptomatic nephrodysbacteriosis without clinical, general laboratory (inclu­ding almost normal general analysis of urine) and instrumental signs of the inflammatory process in the kidneys. In 960/3999 (24.0 %) ca­ses, there was first established the latent form of delayed clinically asymptomatic chronic pyelonephritis. 259/3999 (6.5 %) patients were diagnosed with chronic pyelonephritis at the stage of clinical exacerbation. As a consequence of the formation of a focus of chronic bacterial infection in the kidneys, the patients developed monosymptomatic (only with temperature increase) or full-symptom CBIS, namely: 2024/2784 (72.7 %) children and adults with prolonged subfebrile fever there presented with typical clinical manifestations of CBIS in various combinations, but in 760/2784 (27.3 %) cases, the subfebrile temperature was monosymptoma­tic without other complaints and clinical symptoms. The diagnosis was confirmed by bacteriological examination of warm urine (three times, for three days running) and toxicological blood examination using the diagnostic system Toxicon. Urine cultures of various bacteria were isolated from urine in all 3999 (100 %) patients. Herewith in 2205/3999 (55.1 %) cases, there were isolated one culture of bacteria in each case, in 1608/3999 (40.2 %) patients — simultaneously two cultures of different bacteria, i.e. another 3216 strains, in 186/3999 (4,7 %) — three cultures (558 strains). That is, in general, there were isolated 5979 strains of different bacteria, which were considered as diagnostic confirmation of the presence of a focus of chronic bacterial infection in the kidneys in all 3999 patients with prolonged subfebrile fever, fever of unknown genesis, or febrile attacks. The main factors of the occurrence of temperature regime disorders on the background of CBIS were Enterococci (2471/3999 strains from 61.8 % of patients), Escherichia coli — 1495/3999 strains (from 37.4 % of patients) and Staphylococci (Staphylococcus aureus and Staphylococcus haemolyticus) and Streptococci (Streptococcus pyogenes): a total of 696/3999 strains (from 17.4 % of patients). In 818 (100 %) patients who were examined using the Toxi­con system, all, without exception, the indicators of cytolytic activity of toxic proteomes, which were tested, significantly exceeded the norm (p < 0.001). In the vast majority of patients (in 664/818 or 81.17 % of cases), there was detected severe toxemia, in 140/818 (17.11 %) — moderate and only in 14 (1.71 %) — mild. All 3999 patients with prolonged subfebrile fever, fever of unknown genesis, and FA were treated with bacterial autovaccines made from strains, isolated during the bacteriological examination. One cycle consisted of 2–3 courses of immunization with bacterial vaccines. One course included 10 or 12 subcutaneous injections in increasing dosage during 19–21 days. Between courses, there was maintained an interval of 3 to 4 weeks. The treatment cycle generally lasted from 70 to 110 days, depending on the number of courses. Intervals between treatment cycles were usually maintained for 3 months. The effectiveness of such treatment was 71.2 % after the first cycle, 92.8 % — after the second, and 99.2 % — after the third with full recovery of the ability to work, lost during the illness, and the emotional level of personal life. Conclusions. It has been established that the etiological cause of the occurrence of prolonged subfebrile fever, febrile fevers of unknown genesis, and febrile attacks is such a clinically and nosologically separate disease as chronic bacterial intoxication syndrome, which develops on the background of a chronic bacterial focus, usually locally asymptomatic infection in the kidneys, called nephrodysbacteriosis, and is usually associated with severe bacterial endotoxicosis that was confirmed by appropriate toxicological examination of the blood. The use of bacterial autovaccines was proved to be an effective method of treatment (up to 99.2 %) of patients with increased temperature of bacterial-toxic origin.

scholarly journals Prolonged subfebrile condition, pyretic fever and febrile attacks of unknown genesis: new approach to diagnosis and treatment. Part 2. Diagnostics and treatment

2021 ◽  
Vol 9 (5-6) ◽  
pp. 42-52
Author(s):  
I.S. Markov ◽  
A.I. Markov
Keyword(s):  
Bacterial Infection ◽  
Temperature Regime ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Unknown Origin ◽  
Chronic Pyelonephritis ◽  
Low Grade ◽  
Bacteriological Examination ◽  
Short Term ◽  
Pathological Conditions

Background. The study was aimed to establish the true etiological cause of such pathological conditions as prolonged low-grade fever, fever of unknown genesis, and cases of rapid short-term febrile increase of temperature of unknown origin. Materials and methods. The design of the study was clinical-diagnostic and included the search for ways to diagnose and treat such pathological conditions as prolonged subfebrile fever, fever of unknown genesis, and cases of rapid short-term febrile increase of temperature of unknown origin. The studies were prospective-retrospective and were longitudinal with long-term periodic follow-up of a certain part of the same patients during 1–10 years after diagnosis of CBIS (chronic bacterial intoxication syndrome) and appropriate treatment. According to the effectiveness of the obtained results, the study was direct, because it undoubtedly led to the recovery of the patient with the improvement of his/her state and life. All patients (infants and adults aged till 80 years) who went to the hospital during 2009–2020 with complaints about violation of the temperature regime (subfebrile or febrile increase). Results. During 2009–2020, 3999 patients (adults — 2047/3999, 51.2 %, children — 1952/3999, 48.8 %) with a fever of unknown origin, namely 1578/2047 (77.1 %) adults and 1206/1952 (61.8 %) children with prolonged subfebrile fever, 70/2047 (3.4 %) and 25/1952 (1.3 %), respectively — with febrile fever and 399/2047 (19.5 %) and 721/1952 (36.9 %) — with febrile attacks (FA), were observed by the authors. In all 3999 (100 %) patients, there was detected a focus of chronic bacterial infection in the kidneys. Herewith in more than 2/3 cases (2780/3999 patients, 69.5 %), there was diagnosed the locally asymptomatic nephrodysbacteriosis without clinical, general laboratory (inclu­ding almost normal general analysis of urine) and instrumental signs of the inflammatory process in the kidneys. In 960/3999 (24.0 %) ca­ses, there was first established the latent form of delayed clinically asymptomatic chronic pyelonephritis. 259/3999 (6.5 %) patients were diagnosed with chronic pyelonephritis at the stage of clinical exacerbation. As a consequence of the formation of a focus of chronic bacterial infection in the kidneys, the patients developed monosymptomatic (only with temperature increase) or full-symptom CBIS, namely: 2024/2784 (72.7 %) children and adults with prolonged subfebrile fever there presented with typical clinical manifestations of CBIS in various combinations, but in 760/2784 (27.3 %) cases, the subfebrile temperature was monosymptoma­tic without other complaints and clinical symptoms. The diagnosis was confirmed by bacteriological examination of warm urine (three times, for three days running) and toxicological blood examination using the diagnostic system Toxicon. Urine cultures of various bacteria were isolated from urine in all 3999 (100 %) patients. Herewith in 2205/3999 (55.1 %) cases, there were isolated one culture of bacteria in each case, in 1608/3999 (40.2 %) patients — simultaneously two cultures of different bacteria, i.e. another 3216 strains, in 186/3999 (4,7 %) — three cultures (558 strains). That is, in general, there were isolated 5979 strains of different bacteria, which were considered as diagnostic confirmation of the presence of a focus of chronic bacterial infection in the kidneys in all 3999 patients with prolonged subfebrile fever, fever of unknown genesis, or febrile attacks. The main factors of the occurrence of temperature regime disorders on the background of CBIS were Enterococci (2471/3999 strains from 61.8 % of patients), Escherichia coli — 1495/3999 strains (from 37.4 % of patients) and Staphylococci (Staphylococcus aureus and Staphylococcus haemolyticus) and Streptococci (Streptococcus pyogenes): a total of 696/3999 strains (from 17.4 % of patients). In 818 (100 %) patients who were examined using the Toxi­con system, all, without exception, the indicators of cytolytic activity of toxic proteomes, which were tested, significantly exceeded the norm (p < 0.001). In the vast majority of patients (in 664/818 or 81.17 % of cases), there was detected severe toxemia, in 140/818 (17.11 %) — moderate and only in 14 (1.71 %) — mild. All 3999 patients with prolonged subfebrile fever, fever of unknown genesis, and FA were treated with bacterial autovaccines made from strains, isolated during the bacteriological examination. One cycle consisted of 2–3 courses of immunization with bacterial vaccines. One course included 10 or 12 subcutaneous injections in increasing dosage during 19–21 days. Between courses, there was maintained an interval of 3 to 4 weeks. The treatment cycle generally lasted from 70 to 110 days, depending on the number of courses. Intervals between treatment cycles were usually maintained for 3 months. The effectiveness of such treatment was 71.2 % after the first cycle, 92.8 % — after the second, and 99.2 % — after the third with full recovery of the ability to work, lost during the illness, and the emotional level of personal life. Conclusions. It has been established that the etiological cause of the occurrence of prolonged subfebrile fever, febrile fevers of unknown genesis, and febrile attacks is such a clinically and nosologically separate disease as chronic bacterial intoxication syndrome, which develops on the background of a chronic bacterial focus, usually locally asymptomatic infection in the kidneys, called nephrodysbacteriosis, and is usually associated with severe bacterial endotoxicosis that was confirmed by appropriate toxicological examination of the blood. The use of bacterial autovaccines was proved to be an effective method of treatment (up to 99.2 %) of patients with increased temperature of bacterial-toxic origin.

scholarly journals Application Value of Contrast-Enhanced Ultrasound In The Diagnosis of Intermediate Trophoblastic Tumours

2022 ◽  
Author(s):  
XiaoDan Zhu ◽  
Yin Hu ◽  
LinYu Zhou ◽  
TianAn Jiang
Keyword(s):  
Clinical Symptoms ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Arterial Phase ◽  
Imaging Method ◽  
Low Grade ◽  
Ultrasound Images ◽  
Colour Doppler ◽  
Contrast Enhanced ◽  
Trophoblastic Tumours

Abstract Background: As the rarest gestational trophoblastic neoplasia (GTN), intermediate trophoblastic tumours (ITTs) are very difficult to diagnose before surgery due to the lack of specificity of clinical manifestations. Routine colour Doppler ultrasonography is currently the simplest and reproducible imaging method for diagnosing ITTs, but it is not as specific as other tumours. Through the research and analysis of colour Doppler ultrasound images (CDFI) and contrast-enhanced ultrasonography (CEUS) images of ITTs, the ultrasound characteristics and CEUS perfusion characteristics are summarized, and these findings can provide a reference for the correct diagnosis of ITTs.Methods: Seven ITT patients were diagnosed and treated in our institution from January 2016 to August 2020, and the clinical data of all patients were retrospectively collected and analysed. Two sonographers who had worked for more than 5 years analysed the characteristics of the ultrasound and CEUS. Among them, the characteristics of CEUS are summarized and analysed from the four aspects of contrast enhancement method, time, boundary, and intensity. All cases were diagnosed with pathological support by ITTs.Results: The most common clinical symptoms of ITT are vaginal bleeding and amenorrhea. The serum ß-human chorionic gonadotropin (serum-hCG) level was mainly a low-grade increase, but to determine whether the serum-hCG level can be used as one of the indicators for monitoring ITT recurrence or metastasis, a large sample data analysis is needed. The lesion location, internal echo changes, and blood flow signals of ITTs were not significantly specific compared with those of other GTNs. However, the CEUS performance of ITTs has certain characteristic changes, in which the enhancement mode was mainly regional enhancement, the arterial phase showed slow, equal-slightly high enhancement, and the enhanced bounders were not very clear. Compared with the CEUS performance of other GTNs, it has a certain specificity.Conclusions: Certain characteristic changes in CEUS of ITTs, combined with clinical features, can provide help for the accurate diagnosis of ITT.Trial registration: For non-clinical or non-health care intervention on human participants of what the article reports.

scholarly journals Does Low Grade Systemic Inflammation Have a Role in Chronic Pain?

2021 ◽  
Vol 14 ◽  
Author(s):  
Wen Bo Sam Zhou ◽  
JingWen Meng ◽  
Ji Zhang
Keyword(s):  
Chronic Pain ◽  
Acute Inflammation ◽  
Clinical Manifestations ◽  
Low Grade ◽  
Complex Interactions ◽  
Pathological Conditions ◽  
Psychological Comorbidities ◽  
Underlying Mechanisms ◽  
Harmful Effects

One of the major clinical manifestations of peripheral neuropathy, either resulting from trauma or diseases, is chronic pain. While it significantly impacts patients’ quality of life, the underlying mechanisms remain elusive, and treatment is not satisfactory. Systemic chronic inflammation (SCI) that we are referring to in this perspective is a state of low-grade, persistent, non-infective inflammation, being found in many physiological and pathological conditions. Distinct from acute inflammation, which is a protective process fighting against intruders, SCI might have harmful effects. It has been associated with many chronic non-communicable diseases. We hypothesize that SCI could be a predisposing and/or precipitating factor in the development of chronic pain, as well as associated comorbidities. We reviewed evidence from human clinical studies indicating the coexistence of SCI with various types of chronic pain. We also collated existing data about the sources of SCI and who could have it, showing that those individuals or patients having SCI usually have higher prevalence of chronic pain and psychological comorbidities. We thus elaborate on the need for further research in the connection between SCI and chronic pain. Several hypotheses have been proposed to explain these complex interactions.

Lhermitte-Duclos Disease in Pediatric Population: Report of 2 Cases

2021 ◽  
pp. 1-7
Author(s):  
Ivethe Pregúntegui-Loayza ◽  
Alejandro Apaza-Tintaya ◽  
Alberto Ramírez-Espinoza ◽  
Nancy Mayo-Simón ◽  
Mauro Toledo-Aguirre
Keyword(s):  
Posterior Fossa ◽  
Clinical Symptoms ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Granular Cell ◽  
Cowden Syndrome ◽  
Low Grade ◽  
Nccn Guidelines ◽  
Asymptomatic Children ◽  
Slow Growing

<b><i>Introduction:</i></b> Lhermitte-Duclos disease (LDD), also known as dysplastic cerebellar gangliocytoma, is an uncommon disorder in children, characterized by being a slow-growing lesion of the posterior fossa, which mainly affects the granular cell layer of the cerebellar parenchyma and may be associated with other multiple hereditary hamartomas and neoplasms. <b><i>Case Presentation:</i></b> We report 2 cases of LDD in pediatric patients and describe clinical symptoms and radiological and histopathological characteristics. In addition, we analyzed the relation to Cowden Syndrome based on the International Cowden Syndrome Consortium Operational Criteria and the most updated guidelines by the National Comprehensive Cancer Network (NCCN Guidelines Version 1.2020). <b><i>Conclusion:</i></b> LDD is a very rare disease in childhood but should be considered in the differential diagnosis of posterior fossa lesions. LDD can mimic low-grade glial tumors or infectious diseases. Patients develop late clinical manifestations due to the slow-growing pattern, and conservative treatment with outpatient follow-up may be an option in asymptomatic children.

A Food Illness Outbreak Caused by Salmonella muenster

1982 ◽  
Vol 45 (1) ◽  
pp. 23-25 ◽  
Author(s):  
NASSIM H. NABBUT ◽  
ELIE K. BARBOUR ◽  
HABEEB M. AL-NAKHLI ◽  
SULEIMAN I. ZAMEL
Keyword(s):  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Food Poisoning ◽  
The Other ◽  
Bacteriological Examination ◽  
Epidemiological Investigation ◽  
Large Numbers ◽  
Stool Specimens ◽  
Roast Beef ◽  
Salmonella Serotype

An outbreak of Salmonella food poisoning affected 12 persons attending a home dinner in Riyadh on January 10, 1980. The clinical manifestations were mild in 3 of the patients and severe in the other 9. The incubation period ranged between 14 and 32 h with an average of 18 h. The illness lasted 3–4 days. The clinical symptoms included diarrhea, abdominal colics, vomiting, fever (38–40 C), chills, headache, dizziness, inappetence and muscle and joint aches. Six of the patients required the care of a physician, but none of them required hospitalization. Epidemiological investigation of the outbreak revealed that the implicated food was roast beef. Nine persons who attended the same dinner, but did not eat roast beef, were not ill. The fresh roast beef, approximately 2 kg, was bought from a supermarket. It was cooked the night before the dinner, refrigerated for 24 h, warmed the next day and kept at ambient temperature in the kitchen for about 3 h before it was served. Bacteriological examination of the roast beef showed that Salmonella muenster was present in large numbers. Stool specimens of 11 of the patients were positive for S. muenster. Eight of them excreted the same Salmonella serotype up to 17 days after recovery from the illness; two other patients excreted this serotype up to 27 days after recovery.

scholarly journals Clinical picture in a child who often gets sick (a new look at the origin, diagnosis and treatment). Report 2. Diagnosis and treatment

2021 ◽  
Vol 9 (5-6) ◽  
pp. 6-20
Author(s):  
I.S. Markov ◽  
A.I. Markov
Keyword(s):  
Infectious Diseases ◽  
Clinical Picture ◽  
Inflammatory Diseases ◽  
Clinical Manifestations ◽  
Diagnosis And Treatment ◽  
Enzyme Linked Immunosorbent Assay ◽  
Low Grade ◽  
Bacteriological Examination ◽  
Selective Iga Deficiency ◽  
Group I

Objective: to determine the clinical picture in children who often get sick, taking into account the currently available data from the medical literature and authors’ observations accumulated over the past 25 years of clinical practice. Materials and methods. The design of the study was clinical and diagnostic and included the search for ways to diagnose and treat pathological conditions that compose the current clinical picture of children who often get sick. The studies were prospective and retrospective, longitudinal, with long-term follow-up of a certain part of the same patients for 1–10 years after diagnosis of “frequently ill child” and appropriate treatment. In terms of the effectiveness of the results, the researches were direct, because it undoubtedly contributed to the recovery of the child with the improvement/normalization of his general state and quality of life. The studies were multicenter, conducted in an outpatient setting at the premises of two clinics specialized in the field of chronic infectious diseases, with full laboratory researches and the department of pediatric infectious diseases of the medical university. The participants were children from infancy to 14 years of age, whose parents in 2009–2020 consulted with complaints about frequent illnesses of their children. Results. In 2010–2020, the authors supervised 3,547 children, who often get sick (6–12 episodes a year and even more: 1–2 diseases a month), and the period of each episode of their illness lasted more than 5–7 days. There were 862/3,547 (24.3 %) children under 3 years of age, 1,295/3,547 (36.5 %) from 3 to 7 years of age, and 1,390/3,547 (39.2 %) from 7 to 14 years of age. Given the clinically dominant symptoms, which are often intertwined into one holistic picture of these common diseases, children were divided into two large groups of observations. Group I, which was conventionally called “Clinical picture of frequently ill children with purulent-inflammatory diseases”, included 1,595/3,547 patients (45 %). Another 1,952/3,547 (55 %) individuals were included in group II with a conditional name “Clinical picture of frequently ill children with dominant toxic manifestations”. The second group of patients who often get sick also includes patients with fever not associated with acute purulent-inflammatory conditions or their recurrences. This group under supervision consisted of 1,952/3,547 (55 %) children — from infancy to 14 years with thermoregulatory disorders, including persistent low-grade fever — 1,206/1,952 (61.8 %), febrile seizures — 721/1952 (36.9 %) and 25/1,952 (1.3 %) children of mostly school age with fever at the level of 38–40 ºC and above for several months to 4 years and other symptoms of chronic bacterial intoxication syndrome. All children were examined bacteriologically (nasopharyngeal, oral swab culture, etc., as well as warm urine tests three times, three days in a row), toxicologically using Toxicon diagnostic system; they also underwent general clinical exa­minations, enzyme-linked immunosorbent assay and polymerase chain reaction, determination of immunological status, according to indicators — instrumental examination. Two foci of chronic bacterial infection were found to be present in all frequently ill children: in the nasopharynx, which in 3,467/3,547, or 97.7 % of cases, was associated with S.aureus, and in the kidneys (nephrodysbacteriosis), which was dominated by enterococci and Escherichia coli accounted for almost 2/3 (3,312/5,313, or 63 %) of all isolated urinary strains and detected in the urine of a total of 3,312/3,547 (93.4 %) children. Based on toxicological examination of the blood, severe toxemia was found in the vast majority of children (77/96, or 80.2 %), 16/96 (16.7 %) had moderate and only 3/96 (3.1 %) — mild form. The form of intoxication was mainly compensated in 87/96 (90.6 %) patients, another 9/96 (9.4 %) had generalization stage. When determining the immune status studied in 2,160/3,547 (60.1 %) of frequently ill children from infancy to 14 years of age in both observation groups, it was found that cellular and humoral immunity was usually either within normal limits or often even higher than normal. Only in 67/2,160 (3.1 %) cases, mild cellular immunodeficiency was detected, and in 7/2,160 (0.3 %) children — selective IgA deficiency. Treatment of all 3,547 frequently ill children of both observation groups was performed using bacterial autovaccines made from strains isolated during bacteriological examination. The number of children who underwent treatment the consequences of which can be considered established and not associated with concomitant use of antibacterial drugs was 3,159/3,547, or 89.1 %. In total, 3,093/3159, or 97.9 % of frequently ill children, recovered completely within 6–24 months after starting antibiotic-free bacterial autovaccine treatment. Conclusions. The clinical picture of a child who often gets sick is currently collective and consists of symptoms of recurrent respiratory diseases or recurrent acute respiratory viral infections, recurrent purulent-inflammatory diseases of the nose, pharynx, mouth, ears, eyes and bronchopulmonary system, as well as clinical manifestations of chronic bacterial intoxication syndrome developed on the background of nephrodysbacteriosis. The etiological and pathogenetic diagnosis is confirmed by the results of bacteriological and toxicological examinations. Standard treatment of frequently ill children using antibiotics is not effective. A positive clinical effect can be achieved in 97.9 % of children with complete recovery after the use of bacterial autovaccines made from strains isolated during bacteriological examination.

scholarly journals Clinical picture in a child who often gets sick (a new look at the origin, diagnosis and treatment). Report 1. Origin and clinical picture

2021 ◽  
Vol 9 (4) ◽  
pp. 23-38
Author(s):  
I.S. Markov ◽  
A.I. Markov
Keyword(s):  
Infectious Diseases ◽  
Clinical Picture ◽  
Inflammatory Diseases ◽  
Clinical Manifestations ◽  
Diagnostic System ◽  
Enzyme Linked Immunosorbent Assay ◽  
Low Grade ◽  
Bacteriological Examination ◽  
Selective Iga Deficiency ◽  
Group I

Objective: to determine the clinical picture in children who often get sick, taking into account the currently available data from the medical literature and authors’ observations accumulated over the past 25 years of clinical practice. Materials and methods. The design of the study was clinical and diagnostic and included the search for ways to diagnose and treat pathological conditions that compose the current clinical picture of children who often get sick. The studies were prospective and retrospective, longitudinal, with long-term follow-up of a certain part of the same patients for 1–10 years after diagnosis of “frequently ill child” and appropriate treatment. In terms of the effectiveness of the results, the resear­ches were direct, because it undoubtedly contributed to the reco­very of the child with the improvement/normalization of his general state and quality of life. The studies were multicenter, conducted in an outpatient setting at the premises of two clinics specialized in the field of chronic infectious diseases, with full laboratory researches and the department of pediatric infectious diseases of the medical university. The participants were children from infancy to 14 years of age, whose parents in 2009–2020 consulted with complaints about frequent illnesses of their children. Results. In 2010–2020, the authors supervised 3,547 children, who often get sick (6–12 epi­sodes a year and even more: 1–2 disea­ses a month), and the period of each episode of their illness lasted more than 5–7 days. There were 862/3,547 (24.3 %) children under 3 years of age, 1,295/3,547 (36.5 %) from 3 to 7 years of age, and 1,390/3,547 (39.2 %) from 7 to 14 years of age. Given the clinically dominant symptoms, which are often intertwined into one holistic picture of these common diseases, children were divided into two large groups of observations. Group I, which was conventionally called “Clinical picture of frequently ill children with purulent-inflammatory diseases”, included 1,595/3,547 patients (45 %). Another 1,952/3,547 (55 %) individuals were included in group II with a conditional name “Clinical picture of frequently ill children with dominant toxic manifestations”. The second group of patients who often get sick also includes patients with fever not associated with acute purulent-inflammatory conditions or their recurren­ces. This group under supervision consisted of 1,952/3,547 (55 %) children — from infancy to 14 years with thermoregulatory disorders, including persistent low-grade fever — 1,206/1,952 (61.8 %), febrile seizures — 721/1952 (36.9 %) and 25/1,952 (1.3 %) children of mostly school age with fever at the level of 38–40 °C and above for several months to 4 years and other symptoms of chronic bacterial intoxication syndrome. All children were examined bacteriologically (nasopharyngeal, oral swab culture, etc., as well as warm urine tests three times, three days in a row), toxicologically using Toxicon diagnostic system; they also underwent gene­ral clinical examinations, enzyme-linked immunosorbent assay and polymerase chain reaction, determination of immunological status, according to indicators — instrumental examination. Two foci of chronic bacterial infection were found to be present in all frequently ill children: in the nasopharynx, which in 3,467/3,547, or 97.7 % of cases, was associated with S.aureus, and in the kidneys (nephrodysbacteriosis), which was dominated by enterococci and Escherichia coli accounted for almost 2/3 (3,312/5,313, or 63 %) of all isolated urinary strains and detected in the urine of a total of 3,312/3,547 (93.4 %) children. Based on toxicological examination of the blood, severe toxemia was found in the vast majority of children (77/96, or 80.2 %), 16/96 (16.7 %) had moderate and only 3/96 (3.1 %) — mild form. The form of intoxication was mainly compensated in 87/96 (90.6 %) patients, another 9/96 (9.4 %) had generalization stage. When determining the immune status studied in 2,160/3,547 (60.1 %) of frequently ill children from infancy to 14 years of age in both observation groups, it was found that cellular and humoral immunity was usually either within normal limits or often even higher than normal. Only in 67/2,160 (3.1 %) cases, mild cellular immunodeficiency was detected, and in 7/2,160 (0.3 %) children — selective IgA deficiency. Treatment of all 3,547 frequently ill children of both observation groups was performed using bacterial autovaccines made from strains isolated during bacteriological examination. The number of children who underwent treatment the consequences of which can be considered established and not associated with concomitant use of antibacterial drugs was 3,159/3,547, or 89.1 %. In total, 3,093/3159, or 97.9 % of frequently ill children, recovered completely within 6–24 months after starting antibiotic-free bacterial autovaccine treatment. Conclusions. The clinical picture of a child who often gets sick is currently collective and consists of symptoms of recurrent respiratory diseases or recurrent acute respiratory viral infections, recurrent purulent-inflammatory diseases of the nose, pharynx, mouth, ears, eyes and bronchopulmonary system, as well as clinical manifestations of chronic bacterial intoxication syndrome developed on the background of nephrodysbacteriosis. The etiological and pathogenetic diagnosis is confirmed by the results of bacteriological and toxicological examinations. Standard treatment of frequently ill children using antibiotics is not effective. A positive clinical effect can be achieved in 97.9 % of children with complete recovery after the use of bacterial autovaccines made from strains isolated during bacteriological examination.

Parkinson’s puzzle

2012 ◽  
Vol 153 (52) ◽  
pp. 2060-2069 ◽  
Author(s):  
András Guseo
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Symptoms ◽  
Critical Factor ◽  
Unknown Origin ◽  
Symptomatic Improvement ◽  
Blue Green Algae ◽  
Clinical Observations ◽  
Degenerative Disorders ◽  
Local Cell

Parkinson’s disease is one of the most frequent progressive degenerative disorders with unknown origin of the nervous system. The commutation of the disease on Guam led to the discovery of a neurotoxin which was also found in other continents. This neurotoxin was identified in the common cyanobacteria (blue-green algae). Early clinical observations suggested some loose correlations with gastric and duodenal ulcer and Parkinson’s disease, while recent studies revealed a toxin, almost identical to that found in cyanobacteria in one strain of Helicobacter pylori, which proved to cause Parkinson like symptoms in animals. Therefore, it cannot be ruled out that there is a slowly progressive poisoning in Parkinson’s disease. The disease specific alpha-sinuclein inclusions can be found in nerve cells of the intestinal mucosa far before the appearance of clinical symptoms indicating that the disease may start in the intestines. These results are strengthened by the results of Borody’s fecal transplants, after which in Parkinson patients showed a symptomatic improvement. Based on these observations the Parkinson puzzle is getting complete. Although these observations are not evidence based, they may indicate a new way for basic clinical research, as well as a new way of thinking for clinicians. These new observations in psycho-neuro-immunology strengthen the fact that immunological factors may also play a critical factor facilitating local cell necrosis which may be influenced easily. Orv. Hetil., 2012, 153, 2060–2069.

Etiology and clinical features of epididymo-orchitis: A single-center study in Tehran, Iran

2020 ◽  
Vol 20 ◽  
Author(s):  
Sara Abolghasemi ◽  
Mohammad Alizadeh ◽  
Ali Hashemi ◽  
Shabnam Tehrani
Keyword(s):  
Chlamydia Trachomatis ◽  
Clinical Symptoms ◽  
Urine Culture ◽  
Clinical Manifestations ◽  
Urinary Frequency ◽  
Serological Tests ◽  
Duration Of Symptoms ◽  
Two Samples ◽  
History Of ◽  
Tract Infections

Introduction: Epididymo-orchitis is a common urological disease among men. Little is known about the clinical and epidemiological aspects of the disease in Iran. Thus, the present study was aimed to investigate the etiology, clinical sequelae and risk factors of patients with epididymo-orchitis in Tehran, Iran. Materials and Methods: Patients presenting with epididymo-orchitis were prospectively analyzed in order to study the etiology and pattern of the disease. Bacteriological, molecular and serological tests were undertaken to look for Chlamydia trachomatis, Neisseria gonorrhoeae, Brucella spp., Mycoplasma spp, and other bacteria. Results: Fifty patients with epididymo-orchitis were evaluated according to their clinical symptoms, duration of symptoms, physical examination, and laboratory studies. The mean age of the patients was 53 years. Fever, dysuria, pain in the flanks, urinary frequency and discharges occurred in 58.0%, 50.0%, 50.0%, 28.0% and 6.0%, respectively. Bacterial pathogen was identified in 26% (13/50) of patients by urine culture. Escherichia coli was the etiological agent in 11/13 patients (84.6%). Two out of 50 patients (4.0%) were also positive for Chlamydia trachomatis. Two samples were serologically positive for Brucella spp. High Mean age, fever, urinary frequency, history of the underlying disease and history of urinary tract infections were found to have a significant association with the positive bacteriologic urine culture (P<0.05). Conclusions: The most common clinical manifestations were fever, dysuria, and abdominal pain. E. coli and C. trachomatis were the major causative agents. Use of a set of diagnostic approaches including clinical symptoms, urine culture and more precise techniques such as PCR should be taken into consideration for the definitive diagnosis.

Scrub typhus (Orientia tsutsugamushi), A rapidly spreading epidemic in Chennai - A standalone lab experience

2016 ◽  
Vol 5 (09) ◽  
pp. 4896
Author(s):  
Sripriya C.S.* ◽  
Shanthi B. ◽  
Arockia Doss S. ◽  
Antonie Raj I. ◽  
Mohana Priya
Keyword(s):  
Scrub Typhus ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Febrile Illness ◽  
Orientia Tsutsugamushi ◽  
The Past ◽  
Igm Elisa ◽  
The Mean ◽  
Specific Symptoms ◽  
Symptoms And Signs

Scrub typhus (Orientia tsutsugamushi), is a strict intracellular bacterium which is reported to be a recent threat to parts of southern India. There is re-emergence of scrub typhus during the past few years in Chennai. Scrub typhus is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure to fatal disease. This study documents our laboratory experience in diagnosis of scrub typhus in patients with fever and suspected clinical symptoms of scrub typhus infection for a period of two years from April 2014 to April 2016 using immunochromatography and IgM ELISA methods. The study was conducted on 648 patients out of whom 188 patients were found to be positive for scrub typhus. Results also showed that pediatric (0 -12 years) and young adults (20 – 39 years) were more exposed to scrub typhus infection and female patients were more infected compared to male. The study also showed that the rate of infection was higher between September to February which also suggested that the infection rate is proportional to the climatic condition. Statistical analysis showed that the mean age of the patients in this study was 37.6, standard deviation was 18.97, CV % was 50.45. 

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