scholarly journals Atypical Kawasaki disease in an early infant, a diagnostic challenge: Case report

2021 ◽  
Vol 8 (11) ◽  
pp. 394-396
Author(s):  
Kaifi Siddiqui ◽  
Ayub Ansari ◽  
Ishaq Farooq ◽  
Sheeba Farooqui

A 4.5-month-old girl presented to us with continuous fever for 10 days and loose stools for 2 days. She received short courses of multiple oral antibiotics during this period however, was not relieved. Initial investigations were suggestive of urinary tract infection for which broad spectrum antibiotics were started. However, fever persisted even after 72 h of antibiotics. Blood counts showed persistently high total leukocyte count and increasing platelet count, along with high C-reactive protein. Consequently, a diagnosis of Kawasaki disease (KD) was suspected, which was supported by echocardiographic findings. After she received intravenous immunoglobulins, her fever subsided and lab parameters showed significant improvement. This case highlights an unusual presentation of KD in an uncommonly young age group without much clinical pointers except for persistent fever.

2021 ◽  
Vol 8 (28) ◽  
pp. 2526-2531
Author(s):  
Rabindra Bhunia ◽  
Bindu T. Nair ◽  
Vandana Negi

BACKGROUND Bacteraemia is a common cause of children presenting to the paediatric emergency with acute febrile illness. Blood cultures remain the gold standard for detection of bacteraemia but the positivity is low and also takes time to show positive results. A rapid and reliable biomarker like procalcitonin (PCT), C-reactive protein (CRP), total leucocyte count (TLC), and neutrophil-lymphocyte count ratio (NLCR) can be used to identify febrile children with greater risk for bacteraemia or serious bacterial infections. This would be very helpful to start early treatment of bacteraemia with antibiotics. METHODS The study was an observational cohort study conducted in the Department of Paediatrics of a tertiary care hospital in North India in children between age group 6 months to 12 years presenting with fever of > 100.4° F for 2 - 7 days. Blood samples were sent for PCT, CRP, TLC, NLCR and blood cultures. RESULTS The most sensitive biomarker was total leukocyte count (47.36 %) followed by the neutrophil percentage (26.32 %), C-reactive protein (21.05 %), and procalcitonin (15.79 %). The most specific biomarker was procalcitonin (75.14 %) followed by C-reactive protein (58.56 %), neutrophil percentage (22.65 %) and total leukocyte count (11.05 %). The only biomarker that was statistically significant between the bacteraemia and non-bacteraemia group in the present study was total leukocyte count (P – value < 0.05). CONCLUSIONS The sensitivity and specificity of each single biomarker is low and hence these cannot be used singly to predict bacteraemia. There should be a combination of biomarkers with adequate sensitivity and specificity that can be used to create an algorithm to aid in diagnosis and prognostication. KEYWORDS Procalcitonin, C-Reactive Protein, Blood Culture, Acute Febrile Patient


2019 ◽  
Vol 35 (3) ◽  
Author(s):  
Sobia Niaz ◽  
Javaria Latif ◽  
Shaista Hussain

Background & Objectives: Inflammation is considered as the main triggering factor in evolution of atherosclerotic pathology of heart and blood vessels. Resistin, an inflammatory cytokine is proved to be a main mediator of initiation and progression of mechanisms leading to atherosclerosis, hypertension and ultimately to coronary artery disease. Our objective was to compare the levels of serum resistin, C-reactive protein and total leucocyte count in subjects of hypertension and coronary artery disease; and to observe the correlation of serum resistin with CRP and TLC in the study participants. Methods: Eighty selected participants were divided into four equal groups including normal healthy participants, newly diagnosed cases of hypertension, stable angina pectoris and myocardial infarction, both with hypertension. The study was conducted in the physiology department of Post Graduate Medical Institute Lahore, during 2013. After consent, history and examination, fasting blood samples of the participants were collected. Serum resistin and C-reactive protein were determined by using standard techniques of enzyme linked immunosorbent assay, while total leukocyte count by automated hematology analyzer. Results: The values of serum resistin, C- reactive protein and total leukocyte count were found significantly raised in patients of hypertension, angina pectoris and myocardial infarction with hypertension as compared to normal participants (p<0.001 for all). Significantly positive correlation of resistin was observed with TLC only in hypertensive patients of myocardial infarction (r = 0.459, n = 20, p = 0.042) while in other study groups correlation between resistin and TLC as well as CRP was non-significant. Conclusion: Serum resistin levels along with CRP and TLC are significantly raised in patients of hypertension and coronary artery disease while resistin levels revealed significantly positive correlation with TLC in hypertensive patients of myocardial infarction. doi: https://doi.org/10.12669/pjms.35.3.274 How to cite this:Niaz S, Latif J, Hussain S. Serum resistin: A possible link between inflammation, hypertension and coronary artery disease. Pak J Med Sci. 2019;35(3):---------. doi: https://doi.org/10.12669/pjms.35.3.274 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


2021 ◽  
Vol 3 (1) ◽  
pp. 46-60
Author(s):  
Desman Situmorang ◽  
Permata P Karina

Kawasaki Disease is a spectrum of idiopathic, self-limited fever disease affecting childrenunder 5 years old. This disorder can be challenging to be diagnosed by a pediatrician since thereis no specific diagnostic laboratory test. One atypical Kawasaki Disease case presented withgastrointestinal symptoms, a two-year-old girl was hospitalized with fever, accompanied by non-hemorrhagic diarrhea three days before admission. Physical examination revealed unilateralcervical lymph enlargement and mild-moderate dehydration. Initial laboratory examinationresult showed thrombocytosis, leukocytosis (shift to the left), and normal routine fecal analysis.The patient was initially diagnosed with acute diarrhea with mild-moderate dehydration. She wastreated with a rehydration regimen and antibiotic, but her fever persisted. On the third day ofhospitalization, she fulfilled 3 of the classic Kawasaki Disease criteria (conjunctivitis, crackedlips with strawberry tongue, and lymphadenopathy). Further blood work resulted in increased C-reactive protein 43.35 mg/L and ESR 72 mm/hour, while chest X-ray and electrocardiographwere within normal limit. This patient was proceed to Hasan Sadikin General Hospital for furtherexamination and therapy. Atypical Kawasaki Disease can be a puzzling diagnosis due to itsuncommon presentations. Clinicians should importantly keep it in mind as a differential diagnosisin patients with prolonged fever. Keywords: atypical Kawasaki disease; diarrhea; prolonged fever


Nowa Medycyna ◽  
2019 ◽  
Vol 26 (1) ◽  
Author(s):  
Michał Nycz ◽  
Jakub Kropieniewicz ◽  
Kamil Suliga ◽  
Tomasz Zawadzki ◽  
Mieszko Norbert Opiłka ◽  
...  

Introduction. Colorectal cancer is the third most common cancer worldwide. The introduction of novel diagnostic and treatment methods has resulted in decreasing mortality rates; however, an increase in morbidity is observed. Severe inflammation plays an important role in many aspects associated with carcinogenesis. Neoplasia and inflammatory response are mutually related. Aim. The aim of the study was to evaluate the association between preoperative serum C-reactive protein levels and total leukocyte count in colorectal cancer patients in comparison with postoperative histopathological findings depending on whether there was neoplastic infiltration of the local adipose tissue or not. Material and methods. The study population included 50 patients with colon cancer. Exclusion criteria were distant metastases, neoadjuvant therapy and a past history of cancer diagnosis. Blood findings were compared with histopathology. Patients were divided into two groups – with and without neoplastic infiltration of fat tissue in histopathology. Results. Serum C-reactive protein levels were evaluated in all patients. The tested indicator was higher in the group with infiltration, but was not statistically significant. Additionally, the WBC count was normal in both groups, but it was lower in the group with infiltration, and the result was statistically significant. Conclusions. C-reactive protein level and total leukocyte count can be a helpful and supportive marker in staging in colorectal cancer patients. Owing to the wide availability and low cost of the above mentioned blood tests, they may be easily performed in daily medical practice. The decrease in the total leukocyte count was proportional with higher cancer stage; therefore, it needs to be further investigated.


Author(s):  
Shristi Kafle ◽  
Erika Shrestha ◽  
Sanjay Yadav

Introduction: Periodontal health is crucial and indispensable element of general health. Epidemiologically, it has been linked with cardiovascular diseases with elevated acute phase reactant C-reactive protein, fibrinogen and rheological variables such as total leukocyte count and differential leukocyte counts, which are potential predictors of cardiovascular diseases. Objective: To evaluate and compare cardiovascular disease-related biochemical markers in periodontally healthy subjects, and patients with moderate and severe chronic periodontitis. Methods: An analytical cross-sectional study was conducted in patients attending Department of Periodontology and Oral Implantology, Chitwan Medical College and Teaching hospital, Bharatpur, Chitwan, Nepal from September 2019 to January 2021. A total of 81 individuals of both gender of which 27 periodontally healthy individuals, 27 diagnosed with moderate and 27 diagnosed with severe periodontitis based on gingival index, probing pocket depth and clinical attachment level were enrolled in a study. After which, peripheral blood samples were drawn and serum C-reactive protein, plasma fibrinogen, total leukocyte count and differential leukocyte counts were quantified using the turbidimetric immunoassay. Convenience sampling technique was done. Data was analysed in SPSS v.26.0. Results: The mean serum levels of C-reactive protein, plasma fibrinogen, total leukocyte and differential leukocytes were found to be statistically (P value <0.001) higher in severe and moderate periodontitis subjects compared to periodontally healthy subjects. Conclusion: The increased levels of serum C-reactive protein, plasma fibrinogen, total leukocyte count, and differential leukocyte counts in chronic periodontitis contribute to the inflammatory burden of the individual potentially striking toward an increasing risk for cardiovascular events.  


2021 ◽  
Vol 9 (2) ◽  
pp. 20-24
Author(s):  
Sivakumar Beena ◽  
Shaji Thomas ◽  
Darpan Bhargava ◽  
Suyash Dubey

Purpose: The aim of this study was to evaluate the role of C-reactive protein (CRP), Total Leukocyte Count(TLC) and Erythrocyte Sedimentation Rate (ESR) levels as diagnostic and prognostic indicators in patientsdiagnosed with maxillofacial odontogenic infections.Materials and Methods: A prospective study was done among 30 patients with maxillofacial odontogenicinfections. Blood samples were collected at 3 intervals to detect the level of the study parameters followedby incision and drainage for all the patients under Local anesthesia.Results: The mean CRP, TLC and ESR levels gradually reduced on 5th post-operative day as compared today 1 and 3 suggestive of resolution of the infectious state.Conclusion: We conclude that CRP is required only in selective cases of maxillofacial infection wheremonitoring under intensive care will be required, else TLC alone is sufficient to indicate the presence ofinfection along with adequate medical and surgical care.


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