scholarly journals CLINICOPATHOLOGICAL PROFILE OF SALMONELLA TYPHI AND PARATYPHI INFECTIONS PRESENTING AS FEVER OF UNKNOWN ORIGIN IN A TROPICAL COUNTRY.

2015 ◽  
Vol 7 ◽  
pp. e2015021
Author(s):  
Nayyar Iqbal ◽  
Aneesh Basheer ◽  
Sudhagar Mookkappan ◽  
Anita Ramdas ◽  
Renu G'Boy Varghese ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Enteric Fever ◽  
Fever Of Unknown Origin ◽  
Clinical Laboratory ◽  
Febrile Illness ◽  
Unknown Origin ◽  
Salmonella Typhi ◽  
Common Symptom ◽  
Tropical Country ◽  
The Tropics

Background: Enteric fever, a common infection in the tropics and endemic to India, often manifests as an acute febrile illness. However, presentation as fever of unknown origin (FUO) is not uncommon in tropical countries. Methods: We aim to describe the clinical, laboratory and pathological features of cases hospitalized with fever of unknown origin and diagnosed as enteric fever. All culture proven cases of enteric fever were analyzed retrospectively over a period of three years from January 2011 to December 2013.Results: Seven of 88(8%) cases with enteric fever presented as FUO. Abdominal pain was the most common symptom besides fever. Relative bradycardia and splenomegaly were uncommon. Thrombocytopenia was the most common haematological abnormality, while leucopenia was rare. Transaminase elevation was almost universal. S.Typhi and S.Paratyphi were isolated from six cases and one case respectively.  Yield of organisms from blood culture was superior to that of bone marrow aspirate. Multiple granulomas were identified in 4 out of 6 (67%) of the bone marrows studied, including that due to S. Paratyphi and histiocytic hemophagocytosis was noted in two cases.Conclusion: FUO is a relatively common manifestation of enteric fever in the tropics. Clinical and laboratory features may be atypical in such cases, including absence of relative bradycardia, leucopenia and presence of thrombocytopenia, bicytopenia or pancytopenia.  Moreover, in endemic countries, enteric fever should be considered as a differential diagnosis, next to tuberculosis, in the evaluation of bone marrow granulomas in cases with FUO and culture correlation should be mandatory.

scholarly journals A Case Report on Fever of Unknown Origin in a School Going Child– An Uncommon Answer in a Common Question

2018 ◽  
Vol 17 (2) ◽  
pp. 58-63
Author(s):  
Dhan Bahadur Shrestha ◽  
Suju Mool ◽  
Sijan Karki
Keyword(s):  
Escherichia Coli ◽  
Bone Marrow ◽  
Case Report ◽  
Patient Care ◽  
Enteric Fever ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Bone Marrow Culture ◽  
Febrile Condition ◽  
Inpatient Department

Fever is one of the commonest complaints in paediatrics outpatient as well as inpatient department. Fever of unknown origin (FUO) is a diagnosis of exclusion given to the febrile condition lasting more than three weeks with temperature 38.30C or more with unknown cause despite of one week in patient care. Here we present a case of FUO in a child which was investigated thoroughly and managed on the line of enteric fever. However, the patient remained febrile. Hence, further investigations were undertaken and finally, bone marrow culture grew a very uncommon organism- Escherichia coli. The child was treated as per the sensitivity and responded well to treatment and was discharged after improvement. Here, we would like to present this case of FUO to highlight the possibility of bone marrow invasion by an uncommon organism as a source of fever in children.

scholarly journals Questing one Brazilian query: reporting 16 cases of Q fever from Minas Gerais, Brazil

2006 ◽  
Vol 48 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Paulo Sérgio Gonçalves da Costa ◽  
Marco Emilio Brigatte ◽  
Dirceu Bartolomeu Greco
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Fever Of Unknown Origin ◽  
Q Fever ◽  
Acute Infection ◽  
Case Series ◽  
Febrile Illness ◽  
Unknown Origin ◽  
Clinical Form ◽  
Chronic Q Fever

Q fever has been considered non-existing in Brazil where reports of clinical cases still cannot be found. This case-series of 16 patients is a result of a systematic search for such illness by means of clinical and serologic criteria. Serologic testing was performed by the indirect microimmunofluorescence technique using phase I/II C. burnetii antigens. Influenza-like syndrome was the most frequent clinical form (eight cases - 50%), followed by pneumonia, FUO (fever of unknown origin), mono-like syndrome (two cases - 12.5% each), lymphadenitis (one case - 6.3%) and spondylodiscitis associated with osteomyelitis (one case - 6.3%). The ages varied from four to 67 years old with a median of 43.5. All but one patient had positive serologic tests for phase II IgG whether or not associated with IgM positivity compatible with acute infection. One patient had both phase I and phase II IgG antibodies compatible with chronic Q fever. Seroconvertion was detected in 10 patients. Despite the known limitations of serologic diagnosis, the cases here reported should encourage Brazilian doctors to include Q fever as an indigenous cause of febrile illness.

Utility of bone marrow examination for workup of fever of unknown origin in patients with HIV/AIDS

2015 ◽  
Vol 68 (3) ◽  
pp. 241-245 ◽  
Author(s):  
Andrés E Quesada ◽  
Ashok Tholpady ◽  
Audrey Wanger ◽  
Andy N D Nguyen ◽  
Lei Chen
Keyword(s):  
Bone Marrow ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Bone Marrow Examination ◽  
Hiv Aids

scholarly journals Enteric fever with severe pancytopenia in a four year girl

2010 ◽  
Vol 50 (180) ◽  
Author(s):  
R Pathak ◽  
A Sharma ◽  
A Khanal
Keyword(s):  
Bone Marrow ◽  
Enteric Fever ◽  
Hemophagocytic Syndrome ◽  
Systemic Infection ◽  
Salmonella Typhi ◽  
Bone Marrow Suppression ◽  
Major Health Problem ◽  
Major Health ◽  
Severe Pancytopenia ◽  
Paratyphoid Fever

Typhoid fever and paratyphoid fever (also known as enteric fever) are severe systemic illnesses caused by salmonella typhi and S. paratyphi respectively. Enteric fever is prevalent in developing countries including Nepal, where it still remains as a major health problem. There have been reports of pancytopenia with enteric fever which has been attributed to mechanisms like bone marrow suppression, infection associated hemophagocytic syndrome and disseminated intravascular coagulation. We report here a case of severe pancytopenia in enteric fever as a result of bone marrow suppression due to systemic infection. Keywords: enteric fever, pancytopenia, bone marrow suppression

The Certainty of a Post-Bone Marrow Diagnosis: A Study of the Yield of Bone Marrow Biopsies in a Community Hospital Setting

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 34-35
Author(s):  
Manasi M. Godbole ◽  
Peter A. Kouides
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Fever Of Unknown Origin ◽  
Conflicts Of Interest ◽  
Diagnostic Yield ◽  
Hospital Setting ◽  
Unknown Origin ◽  
Nutritional Deficiencies ◽  
Bone Marrow Biopsies

Introduction: Most studies on the diagnostic yield of bone marrow biopsy including the one by Hot et al. have focused on the yield of bone marrow biopsies in diagnosing the source of fever of unknown origin. However, there have not been any studies performed to our knowledge looking at overall practice patterns and yield of bone marrow biopsies for diagnoses other than fever of unknown origin. We aim to determine the most common indications for performing bone marrow biopsies in a community-based teaching hospital as well as the yield of the biopsies in patients with specified and unspecified pre-test indications to estimate the rate of uncertain post-test diagnoses. Methods: We performed a retrospective data collection study at Rochester General Hospital, NY. A comprehensive search was conducted in our electronic medical data to identify all patients who underwent bone marrow biopsies over a 5 year period from January 2011 - December 2016 for indications other than fever of unknown origin. Patient data including demographics, pre-bone marrow biopsy diagnosis and post-bone marrow diagnosis was obtained. All patients above the age of 18 who underwent bone marrow biopsy for indications other than fever of unknown origin or follow up treatment of a hematological malignancy were included. Results: A total of 223 biopsies were performed. The median age was 59 years (age range- 23-95). One hundred and sixteen patients were male and 107 were female. The most common indications for performing bone marrow biopsy were evaluation of the following possible conditions: multiple myeloma (n=54), myelodysplastic syndrome [MDS] (n=47), lymphoma (n=28) and leukemia (n=18) as well as non-specific indications such as pancytopenia (n=40), anemia (n=22) and thrombocytopenia (n=11). The proportion of cases confirmed by bone marrow biopsy was 45/54 (83%) with the pre-marrow diagnosis of multiple myeloma, 34/47 cases (72%) with the pre-marrow diagnosis of MDS, 15/18 (83%) with the pre-marrow diagnosis of leukemia and 13/28 (46%) in those with the pre-marrow diagnosis of rule out lymphoma. Thirteen cases (18%) with possible MDS had post-bone marrow diagnoses of leukemia, anemia of chronic disease, myelofibrosis or medication-related changes. Five out of twenty two cases (23%) for anemia and 3/11 cases (27%) for thrombocytopenia without otherwise specified pre-bone marrow etiology had uncertain diagnosis after bone marrow biopsy. Conclusion: In about a fifth of patients necessitating a bone marrow, the diagnosis is discordant and can be surprising. It is also worth reporting that in these discordant results, non-hematological causes such as medications, anemia due to chronic diseases or conditions such as cirrhosis or splenomegaly from other etiologies were among the final diagnoses. Interestingly, 20% of the patients with unspecified pre-bone marrow diagnoses such as anemia or thrombocytopenia in our study had an unclear post-bone marrow diagnosis despite undergoing bone marrow biopsy. Our findings are a reminder that the bone marrow exam does not always lead to a definitive diagnosis and the need by exclusion to include in the differential non-hematological etiologies such as nutritional deficiencies, chronic kidney disease or autoimmune disorders. Disclosures No relevant conflicts of interest to declare.

scholarly journals Localized lymphadenopathy with myelodysplastic syndrome associated with tuberculosis

2019 ◽  
Vol 11 (4) ◽  
Author(s):  
Aya Nakaya ◽  
Kazuyoshi Ishii ◽  
Toshiki Shimizu ◽  
Takeshi Tamaki ◽  
Yoshihisa Ishiura ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Myelodysplastic Syndrome ◽  
Valve Replacement ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Replacement Surgery ◽  
Laboratory Examinations ◽  
Valve Replacement Surgery

We report the case of a man who developed myelodysplastic syndrome (MDS) and refractory cytopenia of unilineage dysplasia, 5 months after aortic valve replacement surgery. He also developed fever of unknown origin. After bone marrow- and other laboratory examinations, he was diagnosed with tuberculosis.

Tobramycin versus Gentamicin, in Combination with Cephalotin and Carbenecillin, in Patients Undergoing Bone Marrow Transplantation

1981 ◽  
Vol 67 (6) ◽  
pp. 525-532 ◽  
Author(s):  
Andrea Bacigalupo ◽  
Maria T. Van Lint ◽  
Carla Volta ◽  
Grazia Grazi ◽  
Ornella Soro ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Renal Failure ◽  
Bone Marrow Transplantation ◽  
Acute Leukemia ◽  
Marrow Transplantation ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Febrile Episodes ◽  
Oral Decontamination ◽  
To Receive

Thirty-six patients with severe aplastic anemia or acute leukemia undergoing bone marrow transplantation or intensive hematologic treatments were randomized to receive gentamicin (1 mg/kg/iv q8h) or tobramycin (1 mg/kg/iv q8h) in combination with carbenecillin (500 mg/kg/day i.v. in 4 doses) and cephalotin (200 mg/kg/day i.v. in 6 doses), at the onset of fever during granulocytopenia. Patients in the gentamicin group were treated for a total of 541 patient days (minimum 5, maximum 106), and patients in the tobramycin group for 426 patient days (minimum 9, maximum 48). All patients received oral decontamination, which included the amino glycoside (either gentamicin or tobramycin) given intravenously. This study showed that 1) no patient had an increase in creatinine level above 1.3 mg % and no patient developed renal failure, 2) there was no difference between gentamicin and tobramycin in the efficacy of treating febrile episodes and/or major infections, 3) prolonged intravenous administration (up to 48 consecutive days in the tobramycin group and 106 consecutive days in the gentamicin group) was well tolerated and effective in treating fever of unknown origin in granulocytopenic patients: 45 of 72 febrile episodes resolved while the patients had a granulocyte count below 500/mm3.

scholarly journals From Prolonged Febrile Illness to Fever of Unknown Origin

2003 ◽  
Vol 163 (9) ◽  
pp. 1033 ◽  
Author(s):  
Steven Vanderschueren ◽  
Daniël Knockaert ◽  
Tom Adriaenssens ◽  
Wim Demey ◽  
Anne Durnez ◽  
...  
Keyword(s):  
Fever Of Unknown Origin ◽  
Febrile Illness ◽  
Unknown Origin
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