The swollen neck. Cervical lymphadenitis, parotitis, thyroiditis, and infected cysts

Swelling of the neck can result from a variety of causes, both infectious and noninfectious. This article describes the major causes of neck swelling from the more common infectious processes in the neck--cervical lymphadenitis, parotitis, thyroiditis, and infected cysts. The etiology and pathogenetic considerations, clinical manifestations, differential diagnosis, therapy, and prevention are discussed for each of these conditions.     

长期不明原因发热388例临床分析

目的 探讨不明原因长期发热患者的病因.方法 分析在我院住院诊治且符合不明原因发热诊断标准的388例患者的临床资料.结果 388例患者中经各种检查或诊断性治疗最终明确诊断者253例,确诊率为65.2%.病因：感染性疾病131例,占51.8%,其中结核病55例,占感染性疾病的42.0%（55/131）;结缔组织病69例,占27.3%,成人still病占结缔组织病的30.3%（20/69）;肿瘤37例,占14.6%,其中淋巴瘤占86.4%（32/37）;其他疾病16例,占6.3%;原因未明者135例,占34.8%.结论 感染性疾病仍然是不明原因发热的主要病因,结核病尤其是肺外结核占较大比例.肿瘤性疾病和结缔组织病在发热待查中也占有相当比例,淋巴瘤和成人still疾病是这两类疾病的主要病种.     

Fever in the ICU

Fever is a common problem in ICU patients. The presence of fever frequently results in the performance of diagnostic tests and procedures that significantly increase medical costs and expose the patient to unnecessary invasive diagnostic procedures and the inappropriate use of antibiotics. ICU patients frequently have multiple infectious and noninfectious causes of fever, necessitating a systematic and comprehensive diagnostic approach. Pneumonia, sinusitis, and blood stream infection are the most common infectious causes of fever. The urinary tract is unimportant in most ICU patients as a primary source of infection. Fever is a basic evolutionary response to infection, is an important host defense mechanism and, in the majority of patients, does not require treatment in itself. This article reviews the common infectious and noninfectious causes of fever in ICU patients and outlines a rational approach to the management of this problem.     

Mycobacterial disease associated with aplastic anaemia

Haematological changes associated with infectious disease are relatively common but true aplastic anaemia secondary to infection is rare. We describe a patient wit disseminated Mycobacterium avium-intracellulare infection and who had a histologically proven remission of his aplastic anemia accompanying antimycobacterial therapy. We also review the literature on the haematological changes associated with mycobacterial infections and other infectious causes of aplastic anaemia.     

Transient increase in diarrheal diseases after the devastating earthquake in Kocaeli, Turkey: results of an infectious disease surveillance study.

Immediately after the devastating earthquake in Turkey in August 1999, an infectious disease surveillance system was established in Kocaeli Province (the biggest area affected). This surveillance study was mainly focused on diarrheal diseases. During a 33-day period, 1,468 stool cultures were processed. Diarrheal diseases increased step-by-step and later decreased to the initial level by the end of this period. Cases were scattered throughout the entire region, and the identified causes were various, indicating a multifocal increase. Of the identified causes, Shigella species were the most common. Nevertheless, Shigella isolates also belonged to distinct serotypes and clones. This study indicated a multifocal, multiclonal increase in diarrheal diseases after this massive disaster, thus indicating the necessity to set up infectious disease surveillance systems after such events.     

Pericarditis: Pathophysiology,Diagnosis, and Management

Pericarditis, the most common disease of the pericardium, may be isolated or a manifestation of a systemic disease. The etiology of pericarditis is varied and includes infectious (especially viral and tuberculosis) and noninfectious causes (autoimmune and autoinflammatory diseases, pericardial injury syndromes, and cancer [especially lung cancer, breast cancer, and lymphomas]). Most cases remain idiopathic with a conventional diagnostic evaluation. A targeted etiologic search should be directed to the most common cause on the basis of the patient’s clinical background, epidemiologic issues, specific presentations, and high-risk features associated with specific etiologies or complications (fever higher than 38°C, subacute onset, large pericardial effusion, cardiac tamponade, lack of response to NSAIDs). The management of pericardial diseases is largely empiric because of the relative lack of randomized trials. NSAIDs are the mainstay of empiric anti-inflammatory therapy, with the possible addition of colchicine to prevent recurrences.     

Infectious arteriopathies

After reviewing the physiopathology, the authors report the principal features of infectious arterial disease observed in a department of infectious diseases. Excluding iatrogenic arteritis, particularly after vascular surgery, and some vasculitis in which an infectious agent may play a role, only the classical but now rare causes are described: rickettsial disease, syphilis and typhoid. The most commonly observed problem at present is infectious aneurysms: primary aneurysms secondary to atherosclerosis in which salmonella is by far the predominant organism, before the staphylococci and streptococci. The most serious complication is the major risk of rupture which may be the presenting event. Secondary aneurysms are essentially those of endocarditis. The mechanism is not fully understood and they occur at different stages of the course of the disease. The main problem associated with these aneurysms is their multiplicity and localisation; the intracranial forms are the most common and most serious in the experience of the authors, with their difficulties of diagnosis and treatment: extracranial aneurysms are usually located in the main limb arteries. Adjacent secondary aneurysms are exceptionally rare. Tuberculous and viral causes of aneurysm are among the rarest etiologies discussed.     

Pancoast's syndrome secondary to infectious etiologies: a not so uncommon occurrence

Pancoast's syndrome includes Horner's syndrome, atrophy of the hand muscles and shoulder, axilla or arm pain. This syndrome is caused by an apical thoracic lesion, most commonly a bronchogenic carcinoma, which invades the brachial plexus roots and the cervicothoracic sympathetic chain. Several nonmalignant causes are documented in the literature with infection being one. After a case of Pancoast syndrome caused by a methicillin-sensitive Staphylococcus aureus empyema, we began a systematic search of the literature to identify case reports/series of Pancoast syndrome secondary to infection. Our search was limited to the English language and performed using MEDLINE. Thirty-one cases of Pancoast's syndrome secondary to infectious causes were found in our review of the literature. The infectious causes identified were bacterial, fungal and parasitic organisms; however, no single organism could be identified as the most prevalent. Our review represents the most complete summation of individual case reports on this subject and highlights clinical characteristics of each presentation and the organisms that were encountered. This number of cases of Pancoast's syndrome secondary to infectious causes indicates that this association may be more common than previously reported.     

The health of prisoners

More than 10 million people are incarcerated worldwide; this number has increased by about a million in the past decade. Mental disorders and infectious diseases are more common in prisoners than in the general population. High rates of suicide within prison and increased mortality from all causes on release have been documented in many countries. The contribution of prisons to illness is unknown, although shortcomings in treatment and aftercare provision contribute to adverse outcomes. Research has highlighted that women, prisoners aged 55 years and older, and juveniles present with higher rates of many disorders than do other prisoners. The contribution of initiatives to improve the health of prisoners by reducing the burden of infectious and chronic diseases, suicide, other causes of premature mortality and violence, and counteracting the cycle of reoffending should be further examined.     

Epstein-Barr Viral Hepatitis: An Unusual Case and Review of the Literature

We report a patient with icteric hepatitis and abdominal pain caused by Epstein-Barr virus in the absence of other common features of infectious mononucleosis. The peak alanine aminotransferase was 289 IU/I. Hemolytic anemia and urinary retention complicated the patient's course. Patients with infectious mononucleosis commonly have hepatic involvement but isolated symptomatic hepatitis is unusual. Although rare cases of liver failure have been reported, there is no evidence that Epstein Barr virus causes chronic liver disease. The clinical and histological features of Epstein Barr virus-induced hepatitis are reviewed.     

Causes of deaths using verbal autopsy among adolescents and adults in rural western Kenya

Objective To establish causes and patterns of deaths among adolescents and adults (age >11 years) using verbal autopsy (VA) in a rural area of western Kenya where malaria and HIV are common. Methods Village reporters reported all deaths in Asembo and Gem (population 135 000), an area under routine demographic surveillance. After an interval of ≥1 month, a trained interviewer used a structured questionnaire to ask the caretaker about signs and symptoms that preceded death. Three clinical officers independently reviewed the interviews and assigned two unranked causes of death; a common cause was designated as the cause of death. Results In 2003, 1816 deaths were reported from residents; 48% were male and 72% were between 20 and 64 years of age. Most residents (97%) were ill before death, with 60% of illnesses lasting more than 2 months; 87% died at home. Care was sought by 96%; a health facility was the most common source, visited by 73%. For 1759 persons (97%), a common cause of death was designated. Overall, 74% of deaths were attributed to infectious causes. HIV (32%) and tuberculosis (TB) (16%) were the most frequent, followed by malaria, respiratory infections, anaemia and diarrhoeal disease (approximately 6% each). Death in a health facility was associated with young age, higher education, higher SES, a non‐infectious disease cause and a shorter duration of illness. Conclusion In this area, the majority of adult and adolescent deaths were attributed to potentially preventable infectious diseases. Deaths in health facilities were not representative of deaths in the community. Programmes to prevent HIV and TB infection and to decrease mortality have started. Their impact can be evaluated against this baseline information.     

Infectious diseases in systemic lupus erythematosus: risk factors,management and prophylaxis

Infections are one of the leading causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Therapeutic, disease-related and genetic factors all contribute to a lupus patient's increased susceptibility to infections. Although bacterial pathogens are the most common cause of infections, a wide variety of pathogens have been reported. In high-risk populations, identification and treatment of chronic infections such as tuberculosis, hepatitis B or human immunodeficiency virus, are important prior to the institution of immunosuppression to prevent reactivation or exacerbation of the infection. Judicious use of corticosteroids and cytotoxic drugs is critical in limiting infectious complications. Vaccines against influenza and pneumococcus appear to be safe and immunogenic in SLE patients and their routine administration should be encouraged.     

Nausea and vomiting in HIV: a symptom review

Nausea and vomiting are two of the most common symptoms experienced by those with HIV. While the causes are most commonly attributed to medication side effects, infectious causes, gastroparesis and psychosomatic, therapy aimed at controlling symptoms has not been well studied. Since nausea and vomiting have been identified as the most common cause of discontinuation of highly active antiretroviral therapy (HAART) therapy, and due to the extensive morbidity associated with these symptoms, we sought to review and discuss causes and management of these symptoms in HIV-infected patients and demonstrate the need for further research in this area. Such studies could include investigation into the prophylactic use of antiemetics with initiation or modification of HAART therapy to monitor patient compliance. In addition, anticipatory nausea and vomiting should be further studied, as it could prove to be quite prevalent, as in cancer patients.     

1977例急性、亚急性、慢加急性肝衰竭患者的病因与转归分析

目的 探讨急性肝衰竭(ALF)、亚急性肝衰竭(SALF)、慢加急性肝衰竭(ACLF)的病因. 方法回顾性总结1977例肝衰竭患者的临床资料,对病因、年龄、性别、转归等方面进行比较分析.结果 ALF的前三位病因是:HEV感染(33.96%)、HBV感染(13.21%)与药物性肝病(9.43%);SALF为药物性肝病(31.53%)、HEV感染(16.22%)、HBV感染(9.91%);ACLF为HBV感染(90.29%)、洒精性肝病(2.65%)、HBV与HEV重叠感染(2.26%).常见嗜肝病毒感染者占90.09%(1781例),其中单HBV感染占92.93%(1655例).在HBV感染者中(1655例),26～55岁患者占77.10%(1276例).2005-2007年酒精性肝衰竭患者39例,占酒精性病因患者的81.25%(48例);2006-2007年药物性肝衰竭共23例,占药物性病因的56.10%(41例).除药物性肝损伤外,其他病因均男性多于女性.三类肝衰竭总治愈,好转率为35.56%,HEV感染性肝衰竭的治愈,好转率高于药物性肝衰竭(x2=4.42,P<0.05),其他组间差异无统计学意义.结论 不同类型肝衰竭主要病因不同;HBV感染居肝衰竭病因之首,酒精性、药物性肝衰竭呈上升趋势;HEV感染性肝衰竭治愈、好转率相对较高.     

系统性红斑狼疮并发感染的危险因素临床特点及早期诊断

感染是影响系统性红斑狼疮(SLE)患者病死率的重要因素之一,故早期诊断感染并发症能显著改善SLE患者预后。血清C-反应蛋白(CRP)、降钙素原(PCT)有助于鉴别SLE并发感染和SLE活动,血清KL-6有助于鉴别SLE伴发感染和SLE累及肺脏。SLE合并感染的病原体除了最多见的细菌感染外,病毒和真菌感染近几年有上升趋势,需要引起足够重视。     

Infectious causes of death in patients with rheumatoid arthritis: an autopsy study

OBJECTIVE: To study mortality from infections and accuracy of pre-mortem diagnoses in patients with rheumatoid arthritis (RA) autopsied during a 40-year period. METHODS: We investigated infectious causes of death, findings at autopsy, and clinicians' estimation of cause of death in 369 consecutively autopsied RA and 371 autopsied non-RA patients with same sex, age at death, and year of autopsy. We also compiled clinical features of RA patients from medical records available and examined the association between these and infectious causes of death. RESULTS: Deaths from any infection were more frequent in RA (36%) than in non-RA (26%) patients. In both groups, respiratory and urinary tract infections were the most common infectious causes of death. More RA patients died from urinary tract infections than non-RA patients. In approximately half of the patients in both groups, infection as a cause of death was unrecognized before death, with no major change occurring over the 40-year study period. CONCLUSIONS: Infections, especially respiratory and urinary tract infections, are frequent causes of death in RA patients. The high proportion of undiscovered infections as a cause of death highlights the diagnostic difficulty. With a decreasing number of autopsies being performed at present, greater numbers of infections may be under-reported.     

Challenges to preventing infectious complications, decreasing re-hospitalizations, and reducing cost burden in long-term survivors after allogeneic hematopoietic stem cell transplantation

Even though the overall outcome after allogeneic transplant has improved significantly in the last decades, late infectious diseases are still the most important causes of late morbidity and mortality. Here, impaired immune reconstitution and therapy of chronic graft-versus-host disease (GVHD) represent the major risk factors. In this review, we give a comprehensive overview of late infectious complications and summarize possible diagnostic and therapeutic interventions to prevent these complications.     

Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy

Malignant external otitis is an infection of the external ear canal, mastoid, and base of the skull caused by Pseudomonas aeruginosa. The condition occurs primarily in elderly patients with diabetes mellitus. Current theories on pathogenesis and anatomic correlations are reviewed. Severe, unrelenting otalgia and persistent otorrhea are the symptomatic hallmarks of the disease, whereas an elevated erythrocyte sedimentation rate is the only distinctive laboratory abnormality. Iatrogenic causes such as administration of broad-spectrum antibiotics and aural irrigation may play a predisposing role in high-risk populations. The disease can result in cranial polyneuropathies (with facial nerve [VII] paralysis being the most common) and death. The mainstay of treatment is administration of antipseudomonal antibiotics for four to eight weeks. Recurrence is common, and mortality remains at about 20 percent despite antibiotic therapy. Given the increasing longevity of diabetic patients, the frequency of this disease is increasing. Internists, family practitioners, and ambulatory care physicians must now be cognizant of the presenting symptoms, while infectious disease specialists and otolaryngologists need to be appraised of strides in diagnosis and therapy. The role of surgery should be minimized. Use of new diagnostic radiologic modalities and new antipseudomonal antibiotics discussed in this review should lead to improved outcome.     

Allergy genuflection? It's surmount with special focus on ear,nose and throat

The system that protects body from infectious agents is immune system. On occasions, the system seldom reacts with some foreign particles and causes allergy. Allergies of the ear, nose and throat (ENT) often have serious consequences, including impairment and emotional strain that lowers the quality of life of patients. This is further responsible for the common cold, cough, tonsillitis, dermal infection, chest pain and asthma-like conditions which disturb one's day to day life. The present review enlightens some common ENT allergies which one can suffer more frequently in one's lifetime, and ignorance leads to making the condition chronic. Information regarding pathophysiology and the management of ENT allergy by this review could help clinicians and common people to better understand the circumstances and treatment of ENT allergy.     

Global changes in the epidemiology of community-acquired pneumonia

Lower respiratory tract infections are the most common infectious cause of death in the world and the third most common cause of death globally (all causes). This article reviews the epidemiology of community-acquired pneumonia from a global perspective. Major areas of epidemiological work include (1) disease surveillance to define the burden of disease and to document outbreaks, (2) identification of risk factors for a disease to optimize prevention strategies, and (3) comparisons of treatment effects to improve clinical outcomes for patients with the disease.