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Gonzales Y Tucker RD, Addepalli A. Fever and Rash. Emerg Med Clin North Am 2024; 42:303-334. [PMID: 38641393 DOI: 10.1016/j.emc.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Infectious causes of fever and rash pose a diagnostic challenge for the emergency provider. It is often difficult to discern rashes associated with rapidly progressive and life-threatening infections from benign exanthems, which comprise the majority of rashes seen in the emergency department. Physicians must also consider serious noninfectious causes of fever and rash. A correct diagnosis depends on an exhaustive history and head-to-toe skin examination as most emergent causes of fever and rash remain clinical diagnoses. A provisional diagnosis and immediate treatment with antimicrobials and supportive care are usually required prior to the return of confirmatory laboratory testing.
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Affiliation(s)
- Richard Diego Gonzales Y Tucker
- Department of Emergency Medicine, University of California San Francisco, Box 0209, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Emergency Medicine, Alameda Health System - Wilma Chan Highland Hospital, 1411 E 31st Street, Oakland, CA 94602, USA.
| | - Aravind Addepalli
- Department of Emergency Medicine, University of California San Francisco, Box 0209, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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Shamriz O, Simon AJ, Frizinsky S, Lev A, Megged O, Barel O, Marcus N, Tal Y, Somech R, Toker O. Genetic workup as a complementary tool for the diagnosis of primary complement component deficiencies: a multicenter experience. Eur J Pediatr 2022; 181:1997-2004. [PMID: 35118517 DOI: 10.1007/s00431-022-04397-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 01/05/2022] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
Abstract
UNLABELLED Diagnosis of primary complement deficiencies requires a high index of suspicion. Thus, susceptible patients are often underdiagnosed and untreated. Here, we present a multicenter experience with two novel inborn errors of the classical complement system. This is a retrospective multicenter analysis of computerized medical records of children (<18 years) admitted in the period between 2012 and 2018 at Shaare Zedek Medical Center in Jerusalem and Edmond and Lily Safra Children's Hospital, Tel-Hashomer Medical Center, in Ramat Gan, Israel. Patients were genetically diagnosed by a complementary immune workup. We identified 5 patients (3 males) from four different families harboring two novel mutations in the complement components C6-C8. Genetic mutations were identified by whole-exome sequencing or by sequencing of the coding exons of a single gene based on the findings in the immune workup. Clinical manifestations consisted of meningitis with or without meningococcemia. The immune workup demonstrated nearly absent levels of CH50, compatible with a complement pathway defect. Diagnosis delay ranged between 0 and 30 years. CONCLUSION Awareness of risk factors for primary complement deficiencies, even at the first infectious episode, should facilitate prompt immune and genetic workup, commencing diagnosis and proper treatment for the patient and family. WHAT IS KNOWN • Deficiencies in the classical terminal complement components increase susceptibility to invasive meningococcal infections. • Recurrent meningococcal infections mandate a diagnostic workup of the complement system. WHAT IS NEW • Genetic workup can be utilized for prompt diagnosis of complement deficiencies. • High rates of consanguinity, even in the presence of a single meningococcal infection, should promote immune and genetic workups.
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Walter S, Gil-Prieto R, Gil-Conesa M, Rodriguez-Caravaca G, San Román J, Gil de Miguel A. Hospitalizations related to meningococcal infection in Spain from 1997 to 2018. BMC Infect Dis 2021; 21:1215. [PMID: 34872512 PMCID: PMC8650227 DOI: 10.1186/s12879-021-06916-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Baseline hospitalization, mortality, and in-hospital fatality rates for meningococcal infection are required to evaluate preventive interventions, such as the inclusion of the conjugated quadrivalent meningococcal vaccine and serogroup B based protein vaccines. Methods All meningococcal infection–related hospitalizations in any diagnostic position in Spain from 1st January 1997 through 31st December 2018 were analysed. The annual hospitalization rate, mortality rate and case-fatality rate were calculated. Results The average hospitalization rate for meningococcal infection was 1.64 (95% CI 1.61 to 1.66) hospitalizations per 100,000 inhabitants during the study period and significantly decreased from 1997 to 2018. Hospitalizations for meningococcal infection decreased significantly with age and were concentrated in children under 5 years of age (46%). The hospitalization rates reached 29 per 100,000 and 24 per 100,000 children under 1 and 2 years of age, respectively. The in-hospital case-fatality rate was 7.45% (95% CI 7.03 to 7.86). Thirty percent of the deaths occurred in children under 5 years of age, and more than half occurred in adults. The case fatality rate increased significantly with age (p < 0.001). Conclusion It is necessary to maintain epidemiological surveillance of meningococcal infection to determine the main circulating serogroups involved, track their evolution, and evaluate preventive measures whose effectiveness must be assessed in all age groups.
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Affiliation(s)
- Stefan Walter
- Department of Medicine & Public Health, Universidad Rey Juan Carlos, Avda. Atenas S/N, 28922, Madrid, Spain
| | - Ruth Gil-Prieto
- Department of Medicine & Public Health, Universidad Rey Juan Carlos, Avda. Atenas S/N, 28922, Madrid, Spain.
| | - Mario Gil-Conesa
- Preventive Medicine Service, Hospital Universitario Fundación Alcorcón, Madrid, Spain.,PhD Student Programa de Doctorado en Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Jesús San Román
- Department of Medicine & Public Health, Universidad Rey Juan Carlos, Avda. Atenas S/N, 28922, Madrid, Spain
| | - Angel Gil de Miguel
- Department of Medicine & Public Health, Universidad Rey Juan Carlos, Avda. Atenas S/N, 28922, Madrid, Spain
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Aparecido Nunes A, De Jesus Lopes De Abreu A, Cintra O, A C T Cintra M, Barbosa Coelho E, Nogueira Castro De Barros E. Meningococcal disease epidemiology in Brazil (2005-2018) and impact of MenC vaccination. Vaccine 2021; 39:605-16. [PMID: 33358262 DOI: 10.1016/j.vaccine.2020.11.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Meningococcal disease (MD) presents a substantial public health problem in Brazil. Meningococcal C conjugate (MenC) vaccination was introduced into the routine infant immunization program in 2010, followed by adolescent vaccination in 2017. We evaluated changes in national and regional MD incidence and mortality between 2005 and 2018, serogroup distribution and vaccine coverage. METHODS Data were obtained from national surveillance systems from 2005 to 2018. Age-stratified incidence and mortality rates were calculated and a descriptive time-series analysis was performed comparing rates in the pre-(2005-2009) and post-vaccination (2011-2018) periods; MD due to specific meningococcal serogroups were analyzed in the pre-(2007-2009) and post-vaccination (2011-2018) periods. RESULTS From 2005 to 2018, 31,108 MD cases were reported with 6496 deaths; 35% of cases and deaths occurred in children < 5 years. Incidence and mortality rates declined steadily since 2012 in all age-strata, with significantly lower incidence and mortality in the post-vaccine introduction period in children aged < 1-year, 1-4 years, 5-9 years and 10-14 years. A significant decline in MenC disease in children < 5 years was observed following MenC vaccine introduction; infants < 1 year, from 3.30/100,000 (2007-2009) to 1.08/100,000 (2011-2018) and from 1.44/100,000 to 0.42/100,000 in 1-4-year-olds for these periods. Reductions in MenB disease was also observed. MenW remains an important cause of MD with 748 cases reported across 2005-2018. While initial infant vaccination coverage was high (>95% nationwide), this has since declined (to 83% in 2018); adolescent uptake was < 20% in 2017/18). Regional variations in outcomes and vaccine coverage were observed. CONCLUSION A substantial decline in incidence and mortality rates due to MD was seen following MenC vaccine introduction in Brazil, especially among children < 5 years chiefly driven by reductions in MenC serogroup. While these benefits are considerable, the prevalence of MD due to other serogroups such as MenW and MenB remains a concern. A video summary linked to this article can be found on Figshare: https://doi.org/10.6084/m9.figshare.13379612.v1.
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Affiliation(s)
- Rebecca C Brady
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 6014, Cincinnati, OH 45229-3039, USA.
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Dienstmann G, Avi KT, Leite LAC, Alano JS, Souza MLR, Mulazani MDS, Mendivil PCG. First case report of fulminant septic shock from meningococcemia associated with Cryptococcus neoformans coinfection in an immunocompetent patient. Med Mycol Case Rep 2019; 26:44-6. [PMID: 31660289 DOI: 10.1016/j.mmcr.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 11/23/2022] Open
Abstract
The meningococcal disease manifestation associated with the presence of Cryptococcus neoformans is rare. There are no reports in the literature about these simultaneous infections in immunocompetent patients. The aim of the present study is to describe the first case of fulminant septic shock by Neisseira meningitidis associated with Cryptococcus neoformans coinfection in an immunocompetent patient. We describe a case of an immunocompetent 74-year-old Caucasian woman who presented with fulminant acute meningococcemia associated with cryptococcal meningitis, which progressed to worsening general condition and died of septic shock and multiple organ dysfunctions in less than 48 hours. This case report demonstrates the possibility of coinfections related to Neisseria meningitidis and Cryptococcus neoformans, even in immunocompetent patients, which represent a diagnostic challenge for clinicians, thus encouraging further studies for a better understanding. Meningococcal infections disseminate early, leading to fulminant disease. Cryptococcus neoformans meningitis is uncommon in immunocompetent patients. The association between meningococcal disease and Cryptococcus neoformans infection is very rare and requires a fast diagnosis and management. The real cause of coinfection between Cryptococcus neoformans and Meningococcal disease in immunocompetent patients remains uncertain.
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Lefèvre B, Poinsignon Y, Piau C, Javaugue FC, Talarmin JP, Lefebvre M, Varache N, Drouin H, Tattevin P. Chronic meningococcemia: a report of 26 cases and literature review. Infection 2018; 47:285-288. [PMID: 30341638 DOI: 10.1007/s15010-018-1238-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/15/2018] [Indexed: 11/25/2022]
Abstract
Chronic meningococcemia is defined by blood culture(s) positive for Neisseria meningitidis, symptoms duration > 7 days, and neither meningitis nor shock on admission. This series of 26 consecutive cases illustrates that this is a rare disease (< 5% of meningococcemia, < 0.05 cases per 100,000 inhabitants per year), mostly affecting young adults, males, with no predisposing condition. Major symptoms include fever, rash, and arthralgia. Median time between symptoms onset, and diagnosis is 28 days. Most patients fully recover with a 1-week course of parenteral betalactams.
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Affiliation(s)
- Benjamin Lefèvre
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Yves Poinsignon
- Infectious Diseases and Internal Medicine, Bretagne-Atlantique Hospital, Vannes, France
| | - Caroline Piau
- Microbiology, Pontchaillou University Hospital, Rennes, France
| | | | | | - Maeva Lefebvre
- Infectious Diseases and Tropical Medicine, Hôtel Dieu University Hospital, Nantes, France
| | - Nicolas Varache
- Infectious Diseases and Internal Medicine, General Hospital, Le Mans, France
| | - Hélène Drouin
- Infectious Diseases and Internal Medicine, General Hospital, Laval, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France.
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Mori N, Hayashi T, Nakamura H, Takahashi H. Meningococcal meningitis with neurological complications and meningococcemia due to serogroup W sequence type 11 complex. J Infect Chemother 2018; 24:398-400. [PMID: 29373268 DOI: 10.1016/j.jiac.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 11/23/2017] [Accepted: 12/11/2017] [Indexed: 12/21/2022]
Abstract
Invasive meningococcal disease (IMD) caused by the serogroup W (MenW) sequence type-11 complex strain has recently emerged worldwide. Meningococcal infections due to this strain are associated with high case fatality and often atypical clinical manifestations. However, the annual IMD incidence was low, and MenW is rare in Japan. We described the first Japanese case of meningococcal meningitis and meningococcemia caused by this strain in a previously healthy 27-year-old woman. This case showed various neurological complications such as abducens palsy, cerebellitis, and cerebellar infarction, and reactive arthritis. This case provides useful information on the possibility of spreading IMD strains and the cause of various complications.
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Affiliation(s)
- Nobuaki Mori
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan.
| | - Tomofumi Hayashi
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan
| | - Hideki Nakamura
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan
| | - Hideyuki Takahashi
- Department of Bacteriology I, National Institute of Infectious Disease, 1-23-1 Toyama, Shinjyuku-ku, Tokyo 162-8640, Japan
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Arnáiz-García ME, Arnáiz-García AM, Gutierrez-Diez F, Nistal JF, González-Santos JM, Pulitani I, Amado-Diago C, Arnáiz J. Mutilating Purpura Fulminans in an Adult with Meningococcal Sepsis. P R Health Sci J 2017; 36:179-182. [PMID: 28915308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report a dramatic case of meningococcal sepsis manifesting as purpura fulminans in an elderly diabetic woman. Hemodynamic instability and severe bilateral cutaneous lesions involving her hands and feet developed rapidly. Specific antibiotic therapy and the administration of inotropic and vasopressor drugs were initiated. The severity and extension of the cutaneous lesions (attributed to purpura fulminans) worsened because of the need for vasoconstrictors for the treatment of septic shock. Bilateral transmetatarsal and metacarpal amputations were required to stabilize the patient.
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Affiliation(s)
| | - Ana María Arnáiz-García
- Department of Infectious Diseases, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Francisco Gutierrez-Diez
- Department of Cardiovascular Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Juan Francisco Nistal
- Department of Cardiovascular Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | - Ivana Pulitani
- Department of Cardiovascular Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Carlos Amado-Diago
- Department of Pneumology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Javier Arnáiz
- Department of Radiology, Aspetar-Orthopaedic and Sports Medicine Hospital, Al Buwairda St. Doha, Qatar
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Kılıç M, Dedeoğlu Ö, Göçmen R, Kesici S, Yüksel D. Successful treatment of a patient with ethylmalonic encephalopathy by intravenous N-acetylcysteine. Metab Brain Dis 2017; 32:293-296. [PMID: 27830356 DOI: 10.1007/s11011-016-9928-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/01/2016] [Indexed: 12/28/2022]
Abstract
Ethylmalonic encephalopathy (EE) is an autosomal recessive devastating metabolic disorder affecting the brain, gastrointestinal tract, peripheral vessels and rarely the other vascular organs. We report a 10-month-old girl who presented as a meningococcemia clinic but later diagnosed ethylmalonic encephalopathy. Molecular analyses revealed a homozygous c.554 T > G; p. L185R mutation in ETHE1 gene. She was only partially benefited from riboflavine, coenzyme Q10, metronidazole, N-acetylcysteine and symptomatic treatment and discharged from hospital with the sequela of oxygene dependance and developmental delay. We observed N-acetylcysteine 100 mg/kg/day intravenous infusion theraphy may be the most important drug especially in comatous EE patients.
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Affiliation(s)
- Mustafa Kılıç
- Metabolism Unit, Sami Ulus Children Hospital, Babur cad. No: 44 Altındağ, 06080, Ankara, Turkey.
| | - Özge Dedeoğlu
- Pediatric Neurology Unit, Sami Ulus Children Hospital, Ankara, Turkey
| | - Rahşan Göçmen
- Deparment of Radiology, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Pediatric Intensive Care Unit, Sami Ulus Children Hospital, Ankara, Turkey
| | - Deniz Yüksel
- Pediatric Neurology Unit, Sami Ulus Children Hospital, Ankara, Turkey
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Lavoipierre V, Dellyes A, Aubry C, Zandotti C, Lafforgue P, Parola P, Lagier JC. Acute polyarthritis in a young patient caused by meningococcal and parvovirus B19 infections: a case report and review of the literature. J Med Case Rep 2016; 10:362. [PMID: 27998301 PMCID: PMC5175313 DOI: 10.1186/s13256-016-1156-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/23/2016] [Indexed: 01/09/2023] Open
Abstract
Background Meningococcal infection is a multifaceted disease including acute polyarthritis. This presentation should be known by clinicians in order to prevent delay in treatment. We report what we believe to be the first case of an association of parvovirus B19 and meningococcal polyarthritis in a young adult. Case presentation A 19-year-old Caucasian woman presented to our hospital with fever, intense leg pain, and a transient rash. A physical examination showed asymmetric polyarthritis and no neurological abnormalities. A parvovirus B19 polymerase chain reaction performed using a blood sample and knee fluid aspirate came back positive, but serology was negative for immunoglobulin M and positive for immunoglobulin G. A blood culture was positive for serotype C meningococcus; a polymerase chain reaction performed for Neisseria meningitidis was positive in joint fluid but negative in blood samples (performed after antibiotic treatment had begun). Our patient was treated with ceftriaxone for 15 days, associated with analgesic therapy. Hydroxychloroquine treatment was introduced 5 months after the onset of polyarthritis because of persisting inflammatory arthralgia. Conclusions To the best of our knowledge, this is the first case report of polyarthritis caused by concomitant meningococcal and parvovirus B19 infections. This unusual presentation of meningococcal disease may have resulted from the persistent parvovirus B19 infection. Our experience with this case illustrates the need for a systematic approach to the diagnosis of febrile acute polyarthritis. Only long-term follow-up will reveal if this infectious polyarthritis will evolve towards an autoimmune rheumatism.
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Affiliation(s)
- Virginie Lavoipierre
- Service de Maladies Infectieuses Aigues, Pôle Maladies Infectieuses, Assistance Publique Hôpitaux de Marseille, CHU Timone, Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Anna Dellyes
- Service de Rhumatologie, Assistance Publique Hôpitaux de Marseille, CHU Sainte Marguerite, 13009, Marseille, France
| | - Camille Aubry
- Service de Maladies Infectieuses Aigues, Pôle Maladies Infectieuses, Assistance Publique Hôpitaux de Marseille, CHU Timone, Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Christine Zandotti
- Pôle Maladies Infectieuses, Fédération de Microbiologie, Assistance Publique Hôpitaux de Marseille, CHU Timone, Institut Hospitalo-Universitaire Méditerranée Infection, 13015, Marseille, France
| | - Pierre Lafforgue
- Service de Rhumatologie, Assistance Publique Hôpitaux de Marseille, CHU Sainte Marguerite, 13009, Marseille, France
| | - Philippe Parola
- Service de Maladies Infectieuses Aigues, Pôle Maladies Infectieuses, Assistance Publique Hôpitaux de Marseille, CHU Timone, Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France.,Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Institut Hospitalo-Universitaire Méditerranée-Infection, Marseille, France
| | - Jean-Christophe Lagier
- Service de Maladies Infectieuses Aigues, Pôle Maladies Infectieuses, Assistance Publique Hôpitaux de Marseille, CHU Timone, Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France. .,Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Institut Hospitalo-Universitaire Méditerranée-Infection, Marseille, France.
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Poizeau F, Cormerais M, Darrieux L, Ricordel S, Garnier G, Safa G. [ Meningococcemia without meningitis: A report of two cases]. Rev Med Interne 2016; 37:206-8. [PMID: 26338027 DOI: 10.1016/j.revmed.2015.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/31/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Meningococcemia without meningitis is an often under recognized clinical form of invasive Neisseria meningitidis infection. CASE REPORTS We report two unusual cases of invasive meningococcal disease who presented with meningococcemia without distinct signs of meningitis or severe sepsis manifestation. In both cases, confirmation of the diagnosis is provided by meningococcal PCR performed on blood or skin lesion biopsy. CONCLUSION Clinical recognition of this entity is crucial for early antibiotic treatment and to avoid delayed diagnosis and potentially dangerous complications.
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Abstract
L’année 2013 a été l’année des études génétiques de type GWAS (Genome wide association studies) au service de maladies fréquentes (psoriasis et dermatite atopique) visant à identifier des gènes candidats et celles des grandes cohortes de population tirées de registres publics ou privés. Ainsi des corrélations épidémiologiques sont déclinées : psoriasis et surrisque vasculaire, psoriasis et pathologies ORL, rosacée et migraines, acné et habitudes alimentaires, eczéma et carcinome basocellulaire, vitiligo et moindre risque de cancers cutanés, lupus cutané Ro/SS-A et cancer, eczéma chronique et inhibiteurs calciques, pemphigoïde et diurétiques de l’anse. Les liens entre isotrétinoïne et MICI ne sont pas confirmés. Ceux liant azathioprine et cancers cutanés le sont. Des toxidermies nouvelles voient le jour (pigmentations à l’interféron, hypodermites et sarcoïdose aux inhibiteurs de BRAF muté, toxidermies au vandétanib, etc.) et des toxidermies anciennes sont « revisitées » (patch-tests dans les toxidermies sévères, pigmentation à l’hydroxychloroquine, dermatoses neutrophiliques à l’azathioprine). Diane35® a fait une fausse sortie en janvier 2013 mais le tétrazépam, lui, a fait une vraie sortie en juillet 2013. Des aspects originaux de différentes infections cutanées sont abordés et des données nouvelles sur les MST (méningococcémies et homosexuels masculins, PVH, herpès, syphilis congénitale). Enfin, quelques articles concernant la dermatoscopie, la microscopie confocale et la dermatologie esthétique seront discutés.
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Affiliation(s)
- M Janier
- Centre clinique et biologique des MST, Hôpital Saint-Louis (AP-HP), 42 rue Bichat, 75010 Paris, France; Service de dermatologie, Fondation-Hôpital Saint-Joseph, 185 rue Raymond-Losserand, 75014 Paris, France.
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Abstract
Fever is the most common reason that children and infants are brought to emergency departments. Emergency physicians face the challenge of quickly distinguishing benign from life-threatening conditions. The management of fever in children is guided by the patient's age, immunization status, and immune status as well as the results of a careful physical examination and appropriate laboratory tests and radiographic views. In this article, the evaluation and treatment of children with fevers of known and unknown origin are described. Causes of common and dangerous conditions that include fever in their manifestation are also discussed.
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Affiliation(s)
- Robyn Wing
- Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
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