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Postpartum infections
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Lactation mastitis is a cellulitis of the interlobular connective tissue within the mammary gland that usually occurs within the first 6 weeks postpartum (96). Mastitis occurs in up to 9.5% of breastfeeding women (96,97), but may rarely occur in women who are not nursing. Most cases are sporadic, presenting commonly in the second or third week following delivery (98,99). The onset of symptoms is usually abrupt with chills, malaise, generalized achiness, and fever as high as 39 to 40°C. The affected breast is tender, hot, swollen, and erythematous in a wedge-shaped segment (96) with its apex at the nipple and its base toward the periphery, demarcated by the divisions between the lobes of the breast. Decreased milk secretion may be noted (100), but expression of pus from the ducts is uncommon (99). Poor breastfeeding technique with attachment difficulties, injury to the nipple, nipple fissuring, and milk stasis (101) is considered to be the primary etiologic factor, along with lowered immune status from stress or sleep deprivation (96), but the cause of most cases is unclear (97). One study found fewer than 10 feedings/day to beprotective(96), contrary to common belief. Mastitis is no more common among women who are nursing for the first time than among women who have previously nursed. Previous mastitis is a risk factor for recurrence in successive pregnancies (96), perhaps due to persistence of poor practices (102).
Infections and Their Mimics in Returning Travelers in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Elise Kochoumian, Jonathon Moore, Bushra Mina, Kevin Cahill
Infection can occur after mosquito bite but also can be transmitted by contaminated needle, blood products, and organ transplant. The incubation period of P. falciparum is usually 5–7 days. The onset of uncomplicated infection is insidious and results in delay in confirming the diagnosis. Patients can present with flu-like illness, fever, headache, dizziness, malaise, and body ache, but shaking chills are often absent. Fever follows tertian pattern. Jaundice is common. Splenomegaly might be inconsistent.
Approach to the Febrile Patient
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Chills — A chilly sensation occurs in almost all fevers, especially in viral and bacterial infections. A true chill is accompanied by chattering of the teeth and shivering. The skin becomes pale, cyanotic, and covered with “goose flesh”. This state may continue for 10 to 40 min, then the skin becomes pink and warm and there may be sweating. Antipyretic drugs (especially aspirin), may precipitate or perpetuate chills. Chills may occur singly and are often prominent at the onset of the febrile disease or may be multiple4 (see Table 1).
Bisphosphonates Related Ocular Side Effects: A Case Series and Review of Literature
Published in Ocular Immunology and Inflammation, 2022
Omer Gendelman, Liana Tripto - Shkolnik, Iris Vered, Merav Lidar
Elevated serum levels of the pro inflammatory cytokines interleukin 6 and tumor necrosis factor-α were observed in vivo35,36 and in vitro35,37,38 studies following Pamidronate administration. Indeed, this cytokine milieu is believed to be responsible for the acute phase reaction phenomenon observed 24 hours to several days after the first infusion of nitrogenous bisphosphonates such as Risendronate and Alendronate.9 It has also been reported, less frequently, after administration of non-nitrogenous bisphosphonates such as Etidronate and Clodronate.39 Clinically, the response is characterized by fever, chills and flu like symptoms which tend to resolve within 3 days.9 Although some have suggested that the inflammatory eye reaction represents a limited, contained manifestation of the systemic, generalized acute phase response to bisphosphonates11,37,40 this putative mechanism doesn’t provide a satisfactory explanation for the delayed occurrences of uveitis.
Extrapulmonary tuberculosis
Published in Expert Review of Respiratory Medicine, 2021
Surendra K Sharma, Alladi Mohan, Mikashmi Kohli
Disseminated TB can occur either during primary infection or post-primary TB due to reactivation of a latent focus/re-infection. Clinical manifestations of miliary TB are protean. A subacute clinical presentation is often seen. Fever with chills and rigors and inanition are usually present. Chills and rigors are common. Dry cough and dyspnea are common symptoms. Physical examination may reveal peripheral lymphadenopathy and rarely cutaneous involvement. Signs of involvement of extrapulmonary sites may also be evident such as icterus, hepatomegaly (hepatic involvement), meningitis, or tuberculomas (neurological involvement). Clinically evident gastrointestinal, cardiac or renal involvement is rare. Overt adrenal insufficiency may be evident at the initial presentation, or may develop during treatment. Rarely, fundus examination may reveal choroidal tubercles (bilateral pale grayish white oblong patches); acute respiratory distress syndrome and acute kidney injury are encountered in patients with miliary TB [3–5].
Endogenous Bacterial Endophthalmitis: A Five-Year Retrospective Review at a Tertiary Care Academic Center
Published in Ocular Immunology and Inflammation, 2020
Thomas L. Jenkins, Katherine E. Talcott, Douglas R. Matsunaga, Martha E. Ryan, Anthony Obeid, Christine A. Chung, Sunir J. Garg
The most common presenting ocular symptoms among the 41 patients were decreased vision in 38 patients (73%) followed by pain in 15 patients (37%), floaters in 14 patients (34%), and conjunctival injection in 10 patients (24%). The most common systemic symptom was the presence of fevers and chills in 25 patients (61%). Clinical presentation and predisposing medical conditions are summarized in Tables 2 and 3. The most common medical condition was hypertension (51%). The most common immunosuppressive risk factor was diabetes mellitus (29%), with cancer and renal disease requiring hemodialysis each present in 20% of patients. Admission with recent intravenous drug use was documented in four eyes of four (10%) patients.