Infectious and tropical diseases
Andrew R Houghton, David Gray in Chamberlain's Symptoms and Signs in Clinical Medicine, An Introduction to Medical Diagnosis, 2010
The height and duration of fever are important. Rigors (chills or shivering, often uncontrollable and lasting for 20-30 minutes) are highly signifi cant, and so is a documented temperature over 37.5 °C taken with a reliable oral thermometer. Drenching sweats are also highly signifi cant. Rigors generally indicate serious bacterial infections (lobar pneumonia, endocarditis, septicaemia, cholangitis, pyelonephritis, etc.) or malaria. An oral temperature >39 °C has the same signifi cance as rigors. Rigors generally do not occur in mild viral infections (e.g. those caused by respiratory viruses, Epstein-Barr virus (EBV), hepatitis), malignancy, connective tissue diseases, tuberculosis and other chronic infections. Table 21.1 lists the features that distinguish rigors from a grand mal convulsion.
Pericarditis as a rare complication of pneumococcal pneumonia in a young infant
Published in Acta Cardiologica, 2010
Martial M. Massin, Sophie Guiti Malekzadeh-Milani, Hugues Dessy
Purulent pericarditis is an exceptionally rare complication of pneumococcal pneumonia in infants but a rapidly fatal disease if left untreated.A previously healthy 4-month-old boy presented at our emergency department with a 10-day history of fever and non-productive cough. No signs of heart failure or cardiac friction rub were evidenced. Chest radiography showed lobar pneumonia, right pleural effusion and cardiomegaly. Echocardiography revealed a massive pericardial effusion, and an emergency drainage was performed. Streptococcus pneumoniae grew up from purulent pericardial fluid and blood cultures. After intravenous antibiotherapy, the outcome was favourable. The introduction of the pneumococcal vaccine may favour an increase in the incidence of non-vaccine serotypes which most commonly cause empyaema and perhaps pericarditis.Therefore, pericarditis should always be considered a possible complication in patients with pneumococcal pneumonia and empyaema.
The non-immune inflammatory response: Serial changes in plasma iron, iron-binding capacity, lactoferrin, ferritin and C-reactive protein
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 1986
R. Baynes, W. Bezwoda, T. Bothwell, Q. Khan, N. Mansoor
The interrelationships between various components of the non-immune inflammatory response (white cell count, plasma lactoferrin, C-reactive protein, ferritin, iron and iron-binding capacity), were studied serially in a variety of inflammatory conditions including acute lobar pneumonia, active pulmonary tuberculosis, rheumatoid arthritis on gold therapy and sepsis in the face of marrow hypoplasia induced by chemotherapy. Lactoferrin concentrations paralleled the white count in all groups. They were highest in pneumonia and tuberculosis, mildly elevated in rheumatoid arthritis and markedly decreased in neutropenic sepsis. Very high initial lactoferrin concentrations were associated with a poor prognosis in acute pneumonia. C-reactive protein and ferritin concentrations remained elevated through the period of study in acute pneumonia and neutropenic sepsis, while they gradually normalised over weeks in subjects with tuberculosis or rheumatoid arthritis on therapy. In pneumonia and tuberculosis moderate hypoferraemia and a reduced iron-binding capacity were evident. In contrast, a raised percentage saturation was present in neutropenic sepsis, probably related to erythroid marrow suppression. Comparisons between ferritin, lactoferrin and C-reactive protein in the various groups supported the concept that ferritin behaves in part as an acute phase reactant and that hypoferraemia in inflammation is due to deviation of iron into ferritin stores. The suggestion that lactoferrin is responsible for the hypoferraemia and hyperferritinaemia was not supported by the present data. Iron deficiency appeared to limit the hyperferritinaemic response in rheumatoid arthritis, while erythropoietic inhibition by chemotherapy dampened the hypoferraemic response in neutropenic sepsis.
La Pneumopathie Rhumatismale.
Published in Acta Clinica Belgica, 1959
J. Brichant, F. Meersseman, J. Dehant, F. Lavenne
Summary Report of 7 cases of rheumatic pneumonia, 3 of which were fatal. Rheumatic pneumonia has to be considered not as a concomitant manifestation or as a complication of rheumatic disease but as part of the disease as well as the articular and cardiac involvements, which are of course much more frequent. From the anatomopathological point of view the disease is characterized by lesions of exsudative and exfoliative alveolitis and especially by lesions of the alveolar ducti, either exsudative (hyaline membranes) or proliferative (Masson’s nodules). Although these lesions cannot be absolutely considered as specific of rheumatic pneumonia, it is in rheumatic disease that they are by far the most extensive; if Masson’s nodules are found, the diagnostic may be looked upon almost as a certainty. No doubt whatsoever remains when typical rheumatismal lesions are present in other organs. Rheumatic pneumonia can take up various clinical aspects. In 6 out of 7 of the reported cases, the pneumopathy resulted in intense dyspnea. There was very often a disproportion between physical signs and severity of functional disorders; yet in quite a number of cases disseminated rales were noted and even signs of condensation seemed to us more frequent than in classical descriptions. In one case the clinical picture was very similar to that of lobar pneumonia. Clinically silent forms are also mentioned in the literature. The most typical radiological picture consists of patchy areas of clouding in the central part of pulmonary fields with a clear strip at the periphery. In other cases shadows could be seen on both bases or atypical infiltrations were observed. The authors consider differential diagnosis of pulmonary complications occurring in rheumatic disease. Even when typical articulatory symptoms are not present the possibility of an isolated pulmonary form of rheumatic disease must be considered. Prognosis of rheumatic pneumonia is severe. But this complication is not systematically fatal. Treatment is discussed. If effectiveness of cortico-surrenal hormones is to be hoped for, they ought to be prescrived at the very first signs of a respiratory involvement.