exudates and Fever-of-Unknown-Origin

Topics: Anti-Bacterial Agents; Aspartate Aminotransferases; Doxycycline; Female; Fever of Unknown Origin; Headache; Hemoglobins; Humans; Malaysia; Middle Aged; Myalgia; Orientia tsutsugamushi; Scrub Typhus; Skin Diseases; Travel; Travel-Related Illness

Since 2011, about 100 travellers to the island of Tioman, Malaysia, have been diagnosed worldwide with suspected muscular sarcocystosis, a previously only sporadically observed parasitic disease. Source of infection and therapy remain unclear. Final diagnosis requires microscopic identification of cysts in muscle biopsies. The study objective was a systematic description of characteristic symptoms, laboratory investigations and treatment response.. Systematic case series.. The 26 cases of 5 centers for tropical medicine in Germany showed a characteristic biphasic development: symptoms began in general 2 weeks after mid-holidays (min. 7.5, max. 22 days) with unspecific fever and headaches lasting for almost 1 week. After an asymptomatic period of 2 weeks, severe myalgia (6.5, scale 0-10) and fever developed and lasted for about 6 weeks (min. 7, max. 207 days), accompanied by creatin-phosphokinase(CK)-elevation (up to 3.5 times), and eosinophilia (2.9 times). One out of two muscle biopsies revealed a cyst typical for sarcocystosis. In 6 out of 7 patients an increase in Sarcocystis-specific antibody concentration could be demonstrated by ELISA. Treatment with systemic steroids and albendazole, or ivermectin resulted in significant symptomatic improvement in most of the patients. One patient was treated early with cotrimoxazole and subsequently did not develop a second phase of the disease. All patients had stayed in the North-West of the island Tioman.. Muscular sarcocystosis develops in a biphasic pattern with initial fever and later prolonged myalgia, eosinophilia, and CK-elevation. Steroids achieve symptomatic relief in the late phase. Early cotrimoxazole-therapy could possibly prevent parasitic muscle invasion. In fever after travel to Malaysia differential diagnosis should include sarcocystosis. The source of infection appears to be located in North-West of Tioman. Further studies are needed, including addressing early diagnosis and treatment.

Topics: Adolescent; Adult; Antibodies, Protozoan; Biopsy; Child; Developing Countries; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Female; Fever of Unknown Origin; Germany; Humans; Infectious Disease Incubation Period; Malaysia; Male; Middle Aged; Muscle, Skeletal; Myalgia; Sarcocystis; Sarcocystosis; Travel; Young Adult

Pyrexia of unknown origin (PUO) is a frequent presentation to the Acute Medical Unit, and is a source of significant morbidity, both the psychological burden of an uncertain diagnosis and prognosis and untreated complications of the underlying pathology. We present a problem based review of the management of PUO, illustrated by a patient who recently presented to our unit with fever and systemic malaise after returning from abroad and in whom no cause could be found for more than two months. We describe a structured approach making use of complex modern techniques such as Positron Emission Tomography-Computed Tomography (PET-CT) which ultimately provided the diagnosis for our patient.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Anti-Infective Agents; Anti-Inflammatory Agents; Aorta; Aortography; Arthralgia; Aspirin; Diagnosis, Differential; Female; Fever of Unknown Origin; Headache; Humans; Lansoprazole; Malaysia; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prednisolone; Singapore; Takayasu Arteritis; Tomography, X-Ray Computed; Treatment Outcome

We report a case of a previously healthy 38-year old lady who presented with prolonged fever and hepatosplenomegaly. Intensive investigations were performed for pyrexia of unknown origin which revealed negative. CT scan of the abdomen showed multiple hypodense lesions which did not respond to broad-spectrum antibiotics. Percutaneous biopsy of the splenic lesion revealed granuloma formation and Langhan's giant cells suggestive of TB. She responded well with anti- TB medication but required extended treatment duration of 24 months due to persistence of the splenic lesion on repeated CT scans. This case illustrates a very rare clinical entity of isolated splenic TB with a therapeutic dilemma following incomplete resolution, despite prolonged treatment.

Topics: Adult; Antitubercular Agents; Female; Fever of Unknown Origin; Humans; Malaysia; Tomography, X-Ray Computed; Tuberculosis, Splenic

We studied 1,629 febrile patients from a rural area of Malaysia, and made a laboratory diagnosis in 1,025 (62.9%) cases. Scrub typhus was the most frequent diagnosis (19.3% of all illnesses) followed by typhoid and paratyphoid (7.4%); flavivirus infection (7.0%); leptospirosis (6.8%); and malaria (6.2%). The hospital mortality was very low (0.5% of all febrile patients). The high prevalence of scrub typhus in oil palm laborers (46.8% of all febrile illnesses in that group) was confirmed. In rural Malaysia, therapy with chloramphenicol or a tetracycline would be appropriate for undiagnosed patients in whom malaria has been excluded. Failure to respond to tetracycline within 48 hours would usually suggest a diagnosis of typhoid, and indicate the need for a change in therapy.

Topics: Adolescent; Adult; Bacterial Infections; Child; Female; Fever; Fever of Unknown Origin; Humans; Leptospirosis; Malaria; Malaysia; Male; Middle Aged; Paratyphoid Fever; Scrub Typhus; Togaviridae Infections; Typhoid Fever; Virus Diseases