ro13-9904 and Abdominal-Pain

Development of secondary haemophagocytic lymphohistiocytosis (sHLH) in the context of typhoid fever (TF) is a very rare but serious complication.. Description of the first pediatric case of typhoid fever acquired in a non-endemic area complicated by sHLH. A systematic literature review of sHLH in the context of TF was performed with extraction of epidemiological, clinical and laboratory data.. The literature search revealed 17 articles (22 patients). Fifteen patients were eligible for data analysis (53.4% children). All patients had fever and pancytopenia. Transaminases and LDH were frequently elevated (46.6%). Salmonella typhi was detected mainly by blood culture (64.3%). All the patients received antibiotics whereas immunomodulation (dexamethasone) was used in two cases.. A high suspicion index for this condition is needed even in non-endemic areas. The addition of immunmodulation to standard antimicrobial therapy should be considered in selected cases.

Topics: Abdominal Abscess; Abdominal Pain; Age Distribution; Appendicitis; Asia; Ceftriaxone; Child; Developed Countries; Diagnosis, Differential; Endemic Diseases; Fever; Hepatomegaly; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Methylprednisolone; Middle East; Sex Distribution; Spain; Splenomegaly; Typhoid Fever

Infectious aortitis is a rare clinical entity that most often manifests itself by an aortic aneurysm. The syphilitic or tubercular forms can be subacute. When it is caused by Salmonella sp., Staphylococcus sp. or Streptococcus pneumoniae, the aortitis is acute with alarming symptoms. Germs found in most cases are Salmonella and Staphylococcus aureus. S. pneumoniae rarely causes infectious aortitis. We report the case of a 75-year-old patient seen in an emergency setting for sudden-onset abdominal pain with fever. An abdominal angio-computed tomography (CT) scan showed a sacciform infrarenal abdominal aortic aneurysm, with an inflammatory aspect and periaortic hematoma. Surgical cure was undertaken because of the impending rupture. An interposition aortic replacement graft was implanted. Blood cultures and bacteriological study of the aortic wall isolated a S. pneumoniae. The anatomical pathology study reported fibrin clot leukocyte remodeling of the aortic wall. An intravenous antibiotic regimen was started. Several organisms, including Streptococcus, can cause infectious aortitis. We found 36 cases described in the literature in addition to our patient.

Topics: Abdominal Pain; Aged; Amoxicillin; Aneurysm, Infected; Anti-Bacterial Agents; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Aortitis; Bacteremia; Blood Vessel Prosthesis Implantation; Ceftriaxone; Combined Modality Therapy; Fever; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Pneumococcal Infections; Streptococcus pneumoniae; Tomography, X-Ray Computed

We report four cases of ceftriaxone-associated biliary pseudolithiasis. All cases were treated conservatively without cholecystectomy or endoscopic retrograde cholangiopancreatography. Because conservative treatment is the preferred treatment, clinicians should be aware that biliary pseudolithiasis is possible in patients who have abdominal pain associated with gallbladder stones on imaging. Regardless of whether we are treating adults or children, it is necessary to check for a history of ceftriaxone treatment before symptom onset.

Topics: Abdominal Pain; Aged; Aged, 80 and over; Ceftriaxone; Diagnosis, Differential; Female; Gallstones; Humans; Male; Middle Aged; Young Adult

Topics: Abdominal Pain; Administration, Intravenous; Anti-Bacterial Agents; Borrelia; Ceftriaxone; Cranial Nerves; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Exanthema; Gastroesophageal Reflux; Hematopoietic Stem Cell Transplantation; Humans; Leukocytosis; Lyme Neuroborreliosis; Lymphoma, Mantle-Cell; Magnetic Resonance Imaging; Male; Middle Aged; Spinal Cord

Topics: Abdominal Pain; Administration, Intravenous; Anti-Bacterial Agents; Borrelia; Brain; Ceftriaxone; Cranial Nerves; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Exanthema; Hematopoietic Stem Cell Transplantation; Humans; Leukocytosis; Lyme Neuroborreliosis; Lymphoma, Mantle-Cell; Magnetic Resonance Imaging; Male; Middle Aged; Spinal Cord

Tularemia, a re-emerging, potential life threatening infectious disease, can present itself with nonspecific clinical symptoms including fever, chills and malaise. Taking a detailed history of exposure and a highly raised index of clinical suspicion are necessary to take the appropriate diagnostic and therapeutic steps in this setting. Here, a case report of typhoid tularaemia is presented.. A 53-year old male forester and farmer with protracted fever, abdominal pain, diarrhoea and loss of weight, who experienced productive cough and a pulmonary infiltrate later in the course of disease, was admitted for further investigation. Tularaemia was suspected only owing to history and confirmed by serologic testing more than three weeks after the beginning of the symptoms. The initial antibiotic therapy with ceftriaxone/doxycycline was switched to ciprofloxacin, resulting in the resolution of fever and symptoms.. Tularaemia has to be considered as a differential diagnosis in febrile patients, even more in cases with protracted fever. Since tularaemia is expanding geographically, involving more animal hosts and causing larger outbreaks, clinicians have to be aware of this potentially fatal disease.

Topics: Abdominal Pain; Anti-Bacterial Agents; Body Weight; Ceftriaxone; Ciprofloxacin; Cough; Diagnosis, Differential; Diarrhea; Doxycycline; Farmers; Fever; Francisella tularensis; Humans; Male; Middle Aged; Serologic Tests; Tularemia

We describe a ceftriaxone-resistant

Topics: Abdominal Pain; Adult; Agglutination Tests; Anti-Bacterial Agents; Azithromycin; Bacteremia; Carbapenem-Resistant Enterobacteriaceae; Ceftriaxone; Denmark; Drug Resistance; Escherichia coli; Female; Fever; Humans; Meropenem; Microbial Sensitivity Tests; Pakistan; Plasmids; Polymerase Chain Reaction; Pregnancy; Salmonella typhi; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Travel; Typhoid Fever; Whole Genome Sequencing

Whipple's disease is a chronic, rare, multisystemic, infectious entity, described for the first time in 1907. Its aetiological agent is the Gram-negative rod,

Topics: Abdominal Pain; Administration, Intravenous; Aged; Anti-Bacterial Agents; Arthralgia; Biopsy; Ceftriaxone; Diarrhea; Duodenum; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

We report a rare case of syphilitic meningomyelitis presenting with visceral crisis and possessing characteristic imaging findings.. The patient, a 50-year-old woman, complained of pain in the upper abdomen and back. She then developed numbness in both lower extremities and weakness in the left lower limb.. Magnetic resonance imaging (MRI) of the spinal cord revealed the candle guttering sign and irregular enhancement at the T6 level. Rapid plasma reagin test of the cerebrospinal fluid yielded a titer of 1:8. Thus, the patient was diagnosed with syphilitic meningomyelitis.. She was treated with ceftriaxone and dexamethasone after the failure of penicillin treatment.. She could perform the activities of daily living, and her pain completely disappeared.. A patient with syphilitic meningomyelitis can present with visceral crisis caused by the involvement of the posterior nerve roots or the posterior horn, which usually occurs in patients with tabes dorsalis. Considering the non-specific symptoms and MRI features, we should be aware that abdominal pain may be a symptom of myelopathy, and syphilitic meningomyelitis ought to be taken into account in a patient with longitudinally extensive myelitis.

Topics: Abdominal Pain; Anti-Bacterial Agents; Anti-Inflammatory Agents; Back Pain; Ceftriaxone; Dexamethasone; Female; Humans; Hypesthesia; Lower Extremity; Middle Aged; Pain; Stomach; Tabes Dorsalis

Topics: Abdominal Pain; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Liver Abscess; Male; Metronidazole; Middle Aged; Nausea; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sepsis; Treatment Outcome; Vomiting

A 42-year-old woman presented to our hospital with weeks of worsening pain around her lower ribs. Preceding this, she was managed in primary care with anti-inflammatory drugs and physiotherapy for presumed costochondritis. Assessment in accident and emergency suggested a tender right upper quadrant with fever and neutrophilia. A surgical review of the patient was requested to assess for cholecystitis or delayed pancreatitis. On direct questioning, the patient's back pain was the predominating symptom with no neurological deficit. To assess for delayed pancreatitis, CT imaging was obtained, demonstrating unremarkable intra-abdominal organs. There was also the incidental finding of thickened prevertebral soft tissues anterior to T9 and T10 vertebrae, with vertebral endplate irregularity locally. Subsequent MRI demonstrated typical appearances of infective spondylodiscitis at this level. The patient made a good recovery with intravenous antimicrobials. This case highlights how vertebrodiscitis can present insidiously and unexpectedly, manifesting as abdominal pain.

Topics: Abdominal Pain; Administration, Intravenous; Adult; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Discitis; Female; Humans; Magnetic Resonance Imaging; Thoracic Vertebrae; Treatment Outcome

A 23-year-old Japanese woman, previously a commercial sex worker, presented with a 2-day history of right upper quadrant (RUQ) abdominal pain, worse on deep inspiration. She had noticed increased vaginal discharge 2 months earlier and had developed dull, lower abdominal pain 3 weeks prior to presentation. Although pelvic examination and transvaginal ultrasonography revealed neither a tubal nor ovarian pathology, abdominal CT scan with contrast demonstrated early enhancement of the hepatic capsule, a finding pathognomonic for Fitz-Hugh-Curtis syndrome (FHCS). Cervical discharge PCR assay confirmed Chlamydia trachomatis infection. This case highlights that normal gynaecological evaluation may be insufficient to rule out FHCS, for which physicians should have a high index of suspicion when seeing any woman of reproductive age with RUQ pain.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Contact Tracing; Directive Counseling; Doxycycline; Drug Therapy, Combination; Female; Hepatitis; Humans; Pelvic Inflammatory Disease; Peritonitis; Sex Work; Tomography, X-Ray Computed; Treatment Outcome

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Ceftriaxone; Emergency Service, Hospital; Female; Humans; Methemoglobinemia; Phenazopyridine; Pyelonephritis

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; DNA, Bacterial; Doxycycline; Drug Therapy, Combination; Female; Hepatitis; Humans; Laparoscopy; Pelvic Inflammatory Disease; Peritonitis; Polymerase Chain Reaction; Treatment Outcome

Topics: Abdominal Pain; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antibodies, Monoclonal; Cardiomyopathy, Dilated; Ceftriaxone; Child; Clindamycin; Conjunctivitis; Diagnosis, Differential; Fever; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Infliximab; Jaundice; Male; Methylprednisolone; Mucocutaneous Lymph Node Syndrome; Nafcillin; Shock, Septic; Sodium Chloride; Treatment Outcome

Whipple's disease is a rare chronic multi-systemic infection, caused by Gram-positive bacillus Tropheryma whipplei. The infection usually involves the small bowel, but other organs may also be involved. The diagnosis is often challenging and can only be made on histopathological examination. This report describes 2 patients presenting with abdominal pain and weight loss who finally were diagnosed to have Whipple's disease. One of the patients was a renal transplant recipient. To the best of authors' knowledge, no case of Whipple's disease has yet been reported in Pakistan. The diagnosis were made on the basis of histopathological evaluation of duodenal biopsies. The cases underscore the need for diligent histopathological evaluation of the upper gastrointestinal biopsies and a high index of suspicion for an accurate diagnosis of the condition. The approach to the diagnosis and management of the condition is discussed.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Biopsy; Ceftriaxone; Female; Humans; Intestine, Small; Male; Pakistan; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Weight Loss; Whipple Disease

Topics: Abdominal Pain; Anti-Bacterial Agents; Appendicitis; Ceftriaxone; Colonoscopy; Humans; Male; Middle Aged

Topics: Abdominal Pain; Ceftriaxone; Cystitis; Cystoscopy; Diagnosis, Differential; Emphysema; Female; Humans; Middle Aged; Tomography, X-Ray Computed; Urinary Bladder; Urinary Catheterization

Topics: Abdominal Pain; Adolescent; Anti-Bacterial Agents; Ceftriaxone; Cholelithiasis; Emergency Service, Hospital; Gallbladder; Humans; Male; Ultrasonography

Ceftriaxone is known to cause biliary pseudolithiasis and, rarely, nephrolithiasis mainly in children. However, we reported the development of bilateral distal ureteral ceftriaxone-associated lithiasis in 7 adults, which suggests that the risk of ureterolithiasis impaction should be considered when treating patients with ceftriaxone, even in adults. To avoid strengthening greater renal damage, ureteroscopic insertion of double J stents may be an alternative management for patients with ureteral ceftriaxone-associated lithiasis.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Anuria; Ceftriaxone; Female; Humans; Male; Middle Aged; Radiography; Respiratory Tract Infections; Ultrasonography; Ureter; Ureterolithiasis; Ureteroscopy; Young Adult

Topics: Abdominal Abscess; Abdominal Pain; Aged; Anti-Bacterial Agents; Ceftriaxone; Combined Modality Therapy; Drainage; Emphysema; Female; Flank Pain; Gases; Humans; Klebsiella Infections; Pyelonephritis; Radiography, Abdominal; Rupture, Spontaneous; Tomography, X-Ray Computed

An 83-year-old woman presented to us with a 4-week history of general malaise, subjective fever and lower abdominal pain. Despite the intravenous infusion of antibiotics, her blood results and physical condition worsened, resulting in her sudden death. Autopsy study revealed that the medium-sized veins of the mesentery were infiltrated by eosinophil granulocytes, lymphocytes, macrophages and multinucleated giant cells; however, the arteries were not involved. Microscopically, venous giant cell infiltration was observed in the gastrointestinal tract, bladder, retroperitoneal tissues and myocardium. The final diagnosis was giant cell phlebitis, a rare disease of unknown aetiology. This case demonstrates for the first time that giant cell phlebitis involving extra-abdominal organs, including hearts, can cause serious morbidity.

Topics: Abdominal Pain; Aged, 80 and over; Anti-Bacterial Agents; Autopsy; Ceftriaxone; Death, Sudden; Fatal Outcome; Female; Fever; Fluid Therapy; Giant Cells; Humans; Phlebitis

Tubo-ovarian abscess (TOA), a serious complication of pelvic inflammatory disease, unites the fallopian tube and ovary and, is rarely observed in sexually inactive adolescent girls. A pelvic mass, supposedly originating from the ovary, was detected in a 13-year-old sexually inactive girl suffering from abdominal pain and menstrual disorder. Pelvic ultrasonography pointed out a semisolid, hyperechogenic mass of 57x73 mm in the left adnexal area. Laparotomy revealed an unilateral TOA adhering to the bowel and omentum. Abscess drainage and adhesiolysis were performed and postoperative antibiotherapy was administered. TOA should be considered in the differential diagnosis of females with abdominal pain and adnexal mass whether sexual activity is present or not.

Topics: Abdominal Pain; Abscess; Adolescent; Anti-Infective Agents; Ceftriaxone; Diagnosis, Differential; Drainage; Fallopian Tube Diseases; Female; Humans; Metronidazole; Ovarian Diseases; Ovarian Neoplasms; Sexual Abstinence; Suction; Therapeutic Irrigation

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Ceftriaxone; Enoxaparin; Entamoeba histolytica; Entamoebiasis; Female; Fibrinolytic Agents; Histocytochemistry; Humans; Infarction; Intestinal Diseases, Parasitic; Intestinal Mucosa; Intestine, Small; Laparotomy; Metronidazole; Microscopy; Postpartum Period; Treatment Outcome

Septic pylephlebitis or purulent thrombosis of the portal venous system generally results from a progressive extension of suppurated thrombophlebitis, secondary to an intrabdominal infection. Germs most often found are Escherichia coli and Streptococcus, isolation of Enterobacter cloacae is unusual. We report a particular observation of septic pylephlebitis associated with E. cloacae bacteremia, without biliary, digestive or pancreatic lesion on the CT-scan. The antibiotic sensitivity pattern of the isolated germ and the negative epidemiologic investigation pled in favour of community acquired infection. The infection resolved with antibiotics and anticoagulation, followed by total repermeation of the portal system.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Anticoagulants; Bacteremia; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Enoxaparin; Enterobacter cloacae; Enterobacteriaceae Infections; Fever; Gentamicins; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Portal Vein; Tomography, X-Ray Computed; Venous Thrombosis

A six-year-old boy with high-grade fever and abdominal pain in the epigastric region was examined with ultrasonogram of the abdomen. Hematology-cell analysis, serology (Widal test), urine analysis, and blood cultures were also performed. The ultrasonogram was helpful for the identification of multiple organ involvement with Salmonella typhi. The results revealed mild hepatosplenomegaly, minimal ascitis, and mesenteric lympoadenopathy. Hematological analysis showed a white blood count of 6,300 cells mL-1; a red blood cell count of 4.54 million/cu mm. The erythrocyte sedimentation rate (ESR) was 24 mm/1 hr; hemoglobin level of 11.5 g/dl; and a platelet count of 206,000 cells/mL. The patient's serum was agglutinated with lipopolysaccharide (TO), the titre value was 1:320 dilution, and flagellar antigen (TH) titre was 1:640. The patient was diagnosed with typhoid fever. Ceftriaxone was given intravenously for five days and the patient fully recovered.

Topics: Abdomen; Abdominal Pain; Anti-Bacterial Agents; Antibodies, Bacterial; Ascites; Ceftriaxone; Child; Hematologic Tests; Hepatomegaly; Humans; Lymphatic Diseases; Male; Salmonella typhi; Serologic Tests; Splenomegaly; Treatment Outcome; Typhoid Fever; Ultrasonography

Topics: Abdominal Pain; Adult; Anti-Infective Agents; Ceftriaxone; Constipation; Diagnosis, Differential; Female; Humans; Kidney Calculi; Metronidazole; Nephrostomy, Percutaneous; Pleural Effusion; Potassium Chloride; Radiography; Urinoma; Young Adult

Abdominal pain is common feature of Henoch-Schonlein purpura, which may mimic appendicitis, leading to unnecessary laparotomy. Accordingly, the diagnosis must be confirmed by ultrasonography or computed tomography scan before laparotomy is performed. The authors report a case of simultaneous occurrence of Henoch-Schonlein Purpura and gangrenous appendicitis in an 18 year-old boy. The patient was admitted with abdominal pain, cramps, and mild dehydration. He also complained of small reddish purple on his lower limbs, bilateral knee pain, low-grade fever, as well as bloody stools. The symptoms subsided completely. Eight days later, he returned with nonbloody, nonbilious emesis, abdominal cramps, and right lower quadrant abdominal tenderness. Abdominal ultrasound evaluation was performed to rule out an intussusception but demonstrated appendiceal dilatation with a possible appendicolith without any evidence of intussusception. A laparotomy was undertaken, and appendectomy was performed for gangrenous appendicitis. Simultaneous occurrence of Henoch-Schonlein purpura and acute appendicitis is rarely observed. Clinical features of the patients may mislead the clinicians, resulting in delayed diagnosis or misdiagnosis. The use of ultrasonography and computed tomography scan would confirm the diagnosis before surgery.

Topics: Abdominal Pain; Adolescent; Anti-Bacterial Agents; Appendectomy; Appendicitis; Arthralgia; Ceftriaxone; Combined Modality Therapy; Diagnosis, Differential; False Negative Reactions; Fever; Gangrene; Gastrointestinal Hemorrhage; Humans; Hydrocortisone; IgA Vasculitis; Intussusception; Male; Metronidazole; Prednisone; Ultrasonography

Acute pancreatitis is a pancreatic inflammation that recognises Salmonella typhi among its aetiological agents. In this article the authors describe two cases of acute pancreatitis secondary to typhoid fever, evolving towards complete recovery. These two cases, besides confirming that Salmonella typhi can be responsible for acute pancreatitis, remind us that during typhoid fever, amylase enzyme test should be always assessed. Moreover, salmonella infection must also be considered in cases of non-alcoholic or non-lithiasic pancreatitis.

Topics: Abdominal Pain; Acute Disease; Adult; Anti-Bacterial Agents; Anti-Ulcer Agents; Ceftriaxone; Female; Gabexate; Humans; Male; Octreotide; Omeprazole; Pancreatitis; Serine Proteinase Inhibitors; Typhoid Fever

A case of pneumatosis cystoides intestinalis (PCI) associated with perforated duodenal ulcer and Meckel's diverticulum is presented. The patient was managed with direct suturing of the perforation and reinforcement with an omental patch. Meckel's diverticulum was excised. PCI was followed up and disappeared postoperatively in the 4th week.

Topics: Abdominal Pain; Adult; Anti-Infective Agents; Ceftriaxone; Chronic Disease; Duodenal Ulcer; Humans; Male; Meckel Diverticulum; Metronidazole; Oxygen Inhalation Therapy; Peptic Ulcer Perforation; Pneumatosis Cystoides Intestinalis; Proton Pump Inhibitors

This study reviewed the clinical outcomes of patients with an aortic aneurysm infected with Salmonella treated by a single centre over 6 years.. Data were collected by a retrospective case-note review.. Between September 1995 and December 2001, 121 patients with non-typhoid Salmonella bacteraemia were treated, of whom 24 patients had an aortic aneurysm infected with Salmonella. Ten had a suprarenal and 14 an infrarenal aortic infection. The most common responsible pathogen was group C Salmonella (12 patients). All of the 20 patients who had combined medical and surgical therapy survived, whereas two of four who had medical therapy alone died. There were two late deaths during a mean follow-up of 23 (range 3-63) months.. The incidence of aortic infection in patients with non-typhoid Salmonella bacteraemia was high in Taiwan. Timely surgical intervention and prolonged intravenous antibiotic therapy resulted in excellent outcomes.

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Ambulatory Care; Aneurysm, Infected; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Bacteremia; Ceftriaxone; Cephalosporins; Combined Modality Therapy; Drug Therapy, Combination; Female; Fever; Follow-Up Studies; Hospitalization; Humans; Male; Middle Aged; Retrospective Studies; Salmonella Infections

Topics: Abdominal Pain; Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Child; Female; Fever; Humans; Penicillins; Pneumonia; Radiography

Because hospitalization and intravenous antibiotics for treatment of a potentially fatal bacterial infection in febrile children with sickle cell disease (SCD) are difficult to apply, outpatient treatment has been considered in developed countries for selected patients. Eligibility criteria and procedures may differ in developing countries because of unique economic and social conditions. After clinical evaluation within 36 hr of the onset of a fever exceeding 38.5 degrees C, children with SCD who are being closely followed as a part of a SCD cohort in Cotonou (West Africa), were treated as outpatients. The antibiotic regimen consisted of intramuscular injection of ceftriaxone 50 mg/kg/day for 2 days followed by amoxicillin 25 mg/kg x 3/day x 4 days and oral hyper-hydration. Patients were observed for 6 hr and thereafter discharged with a medical control at day 2, day 8 + day 15. All 60 children included completed their treatment, and none were lost to follow-up. A definite or a presumed bacterial infection was the cause of the febrile episode in 76.7% of cases. An appreciable decrease in fever was observed from day 2 and only 2 patients were hospitalized at day 3, one for abdominal painful crisis and one other for persistent fever without documented infection. No severe bacterial infections, recurrence of febrile episode, nor death were encountered during the follow-up. The cost of this outpatient approach is US $30 per patient as compared to US $140 per patient if the patient had been hospitalized. Outpatient management of febrile episode in children with SCD is feasible and cost-effective in Sub-Saharan African. It requires, however, improved medical education on SCD and immediate medical attention after the onset of fever.

Topics: Abdominal Pain; Administration, Oral; Ambulatory Care; Amoxicillin; Anemia, Sickle Cell; Bacterial Infections; Benin; Ceftriaxone; Child; Child, Preschool; Cohort Studies; Combined Modality Therapy; Developing Countries; Drug Costs; Drug Therapy, Combination; Female; Fever; Fluid Therapy; Follow-Up Studies; Hospitalization; Humans; Infant; Injections, Intramuscular; Malaria, Falciparum; Male; Pilot Projects; Recurrence

Neisseria meningitidis infection (meningococcemia) is very common throughout the world. It usually presents as meningitis or sometimes pharyngitis. A gastroenteritis-like syndrome, with diarrhea, vomiting and abdominal pain, may occur in children but is very rare in adults. Search of the medical literature revealed only 3 such cases, all in young adults. We report an 80-year-old woman who presented with fever, diarrhea and abdominal pain. Meningococcus infection was later suspected, and proved by culture. Although treatment was intensive and included ceftriaxone (Rocephin) and garamycin, she did not respond and died 40 hours after admission. We draw attention to the possibility that what is usually a common symptom can be the first presentation of a serious, often fatal condition.

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Ceftriaxone; Diagnosis, Differential; Diarrhea; Drug Therapy, Combination; Fatal Outcome; Female; Gastroenteritis; Gentamicins; Humans; Meningitis, Meningococcal; Neisseria meningitidis