succimer and Fever

Topics: Child; Fever; Humans; Infant; Kidney; Radiopharmaceuticals; Succimer; Urinary Tract Infections

Mercury poisoning is an uncommon diagnosis in the United States, but it is a differential diagnosis that physicians should consider because it can lead to potentially fatal complications if untreated. Due to the nonspecific presentation of mercury poisoning, which includes symptoms such as fever, nausea, vomiting, and abdominal pain, misdiagnosis may occur unless a proper history is taken.. In the present case, a white female patient was misdiagnosed repeatedly with a viral illness and sent home from the local hospital. The patient presented with a diffuse full-body rash, fever, myalgias, headache, peripheral neuropathy, oral paresthesias, and tender cervical posterior lymphadenopathy. After obtaining a thorough history, it was discovered that the patient and her family were exposed to mercury through a spill of elemental mercury in their home. Blood mercury levels in the patient were 170 ng/mL. The patient was treated with a course of dimercaprol. Her symptoms improved and she was discharged on hospital day 5. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ultimately, mercury poisoning is a treatable condition, but if exposure continues and the patient is not treated, it may lead to complications such as severe pneumonitis, renal tubular necrosis, and neurological dysfunction. In some instances, neurological symptoms may persist even if the source of exposure is removed. For these reasons, recognition and prompt treatment after a suspected exposure is important.

Topics: Adult; Chelating Agents; Chelation Therapy; Emergency Service, Hospital; Environmental Exposure; Exanthema; Female; Fever; Humans; Mercury; Mercury Poisoning; Myalgia; Succimer

Topics: Chelating Agents; Exanthema; Fever; Humans; Lead Poisoning; Male; Middle Aged; Occupational Diseases; Succimer

Delta neutrophil index (DNI) is the fraction of circulating immature granulocytes, which reflects severe bacterial infections and septic condition but has not been studied in urinary tract infection (UTI). Here, we evaluated the value of DNI in predicting acute pyelonephritis (APN) or vesicoureteral reflux (VUR) using the data of 288 patients. Conventional inflammatory markers (white blood cell [WBC] count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and DNI were measured. WBC, CRP, ESR and DNI were higher in APN than in lower UTI (p < 0.01). Multiple logistic-regression analyses showed that DNI was a predictive factor for areas of lack of uptake on dimercaptosuccinic acid (DMSA) scans (P < 0.01). The area under the receiver operating characteristic (AUC) was also high for DNI (0.622, 95% CI 0.558-0.687, P < 0.01) as well as for CRP (0.731, 95% CI 0.673-0.789, P < 0.01) for the prediction of DMSA defects. DNI demonstrated the highest area under the ROC curve for diagnosis of VUR (0.620, 95% CI 0.542-0.698, P < 0.01). To the best of our knowledge, this is a first study demonstrating that DNI can be used as a diagnostic marker to distinguish APN from lower UTI and function as a diagnostic marker indicative of VUR compared to other conventional markers.

Topics: Area Under Curve; Blood Sedimentation; C-Reactive Protein; Female; Fever; Humans; Infant; Logistic Models; Male; Neutrophils; Reflex; ROC Curve; Succimer; Urinary Tract Infections

To determine use of early Tc-99m dimercaptosuccinic acid scintigraphy in screening for vesicoureteral reflux following first febrile urinary tract infection.. 43 children (1 mo-5 yr) with first febrile urinary tract infection underwent micturating cystourethrography, abdominal sonogram and early dimercaptosuccinic acid scintigraphy.. Early dimercaptosuccinic acid scintigraphy had 72% sensitivity and 76% specificity for vesicoureteral reflux. For dilating vesicoureteral reflux, sensitivity and specificity were 100% and 75%, respectively.. Early dimercaptosuccinic acid scintigraphy has the potential to replace micturating cystourethrography in initial evaluation of febrile urinary tract infection.

Topics: Child, Preschool; Fever; Humans; Infant; Kidney; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

To evaluate the role of renal ultrasonography (USG) in predicting vesicoureteral reflux (VUR) in children with mild renal scarring determined by dimercaptosuccinic acid scintigraphy performed after attack of urinary tract infections (UTI).. Dimercaptosuccinic acid scintigraphy, voiding cystourethrography (VCUG), and renal USG findings were evaluated retrospectively in children with UTI. Each kidney was evaluated as a separate renal unit (RU). RUs with severe scarring were excluded from the study. RUs having mild scarring with and without abnormal USG findings (group 1 and group 2, respectively) were compared in terms of the presence of VUR.. There were a total of 228 patients (70 men, mean age 47.06 ± 44.14 months) and 456 RUs. Of the 185 RUs with mild scarring, 55 had abnormal USG findings (group 1), whereas 130 had normal USG findings (group 2). The rates of VUR and severe VUR (≥grade 4) were higher in group 1 compared with group 2 (69% vs 43%, P = .001 and 35% vs 7% respectively, P <.001). The sensitivity, specificity, positive predictive value, negative predictive value, and odds ratio of USG findings in predicting VUR in RU with mild scarring were 68%, 80%, 38%, 93%, and 8.2, respectively.. Normal renal USG findings exclude a diagnosis of high-grade VUR to a large extend in children with UTI and mild renal scarring. Refraining from invasive VCUG might be a reasonable approach in these patients provided that no other predisposing factors for UTI and/or renal scarring present.

Topics: Child; Child, Preschool; Cicatrix; Female; Fever; Humans; Infant; Kidney; Male; Pyelonephritis; Radionuclide Imaging; Retrospective Studies; Succimer; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

We report a cross-sectional study performed to evaluate the imaging findings of 40 children, aged one month to five years (16.65 ± 14.97 months), who presented with protracted fever of more than 48 hours due to urinary tract infection (UTI). About 85% of the patients had positive Tc99-Dimercaptosuccinic acid (DMSA) scan and 58% had vesicoureteral reflux (VUR). Kidney sonography aided in the diagnosis and treatment in 10% of the patients. Age, sex, presence or laterality of VUR did not contribute to defective DMSA scan (pyelonephritis) (P > 0.05). Delayed diagnosis and treatment of febrile UTI is associated with a high incidence of positive findings of DMSA scan irrespective of age, sex or presence/absence of VUR. In mild VUR, the DMSA scan may be normal while in patients with moderate and severe VUR the DMSA scan is almost always abnormal. Thus, our study shows that a normal DMSA scan can help in ruling out moderate to severe forms of VUR and that cystography remains an excellent and standard tool for the diagnosis of VUR.

Topics: Chelating Agents; Child, Preschool; Cross-Sectional Studies; Female; Fever; Humans; Infant; Kidney; Male; Prognosis; Radionuclide Imaging; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Child; Diagnostic Techniques, Urological; Fever; Humans; Succimer; Urinary Tract Infections; Vesico-Ureteral Reflux

We conducted a retrospective multicenter review to estimate the prevalence of urological abnormalities in Chinese children with first febrile urinary tract infection (UTI) and to evaluate the selective imaging strategy recommended by the NICE guideline for detecting underlying abnormalities. Atypical UTI was defined as in the NICE UTI guideline. Overall, 576 boys and 244 girls aged below 24 months were reviewed. All underwent ultrasound (US) and micturating cystourethrogram (MCUG) and 612 underwent DMSA scans. US was abnormal in 73 (8.9%) and vesicoureteral reflux was shown in 195 patients (23.8%). A total of 126 patients were considered to have remediable urological abnormalities requiring additional surgical or medical interventions. The NICE guideline yielded excellent negative predictive values (NPV) of 100-94.4% in girls but 91% in boys. If all boys underwent US and DMSA and only those with atypical UTI or abnormal US or DMSA proceeded to MCUG, then the NPV increased to 95.2% and 97.4% for boys aged below and above 6 months, respectively. These revised strategies would substantially save invasive studies-DMSA and MCUG in 27 and 74% of girls aged below and above 6 months, respectively, or MCUG in 23 and 59% of boys aged below and above 6 months, respectively.

Topics: Asian People; Child; Diagnostic Imaging; Female; Fever; Humans; Infant; Male; Practice Guidelines as Topic; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Succimer; Urinary Tract Infections

The aim of this study was to evaluate the usefulness of procalcitonin (PCT) as a marker of renal scars in infants and young children with a first episode of acute pyelonephritis. Children aged 7 days to 36 months admitted for first febrile urinary tract infection (UTI) to a pediatric emergency department were prospectively enrolled. The PCT concentration was determined at admission. Acute (99m)Tc-dimercaptosuccinic acid (DMSA) scintigraphy was performed within 7 days of admission and repeated 12 months later when abnormal findings were obtained on the first scan. Of the 72 children enrolled in the study, 52 showed signs of acute pyelonephritis (APN) on the first DMSA scan. A follow-up scintigraphy at the 12-month follow-up performed on 41 patients revealed that 14 (34%) patients had developed renal scars; these patients also presented significantly higher PCT values than those without permanent renal lesions [2.3 (interquartile range 1-11.6) vs. 0.5 (0.2-1.4) ng/mL; p = 0.007]. A comparison of the PCT concentration in patients with febrile UTI without renal involvement, with APN without scar development and with APN with subsequent renal scarring revealed a significant increasing trend (p = 0.006, Kruskal-Wallis test). The area under the ROC curve for scar prediction was 0.74 (95% confidence interval 0.61-0.85), with an optimum statistical cut-off value of 1 ng/mL (sensitivity 78.6%; specificity 63.8%). Based on these results, we suggest that serum PCT concentration at admission is a useful predictive tool of renal scarring in infants and young children with acute pyelonephritis.

Topics: Acute Disease; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Child, Preschool; Cicatrix; Cohort Studies; Female; Fever; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney; Male; Predictive Value of Tests; Prospective Studies; Protein Precursors; Pyelonephritis; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Succimer; Time Factors; Ultrasonography; Urinary Tract Infections

In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis is a challenge, particularly during infancy. In an attempt to differentiate acute pyelonephritis from lower urinary tract infection (UTI), we measured intrarenal resistive index (RI). We evaluated its ability to predict renal involvement as assessed by dimercaptosuccinic acid (DMSA) scintigraphy. In total 157 patients admitted to the pediatric department of the Sişli Etfal Hospital with clinical signs of febrile UTI were included in the study. The children were divided into groups according to their age at the time of ultrasonography (US). RI was measured from the renal arteries with Doppler US in the first 72 h in all 157 children. Renal involvement was assessed by (99m)Tc-DMSA scintigraphy in the first 7 days after admission. The examination was repeated at least 6 months later if the first result was abnormal. All available patients with an abnormal scintigraphy underwent voiding cystourethrography 4-6 weeks after the acute infection. All patients with vesicoureteral reflux and scarred kidneys were excluded from the study. DMSA scintigraphy demonstrated abnormal changes in 114 of 157 children and was normal in the remaining 43 children. Of these 114 children, 104 underwent repeat scintigraphy, of whom 77 showed partially or totally reversible lesion(s). Of these 77 children, 17 children (22%) with vesicoureteral reflux were excluded. Thus, we compared the 43 children with lower UTI with the 60 children with definite acute pyelonephritis at admission. Kidneys with changes of acute pyelonephritis had a mean RI of 0.744+/-0.06 in infants, 0.745+/-0.03 in preschool children, and 0.733+/-0.09 in patients of school age with upper UTI. However, the mean RI was 0.703+/-0.06 in infants, 0.696+/-0.1 in preschool children, and 0.671+/-0.09 in school-aged patients with lower UTI. The mean RI values were significantly higher in patients with upper UTI ( P<0.001). There was a highly significant correlation between RI values and the severity of the renal lesion as ranked by DMSA scintigraphy ( P<0.001). When the cut-off RI value was 0.715, there was an 80% sensitivity and a 89% specificity for diagnosing upper UTI. Refluxing kidneys and scarred kidneys also had higher RI values. In conclusion, RI values were increased significantly in children with febrile UTI when renal parenchymal involvement (assessed by DMSA scintigraphy) was present. Our results also support the vi

Topics: Child; Child, Preschool; Cicatrix; Escherichia coli Infections; Female; Fever; Humans; Infant; Male; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Risk Assessment; Severity of Illness Index; Succimer; Ultrasonography, Doppler, Color; Urinary Tract Infections; Vesico-Ureteral Reflux

Dimercaptosuccinic acid (DMSA) renal scans were performed on 75 children (115 refluxing renal units) to determine the efficacy of routine scanning in patients with various grades of vesicoureteral reflux. Cystourethrography demonstrated grades I and II reflux in 75 renal units and grades III to V in 40. Of the patients 51 presented with febrile urinary tract infection and 24 were asymptomatic (patients presenting with nonfebrile urinary tract infections or those undergoing sibling screening). Renal ultrasounds were performed in 60 patients. All patients were initially managed with medical therapy and 19 (25%) ultimately underwent antireflux surgery. DMSA scans demonstrated scarring in 17 of 40 renal units (43%) of patients with high grade vesicoureteral reflux and 6 of 75 renal units (8%) of those with low grade reflux. Renal ultrasounds that were interpreted as normal always correlated to a normal DMSA scan in asymptomatic patients. In patients presenting with febrile urinary tract infections the correlation between ultrasound and DMSA scan was inconsistent. We advocate a tailored approach in the evaluation of patients with vesicoureteral reflux. Renal sonography may be sufficient in the assessment of renal scarring in asymptomatic patients with reflux and those with low grade reflux. Conversely, in patients with high grade vesicoureteral reflux, a history of febrile urinary tract infections and abnormal renal ultrasound DMSA renal scans appear to be most useful.

Topics: Child; Child, Preschool; Cicatrix; Female; Fever; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Predictive Value of Tests; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

Urinary N-acetyl-beta-glucosaminidase (NAG) and beta-2-microglobulin (B2M) concentrations were measured in 24 pediatric patients with febrile urinary tract infection (UTI) and compared with the technetium-99m-labeled dimercaptosuccinic acid (DMSA) renal scan results, in order to evaluate a noninvasive means to localize the site of UTI. Increased urinary B2M and NAG were not associated with renal inflammation (pyelonephritis), as defined by positive dimercaptosuccinic acid scan. Median NAG concentrations were 114.2 mumol/hour/mg creatinine (CR) (range, 5.7 to 305.4) in 17 febrile UTI patients vs. 13.8 (range, 3.4 to 104.3) in 17 age and sex-matched febrile controls with negative urine cultures, P = 0.0001. The sensitivity and specificity of NAG > or = 40 mumol/hour/mg of CR in predicting UTI in febrile patients, regardless of the site of infection, were 88 and 88%, respectively. Increased urinary NAG is associated with UTI in febrile patients regardless of the level of infection (scan status), and may be an informative indicator of UTI.

Topics: Acetylglucosaminidase; beta 2-Microglobulin; Biomarkers; Child; Child, Preschool; Clinical Enzyme Tests; Fever; Humans; Infant; Infant, Newborn; Organotechnetium Compounds; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

Correlation of virulence factors of Escherichia coli with renal inflammation documented by 99mTc-dimercaptosuccinic acid renal scan was undertaken in 59 children with febrile urinary tract infections to identify more accurately the role of bacterial virulence factors in the development of pyelonephritis. P fimbriae were present in 63% of isolates from the positive scan group and 83% of those from the negative scan group (P = 0.126). Multivariate regression analysis showed no significant role for established E. coli virulence factors in the development of pyelonephritis. The pap genome was independently associated with negative scan (P less than 0.007) and with the absence of reflux (P = 0.031). E. coli pyelonephritogenic clone O16:K1:H6 was isolated from negative scan patients and did not produce hemolysin. We conclude that P fimbriae are important in the development of febrile urinary tract infection regardless of the level of infection. Virulent E. coli clones described in prior Scandinavian urinary tract infection studies were not common causes of pyelonephritis in our patient population.

Topics: Adolescent; Child; Child, Preschool; Escherichia coli; Escherichia coli Infections; Female; Fever; Fimbriae, Bacterial; Humans; Infant; Infant, Newborn; Male; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Virulence