Horečka nejasného původu představuje klinický syndrom s pestrou diferenciální diagnostikou, který je definovaný jako febrilní stav s opakovaně naměřenou tělesnou teplotou více jak 38,3 °C, trvající déle jak 3 týdny, jehož etiologie zůstává neobjasněná po provedení podrobného klinického vyšetření a souboru základních laboratorních a zobrazovacích vyšetření. Syndrom mohou vyvolat infekční, neinfekční zánětlivá, hemato-onkologická či nádorová onemocnění. Významnou součástí diferenciální diagnostiky jsou rovněž polékové reakce nebo interní onemocnění. V předkládaném sdělení je prezentováno pět případů horečky nejasného původu z rutinní ambulantní praxe infekčního lékaře, které zdůrazňují nezbytnost širšího diferenciálně-diagnostického uvažování a zejména kvalitní mezioborové spolupráce při péči o pacienty s protrahovanými febrilními stavy. Součástí odborného sdělení je krátké přehledové pojednání o etiologii a diagnostice horečky nejasné etiologie.
Fever of unknown origin represents a clinical syndrome characterized by a fever of over 38.3 °C documented on several occasions during a period of at least 3 weeks, etiology of which remains unexplained after obtaining a detailed history, conducting a thorough physical exam, and an array of basic laboratory tests and diagnostic imaging. Most cases of this syndrome are caused by infections, non- infectious inflammatory diseases, and neoplasms. In addition, drug fevers and internal medicine diseases should be included in the differential diagnostic work-up in all patients. This article presents five case reports of fever of unknown origin managed at an outpatient clinic of a tertiary care center for infectious diseases. This case series emphasizes the need for a consistent, broad and interdisciplinary diagnostic work-up. In addition, we present a review of the etiology and clinical management of fever of unknown origin.
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- abstrakt z konference MeSH
Peripheral neurotoxicity is the most typical non-haematological adverse effect of taxanes. Symptoms are dominated by sensory peripheral neuropathy, the incidence and degree of which depend on the cumulative dose level. The impact of neurotoxicity on the patient´s quality of life is significant, therefore it is necessary to consider the selection of therapy and the patient´s pre-existing risk factors for developing neuropathy and to get acquainted with current management options, including genetic prediction of polyneuropathy. This review article reports on a very common complication of cancer therapy that can be encountered at each internist´s outpatient dispensary.
Fever of unknown origin is a rare clinical syndrome, that represents a significant diagnostic challenge. There have been described more than 200 potential diseases, that can manifest as a fever of unknown origin. These are classically divided into following categories: infections, non-infectious inflammatory diseases, malignancies, and other miscellaneous disorders. Each of the disease type is associated with rather characteristic symptoms, clinical signs and laboratory findings, which are individually non-specific, but may provide helpful clues for a further focused diagnostic work-up. The clinician’s task is to be able to identify these hallmark clinical features and to correctly interpret their significance and limitations in the appropriate differential diagnostic context. The aim of this review is to provide up-to-date clinical research evidence and to propose a concise clue-oriented diagnostic approach.
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- diagnostické techniky a postupy MeSH
- diagnostické zobrazování MeSH
- diferenciální diagnóza MeSH
- fyzikální vyšetření metody MeSH
- horečka neznámého původu * diagnóza etiologie MeSH
- infekční nemoci diagnóza MeSH
- klinické laboratorní techniky metody MeSH
- lidé MeSH
- nádory diagnóza MeSH
- revmatické nemoci diagnóza MeSH
- zánět diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: S100A11 (calgizzarin), a member of the S100 family, is associated with oncogenesis, inflammation and myocardial damage. Our aim was to analyse S100A11 in idiopathic inflammatory myopathies (IIMs) and its association with disease activity features and cancer development. METHODS: S100A11 in muscle was determined by immunohistochemistry in polymyositis (PM), dermatomyositis (DM), myasthenia gravis (MG) and in subjects without autoimmune inflammatory disease (HC). S100A11 in plasma was measured in 110 patients with IIMs (PM, DM, and cancer associated myositis (CAM) patients) and in 42 HC. Disease activity was assessed by myositis disease activity assessment (MYOACT), muscle enzymes and C-reactive protein (CRP) were measured by routine laboratory techniques; autoantibodies by immunoprecipitation or by immunoblot. RESULTS: We observed an accumulation of S100A11 in the cytoplasm of regenerating and necrotizing muscle fibres of PM and DM patients. S100A11 was increased in plasma of all myositis patients compared to HC (3.8 (1.5-16.8) vs 2.8 (1.7-11.2)ng/ml, p=0.011) and in DM and CAM patients compared to HC (4.0 (2.2-14.9) and 4.5 (1.5-9.1) vs 2.8 (1.7-11.2)ng/ml, p<0.001 and p=0.022, respectively). In all myositis patients, S100A11 correlated with the levels of lactate dehydrogenase (r=0.256, p=0.011), aspartate aminotransferase (AST) (r=0.312, p=0.002), CRP (r=0.254, p=0.022) and MYOACT (r=0.245, p=0.022). S100A11 was associated with MYOACT (r=0.377, p=0.030) and pulmonary and cutaneous disease activity in DM patients (r=0.408, p=0.017 and r=0.417, p=0.01, respectively). S100A11 was related to the levels of AST (r=0.412, p=0.027) in PM and to the levels of creatine phosphokinase (r=0.432, p=0.028) in CAM patients. CONCLUSIONS: We show for a first time a potential implication of S100A11 in the local inflammatory and tissue remodelling processes in myositis and an association of circulating S100A11 with disease activity and extra muscular manifestations in DM.
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- autoimunitní nemoci imunologie patologie MeSH
- autoprotilátky imunologie MeSH
- C-reaktivní protein analýza MeSH
- dospělí MeSH
- kosterní svalová vlákna * patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- polymyozitida * imunologie patologie MeSH
- proteiny S100 * metabolismus MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- MeSH
- diferenciální diagnóza MeSH
- lidé MeSH
- prognóza MeSH
- Sjögrenův syndrom * diagnóza komplikace terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
