Occult bacterial infection in adults with unexplained fever: validation of a diagnostic index

Article Abstract:

Bacterial infections can produce a wide range of symptoms and conditions. In some patients, fever is the only symptom of bacterial infection, especially in patients who are very young or very old. A diagnostic index which was developed previously was used to estimate the likelihood of hidden bacterial infection in adults. The index is calculated on the basis of patient age, the presence of diabetes, red blood cell sedimentation rate, white blood cell count, and neutrophil band count. The resulting index classifies patients into four groups of increasing risk. This index was evaluated in a clinical setting on 113 consecutively admitted patients with fever without a recognizable cause. The results of the classification were compared with laboratory findings indicating bacteremia, meaning bacteria in the blood, or other infection. None of the patients in the first group were found to have bacteremia or other infection. In the second group, 11 percent were found to have bacteremia and 27 percent some bacterial infection. The percentages were 17 and 32 percent, respectively, for the third group. In the fourth, and highest risk, group, 53 percent were found to be infected and 35 percent had bacteremia. Twenty-nine percent of patients in the fourth group died, compared with none in the first group. The results suggest that the index, which can be calculated rapidly after admission to an emergency ward, could give an early indication of the likelihood of infection. In the present study, the treatment of 11 percent of the patients would have been different if the diagnostic index had been taken into account. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Bacterial infections, Bacteremia

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Vancomycin-induced thrombocytopenia

Article Abstract:

A case report is presented of an unusual side effect of vancomycin, an antibiotic drug. The patient, a 54-year-old alcoholic man, developed redness and swelling of a joint in the left foot that progressed to the entire foot, and then the right foot and hands. Antibiotics (amoxicillin-clavulanate) and metronidazole (used to treat certain infections) had been prescribed for the patient two days before admission to the hospital. After an initial diagnosis of cellulitis (inflammation of connective tissue), vancomycin and another antibiotic were administered. Vancomycin was stopped after a short time because cell cultures did not show the presence of infective organisms, but was started again several days later when organisms were discovered in drainage from the patient's heels. Two days later, the patient's level of platelets (cells essential for blood clotting) fell, and the antibiotics were again discontinued. When signs of inflammation again appeared, vancomycin was prescribed again, but withdrawn after only 12 hours when platelet levels fell again. It was apparent that the vancomycin had caused the severe drop in platelet level, a condition known as thrombocytopenia. After additional treatment, the patient's condition improved. Such decreases in blood cell levels are rare side effects of vancomycin; a brief review of the medical literature on this topic is presented. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Blood platelets, Thrombocytopenia

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Vancomycin allergy presenting as fever of unknown origin

Article Abstract:

A 37-year-old woman receiving long-term hemodialysis was admitted to the hospital with a fever of unknown origin. She had been prescribed an antibiotic, vancomycin, shortly before the onset of the fever. She had taken this medication on previous occasions without any problems. After her admission, the patient was again given vancomycin. Immediately her temperature rose, she developed a rash and an increase in the type of white blood cells which are associated with allergic responses (eosinophils). When the antibiotic was stopped and she was given steroid medication to alleviate the allergic symptoms, her condition improved. This type of prolonged sensitivity reaction after a single dose of vancomycin is related to the long half-life, or the period of time it takes for one half of the medication to be processed out of the body, of this medication in patients with kidney disease. This case should alert physicians to the possibility of unusual drug reactions in such patients.

Care and treatment, Kidney diseases, Drug allergy, Drug hypersensitivity

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