Nimmagadda Nikitha, Khillare Kishor M, Satpathy Prasanna Kumar, Gowda Bharath S, Narayana Varun, Gopal Prashant, Tripathy Srikanth, Athavale Prachi V
Internal Medicine, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND.
Gastroenterology and Hepatology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, IND.
Cureus. 2023 Feb 9;15(2):e34818. doi: 10.7759/cureus.34818. eCollection 2023 Feb.
Background Management of a febrile patient is based on understanding the pathophysiology of an abnormal temperature and temperature regulation, impacts of fever, and its treatment. In the current study, we aimed to characterize and compare the epidemiological, etiologic, microbiological, serological, clinical, and outcome traits of febrile patients with acute neutropenia admitted to a tertiary care center in Western Maharashtra. Methods Adult patients with a history of fever of less than two weeks' duration and without any immunosuppressive state were screened with predefined inclusion and exclusion criteria. General and demographic information (age and gender), and clinical examinations (type and duration of fever) were recorded. Biochemical, hematologic (total and differential cell counts), and immunologic measurements (rapid malaria, dengue, , and viral hepatitis antigen antibodies) were performed. Data were analyzed using an appropriate statistical package. Results A total of 403 (214 males) young adults (aged: 29±11 years) with clinical presentation of fever were studied. The majority (n=361, 89.6%) had low-grade continuous fever with an average duration of 3±1 (mean±standard deviation (SD)) days. Headache and myalgia were the common symptoms present, and patients had an average hospital stay of 4±1 days. Dengue (55%) was the most common cause of febrile neutropenia, and all patients recovered well without antibiotics and granulocyte colony-stimulating factor. The mean C-reactive protein (CRP) level was 61.4±4.4 mg/L. CRP and procalcitonin (PCT) were directly correlated with the degree of neutropenia and inversely correlated with total leucocyte count (TLC). Conclusions It was highlighted from this study that antibiotics are not necessary for viral infections that have been diagnosed to stop the development of secondary bacterial infections. A clinician should be aware of "when not to use antibiotics," or the world will soon have to deal with superbugs.
背景 发热患者的管理基于对体温异常及体温调节的病理生理学、发热的影响及其治疗的理解。在本研究中,我们旨在描述和比较入住西马哈拉施特拉邦一家三级医疗中心的急性中性粒细胞减少发热患者的流行病学、病因学、微生物学、血清学、临床和结局特征。方法 对病程小于两周且无任何免疫抑制状态的发热成年患者按照预先定义的纳入和排除标准进行筛查。记录一般和人口统计学信息(年龄和性别)以及临床检查结果(发热类型和持续时间)。进行生化、血液学(全血细胞计数和分类计数)和免疫学检测(快速疟疾、登革热及病毒性肝炎抗原抗体检测)。使用适当的统计软件包对数据进行分析。结果 共研究了403例(214例男性)有发热临床表现的年轻成年人(年龄:29±11岁)。大多数患者(n = 361,89.6%)为低热持续热型,平均持续时间为3±1(均值±标准差(SD))天。头痛和肌痛是常见症状,患者平均住院时间为4±1天。登革热(55%)是发热性中性粒细胞减少最常见的病因,所有患者未使用抗生素和粒细胞集落刺激因子均恢复良好。平均C反应蛋白(CRP)水平为61.4±4.4mg/L。CRP和降钙素原(PCT)与中性粒细胞减少程度呈正相关,与白细胞总数(TLC)呈负相关。结论 本研究强调,对于已确诊的病毒感染,无需使用抗生素来阻止继发性细菌感染的发生。临床医生应意识到“何时不使用抗生素”,否则世界很快将不得不应对超级细菌。