title: Bacterial infections in anorexia nervosa: delayed recognition increases complications.
abstract: OBJECTIVE
  We compared the natural history of bacterial infection in patients with anorexia nervosa (AN) with controls, and assessed which of a range of patient characteristics were associated with infection, fever response, and the rate of infectious complications in AN patients.
  
  
  METHODS
  The charts of 311 consecutive hospital admissions of AN patients were reviewed. Patients who had a bacterial infection while in the hospital were compared with the AN patients who did not have an infection, with respect to a range of demographic and disease variables. Fever response and infection complication rate also were evaluated in AN patients with a bacterial infection and in nonanorectic control subjects admitted with a bacterial infection.
  
  
  RESULTS
  AN patients with a bacterial infection showed a reduced fever response, were often difficult to diagnose because of fewer signs and symptoms, and infection became more frequent with increasing patient age.
  
  
  CONCLUSIONS
  A reduction in fever response and the signs and symptoms of infection significantly delayed diagnosis in AN patients and increased the complication rate from bacterial infection. We recommend that an increased index of suspicion and an early complete blood count and bacteriologic cultures be adopted for the investigation of bacterial infection in AN patients.
authors.affiliation: Department of Psychology, University of New England, Armidale, New South Wales, Australia. rhonda.brown@pobox.une.edu.au
authors.forename: Rhonda F
authors.initials: RF
authors.lastname: Brown
authors.forename: Roger
authors.initials: R
authors.lastname: Bartrop
authors.forename: Pierre
authors.initials: P
authors.lastname: Beumont
authors.forename: C Laird
authors.initials: CL
authors.lastname: Birmingham
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications* / Q000503:physiopathology; D001424:Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D005334:Fever / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D009517:New South Wales / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome