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Febrile Illness (febrile + illness)
Selected AbstractsPotentiation of 3-hydroxyglutarate neurotoxicity following induction of astrocytic iNOS in neonatal rat hippocampal culturesEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 11 2001Stefan Kölker Abstract Neuronal damage in glutaryl-CoA dehydrogenase deficiency (GDD) has previously been addressed to N- methyl- d -aspartate (NMDA) receptor-mediated neurotoxicity of the accumulating neurotoxic metabolite 3-hydroxyglutarate. However, acute encephalopathic crises in GDD patients are typically precipitated by febrile illness or even routine vaccinations, suggesting a potentiating role of inflammatory cytokines. In the present study we investigated the effect of interleukin-1, and interferon-, on 3-hydroxyglutarate toxicity in rat cortical astrocyte cultures and neonatal rat hippocampal cultures. A cotreatment of both culture systems with interleukin-1, and interferon-, induced the protein expression of astrocytic inducible nitric oxide synthase (iNOS), resulting in increased nitric oxide (NO) production. Cytokine pretreatment alone had no effect on cell viability but potentiated 3-hydroxyglutarate neurotoxicity. NOS inhibition by aminoguanidine and L-NAME prevented an iNOS-mediated potentiation of 3-hydroxyglutarate neurotoxicity but failed to protect neurons against 3-hydroxyglutarate alone. In contrast, superoxide dismutase/catalase as well as MK-801 prevented toxicity of 3-hydroxyglutarate alone as well as its potentiation by iNOS, supporting a central role of NMDA receptor stimulation with subsequently increased superoxide anion production. It is concluded that the potentiation of 3-hydroxyglutarate neurotoxicity is most probably due to an induction of astrocytic iNOS and concomitantly increased NO production, enabling enhanced peroxynitrite formation. Thus, we provide evidence for a neuroimmunological approach to the precipitation of acute encephalopathic crises in GDD by inflammatory cytokines. [source] Genotype,phenotype correlation in skin fragility-ectodermal dysplasia syndrome resulting from mutations in plakophilin 1EXPERIMENTAL DERMATOLOGY, Issue 2 2002T. Hamada Abstract: We report a 42-year-old Japanese man with an unusual autosomal recessive genodermatosis. The clinical features comprised normal skin at birth, loss of scalp hair at 3-months of age after a febrile illness, progressive nail dystrophy during infancy, palmoplantar keratoderma starting around the age of 18 years and trauma-induced skin fragility and blisters noted from the age of 20 years. Skin biopsy of rubbed non-lesional skin revealed widening of spaces between adjacent keratinocytes from the suprabasal layer upwards. Electron microscopy demonstrated a reduced number of hypoplastic desmosomes. Immunohistochemical labeling showed a reduction in intercellular staining for the desmosome component plakophilin 1. Mutation analysis revealed a homozygous intron 11 donor splice site mutation in the plakophilin 1 gene, 2021+1 G>A (GenBank no. Z34974). RT-PCR, using RNA extracted from the skin biopsy, provided evidence for residual low levels of the full-length wild-type transcript (,8%) as well as multiple other near full-length transcripts, one of which was in frame leading to deletion of 17 amino acids from the 9th arm-repeat unit of the plakophilin 1 tail domain. Thus, the molecular findings help explain the clinical features in the patient, who has a similar but milder phenotype to previously reported patients with skin fragility-ectodermal dysplasia syndrome associated with complete ablation of plakophilin 1 (OMIM 604536). This new ,mitis' phenotype provides further clinicopathological evidence for the role of plakophilin 1 in keratinocyte cell,cell adhesion and ectodermal development. [source] Cytokine cascade in dengue hemorrhagic fever: implications for pathogenesisFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 3 2000U.C. Chaturvedi Abstract Dengue virus produces a mild acute febrile illness, dengue fever (DF) and a severe illness, dengue hemorrhagic fever (DHF). The characteristic feature of DHF is increased capillary permeability leading to extensive plasma leakage in serous cavities resulting in shock. The pathogenesis of DHF is not fully understood. This paper presents a cascade of cytokines, that in our view, may lead to DHF. The main feature is the early generation of a unique cytokine, human cytotoxic factor (hCF) that initiates a series of events leading to a shift from Th1-type response in mild illness to a Th2-type response resulting in severe DHF. The shift from Th1 to Th2 is regulated by the relative levels of interferon-gamma and interleukin (IL)-10 and between IL-12 and transforming growth factor-,, which showed an inverse relationship in patients with DF. [source] The burden of influenza in East and South-East Asia: a review of the English language literatureINFLUENZA AND OTHER RESPIRATORY VIRUSES, Issue 3 2008James M. Simmerman Abstract, While human infections with avian influenza A (H5NI) viruses in Asia have prompted concerns about an influenza pandemic, the burden of human influenza in East and Southeast Asia has received far less attention. We conducted a review of English language articles on influenza in 18 countries in East and Southeast Asia published from 1980 to 2006 that were indexed on PubMed. Articles that described human influenza-associated illnesses among outpatients or hospitalized patients, influenza-associated deaths, or influenza-associated socioeconomic costs were reviewed. We found 35 articles from 9 countries that met criteria for inclusion in the review. The quality of articles varied substantially. Significant heterogeneity was noted in case definitions, sampling schemes and laboratory methods. Early studies relied on cell culture, had difficulties with specimen collection and handling, and reported a low burden of disease. The recent addition of PCR testing has greatly improved the proportion of respiratory illnesses diagnosed with influenza. These more recent studies reported that 11,26% of outpatient febrile illness and 6-14% of hospitalized pneumonia cases had laboratory-confirmed influenza infection. The influenza disease burden literature from East and Southeast Asia is limited but expanding. Recent studies using improved laboratory testing methods and indirect statistical approaches report a substantial burden of disease, similar to that of Europe and North America. Current increased international focus on influenza, coupled with unprecedented funding for surveillance and research, provide a unique opportunity to more comprehensively describe the burden of human influenza in the region. [source] Cutaneous manifestations of dengue viral infection in Punjab (north India)INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 7 2007Emy Aby Thomas MBBS Background, Dengue infection is emerging as a public health problem in India. Despite numerous studies, there is a paucity of literature regarding the cutaneous manifestations of dengue. This study was performed to investigate the prevalence and type of cutaneous manifestations in dengue viral infection. Methods, Two hundred and fifty-six patients with febrile illness, admitted to the Christian Medical College and Hospital, Ludhiana, India, were studied. On the basis of the clinical criteria and laboratory tests, 124 patients were diagnosed with dengue viral infection, and these patients were investigated in detail. Serologic tests were attempted in only 84 patients, and all of these samples tested positive for anti-dengue immunoglobulin M (IgM) antibodies. Results, Of the 124 patients with dengue infection, 41 (23.1%) were classified with dengue fever (DF) and 83 (66.9%) with dengue hemorrhagic fever (DHF), four (3.2%) of whom had dengue shock syndrome (DSS). Cutaneous involvement was seen in 46.8% of patients, the most common symptom being maculopapular/morbilliform eruption (48.3%), followed by ecchymotic (27.6%), petechial (13.8%), and macular/scarlatiniform (10.3%) eruption. Maculopapular eruption was observed more in DF, whereas petechiae, ecchymosis, and mucosal involvement were seen more in DHF; 72.4% of patients with cutaneous manifestations were asymptomatic, and 27.6% had pruritus. Involvement was generalized in 48.3% of patients, with the limbs and trunk involved in 32.8% and 18.9% of patients, respectively. Mucosal involvement was seen in 29.8% of patients, with conjunctival involvement being the most common (20.9%), followed by the lips (4.8%), palate (2.4%), and tongue (1.6%). Conclusions, This study describes the variety of cutaneous features associated with dengue viral infection which may evolve during the course of the disease. As a significant proportion of patients showed cutaneous features, these manifestations, together with simple laboratory tests, will be helpful in the early diagnosis of dengue viral infection. [source] HHV-6 infection , not only tertian feverJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 3 2009Isabella Fried Summary The primary infection with the human herpesvirus (HHV) 6 usually occurs before the age of two (95%) and clinically either presents as tertian fever followed by exanthem subitum (10%) or even more often as febrile disease without an exanthem. In adults an active HHV-6 infection can present as febrile illness. A 19-year-old immunocompetent patient presented with high fever, exanthem, swelling of the lymph nodes and pancytopenia and was serologically diagnosed as active HHV-6 infection with anti- HHV-6-IgM- and -IgG antibodies. Since the antibodies were already detectable on day 5 of disease, with persistence of high IgG and undetectable IgM after 4 weeks, a reactivation seemed most likely. There was no evidence for an underlying immunosuppressive disease or reactivation induced by viral co-infection. Fulminant hepatitis or meningoencephalitis are the most frequent complications in immunocompetent individuals and have to be recognized at an early stage. [source] African tick bite fever , Papulovesicular exanthem with fever after staying in South AfricaJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 5 2008Jan Schuster Summary In the wake of expanding international tourism, rickettsioses are increasingly observed also in central Europe. African tick bite fever is a recently described, acute febrile illness with characteristic skin lesions. It is caused by Rickettsia africae, which is transmitted to humans by ticks of the Amblyomma genus. A 60-year-old woman presented with a papulovesic-ular exanthem, fever, and headache after returning from South Africa. A purple nodule with central necrosis ("tache noire"or "inoculation eschar") was noticed on the lower leg. Antibodies against rickettsia of the spotted fever group were detected serologically. Oral doxycycline led to clearance of the disease after few days of treatment. [source] The use of antipyretic medications in the prevention of febrile convulsions in childrenJOURNAL OF CLINICAL NURSING, Issue 4 2000Edward Purssell BSc ,,Febrile convulsions are a relatively common outcome in paediatric febrile illness, although it is not known why some children suffer these. ,,Antipyretic medications may form the basis for some treatment regimens, although they are not recommended in published guidelines. ,,There is little evidence that the prophylactic use of antipyretics has any effect in reducing the incidence of febrile convulsions. ,,Consequently, educational interventions aimed at reducing parental fear and helping them to care for their children during febrile illnesses may be more efficacious. [source] Predominant human herpesvirus 6 variant A infant infections in an HIV-1 endemic region of Sub-Saharan AfricaJOURNAL OF MEDICAL VIROLOGY, Issue 5 2009Matthew Bates Abstract Human herpesvirus 6, HHV-6, commonly infects children, causing febrile illness and can cause more severe pathology, especially in an immune compromised setting. There are virulence distinctions between variants HHV-6A and B, with evidence for increased severity and neurotropism for HHV-6A. While HHV-6B is the predominant infant infection in USA, Europe and Japan, HHV-6A appears rare. Here HHV-6 prevalence, loads and variant genotypes, in asymptomatic compared to symptomatic infants were investigated from an African region with endemic HIV-1/AIDS. DNA was extracted from blood or sera from asymptomatic infants at 6 and 18 months age in a population-based micronutrient study, and from symptomatic infants hospitalised for febrile disease. DNA was screened by qualitative and quantitative real-time PCR, then genotyped by sequencing at variable loci, U46 (gN) and U47 (gO). HIV-1 serostatus of infants and mothers were also determined. HHV-6 DNA prevalence rose from 15% to 22% (80/371) by 18 months. At 6 months, infants born to HIV-1 positive mothers had lower HHV-6 prevalence (11%, 6/53), but higher HCMV prevalence (25%, 17/67). HHV-6 positive febrile hospitalized infants had higher HIV-1, 57% (4/7), compared to asymptomatic infants, 3% (2/74). HHV-6A was detected exclusively in 86% (48/56) of asymptomatic HHV-6 positive samples genotyped. Co-infections with both strain variants were linked with higher viral loads and found in 13% (7/56) asymptomatic infants and 43% (3/7) HIV-1 positive febrile infants. Overall, the results show HHV-6A as the predominant variant significantly associated with viremic infant-infections in this African population, distinct from other global cohorts, suggesting emergent infections elsewhere. J. Med. Virol. 81:779,789, 2009. © 2009 Wiley-Liss, Inc. [source] Characterization of tick-borne encephalitis virus from latvia: Evidence for co-circulation of three distinct subtypesJOURNAL OF MEDICAL VIROLOGY, Issue 4 2001Åke Lundkvist Abstract Viruses of the tick-borne encephalitis (TBE) antigenic complex within the family Flaviviridae cause a variety of diseases, including uncomplicated febrile illness, meningoencephalitis, and hemorrhagic fever. Different domesticated animals or wildlife species often act as reservoir hosts and ixodid ticks serve as vectors. Although TBE is a serious problem in Latvia, the knowledge concerning TBE virus (TBEV) strains circulating in the country is most limited. Only two strains (Latvia-1-96 isolated from a TBE patient, and RK1424 originating from an Ixodes persulcatus tick), which belonged to the Siberian and the Far Eastern subtypes of TBEV, respectively, have previously been characterized. In the present study, we concentrated on the western and central regions of Latvia, with predominantly Ixodes ricinus ticks. Five virus strains were isolated from serum samples of patients with clinical symptoms of an acute TBE infection. Nucleotide sequences encoding the envelope (E) protein of TBEV, which were recovered from the five TBEV isolates, showed the highest level of identity to the corresponding sequences of the prototype strain Neudoerfl and other European strains of the Western TBEV subtype characterized previously. Accordingly, phylogenetic analysis placed the new Latvian isolates within the Western genetic lineage of TBEV. Taken together with earlier observations, the results proved that all three TBEV subtypes are co-circulating in Latvia and indicated that the genetic diversity of TBEV within certain geographical areas is much more complex than previously believed. J. Med. Virol. 65:730,735, 2001. © 2001 Wiley-Liss, Inc. [source] Symptomatic infant characteristics of congenital cytomegalovirus disease in AustraliaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 8 2005Sian C Munro Background: Human cytomegalovirus (CMV) is the most common cause of viral intrauterine infection. In utero transmission can occur during primary maternal infection, reactivation or reinfection of seropositive mothers. Objective: To describe the aetiology and clinical features of infants diagnosed with congenital CMV and to document maternal factors that were presented. Methods: Active national surveillance was initiated in 1999 in collaboration with the Australian Paediatric Surveillance Unit. Results: Monthly notifications resulted in 70 cases of congenital CMV being identified between 1999 and 2003. Nearly all of the cases were symptomatic with the most common clinical sequelae reported in infected infants being jaundice, thrombocytopaenia, hepatomegaly, petechiae, purpura and splenomegaly. Almost half (43.5%) of the infants had central nervous system (CNS) complications, such as microcephaly, chorioretinitis, sensorineural hearing loss, intracranial calcifications, developmental delay or seizures, with over half presenting two or more CNS abnormalities. Maternal febrile illness was noted in 54.8% of the cases. The majority of mothers were primiparous (46.4%) or secundiparous (39.3%), indicating two different population groups at risk of primary CMV infection. Conclusion: This study documents symptomatic congenital CMV cases in Australia. [source] Importation of Dengue by Soldiers Returning from East Timor to North Queensland, AustraliaJOURNAL OF TRAVEL MEDICINE, Issue 4 2002Scott Kitchener Background: Soldiers based in Townsville, Australia, returned from East Timor following peacekeeping operations during the wet season of 1999 to 2000. This represented the potential to import dengue virus into north Queensland, a dengue receptive area of Australia. This article seeks to outline the measures taken by the Australian Defence Force (ADF) to prevent local transmission and to present the outcomes. Methods: Soldiers returning to north Queensland were provided with education on dengue fever and in the fortnight before return, their living areas were subjected to intensive vector control measures, in order to reduce the risk of acquisition of dengue. They were further encouraged to present early with any febrile illness following their return to Townsville. Provisionally diagnosed dengue cases were notified to the state public health authorities immediately and cases were isolated until suitable vector control programs were implemented or the potentially viremic period exceeded. Serologic and virologic investigations were undertaken to identify the passage and probable serotype or confirm the presence and serotype of dengue virus. Results: Nine serologically confirmed cases of dengue were identified as viremic in north Queensland. Six cases were identified as arising from dengue serotype 2, two were from serotype 3, and one case was ill defined. No dengue cases have been reported in the local population 4 months following these ADF cases. Conclusions: Local outbreaks of dengue fever have occurred in north Queensland following the importation of dengue virus in returned travelers. The successful prevention of local transmission in these circumstances was contributed to by early notification of cases and prevention of transmission through isolation of cases and collaboration between ADF and state and local public health authorities in vector control. The management of potentially viremic returning service personnel represents a future challenge for the ADF. [source] Highly elevated ferritin levels and the diagnosis of hemophagocytic lymphohistiocytosisPEDIATRIC BLOOD & CANCER, Issue 6 2008Carl E. Allen MD Abstract Background Hemophagocytic lymphohistiocytosis (HLH) is a potentially lethal condition characterized by a pathologic inflammation. The diagnostic criteria for HLH include fever, splenomegaly, cytopenias, hypertriglyceridemia, hypofibrinogenemia, abnormal natural killer cell (NK cell) functional assay, elevated soluble IL-2R, level, and elevated ferritin level (>500 µg/L). Institution of timely therapy in these critically ill patients may be delayed by difficulties establishing the diagnosis. NK cell functional assay and soluble IL-2R, level may require send-out to a specialized lab. However, ferritin level is available on a same-day basis at most institutions. In this study, we examined the utility of quantitative ferritin levels in diagnosing HLH. Procedure All patients with ferritin values >500 µg/L obtained at Texas Children's Hospital between January 10, 2003 and January 10, 2005 were identified. Patient charts were reviewed for ferritin levels and hospital course. Results During the study interval, 330 patients had ferritin levels >500 µg/L. Ten of the 330 patients were diagnosed with HLH. A ferritin level over 10,000 µg/L was 90% sensitive and 96% specific for HLH. Another diagnostic category with significantly elevated ferritin level was illness of unknown cause (n,=,10), and only two of these patients were fully evaluated for HLH. Conclusions Ferritin levels above 10,000 µg/L appear to be specific and sensitive for HLH. In patients without a significant medical history and a new onset of febrile illness with highly elevated ferritin levels, the diagnosis of HLH should be evaluated. Pediatr Blood Cancer 2008;50:1227,1235. © 2007 Wiley-Liss, Inc. [source] Tissue HHV6 and 7 determination in pediatric solid organ recipients , a pilot studyPEDIATRIC TRANSPLANTATION, Issue 6 2003M. Gupta Abstract:, Herpes virus infections remain a major challenge in solid organ transplantation. HHV6 and 7 blood viral load was associated with pathology after renal transplantation. Little is known about the significance of tissue HHV6 and 7 infections. A total of 18 tissue biopsies (13 kidney, three GI and two BAL) from nine pediatric transplant patients (five kidney, two liver, one combined liver and kidney and one bone marrow transplant) were subjected to blood HHV6 IgG and IgM testing. In addition, tissue HHV6 and 7 semi-quantitative PCR analysis with subsequent detection by ELISA and quantitative methods were applied to the same samples. We also studied four native kidney biopsies of children with other kidney disease. The results of the biopsies were correlated with clinical data. Of the transplant patients, 78% were HHV6 IgG positive. Six of nine had a positive IgM on at least one occasion, however, only two of nine transplant patients were symptomatic with a mixed CMV/EBV septic picture of multi-organ failure. Only these two patients had a significant tissue viral load for HHV6. Additionally, a very significant tissue viral load for HHV6 was detected in an immunocompromised patient 3 wk after a roseola-like febrile illness. The HHV6 copies were 31, 88 and 206 per 10 ,L of DNA, respectively. In the patient who also had the fourth positive ELISA for HHV6 PCR product, the Multiplex PCR and restriction enzyme assay on its PCR product revealed a significant contribution by HHV7, while the HHV6-B signal was rather weak. Significant tissue HHV6 loads can be found in tissue biopsies from organ recipients with significant illness and also in native kidneys after primary infection. This may explain the high prevalence of HHV6 in transplanted kidneys. Further studies on HHV6 and 7 using molecular techniques should be supported. [source] Clinical spectrum in hospitalized children with echovirus type 13 infectionPEDIATRICS INTERNATIONAL, Issue 2 2005Ken-Ichiro Kobayashi AbstractBackground:,The aim of this study was to investigate the clinical spectrum of echovirus type 13 (E13) infection in hospitalized children. Methods:,From April to August 2002, prospective viral surveillance was performed for hospitalized patients (aged 10 days to 14 years) irrespective of their presenting symptoms and severity. Medical records of laboratory-confirmed echovirus 13 infection were reviewed. Results:,Of the 41 patients analyzed, the median age was 3.4 years and 30% of them were less than 1 year of age. The male:female ratio was 1.6:1. The main clinical features were non-specific febrile illness (nine patients), gastroenteritis (seven), bronchitis (seven), aseptic meningitis (16) and idiopathic thrombocytopenic purpura (two). Each age group had their representative symptoms: less than 1 year of age, non-specific febrile illness; from 1 to 6 years of age, enterocolitis and bronchitis; more than 6 years of age, aseptic meningitis. Conclusion:,The representative symptoms of E13 infection in hospitalized patients were variable but strongly associated with age distribution. It was of interest to note that two patients developed diopathic thrombocytopenic purpura along with the infection. [source] Long-term neurological and functional outcome in Nipah virus infectionANNALS OF NEUROLOGY, Issue 3 2007James J. Sejvar MD Objective Nipah virus (NiV) is an emerging zoonosis. Central nervous system disease frequently results in high case-fatality. Long-term neurological assessments of survivors are limited. We assessed long-term neurologic and functional outcomes of 22 patients surviving NiV illness in Bangladesh. Methods During August 2005 and May 2006, we administered a questionnaire on persistent symptoms and functional difficulties to 22 previously identified NiV infection survivors. We performed neurologic evaluations and brain magnetic resonance imaging (MRI). Results Twelve (55%) subjects were male; median age was 14.5 years (range 6,50). Seventeen (77%) survived encephalitis, and 5 survived febrile illness. All but 1 subject had disabling fatigue, with a median duration of 5 months (range, 8 days,8 months). Seven encephalitis patients (32% overall), but none with febrile illness had persistent neurologic dysfunction, including static encephalopathy (n = 4), ocular motor palsies (2), cervical dystonia (2), focal weakness (2), and facial paralysis (1). Four cases had delayed-onset neurologic abnormalities months after acute illness. Behavioral abnormalities were reported by caregivers of over 50% of subjects under age 16. MRI abnormalities were present in 15, and included multifocal hyperintensities, cerebral atrophy, and confluent cortical and subcortical signal changes. Interpretation Although delayed progression to neurologic illness following Nipah fever was not observed, persistent fatigue and functional impairment was frequent. Neurologic sequelae were frequent following Nipah encephalitis. Neurologic dysfunction may persist for years after acute infection, and new neurologic dysfunction may develop after acute illness. Survivors of NiV infection may experience substantial long-term neurologic and functional morbidity. Ann Neurol 2007 [source] Emesis predicts bacteremia in immunocompromised children with central venous catheters and fever,CANCER, Issue 14 2009Matthew W. Richardson MD Abstract BACKGROUND: The objective of this study was to determine whether vomiting at presentation of a febrile illness in immunocompromised children with central venous catheters (CVCs) predicts bacteremia. METHODS: A chart review was conducted of children who were admitted to the hospital with a diagnosis of cancer or aplastic anemia, fever, and a CVC. Data were collected on the presence or absence of vomiting, catheter type, presence or absence of severe neutropenia, C-reactive protein (Crp) value, and culture results. RESULTS: There were 143 admissions for fever among 48 children. Among 35 admissions with emesis, 19 included bacteremia; whereas, among 107 admissions without emesis, 19 included bacteremia (P < .001). There was a 5-fold greater risk of bacteremia in children with children without vomiting (odds ratio, 5.50; 95% confidence interval, 2.20-13.67). Gram-negative organisms were more likely to be associated with vomiting than Gram-positive organisms (P = .008). Children with severe neutropenia did not have a significantly higher rate of bacteremia than children who had neutrophil counts >500 cells/mm3. Other factors that were associated with higher rates of bacteremia were underlying diagnosis and catheter type. CONCLUSIONS: Immunocompromised children with a CVC and a fever who presented with vomiting were more likely to have bacteremia than similar children who presented without vomiting. Gram-negative organisms were more likely to be associated with emesis than Gram-positive organisms. The absence of severe neutropenia was not associated with a decreased likelihood of bacteremia. These findings may be useful in identifying children who are at high risk for bacteremia and in determining initial, empiric therapy. Cancer 2009. © 2009 American Cancer Society. [source] Management of fever without source in young children presenting to an emergency roomACTA PAEDIATRICA, Issue 11 2006Martial M. Massin Abstract Background: The management of fever without source in young children is controversial. Aim: To analyse the management approach in our paediatric emergency room, and to correlate it to existing practice guidelines. Methods: We indexed 2176 consecutive patients, aged 1 to 36 mo, seen in our emergency department because of fever,,,38.5°C. Patients with chronic illness, recent antibiotic use, focal bacterial infection or typical viral illness were excluded, and the management approach of the remaining 376 patients was analysed. Results: The most common final diagnosis was acute febrile illness (n=228), whereas bacterial and viral infections were demonstrated in 120 and 28 patients, respectively. Most of the time, our residents correctly ordered complete blood count, chest radiograph and urinalysis in children for whom those investigations are recommended. A blood culture was rarely obtained, even in patients under empirical antibiotherapy. Residents often ordered chest radiograph and urinalysis in low-risk patients, and conflicted with guidelines when considering the prescription of empirical antibiotherapy. Their management allowed the early diagnosis and treatment of two pneumococcal bacteraemias, one meningococcal bacteraemia, seven urinary tract infections and 11 pneumonias, which would have been initially missed by strict adherence to the guidelines. Conclusion: Significant differences exist in the management of the young febrile child between our practice patterns and guidelines, without influence on patient outcome. [source] Accuracy of triage nurses in predicting patient dispositionEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2007Anna Holdgate Abstract Objective:, Increasing demand to reduce patient waiting times and improve patient flow has led to the introduction of a number of strategies such as fast track and patient streaming. The triage nurse is primarily responsible for identifying suitable patients, based on prediction of likely admission or discharge. The aim of the present study was to explore the accuracy with which triage nurses predict patient disposition. Methods:, Over two separate 1-week periods, triage nurses at two urban tertiary hospitals electronically recorded in real time whether they thought each patient would be admitted or discharged. The patient's ultimate disposition (admission or discharge), age, sex, diagnostic group, triage category and time of arrival were also recorded. Results:, In total, 1342 patients were included in the study, of which 36.0% were subsequently admitted. Overall, the triage nurse correctly predicted the disposition in 75.7% of patients (95% CI: 73.2,78.0). Nurses were more accurate at predicting discharge than admission (83.3%,vs 65.1%,,P = 0.04). Triage nurses were most accurate at predicting admission in patients with higher triage categories and most accurate at predicting discharge in patients with injuries and febrile illnesses (89.6%, 95% CI: 85.6,92.6). Predicted discharge was least accurate for patients with cardiovascular disease, with 41.1% (95% CI: 26.4,57.8) of predicted discharges in this category subsequently requiring admission. Conclusion:, Triage nurses can accurately predict likely discharge in specific subgroups of ED patients. This supports the role of triage nurses in appropriately identifying patients suitable for ,fast track' or streaming. [source] Iron Status: A Possible Risk Factor for the First Febrile SeizureEPILEPSIA, Issue 7 2002Azhar S. Daoud Summary: ,Purpose: We conducted a controlled study to investigate the relation of iron status and first febrile seizure (FFS). Methods: Measures of iron sufficiency including hemoglobin concentration (HB), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and plasma ferritin (PF) were prospectively measured in 75 children with FFS and compared with 75 controls matched for age and sex with febrile illnesses without convulsions. Results: Mean ferritin level was significantly lower in cases with FFS (29.5 ± 21.3 ,g/L) than in controls (53.3 ± 37.6 ,g/L) with p = 0.0001. The proportion of subjects with a PF level ,30 ,g/L was significantly higher among children with FFS (49 of 75 vs. 24 of 75) than in controls (p = 0.000). Mean levels of HB, MCV, and MCH also were lower among FFS cases, but differences failed to attain statistical significance. A higher proportion of cases with FFS had an HB <110 g/L, MCV <72 fL, and MCH <24 pg than did the controls, but the differences were not statistically significant. There were no statistically significant differences between the cases and the controls in the mean peak temperature on admission, types of underlying illness, or family history of epilepsy and of febrile convulsion. Conclusions: PF level was significantly lower in children with FFS than in the reference group, suggesting a possible role for iron insufficiency in FFS. [source] The use of antipyretic medications in the prevention of febrile convulsions in childrenJOURNAL OF CLINICAL NURSING, Issue 4 2000Edward Purssell BSc ,,Febrile convulsions are a relatively common outcome in paediatric febrile illness, although it is not known why some children suffer these. ,,Antipyretic medications may form the basis for some treatment regimens, although they are not recommended in published guidelines. ,,There is little evidence that the prophylactic use of antipyretics has any effect in reducing the incidence of febrile convulsions. ,,Consequently, educational interventions aimed at reducing parental fear and helping them to care for their children during febrile illnesses may be more efficacious. [source] Periodic fever syndromes: a diagnostic challenge for the allergistALLERGY, Issue 12 2007M. Lierl The objective was to present a case of periodic fever with aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA), summarize the medical literature on PFAPA, review the differential diagnosis and suggest a diagnostic approach to periodic fevers in children. A PubMed search was conducted for all case reports and series of patients with PFAPA. The references of these papers yielded further case reports. Review articles or large case series were used for sources of information regarding the other periodic fever and autoinflammatory syndromes. All cases reported as PFAPA were included in the review, even though a few of the cases may not have been accurately diagnosed. The periodic fever and autoinflammatory syndromes of childhood are a group of diseases that cause repeated febrile illnesses with various associated symptoms. Except for PFAPA, each of these diseases is caused by a known genetic mutation. Effective treatment options and long-term prognosis varies among these syndromes. Children with periodic fever or autoinflammatory syndromes sometimes present to an Allergy/Immunology clinic for immunologic evaluation. It is important for the Allergy/Immunology specialist to be familiar with the clinical presentation, diagnostic approach and treatment of these conditions. [source] The effect of fever, febrile illnesses, and heat exposures on the risk of neural tube defects in a Texas-Mexico border populationBIRTH DEFECTS RESEARCH, Issue 10 2004Lucina Suarez Abstract BACKGROUND Hyperthermia produces neural tube defects (NTDs) in a variety of animal species. Elevated maternal body temperatures may also place the developing human embryo at risk. We examined the relation between maternal hyperthermia and the development of NTDs in a high-risk Mexican-American population. METHODS Case-women were Mexican-American women with NTD-affected pregnancies who resided and delivered in any of the 14 Texas counties bordering Mexico, during 1995,2000. Control-women were randomly selected from study area residents delivering normal live births, frequency-matched to cases by hospital and year. Information on maternal fevers, febrile illnesses, exposures to heat generated from external sources, and hyperthermia-inducing activities was gathered through in-person interviews, conducted about six weeks postpartum. RESULTS The risk effect (OR) associated with maternal fever in the first trimester, compared to no fever, was 2.9 (95% CI, 1.5,5.7). Women taking fever-reducing medications showed a lower risk effect (OR, 2.4; 95% CI, 1.0,5.6) than those who did not (OR, 3.8; 95% CI, 1.4,10.9). First-trimester maternal exposures to heat devices such as hot tubs, saunas, or electric blankets were associated with an OR of 3.6 (95% CI, 1.1,15.9). Small insignificant effects were observed for activities such as cooking in a hot kitchen (OR, 1.6; 95% CI, 1.0,2.6) and working or exercising in the sun (OR, 1.4; 95% CI, 0.9,2.2). CONCLUSIONS Maternal hyperthermia increases the risk for NTD-affected offspring. Women intending to become pregnant should avoid intense heat exposures, carefully monitor and manage their febrile illnesses, and routinely consume folic acid supplements. Birth Defects Research (Part A), 2004. © 2004 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||||||||