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PubMed1978

Fever and survival in rabbits infected with Pasteurella multocida.

1. Fever and survival rate of New Zealand white rabbits, injected with two doses of live Pasteurella multocida, were compared to determine if the relation between fever and survival observed in reptiles is also seen in a mammal. Since it is known that fever is beneficial in infected reptiles, our experiments were viewed as an initial step in the investigation of a similar potentially beneficial effect in mammals.2. There was a statistically significant correlation between the fever magnitude and survival. As fever increased up to 2.25 degrees C, the survival rate increased. Fevers above this level were associated with a decreased survival rate.3. Antipyretic drugs were administered to half the rabbits. The drugs were ineffective in reducing the fevers produced by injections of large doses of bacteria. Rabbits infused with antipyretics had a decreased mortality rate. The decreased mortality rate may be due to some action of the drugs other than their antipyretic effect.4. In vitro growth of P. multocida at normal (39 degrees C) and febrile (42 degrees C) temperatures was not significantly different. This suggests that the increased survival rate associated with higher fevers was not due to a direct inhibition of the growth of the bacteria by the increased temperature. It may be due to an enhancement of some aspect of the rabbits' immunological defences.5. It remains to be determined whether fever causes a higher survival rate or whether fever is only correlated with survival rate.

Animals↗
PubMed1993

Glucocorticoids alter fever and IL-6 responses to psychological stress and to lipopolysaccharide.

The purpose of this study was to determine whether glucocorticoids exert inhibitory feedback on lipopolysaccharide (LPS)-induced fever, stress-induced fever (exposure to an open field), and plasma concentrations of interleukin-6 (IL-6)-like and tumor necrosis factor-alpha (TNF)-like activity in biotelemetered rats. Injections of LPS (50 micrograms/kg) or exposure to an open field (30 min) led to significantly higher fevers in adrenalectomized (ADX) rats than in sham-ADX rats. To test the hypothesis that higher fevers were specifically the result of an absence of glucocorticoids, the glucocorticoid antagonist RU 38486 (20 mg/kg) was administered orally to rats with intact adrenal glands. The RU 38486-treated rats had higher plasma concentrations of IL-6-like activity and developed significantly higher fevers than did vehicle-treated rats. Rats injected intracerebroventricularly with 10 ng RU 38486 also developed higher fevers. Other ADX animals were implanted subcutaneously with replacement corticosterone pellets before exposure to an open field or injection with LPS. In response to an open field or injection with LPS, ADX animals implanted with replacement pellets that mimic plasma concentrations of corticosterone observed in stressed animals (100-mg pellets) developed fevers that were significantly lower than those observed in ADX rats given placebo pellets, but that were not different from fevers in sham-ADX rats given placebo pellets. ADX animals implanted with replacement pellets that mimic plasma concentrations of corticosterone observed in unstressed animals (25-mg pellets) developed fevers that were significantly higher than those observed in sham-ADX rats given placebo pellets, but that were not different from fevers in ADX rats given placebo pellets.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenalectomy↗
PubMed1985

Differences in endogenous pyrogen fevers induced by iv and icv routes in rabbits.

We have compared the characteristics of fevers produced by endogenous pyrogen administered by the intravenous (iv) and by the intracerebroventricular (icv) routes in conscious rabbits. Fevers induced by the intracerebroventricular route have a longer latency to onset, a less steep rise in body temperature, and a longer time to peak elevation in body temperature than do fevers induced by the intravenous route. Furthermore, a dose of indomethacin (2 mg/kg) administered intravenously, which is effective in markedly attenuating fevers produced by the intravenous route, was completely without effect on fevers induced by the intracerebroventricular route. On the other hand, when indomethacin (500 micrograms) was infused intracerebroventricularly, it markedly reduced fevers induced by the subsequent injection of endogenous pyrogen into the contralateral cerebral ventricle, but such pretreatment had little effect on fevers elicited by intravenous injections of endogenous pyrogen. It is concluded that the sites of action of endogenous pyrogen in response to intravenous injections of pyrogen are different from those responding to intracerebroventricular injections of pyrogen and that this is manifest in several distinct differences in the characteristics of the two fevers. These results indicate that the intracerebroventricular model of fever production is not appropriate for the study of the normal pathogenesis of fever.

Animals↗
PubMed1995

Fever in acute stroke worsens prognosis. A prospective study.

BACKGROUND AND PURPOSE: No definitive data are yet available on the effects of body temperature on neurological damage after cerebral ischemia in humans. Experimental animal models have provided much evidence, but to our knowledge, only two studies on the relationship between fever and prognosis of stroke in humans have been published. The aim of our study was to investigate the prognostic role of fever in the first 7 days of hospitalization in a cohort of patients admitted to our hospital for acute stroke. METHODS: We analyzed the data of 183 patients included in a prospective observational prognostic study. Vital status at 30 days was considered the main outcome and was obtained for all patients. Age, level of consciousness, and glycemia at the time of hospitalization were considered covariates for an exact logistic regression analysis. The maximum temperature recorded during the first 7 days dichotomized as "no or low fever" versus "high fever" was added to the model. Death within 10 days, taken as a secondary outcome suggestive of death from neurological causes, was analyzed with exact permutation tests. RESULTS: Of the 183 patients analyzed in this study, 43% had fever during the first 7 days after hospitalization. The mean value of the maximum temperature recorded during the first 7 days in the 78 febrile patients was 38.3 degrees C, and the median was 37.9 degrees C. Onset of fever occurred in only 15% of febrile patients during the first day and in 49% on the second. The prognostic roles of age, level of consciousness, and glycemia were confirmed by exact logistic regression. Degree of consciousness impairment was the strongest prognostic variable, with an odds ratio (OR) of 11.4 (95% confidence interval [CI], 4.4 to 31.6). High fever (maximum temperature recorded during the first 7 days > or = 37.9 degrees C) was an independent factor for a worse prognosis, with an OR of 3.4 (95% CI, 1.2 to 9.5). The OR of dying within 10 days versus dying between 11 and 30 days was 4.9 (95% CI, 1.2 to 25.2) in patients with high fever with respect to all other patients. CONCLUSIONS: Fever in the first 7 days was an independent predictor of poor outcome during the first month after a stroke. No data were available on the underlying causes of fever, but the higher risk of death in the first 10 days, most frequently attributed to neurological mechanisms, suggested that high temperature was an independent component of poor prognosis and not only an epiphenomenon of other complications in the course after a stroke. In agreement with animal studies, we found that patients with higher temperature had a worse stroke outcome.

Aged↗
PubMed1996

Neoplastic fever.

Neoplastic fever, that is fever arising solely as a manifestation of malignancy, is not as common as was thought but still constitutes a troublesome symptom and is difficult to manage. The mechanism of neoplastic fever production involves cytokines such as tumour necrosis factor (TNF), interleukins 1 and 6 (IL-1, IL-6) and interferon (IFN), produced either by host macrophages in response to tumour, or sometimes by the tumour itself. The cytokines stimulate production of prostaglandins which act on the hypothalamus causing a change in the thermostatic set point. This mechanism is similar to that of infective fever. Paracetamol (acetaminophen) will often only partially lyse neoplastic fever but nonsteroidal anti-inflammatory drugs have been shown to be effective. On the basis of small studies, naproxen has been proposed as a useful test to discriminate between neoplastic and infective fever. If this is so, it must be acting through a pathway hitherto undescribed and specific to neoplastic fever. Other work shows that this group of drugs effectively lyses both types of fever. Therefore larger studies are needed to confirm or refute the "Naproxen test' and neoplastic fever remains a diagnosis of exclusion. In the future, cytokine antagonists may have a role in managing neoplastic fever, but, until their actions are better understood, nonsteroidal anti-inflammatory drugs remain the medication of choice if standard antipyretics have failed.

Analgesics, Non-Narcotic↗
PubMed2006

Pontiac fever: an operational definition for epidemiological studies.

BACKGROUND: Pontiac fever is usually described in epidemic settings. Detection of Pontiac fever is a marker of an environmental contamination by Legionella and should thereby call for prevention measures in order to prevent outbreak of Legionnaire's disease. The objective of this study is to propose an operational definition of Pontiac fever that is amenable to epidemiological surveillance and investigation in a non epidemic setting. METHODS: A population of 560 elderly subjects residing in 25 nursing homes was followed during 4 months in order to assess the daily incidence of symptoms associated, in the literature, with Pontiac fever. The water and aerosol of one to 8 showers by nursing home were characterized combining conventional bacterial culture of Legionella and the Fluorescence In Situ Hybridization (FISH) technique that used oligonucleotides probes specific for Legionellaceae. A definition of Pontiac fever was devised based on clinical symptoms described in epidemic investigations and on their timing after the exposure event. The association between incidence of Pontiac fever and shower contamination levels was evaluated to test the relevance of this definition. RESULTS: The proposed definition of Pontiac fever associated the following criteria: occurrence of at least one symptom among headache, myalgia, fever and shivers, possibly associated with other 'minor' symptoms, within three days after a shower contaminated by Legionella, during a maximum of 8 days (minimum 2 days). 23 such cases occurred during the study (incidence rate: 0.125 cases per person-year [95% CI: 0.122-0.127]). A concentration of Legionella in water equal to or greater than 10(4).L(-1) (FISH method) was associated with a significant increase of incidence of Pontiac fever (p = 0.04). CONCLUSION: Once validated in other settings, the proposed definition of Pontiac fever might be used to develop epidemiological surveillance and help draw attention on sources of Legionella.

Aerosols↗
PubMed1993

Recurrent fever associated with progesterone action and persistently elevated serum levels of immunoreactive tumor necrosis factor-alpha and interleukin-6.

We describe two women who suffer from recurrent fever up to 40 C in association with progesterone action and who have continuously elevated serum levels of immunoreactive tumor necrosis factor-alpha (TNF alpha) and interleukin-6 (IL-6). In patient 1, recurrent fever began at age 17 yr and has now continued for 11 yr. The patient has had three early pregnancy terminations because of continuous fever and, thereafter, three early pregnancy losses associated with fever. In patient 2, fever first appeared at age 18 yr, and the attacks have now continued for 3 yr. The association between fever and progesterone action is supported by the following facts. 1) The episodes of fever appear in the midluteal phase of the menstrual cycle concomitantly with the highest concentration of serum progesterone. 2) Fever is further exaggerated in early pregnancy. 3) Synthetic progestins induce fever regardless of the day of the menstrual cycle. 4) The progesterone antagonist RU 486 and an agonist of GnRH, nafarelin, are capable of preventing the fever, with no effect on serum cytokine levels. Although the underlying mechanism of elevated TNF alpha and IL-6 levels in our patients remains unknown, the data suggest that these cytokines cooperate with progesterone in exerting a pyrogenic response in the hypothalamic thermoregulatory center.

Acute-Phase Proteins↗
PubMed2004

Prospective analysis of clinical characteristics and risk factors of postbronchoscopy fever.

STUDY OBJECTIVES: To assess the clinical characteristics of fever after fiberoptic bronchoscopy (FOB) and to identify the independent risk factors of postbronchoscopy fever. STUDY DESIGN: Prospective study. SETTING: Tertiary care university hospital. STUDY SUBJECTS: Immunocompetent adults undergoing FOB between July 2001 and April 2002. MEASUREMENTS AND RESULTS: Five hundred eighteen adults were included in this study. The incidence of postbronchoscopy fever was 5%, and the mean onset time of the fever was 8.7 +/- 1.1 h after FOB (mean +/- SEM). In most cases, the fever subsided spontaneously within a day, with a mean fever duration of 14.0 +/- 3.1 h. No organisms were isolated from blood culture specimens drawn at the time of fever, although significant increases in total leukocytes and neutrophil counts were observed in the peripheral blood at the time of fever compared to levels prior to FOB. Univariate analysis showed that fever was related to multiple factors, such as the radiologic extent of involvement, consolidation, abnormal bronchoscopic findings, biopsy, lavage, the amount of saline solution or drug administered, the duration of the procedure, the severity of bleeding, and a final diagnosis of pulmonary tuberculosis. However, after multivariate analysis, the final diagnosis of pulmonary tuberculosis and the severity of bleeding were identified as independent risk factors. CONCLUSIONS: Fever after FOB occurs relatively frequently but transiently in immunocompetent adults. Independent risk factors for the development of this complication seem to be related to the diagnosis of pulmonary tuberculosis and the severity of bleeding during FOB.

Bronchoscopy↗
PubMedDate not supplied

Aetiology of prolonged fever in antiretroviral-naïve human immunodeficiency virus-infected adults.

BACKGROUND: Prolonged fever is a common symptom among human immunodeficiency virus (HIV) infected individuals, and is usually due to a cause that is easily treatable. Limited data are available regarding the causes of fever in HIV-infected Indian patients. In this paper, we have profiled the causes of prolonged fever in a cohort of HIV-infected Indian patients and have developed suitable algorithms to assist in an early diagnosis. METHODS: From February 1997 to October 1998 (20 months), 100 HIV-infected patients (age > 12 years) were evaluated for 100 episodes of prolonged fever (fever > 100 degrees F for more than 2 weeks in outpatients and > 3 days in inpatients). Patients with terminal acquired immunodeficiency syndrome (AIDS) were excluded. Patients were evaluated on the basis of the symptoms associated with prolonged fever and investigated according to pre-existing algorithms. RESULTS: Among such episodes of fever, infection was the major cause and included tuberculosis, especially the extra-pulmonary and disseminated forms (69%), cryptococcosis (10%) and Pneumocystis carinii pneumonia (7%). Other causes included bacterial pneumonia, amoebic liver abscess, disseminated histoplasmosis and cerebral toxoplasmosis. Patients were naïve for antiretroviral therapy and did not receive prophylaxis for opportunistic infections. The diagnostic yield of ultrasound of the abdomen (85%), fine-needle aspiration cytology of enlarged lymph nodes (75.6%) and bone marrow trephine biopsy (41.6%) were found to be high in our study. CONCLUSIONS: Tuberculosis is the commonest cause of prolonged fever in HIV-infected adults in India. Non-infectious causes were not seen in this series. We have suggested an algorithmic approach for establishing the cause of fever in these patients. In situations where laboratory evaluation does not reveal a cause for prolonged fever, a therapeutic trial with antituberculous therapy in selected patients is justified.

AIDS-Related Opportunistic Infections↗
PubMed2005

Concurrent malaria and enteric fever in Pakistan.

INTRODUCTION: The precise incidence of concurrent malaria and enteric fever in most geographical areas is largely unknown, and no data on such an association exists in Asia. Because both malaria and enteric fever are hyperendemic in Pakistan, we sought to determine the frequency, epidemiology, and clinical and laboratory features of dual malaria and enteric fever in a tertiary care setting. METHODS: We conducted a retrospective case-control study of 1,891 patients hospitalised with malaria over a ten-year period and identified 21 patients with concurrent culture-proven enteric fever. RESULTS: Cases with dual infection had significantly more gastrointestinal symptoms at the time of admission, including nausea, vomiting, abdominal pain, and/or diarrhoea compared to matched control subjects with uncomplicated malaria (p-value is less than 0.006). Cases were more likely to have a continuous rather than intermittent fever (p-value is less than 0.0001), delayed defervescence in response to antimalarial treatment (p-value is less than 0.006), normal or low white blood cell counts (p-value is less than 0.04), relatively higher platelet counts among cases versus control (p-value is less than 0.05) and serum haemoglobin (p-value is less than 0.06), elevated alanine aminotransferase levels (p-value is less than 0.02), and a prolonged hospital stay (p-value is less than 0.03). The negative predictive values for gastrointestinal symptoms, continuous fever pattern and delayed defervescence were 80 percent, 72 percent and 74 percent, respectively. CONCLUSION: Patients with malaria who have marked gastrointestinal symptoms, continuous pattern of fever and persistence of fever for more than 24 hours after appropriate antimalarial therapy, should be investigated or empirically treated for concurrent enteric fever. The absence of the above clinical features in patients with uncomplicated malaria should reassure physicians that there is no concurrent typhoid fever.

Adolescent↗
PubMed2005

Relationship between HLA-DR, HLA-DQ alleles and MEFV gene mutations in familial Mediterranean fever (FMF) patients.

BACKGROUND/AIMS: Three missense mutations clustered on the carboxyl-terminal portion of the MEFV gene (M680I, M694V, and V726A) have been observed in over 80% of affected alleles in several ethnic groups of familial Mediterranean fever patients. Several immunologic abnormalities were found both in cellular and humoral components in Mediterranean fever patients. Those observations have pointed the way for analysis of the HLA region in Mediterranean fever. We intended to compare HLA DR/DQ alleles with those major mutations in the MEFV gene in Mediterranean fever patients. METHODS: The distribution of MEFV gene mutations and HLA-DR, HLA-DQ alleles were analyzed in 40 index Turkish Mediterranean fever patients, 28 family members and 42 healthy controls. M680I, M694V, and V726A mutations were studied by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) analysis. HLA-DR and DQ allele subgroups were studied using SSP-PCR technique. RESULTS: A total of 37 (92.5%) patients in 40 Mediterranean fever index patients were found to carry one of the three missense mutations. The HLA-DR4 allele frequency was significantly higher in the Mediterranean fever patient group. When comparisons were made between Mediterranean fever mutations and HLA allele frequencies, M694V mutation with HLA DR3, DR11/5 and DR 13/6 and M680I mutation with DR7 allele subgroups were statistically significant. DQ6/1, DQ7/3, and DQ8/3 allele with M694V, DQ2 allele with M680I, and DQ6/1 with V726A mutations were also statistically significant. CONCLUSIONS: Our results indicate a relationship between some HLA-DR/DQ alleles and MEFV mutations in Mediterranean fever patients. We suggest HLA-DR/DQ alleles and their role in the pathogenesis of Mediterranean fever need further analysis and comparative studies.

Alleles↗
PubMed2006

Clinical and epidemiological features of hospitalized acute Q fever cases from Split-Dalmatia County (Croatia), 1985-2002.

BACKGROUND: Q fever shows a wide diversity of clinical manifestation. Q fever is endemic in northern Croatia, but the epidemiological and clinical characteristics of this disease in various ecological areas of southern Croatia are unclear. MATERIAL/METHODS: From January 1985 to December 2002, acute Q fever cases hospitalized at Split University Hospital were analyzed. Acute Q fever was defined as fever (>38 degrees C) with clinical findings in lung and/or liver verified by serologic testing with Coxiella burnetii phase II antigen. RESULTS: During the period of observation, 155 acute Q fever cases were hospitalized. The mean incidence of acute Q fever in the study region was 0.20/100,000/year (95%CI:0-0.78) in the coastal area and 4.64/100,000/year (95%CI:0.44-8.85) in the non-coastal areas, with a male predominance (chi2=60.0; p=0.0000) and a mean male to female ratio of 4.2:1. People of essentially all ages (4-76 years) were affected, the highest rate of infection being recorded in 20- to 49-year-old age groups. In contrast to adults, girls were more frequently affected than boys (2:1). No case of acute Q fever was recorded on any of the nearby islands. Clinically, acute Q fever most commonly presented with both pneumonia and hepatitis (60.0%), followed by pneumonia (25.8%), hepatitis (9.0%), and nonspecific febrile illnesses (5.2%). CONCLUSIONS: C. burnetii is endemic in rural, coastal, and non-coastal areas of southern Croatia and is associated with stock breeding. In these areas, Q fever occurs sporadically and epidemically. Males 20-49 years of age were the prevalent cases.

Acute Disease↗
PubMed1988

Fever and acute phase reactants in the rat.

In rats synthesis of some acute phase reactants can be induced by a combination of corticosteroids and adrenaline. During fever both hormones show high plasma levels. We studied the effect of fever induced by intra-cerebroventricular (i.c.v.) injection of PGE2 on the acute phase response. Fever was continuously recorded and 24 h after induction acute phase reactant (APR) response was measured as indicated by the rise of alpha-macrofetoprotein (alpha M FP, alpha 2 macroglobulin of the rat). Controls received 0.9% saline i.c.v. Controls did not develop fever (dTmax less than or equal to 1 degree C) nor did they show significant APR response. The maximal rise in body temperature after PGE2 (2.6 +/- 0.7 degrees C) correlated significantly with the rise in alpha M FP concentration 24 h later. Adrenalectomy prevented the APR response completely but the magnitude of the fever reaction remained the same (2.1 +/- 0.3 degrees C). alpha-Blockade gave a smaller fever response but had no effect on the APR response. In alpha- and beta-blockade, fever response was normal but no APR response was obtained. Destroying the sympathetic nerve supply to the liver with 6-OH dopamine retarded the fever response but again APR response was not impeded. In order to differentiate between the role of fever as such and the effect of PGE2 on APR synthesis, we used heat exposure to induce hyperthermia in normal rats who showed an APR response comparable with that after i.c.v. PGE2. Pretreatment with sodium salicylate before inducing hyperthermia led to a variable rise in alpha M FP. Fever as such, without tissue injury, induces an APR response. The pathway to this effect probably involves circulating corticosterone and adrenaline, possibly via a beta-receptor mediated stimulation.

Acute-Phase Proteins↗
PubMed1989

Fever characteristics in tuberculosis--clinical observation in 597 cases.

Fever characteristics were analyzed in 597 cases of tuberculosis diagnosed by positive culture for mycobacteria tuberculosis admitted to Chang Gung Memorial Hospital between March 1984 and February 1986. Among them, fever was noted in 356 cases (60.0%). Several factors were predisposing to the absence of fever: having a past history of tuberculosis (p less than or equal to 0.01), having a limited lung lesion (p less than 0.05), having an infection with isoniazide (INH) resistant strain (p less than 0.05). Fever typically developed in the late afternoon or evening in 66% of the cases, and this typical fever was significantly more common in patients less 60 years of age (p less than 0.05). The fever was low grade (less than 38.5 degrees C) in 59% of the cases. Among the 137 cases whose fever courses were completely monitored in the hospital, there were 30 cases (22%) whose fever subsided within 3 days after the start of antituberculous chemotherapy, 102 cases (74%) within 1 week and 128 cases (93%) within 2 weeks. Fever resolved within 4 weeks in all but one patient. There was no clinical factor predisposing to the delay of time for the fever to resolve including sex, age, immunocompromised condition, having a past history of tuberculosis, the infectious site(s) of tuberculosis, the extent of pulmonary involvement, the presence of cavitation in pulmonary involvement, and infection with resistant strains.

Adult↗
PubMed1993

Fever among outpatients with advanced human immunodeficiency virus infection.

BACKGROUND: Fever is common among persons with human immunodeficiency virus (HIV) infection. However, the clinical implications of fever in this population have not been evaluated. We therefore undertook a prospective study of fever in persons with advanced HIV infection to determine the incidence and etiology of fever in this patient group. METHODS: Prospective natural history study of 176 patients with advanced HIV infection followed up at Memorial Sloan-Kettering Cancer Center, New York, NY, from April 1, 1990, through December 31, 1990. RESULTS: Fever occurred in 46% of patients. A diagnosis was made in 83% of episodes, with acquired immunodeficiency virus-defining illnesses accounting for half of the diagnosed cases. Patients whose conditions required more than 2 weeks to diagnose most often had lymphoma, Mycobacterium avium-intracellulare bacteremia, or Pneumocystis carinii pneumonia. Four patients had persistent unexplained fever without a clear source. Only one patient had fever that clearly responded to antiretroviral therapy. CONCLUSIONS: Fever is common among outpatients with advanced HIV infection. Human immunodeficiency virus itself is rarely the cause of fever in such patients; the cause of the fever should be thoroughly evaluated.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Fever of unknown origin in patients infected with the human immunodeficiency virus].

BACKGROUND: To describe the clinical features and the final diagnosis of patients infected with human immunodeficiency virus who presented fever of unknown origin. METHODS: Retrospective study, from November 1989 to January 1994, of all patients infected with HIV who had fever of unknown origin and who were admitted to a community hospital in a Mediterranean area in Alicante (Spain). Fever of unknown origin was defined as fever exceeding 38.3 degrees C lasting for at least three weeks with no diagnosis in the first three days of hospitalization after fulfilling clinical exam, three blood cultures, acid-fast bacilli stain in sputum and chest-X-ray. RESULTS: Of a cohort of 231 patients, 27 (12%) were evaluated because of fever of unknown origin during their follow-up. Patients' mean age was 31 years (interval, 22-75) and intravenous drug use (81%) was the most common risk factor for HIV infection. A total of 31 episodes of fever of unknown origin were reviewed. Twenty-three (74%) episodes occurred in patients with less than 200 CD4 lymphocytes/mm3. A final diagnosis of fever of unknown origin was achieved in 24 (77%) episodes: visceral leishmaniasis (n = 11), tuberculosis (n = 9), non-Hodgkin's lymphoma (n = 1), CNS toxoplasmosis (n = 1), cryptococcal meningitis (n = 1) and drug adverse reaction (n = 1). CONCLUSIONS: HIV-infected patients with fever of unknown origin very often show severe immunodeficiency. Cryptococcal antigen testing should be carried out in the initial evaluation of fever of unknown origin in HIV-infected patients. In our area, 64% of episodes of fever of unknown origin were caused by visceral leishmaniasis or tuberculosis.

Adult↗
PubMedDate not supplied

Imported viral haemorrhagic fever with a potential for person-to-person transmission: review and recommendations for initial management of a suspected case in Belgium.

Viral haemorrhagic fevers are caused by a wide range of viruses. There are 4 types of viruses well known to spread from person to person and able to cause nosocomial outbreaks with a high case fatality rate: an arenavirus (Lassa fever and more exceptionally the Junin and Machupo virus), a bunyavirus (Crimean-Congo haemorrhagic fever) and the Filoviridae (Ebola and Marburg viruses). So far there have been only a limited number of imported cases of viral haemorrhagic fever in industrialized countries. In recent years an increasing number of outbreaks of filovirus infections have occurred in Africa and in 2000 5 cases of Lassa fever were brought from Sierra Leone to Europe. Therefore European physicians should consider the possibility of a viral haemorrhagic fever in an acutely ill patient just returning from Africa or South-America with fever for which there is no obvious cause. Such patients should be questioned for risk factors for viral haemorrhagic fever. Using universal precautions for handling blood and body fluids and barrier nursing techniques there is little risk that if a patient with viral haemorrhagic fever arrives in Belgium there will be secondary cases.

Belgium↗
PubMed2001

Perinatal risk factors for hay fever--a study among 2550 Finnish twin families.

Previous studies have suggested that perinatal factors influence the risk for asthma but population studies on perinatal factors and risk for hay fever are few. We studied the effect of perinatal factors on the risk for hay fever among adolescent twins by a questionnaire study involving five consecutive nation-wide birth cohorts of 16-year-old twins and their parents. The risk for parent-reported, doctor-diagnosed hay fever in the adolescents associated with several perinatal characteristics was assessed with logistic regression analysis among individuals and by a discordant pair analysis. In the univariate analysis of the birth factors, the risk for hay fever increased with increasing birth weight (p for trend = 0.048, OR for those > or = 3000 g 1.35, 95% CI 0.91-2.02 compared to those < 2000 g) and gestational age (p for trend = 0.04, OR for those born after 40 weeks of gestation 2.24, 95% CI 1.03-4.86, compared to those born before 33 weeks of gestation) and was lower in those subjects hospitalised in the neonatal period (OR 0.74, 95% CI 0.58-0.93). Because of significant interactions between parental hay fever status and birth factors (ponderal index, p = 0.03 and maternal age p = 0.04), stratified analysis were performed. The positive association between birth weight and hay fever was most obvious among adolescents with no parental history of hay fever (p for trend = 0.03). Similar, though not significant, trends were found with other birth factors among these families, whereas no such trend was found among adolescents with parental hay fever, suggesting that gestational maturity increases the risk for hay fever in the absence of genetic predisposition. However, of the perinatal factors only neonatal hospitalisation (OR 0.75, 95% CI 0.59-0.96) remained a significant risk factor for the development of hay fever, when adjusted for non-perinatal factors.

Adolescent↗