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PubMed1990

Yellow fever haemagglutination-inhibiting, neutralising and IgM antibodies in vaccinated and unvaccinated residents of Ibadan, Nigeria.

A survey for yellow fever virus haemagglutination inhibiting (HI) and neutralising (N) and IgM antibodies was carried out in unvaccinated people in Ibadan and in those immunised with the yellow fever 17-D vaccine. A total of 207 people were tested for HI antibody to yellow fever and two other flaviviruses namely: Wesselsbron and Uganda S. viruses. Prevalence of HI antibody to each flavivirus antigen was as follows: Yellow fever 26%, Wesselsbron 18% and Uganda S 33%. Of the 207 people, 37 (18%) had yellow fever N antibody. There was a higher prevalence of N antibody to yellow fever virus in adults than children. Twenty-one people vaccinated with 17-D yellow fever vaccine donated post-vaccination sera; 10 (48%) had no prevaccination HI antibody, 7 (33%) had HI antibody to one flavivirus and 4 (19%) to two or more flaviviruses. Ninety percent of seronegative people and all those with prevaccination flavivirus antibodies developed HI or N antibody, following vaccination. A total of 58 unvaccinated people were tested for yellow fever IgM antibody by an enzyme linked immunosorbent assay, 2 (3%) were positive; suggesting that active yellow fever transmission was in progress at the time of survey.

Adolescent↗

PubMed1982

[Recurrent fever of unknown etiology lasting more than 6 months. Report on 85 patients].

85 patients having recurrent fever of unclarified aetiology of more than 38.5 degrees C for more than 6 months were examined in a prospective study. Of these, 10 had an inflammation due to pathogens, 12 a malignant disease, 15 a collagenous or inflammatory vascular disease, while 9 had various diseases, 5 a familial Mediterranean fever and 18 a "periodic fever". In 16 patients, in most of whom the course of the disease extended over several years, the cause of the fever could not be clarified. Among the patients with polycyclic fever over many years or decades, alternating with symptom-free intervals, one can differentiate especially the systemic Still's syndrome, which also occurs in adults and which is identical with the so-called subsepsis allergica, the familial Mediterranean fever and the "periodic fever". There are no satisfactory pointers towards the existence of a relapsing fever of its own caused by an increase of unconjugated aetiocholanolone in the plasma ("aetiocholanolone fever").

Adolescent↗

PubMed1998

The hereditary periodic fever syndromes: molecular analysis of a new family of inflammatory diseases.

The hereditary periodic fever syndromes are a group of Mendelian disorders characterized by episodic fever and serosal or synovial inflammation. Familial Mediterranean fever (FMF) and the hyperimmunoglobulinemia D and periodic fever syndrome are both recessively inherited, while three dominantly inherited syndromes have been described, the best-characterized of which is familial Hibernian fever (FHF). The last year has seen two major developments in this field: the FMF gene was identified on chromosome 16p by positional cloning, and a second major periodic fever locus was mapped to distal chromosome 12p. The FMF gene (MEFV) encodes a novel 781 amino acid protein; to date, eight different missense mutations and a number of polymorphisms have been described. Seven of the eight mutations occur within a region of 82 amino acids near the C-terminus. Computational analysis of the conceptual protein reveals five different domains/motifs compatible with a nuclear effector function. MEFV is expressed preferentially in granulocytes and myeloid bone marrow precursors, giving rise to speculation that the protein may serve as a transcriptional regulator of inflammation in granulocytes. The second periodic fever locus was mapped by two different groups: one studying FHF, the other studying a similar dominantly inherited syndrome designated familial periodic fever. Both genes map to the same 19 cM region on distal chromosome 12p, strongly suggesting a common locus. The molecular characterization of the periodic fever genes should provide important new insights into the regulation of inflammation in general.

Amino Acid Sequence↗

PubMed2007

Fever after a stay in the tropics: diagnostic predictors of the leading tropical conditions.

Differential diagnosis of fever in travelers returning from the tropics is extremely diverse. Apart from the travel destination, other diagnostic predictors of tropical infections are poorly documented in returning travelers. From April 2000 to December 2005, we prospectively enrolled all patients presenting at our referral centers with fever within 1 year after visiting a tropical or subtropical area. For clinical relevance, the diagnostic predictors of the leading tropical conditions were particularly investigated in the febrile episodes occurring during travel or within 1 month after return (defined as early-onset fever). In total, 2071 fever episodes were included, occurring in 1962 patients. Most patients were western travelers (60%) or expatriates (15%). Regions of exposure were mainly sub-Saharan Africa (68%) and southern Asia/Pacific (14%). Early-onset fever accounted for 1619 episodes (78%). Most tropical infections were related to specific travel destinations. Malaria (mainly Plasmodium falciparum) was strongly predicted by the following features: enlarged spleen, thrombocytopenia (platelet count <150 x 10(3)/microL), fever without localizing symptoms, and hyperbilirubinemia (total bilirubin level >or=1.3 mg/dL). When malaria had been ruled out, main predictors were skin rash and skin ulcer for rickettsial infection (mainly African tick bite fever); skin rash, thrombocytopenia, and leukopenia (leukocyte count <4 x 10(3)/microL) for dengue; eosinophil count >or=0.5 x 10(3)/microL for acute schistosomiasis; and enlarged spleen and elevated alanine aminotransferase level (>or=70 IU/L) for enteric fever. The initial clinical and laboratory assessment can help in selecting appropriate investigations and empiric treatments for patients with imported fever.

Adult↗

PubMed1993

Should yellow fever vaccine be included in the expanded program of immunization in Africa? A cost-effectiveness analysis for Nigeria.

The cost-effectiveness of preventive yellow fever vaccination versus emergency mass vaccination campaigns for epidemic control remains a matter of controversy. Until recently, Nigeria and other anglophone countries in West Africa most severely afflicted by yellow fever epidemics have followed a policy of emergency control. The effects of including yellow fever 17D vaccine in the Expanded Program of Immunization (EPI) on the immune status of the Nigerian population was studied under conservative assumptions of vaccine coverage and efficacy. The model defined the age-specific prevalence of immunity resulting from vaccination of infants and from natural endemic infection beginning in 1991 and extending over a time horizon of 35 years. The data were used to predict the number of cases and deaths during hypothetical epidemics in 2006 and 2026, representing the historic periodicity of epidemics. A second model was used to demonstrate that a > or = 60% prevalence of immunity would preclude epidemic yellow fever transmission; under base case assumptions, this prevalence would be reached after 18 years of initiating routine yellow fever vaccination in the Guinea savannah zone, the region most often affected by epidemics. Using assumptions based on data from other African countries, the cost of adding yellow fever vaccine to the existing EPI was estimated as +0.65 per fully immunized child, whereas the cost of emergency vaccination in the face of an epidemic was estimated as +7.84/person. Vaccine coverage rates achievable by the EPI were modeled on recent successes with measles vaccine, and began in 1991 at 60%. The effective vaccine coverage rate in an emergency campaign was taken as 10%, based on recent experience. For an epidemic of moderate size in 2006 (morbidity similar to the documented outbreak in 1987), the cost-effectiveness of emergency mass immunization for control of hypothetical yellow fever epidemics was two-fold higher ($381/case and $1,904/death prevented) than that of the EPI ($763/case and $3,817/death prevented). However, despite its higher cost, the efficiency of the EPI was seven-fold greater in terms of cases and deaths prevented. In large epidemics, such as that occurring over successive years (1986-1991) in Nigeria, cost-effectiveness of the EPI exceeded that of emergency control. The EPI may also play an important role in the prevention of endemic yellow fever. Assuming annual rates of endemic yellow fever predicted by serologic surveys, routine vaccination would significantly reduce morbidity and mortality at cost-effectiveness ratios within the range for other diseases prevented by the EPI, including polio, tetanus, and diphtheria.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed2004

Changing characteristics of typhoid fever in Taiwan.

Typhoid fever, a systemic disease caused by Salmonella typhi, is classically characterized by fever and abdominal symptoms. Although now considered uncommon, it seems to have re-emerged in Taiwan in recent years. We conducted a retrospective study of the clinical characteristics and microbiologic findings in 24 confirmed cases of typhoid fever treated over a 7-year period at a medical center in northern Taiwan. There were 11 males and 13 females, including 15 adults (over 18 years in age) and 9 children. Their mean age was 24.7 years (range, 9 months to 58 years). Twelve patients had recently returned from abroad, mostly from Southeast Asia. The most common complaints were fever (24/24), diarrhea (18/24), abdominal pain (10/24), and cough (10/24). The average duration of fever before diagnosis was 14.1 days, with a maximum of 30 days. Relative bradycardia was noted in 6 patients. Leukopenia was noted in 2 patients. S. typhi was isolated from blood culture in 20 cases, from stool culture in 3 cases, and from bone marrow culture in 1 case. Widal test was only positive initially in 7/18 cases. Fever of unknown origin was the most common initial diagnosis. Typhoid or enteric fever was impressed initially in only 2 cases. Almost all isolates of S. typhi were susceptible to antibiotics currently used for typhoid fever, with only 1 isolate resistant to chloramphenicol. All patients survived after antibiotic treatment. Only 1 patient developed recurrence after a 10-day course of ceftriaxone. In conclusion, the diagnosis of typhoid fever is often challenging due to non-specific symptoms and lack of an immediate confirmatory test. It is important to include this disease in the differential diagnosis of febrile patients with abdominal symptoms.

Abdominal Pain↗

PubMedDate not supplied

[Adenosine deaminase in typhoid fever and other febrile diseases].

The contribution of serum adenosine deaminase (ADA) activity to the diagnosis of typhoid fever was assessed in 246 children and in 46 adults, by Giusti's original technique. Children included otherwise healthy patients admitted for elective surgical conditions or under follow up for epilepsy which were considered to be a control group (n: 81), presumptive viral diseases (n: 31), miscellaneous febrile diseases except for typhoid fever (n: 41), different kinds of bacteremia (n: 6), diarrhea due to Salmonella typhimurium (n: 14), viral hepatitis (n: 24), and culture proven typhoid fever (n: 49). Adult's group included 39 healthy controls and 7 patients with culture proven typhoid fever. Among children mean ADA activity was as follows: control group 28 +/- 7.8, viral disease 35.3 +/- 13.1, miscellaneous febrile disease 36.1 +/- 15.6, bacteremia group: 30.3 +/- 10.3, salmonellosis group 51.6 +/- 9, hepatitis group 68.3 +/- 34.5, typhoid fever group 124.4 +/- 40.8 U/I 37 degrees C. Among adults, values were 18.4 +/- 7.5 for controls and 112.8 +/- 19.2 U/I 37 degrees C in typhoid fever patients. In both adults and children ADA activity was significantly higher in the typhoid fever group (p < 0.0001). Untreated typhoid fever patients had their higher ADA activity between 10th and 15th day of illness. When ADA cut point was set at 80 U/I, sensitivity of the test was 91.8% and specificity was 91.4% as a preliminary clue to the recognition of typhoid fever.

Adenosine Deaminase↗

PubMed1996

Yellow fever: a decade of reemergence.

Since the 1980s, yellow fever has reemerged across Africa and in South America. The total of 18 735 yellow fever cases and 4522 deaths reported from 1987 to 1991 represents the greatest amount of yellow fever activity reported to the World Health Organization (WHO) for any 5-year period since 1948. There is an excellent vaccine against yellow fever. At present, a high proportion of travelers to at-risk areas are reported to be immunized, reflecting widespread knowledge about the International Health Regulations. In South America, yellow fever remains an occupational hazard for forest workers, who should be immunized. However, Aedes aegypti mosquitoes are now present in urban areas in the Americas (including southern parts of the United States), and there is concern that yellow fever could erupt in explosive outbreaks. In Africa, a large proportion of cases have occurred in children. The WHO, the United Nations Children's Fund (UNICEF), and the World Bank have recommended that 33 African countries at risk for yellow fever add the vaccine to the routine Expanded Programme on Immunization; studies show that this would be highly cost-effective. To date, financing yellow fever vaccine has been a major problem for these countries, which are among the poorest in the world. For this reason, WHO has launched an appeal to raise $70 million for yellow fever control in Africa.

Africa↗

PubMed2003

Influence of fever on the hypermetabolic response in burn-injured children.

BACKGROUND: Burn injury typically elicits a hypermetabolic response characterized by increased energy expenditure and muscle protein catabolism. HYPOTHESIS: Fever further increases energy expenditure and muscle loss in otherwise highly hypermetabolic burn patients. DESIGN: Retrospective analysis of experimental study. SETTING: University hospital. PATIENTS: Eighty-four children (aged 2-18 years) with burns covering 40% or more of total body surface area. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Simultaneous measurements of indirect calorimetry and leg net balance of phenylalanine (as an index of muscle protein catabolism) were obtained. Patients were stratified by their rectal temperature taken at the time of these metabolic measurements: afebrile (n = 28; temperature, <39.0 degrees C); mild fever (n = 26; temperature, 39.0 degrees C-39.4 degrees C); moderate fever (n = 18; temperature, 39.5 degrees C-39.9 degrees C); or severe fever (n = 12; temperature, > or =40.0 degrees C). RESULTS: Febrile and afebrile patients were similar in age, body weight, and extent of burn area. Severe fever was associated with significantly increased resting energy expenditure (mean +/- SD resting energy expenditure-predicted basal, 1.38 +/- 0.39 for afebrile patients vs 1.68 +/- 0.30 for patients with severe fever; P<.05) and a greater net loss of phenylalanine from the leg (net balance of phenylalanine, -6.0 +/- 6.2 mg/min per 100 mL of leg volume for afebrile patients vs -10.8 +/- 7.2 mg/min per 100 mL for patients with severe fever; P<.05). Patient groups were similar in plasma glucose concentration and extent of leukocytosis. CONCLUSIONS: These findings demonstrate the association of severe fever with further increase in energy expenditure and muscle protein catabolism in otherwise hypermetabolic burned children. This suggests a possible metabolic benefit in attenuating fever in such patients.

Body Temperature↗

PubMed1985

Absence of correlation between liver metastases and unexplained fever episodes.

An accepted, although debatable explanation for fever of unexplained origin (FUO) in cancer patients is the presence of liver metastases. This controlled study was aimed to determine whether FUO is more common in patients with liver metastases (Group A) as compared to those without evidence of spread to the liver (Group B). One hundred forty-five patients were studied in each group. Fever of unknown origin was experienced by 45 patients of Group A (31%) and 39 of Group B (26.9%). The duration and the fever characteristics were comparable in both groups. There was no relationship between the extent of the liver metastases and the incidence of FUO. That FUO was not caused by the presence of liver metastases per se, is deduced also from the remission of fever in 18 preoperative episodes after the resection of the primary tumor only, in spite of the persistence of the liver metastases. The type of fever and its duration was similar in patients with or without liver metastases. Thirteen severe infectious conditions were missed by the premature adoption of the convenient diagnosis of "fever due to liver metastases." Indomethacin, administered to normalize the fever incorrectly attributed to the liver metastases, obscured four of the above infectious conditions, with a fatal outcome. The authors conclude that the existence of "fever due to liver metastases" as an entity is not supported by the current study, and that the premature adoption of this diagnosis further compromised the outcome of patients with liver metastases and unexplained fever.

Adrenal Cortex Hormones↗

PubMed2002

Penicillin for secondary prevention of rheumatic fever.

BACKGROUND: People with a history of rheumatic fever are at high risk of recurrent attacks of rheumatic fever and developing rheumatic heart disease following a streptococcal throat infection. Giving penicillin to these people can prevent recurrent attacks of rheumatic fever and subsequent rheumatic heart disease. However, there is no agreement on the most effective method of giving penicillin. OBJECTIVES: To assess the effects of penicillin compared to placebo and the effects of different penicillin regimens and formulations for preventing streptococcal infection and rheumatic fever recurrence. SEARCH STRATEGY: We searched the Controlled Trials Register (Cochrane Library Issue 2, 2001), MEDLINE (1997 to July 2000), EMBASE (1998 to July 2000), reference lists of articles and we contacted experts in the field. SELECTION CRITERIA: Randomised and quasi-randomised studies comparing (i) penicillin with control, (ii) oral with intramuscular penicillin (iii) 2- or 3-weekly with 4-weekly intramuscular penicillin in patients with previous rheumatic fever. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Nine studies were included (n=3008). Data were not pooled because of heterogeneity. Overall, the methodological quality of included studies was poor. Three trials (n= 1301) compared penicillin with control. Only one of three studies showed that penicillin reduced rheumatic fever recurrence (RR 0.45, 95% CI 0.22 to 0.92) and streptococcal throat infection (RR 0.84, 95% CI 0.72 to 0.97). Four trials (n=1098) compared intramuscular with oral penicillin and all showed that intramuscular penicillin reduced rheumatic fever recurrence and streptococcal throat infections compared to oral penicillin. One trial (n= 360) compared 2-weekly with 4-weekly intramuscular penicillin. Penicillin given every two-weeks was better at reducing rheumatic fever recurrence (RR 0.52, 95% CI 0.33 to 0.83) and streptococcal throat infections (RR 0.60, 95% CI 0.42 to 0.85). One trial (n= 249) showed 3-weekly intramuscular penicillin injections reduced streptococcal throat infections (RR 0.67, 95% CI 0.48 to 0.92) compared to 4-weekly intramuscular penicillin. REVIEWER'S CONCLUSIONS: Intramuscular penicillin seemed to be more effective than oral penicillin in preventing rheumatic fever recurrence and streptococcal throat infections. Two-weekly or 3-weekly injections appeared to be more effective than 4-weekly injections. However, the evidence is based on poor quality of trials.

Administration, Oral↗

PubMed2004

Fever in biopsy-proven giant cell arteritis: clinical implications in a defined population.

OBJECTIVE: To assess the frequency and clinical features of biopsy-proven giant cell arteritis (GCA) patients who had fever at the time of diagnosis of the disease, and the relationship between fever, ischemic complications, and the systemic inflammatory response in GCA. METHODS: A retrospective study of biopsy-proven GCA patients diagnosed between 1981 and 2001 was performed at the single referral hospital for a well-defined population in the Lugo region of northwest Spain. Patients were considered as having fever if the axillary temperature at the time of admission or during the followup prior to the onset of corticosteroid therapy was > or =38 degrees C. RESULTS: During the period of study, 21 (10%) of the 210 biopsy-proven GCA patients had fever. Two of them fulfilled criteria for fever of unknown origin. Patients with fever had a lower frequency of severe ischemic manifestations than the rest of biopsy-proven GCA patients. They also exhibited a more severe inflammatory disease, with significant abnormality in most laboratory variables, including higher elevation of erythrocyte sedimentation rate, lower values of hemoglobin, and higher proportion of patients with increased alkaline phosphatase. By logistic regression analysis, we observed that patients with fever had an increased risk of developing anemia (odds ratio [OR] 12.24). In contrast, a negative association between severe ischemic manifestations and fever was found (OR 0.41). CONCLUSION: Biopsy-proven GCA patients with fever constitute a subgroup of patients with more severe inflammatory response and less ischemic disease.

Aged↗

PubMedDate not supplied

Humoral immune response during filarial fever in Bancroftian filariasis.

Humoral immune responses against filarial parasitic infection were studied in 62 cases of acute filarial disease presenting with filarial fever with adenolymphangitis, in a community where Bancroftian filariasis was endemic, during and about one month before and after the febrile episode. Their total leucocyte and differential peripheral blood cell counts and anti-streptolysin O titre were determined and compared. Polymorphonuclear cellular responses and anti-streptolysin O titre did not show any significant alteration during and after fever. Three of 53 previously amicrofilaraemic subjects (9 of whom were initially microfilaraemic) had microfilaria in their circulation during fever, with a significant increase in their geometric mean microfilaria count. Titres of specific immunoglobulin (Ig) G and IgG4 antibody to Wuchereria bancrofti microfilarial excretory/secretory antigens (measured by enzyme-linked immunosorbent assay) decreased significantly during the fever and the lower levels were maintained one month after fever. The mean circulating immune complex level increased significantly during fever, and a significant percentage of cases demonstrated circulating filarial antigen during fever, which declined after one month, suggesting the release of filarial antigen into the circulation during fever which bound to antibodies to form immune complexes. These observations do not support the suggestion that bacterial infection is the aetiology of filarial fever. It is postulated that antigens released from parasites into the circulation during parturition by adult worms may evoke an allergic response in the host, causing periodic febrile episodes.

Animals↗

PubMed1985

The pharmacology of fever.

The ability to minimise, if not prevent, large variations in deep body temperature that would otherwise result from some environmental conditions is a homeostatic function of unquestioned benefit that is demonstrated only by the more highly evolved animals. Nevertheless, body temperature is raised above normal values in many pathological conditions. This increase in temperature or fever is an active and co-ordinated response, which indicates the involvement of the CNS. Central injection and lesion studies have shown that the brain, in particular the PO/AH, is the site of action of fever-inducing agents, termed pyrogens. Electrophysiological data show that pyrogens modify the activity of central thermosensitive neurones as if to increase heat gain and decrease heat loss. The common response of fever to pyrogens of diverse origins is attributable to fever being mediated by an endogenous pyrogen released by phagocytic cells in the host. The mechanism by which central neuronal function is disturbed by pyrogens present in the periphery is not known. Tracer studies have yet to demonstrate the passage of a pyrogen across the blood-brain barrier. The possible involvement of several putative neurotransmitters and modulators in fever has been reviewed here, but most compounds have not been studied sufficiently to allow firm conclusions to be drawn. Much of the data is limited to the effects of the putative mediators on normal thermoregulation but, even when the effect is hyperthermia, such observations do not necessarily indicate a role for the endogenous material in fever. Dose-response curves for agonists and the effects of antagonists are often undetermined. This shortfall in data is due to some extent to the nature of fever; a central response in vivo over several hours. Although fever may enhance other host reactions to combat infection and inflammation, neither this benefit nor the undesirability of antipyretic therapy has been demonstrated unequivocally in either homeothermic laboratory animals or humans. Consequently, antipyretic drugs continue to be used clinically to alleviate the fever, malaise and/or pain commonly associated with disease. The drugs in common usage are the nonsteroidal antipyretic analgesics, many of which also have an anti-inflammatory effect. The primary mode of action of these drugs as antipyretics appears at present to be the inhibition of cyclo-oxygenase and a consequent reduction of prostanoid material in pyrogen-sensitive areas of the brain.(ABSTRACT TRUNCATED AT 400 WORDS)

Acetylcholine↗

PubMed2007

Intensive care unit management of fever following traumatic brain injury.

Fever, in the presence of traumatic brain injury (TBI), is associated with worsened neurologic outcomes. Studies prior to the publication of management guidelines revealed an undertreatment of fever in patients with neurologic insults. Presently the adult TBI guidelines state that maintenance of normothermia should be a standard of care therefore improvement in management of fever in these patients would be expected. The specific aims of the study were to: (1) determine the incidence of fever (T>or=38.5 degrees C) in a population of critically ill patients with TBI; (2) describe what interventions were recorded by intensive care unit (ICU) nurses in managing fever; (3) ascertain the rate of adherence with published normothermia guidelines. Medical record review of available hospital records was conducted on patients admitted to a level I trauma center following severe TBI (N=108) from the parent study. Temperature data was abstracted and contemporaneous nursing documentation was examined for evidence of intervention for fever and adherence with published standards. Data analyses were performed that included descriptive statistics. Seventy-nine percent of TBI patients (85/108) had at least one recorded fever event while in the ICU. However in only 31% of events did the patient receive any documented intervention by nursing staff for the elevated temperature. The most frequently documented intervention was pharmacologic (358/1166 elevations). Other nursing actions (e.g. use of fan) accounted for a minority (<1%) of nursing interventions documented. Patients were more likely to have a high temperature that exceeded 40 degrees C (13%) than a temperature that was normothermic (5%). There continues to be an under treatment of fever in patients with TBI by critical care nurses despite our knowledge of its negative effects on outcomes. There remains a gap in translation between patient outcomes research and bedside practice that needs to be overcome, thus research efforts need to now focus on understanding nurses' decision-making processes and the best methods of fever reduction in patients with TBI.

Adult↗

PubMed2000

The nitric oxide pathway is an important modulator of stress-induced fever in rats.

Psychological stress evokes a number of physiological responses, including a rise in body temperature (T(b)), which has been suggested to be the result of an elevation in the thermoregulatory set point, i.e., a fever. This response seems to share similar mechanisms with infectious fever. A growing number of studies have provided evidence that nitric oxide (NO) has a modulatory role in infectious fever, but no report exists about the participation of NO in stress fever. Thus, the present study aimed to verify the hypothesis that NO modulates stress fever by using restraint stress as a model. To this end, we tested the effects of the non-specific NO synthase (NOS) inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME) or its inactive enantiomer N(G)-nitro-D-arginine methyl ester (D-NAME) on colonic T(b) of restrained or unrestrained rats. A rapid increase in T(b) was observed when animals were submitted to restraint. Intravenous (i.v.) injection of L-NAME at a dose (10 mg/kg) that caused no change in T(b) when administered alone significantly attenuated the elevation in T(b) elicited by stress, indicating that the NO pathway may mediate stress fever. Moreover, intracerebroventricular (i.c.v.) L-NAME (250 microg/microl) caused a rise in T(b) of euthermic animals and enhanced stress fever, supporting that NO in the central nervous system (CNS) leads to a reduction in T(b) and, therefore, this is unlikely to be the site where NO may mediate stress fever. Taken together, these data indicate that the NO pathway plays an important role in modulating restraint stress-induced fever in rats.

Animals↗

PubMedDate not supplied

An update on concurrent malaria and typhoid fever in Cameroon.

Malaria and typhoid fever are endemic diseases in Cameroon, with overlapping signs and symptoms. While the high prevalence of malaria is an established fact, it is only within the past 5 years that an unusually high number of illnesses have been diagnosed as malaria co-existing with typhoid fever. The Widal test is widely used as the sole laboratory test for the diagnosis of typhoid fever. To investigate the extent of the malaria and typhoid fever association, we used blood and stool cultures as additional diagnostic tests for typhoid fever. We report that, of 200 patients presenting with fever, 17.0% had concurrent malaria and typhoid fever (Salmonella typhi) based on bacteriological proven diagnosis as compared with 47.9% based on the Widal test. A higher proportion of patients (32.5%) had malaria coexisting with S. typhimurium when compared to S. paratyphi (2%) and S. typhi (P < 0.05). We conclude that the number of fever cases diagnosed as malaria co-existing with typhoid fever is overestimated.

Adolescent↗

PubMed1996

10-year educational programme aimed at rheumatic fever in two French Caribbean islands.

BACKGROUND: In less developed countries, rheumatic fever still occurs. We started a long-term educational programme in two French Caribbean islands that was directed at the public and at health-care workers to see whether we could reduce the incidence of rheumatic fever. METHODS: Our 10-year programme started in 1981 in Martinique and Guadeloupe, and was based in the community and in clinics and hospitals. The programme established a registry of all cases of primary and secondary rheumatic fever (diagnosed by Jones' modified criteria), with systematic hospital admission of children. We graded carditis as severe, mild, or subclinical, and acute glomerulonephritis was defined by oedema, proteinuria, and haematuria for less than 3 months. The educational part of the programme targeted the public and health-care workers, including doctors, with written information distributed in schools or via radio and television broadcasts or videotapes. For the public, the benign clinical presentation of the initial streptococcal infection was contrasted with the severity of later heart disease. FINDINGS: The first months of the programme led to a 10-20% increase in the number of rheumatic fever cases admitted to hospital, because of the renewed attention paid to the disease. Therefore we took 1982 as the baseline year. In 1982-83 the incidence of rheumatic fever was 19.6 per 100 000 inhabitants aged under 20 in Martinique, and 17.4 per 100 000 in Guadeloupe. In 100 Martinique children and 97 Guadeloupe children in 1982-83, 40 and 71% had carditis, respectively (severe in 10 and 32%). Rheumatic fever was preceded by symptomatic sore throat in 52 and 41% of cases, respectively. The disease was not seen in children with active streptococcal cutaneous infections. Disease frequency was highest in the poorest areas and families, a finding that persisted over time. The programme was associated with a progressive decline in the frequency of rheumatic fever: final reduction of 78% in Martinique and 74% in Guadeloupe. The frequency of carditis also fell. Apart from two outbreaks in one hospital, the frequency of acute glomerulonephritis also declined; 31% of cases had had sore throat, while 56% had skin infections. The cost of the programme during the 4 most intensive years was FFr 250 000 (US$ 44 500) in each island. The cost of childhood rheumatic fever, excluding late sequelae, was initially (in 1982) about FFr 7.8 million (US$ 1426 000). The cost fell to an average of Ffr 550 000 (US$ 100 000) per year in 1991-92. INTERPRETATION: A rapid decline in rheumatic fever incidence was achieved at modest cost. Such a programme needs to be continued because of the risk of disease resurgence.

Adolescent↗