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PubMed2001

Yellow fever: an update.

Yellow fever, the original viral haemorrhagic fever, was one of the most feared lethal diseases before the development of an effective vaccine. Today the disease still affects as many as 200,000 persons annually in tropical regions of Africa and South America, and poses a significant hazard to unvaccinated travellers to these areas. Yellow fever is transmitted in a cycle involving monkeys and mosquitoes, but human beings can also serve as the viraemic host for mosquito infection. Recent increases in the density and distribution of the urban mosquito vector, Aedes aegypti, as well as the rise in air travel increase the risk of introduction and spread of yellow fever to North and Central America, the Caribbean and Asia. Here I review the clinical features of the disease, its pathogenesis and pathophysiology. The disease mechanisms are poorly understood and have not been the subject of modern clinical research. Since there is no specific treatment, and management of patients with the disease is extremely problematic, the emphasis is on preventative vaccination. As a zoonosis, yellow fever cannot be eradicated, but reduction of the human disease burden is achievable through routine childhood vaccination in endemic countries, with a low cost for the benefits obtained. The biological characteristics, safety, and efficacy of live attenuated, yellow fever 17D vaccine are reviewed. New applications of yellow fever 17D virus as a vector for foreign genes hold considerable promise as a means of developing new vaccines against other viruses, and possibly against cancers.

Aedes↗
PubMed1997

Value of clinical features in the diagnosis of enteric fever.

There is no objective data on the value of individual clinical symptoms or signs in the diagnosis of enteric fever in a febrile patient. The purpose of the study was to assess the value of some clinical and simple laboratory features in the diagnosis of enteric fever. One hundred & six patients with microbiologically confirmed enteric fever and 170 patients with other established febrile illnesses were included in the evaluation. History of stepladder pattern of rise of temperature, loose motions, relative bradycardia and coated tongue proved to be powerful markers of enteric fever with high specificity (100%, 94.71%, 94.71%, 94.12% respectively), positive and negative predictive values. Headache, hepatomegaly and splenomegaly were moderately powerful. ESR and WBC count appeared to have little value in the diagnosis of enteric fever. Pattern of onset and loose motions did not discriminate between typhoid and paratyphoid fever. Most of these patients had illness persisting beyond one week by which viral infections and infectious enterocolitides were largely excluded. Elucidation of power of these markers in distinguishing enteric fever from other febrile illnesses with the help of better designed prospective studies would lessen our dependence on expensive and time consuming laboratory investigations.

Adolescent↗
PubMed1997

Doppler echocardiography distinguishes between physiologic and pathologic "silent" mitral regurgitation in patients with rheumatic fever.

BACKGROUND: The diagnosis of rheumatic fever is based on physical findings (major) and supporting laboratory evidence (minor) as defined by the Jones criteria. Rheumatic carditis is characterized by auscultation of a mitral regurgitant murmur. Doppler echocardiography, however, may detect mitral regurgitation when there is no murmur ("silent" mitral regurgitation), even in normal individuals. HYPOTHESIS: The hypothesis of this study was that physiologic mitral regurgitation can be differentiated from pathologic "silent" mitral regurgitation by Doppler echocardiography. METHODS: The study group consisted of 68 patients (2-27 years) with normal two-dimensional imaging and Doppler evidence of mitral regurgitation but no murmur. Patients with rheumatic fever (n = 37) met Jones criteria (chorea in 20, arthritis in 17). Patients without rheumatic fever (n = 31) were referred for innocent murmur (n = 7), abnormal electrocardiogram (n = 13), and chest pain (n = 11). Echoes were independently reviewed by two cardiologists blinded to the diagnosis. Pathologic mitral regurgitation was defined as meeting the following four criteria: (1) length of color jet > 1 cm, (2) color jet identified in at least two planes, (3) mosaic color jet, and (4) persistence of the jet throughout systole. Jet orientation was also noted. RESULTS: Using the above criteria, there was agreement in echo interpretation of pathologic versus physiologic mitral regurgitation in 67 of 68 patients (interobserver variability of 1.5%). Pathologic regurgitation was found in 25 (68%) patients with rheumatic fever but in only 2 (6.5%) patients without rheumatic fever (p < 0.001). The specificity of Doppler for detecting pathologic regurgitation was 94% with a positive predictive value of 93%. The color mitral regurgitant jet was posteriorly directed in all 25 patients with rheumatic fever. CONCLUSION: Pathologic "silent" mitral regurgitation of rheumatic fever can be distinguished from physiologic mitral regurgitation using strict Doppler criteria, particularly when the jet is directed posteriorly. These data support the use of Doppler echocardiography as a minor criterion for evaluating patients with suspected rheumatic fever.

Acute Disease↗
PubMedDate not supplied

Central thermosensitivity during fever produced by intra-PO/AH and intravenous injections of pyrogen.

Squirrel monkeys with thermodes implanted in the preoptic/anterior hypothalamic (PO/AH) region and the medulla oblongata were used to examine three questions about central thermoresponsiveness in fever: Does thermoresponsiveness of the PO/AH region and medulla change during fevers caused by injection of bacterial endotoxin IV or directly into the PO/AH region? Does thermosensitivity of these brain regions determine the upper fever limit? Is thermoresponsiveness of the PO/AH region affected by local injections of salicylate? Changes in rectal temperature and oxygen consumption in response to heating and cooling the PO/AH region were reduced during fever caused by intra-PO/AH injections of bacterial endotoxin compared with changes produced during afebrile periods. PO/AH thermosensitivity was also reduced during fever caused by IV administration of bacterial pyrogen. Prolonged cooling of the PO/AH region or the medulla oblongata during fever produced by peripheral and central pyrogen injections did not cause rectal temperature (Tre) to rise above 41.1 degrees C although local heating reduced Tre or limited the fever maximum. From the latter result it is concluded that both pools of central thermoreceptors can limit maximal fever by reacting to local high temperature but that lowered temperature in neither region can raise Tre above a level determined by antagonistic input from thermoreceptors in other parts of the body. Injections of sodium salicylate into the PO/AH region had no effect on thermoresponsiveness of the region. This finding reinforces the idea that salicylates do not produce antipyresis by acting directly on thermosensitive cells of the central temperature control system.

Animals↗
PubMed2005

Distinguishing dengue fever from other infections on the basis of simple clinical and laboratory features: application of logistic regression analysis.

BACKGROUND: Dengue fever is a frequent cause of admission to hospital in South East Asia, however many of the clinical characteristics and abnormalities on laboratory investigations at presentation are found in other common infections. OBJECTIVES: To describe the clinical and laboratory features of dengue fever and other common febrile illnesses in Singapore. STUDY DESIGN: We performed a prospective study of consecutive adult admissions to an infectious diseases hospital. Logistic regression analysis was used to identify symptoms, physical signs and laboratory features that differentiated dengue fever from other febrile illnesses within the first 2 days of admission. RESULTS: Of the 381 patients studied, 148 had serologically confirmed dengue fever. Most of these had uncomplicated dengue fever, and only 9% had dengue haemorrhagic fever. A model based on clinical features alone (including a variety of cutaneous signs, pulse rate and the presence of pharyngeal injection) was able to differentiate dengue fever from other infections with a sensitivity of 74% and specificity of 79%. A model based on clinical features (rash) and laboratory parameters (white cell count, haemoglobin, prothrombin time, creatinine and bilirubin levels), achieved a sensitivity of 84% and specificity of 85%. CONCLUSIONS: A combination of simple clinical and laboratory parameters are potentially able to predict dengue fever with a high level of accuracy in adults presenting to hospital with febrile illnesses in Singapore.

Adult↗
PubMed1996

Lack of association between mitral valve prolapse and history of rheumatic fever.

To determine whether rheumatic fever is associated with mitral valve prolapse (MVP) diagnosed by echocardiography, records from 561 subjects participating in a prospective family study were reviewed. The prevalence of a history of rheumatic fever by modified Jones criteria was determined in 92 probands and 112 affected relatives or spouses with M-mode and two-dimensional echocardiographic findings of MVP, accompanied in most instances by classic auscultatory findings, and in 357 family members without MVP. The prevalence of rheumatic fever was 5.4% in both MVP sub-groups and 2.2% in the family members without MVP (p<0.05 vs the combined MVP group). However, people with a history of rheumatic fever were older than the remaining subjects (48 +/- 17 vs 36 +/- 20 years, p<0.01) as expected because of the decline in rheumatic fever in the twentieth century, and subjects with MVP were older than subjects without MVP (39 +/- 16 vs 34 +/- 22 years, p<0.01). Multiple logistic regression showed that after the independent relation of older age with a positive history of rheumatic fever (p<0.01) was taken into account, there was a trend toward a lower likelihood of previous rheumatic fever associated with MVP (odds ration 0.42, p=0.07). These results do not support either a true association or a causal role of rheumatic fever in the pattern of mitral leaflet motion and auscultatory abnormalities in adults, for which the term MVP is generally used.

Adult↗
PubMed2003

The influence of the dietary intake of fatty acids and antioxidants on hay fever in adults.

BACKGROUND: The objective of the investigation was to explore in a prospective study the associations between dietary intake of fatty acids, antioxidants and hay fever manifestation in adulthood. METHODS: Three hundred and thirty-four hay fever cases with adult onset of clinical symptoms from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heidelberg cohort were identified during follow-up and matched with 1336 controls. Dietary intake data were obtained by means of validated food frequency questionnaires. The influence of dietary fatty acid and vitamin intake on hay fever risk was estimated by means of unconditional logistic regression. RESULTS: High intake of oleic acid was positively associated with hay fever [odds ratio (OR): 2.86, 95% confidence intervals (95% CI): 1.22-6.70], whereas high intake of eicosapentaenoic acid was inversely related to hay fever (OR: 0.45, 95% CI: 0.22-0.93). Furthermore, high beta-carotene intake increased the risk of hay fever (OR: 1.69, 95% CI: 1.09-2.63) while increasing intake of vitamin E was a protective factor (OR: 0.38, 95% CI: 0.17-0.85). In grouped analyses, the effects of beta-carotene and vitamin E were mainly observed among women and ex-/current-smokers; in these subgroups, linoleic acid increased the risk of hay fever. CONCLUSIONS: In conclusion, the present results provide further evidence that dietary factors might affect the risk of clinical manifestation of hay fever. However, the effects in smokers and women may suggest different biological mechanisms for the investigated nutrients, which need further research.

Adult↗
PubMed1998

[Two cases of spotted fever group rickettsiosis contracted in southern parts of Africa].

A 40-year-old Japanese male stayed in Zimbabwe and developed a fever above 38 degrees C during which he noted a typical eschar in the lumbar region and also regional inguinal lymphadenopathy. Although not conspicuous, erythematous eruptions accompanied by itching were observed on the face, trunk and lower extremities. After returning to Japan and visiting our hospital, he was suspected of rickettsiosis and put on minocycline which gradually led to the improvement of the symptoms. Immunofluorescence antibody determinations disclosed rising titers against Rickettsia conorii (R. conorii) for both IgM and IgG classes. The second patient, a 34-year-old Japanese male, developed fever, generalized erythema and a typical eschar while staying in South Africa. The first blood sample showed positive IgM and IgG antibodies against R. conorii, and the second sample a decline in IgM but not in IgG class antibodies. Both cases were diagnosed as spotted fever group rickettsiosis based on their clinical manifestations including typical eschar and also the results of antibody determinations. Most of the previous cases of spotted fever group rickettsiosis in Africa have been regarded as Mediterranean spotted fever which is caused by R. conorii and transmitted by Rhipicephalus sanguineus. However, recently, the presence of another type of spotted fever group rickettsiosis, African tick-bite fever, caused by Rickettsia africae and transmitted by Amblyomma hebraeum has been proposed. Although clinical features of the two rickettsiosis are reported to be separable, apparent cross reaction between the two organisms hampers the use of conventional antibody determinations for their differentiation. For the two cases presented here identification of the causative rickettsia species was impossible, because they were not isolated. With ever increasing numbers of international travel, physicians should be alert to the possibility of spotted fever group rickettsiosis when encountering febrile patients returning from endemic countries. This is particularly important considering that beta-lactam antibiotics commonly used as an empiric therapy are not effective, and the disease has a potential to develop into severe forms.

Adult↗
PubMed2002

Milk fever control principles: a review.

Three main preventive principles against milk fever were evaluated in this literature review, and the efficacy of each principle was estimated from the results of controlled investigations. Oral calcium drenching around calving apparently has a mean efficacy of 50%-60% in terms of milk fever prevention as well as prevention of milk fever relapse after intravenous treatment with calcium solutions. However, some drenches have been shown to cause lesions in the forestomacs. When using the DCAD (dietary cation-anion difference) principle, feeding rations with a negative DCAD (measured as (Na + K)-(Cl + S)) significantly reduce the milk fever incidence. Calculating the relative risk (RR) of developing milk fever from controlled experiments results in a mean RR between 0.19 and 0.35 when rations with a negative versus positive DCAD are compared. The main drawback from the DCAD principle is a palatability problem. The principle of feeding rations low in calcium is highly efficient in milk fever prevention provided the calcium intake in the dry period is kept below 20 g per day. Calculating the relative risk (RR) of developing milk fever from controlled experiments results in a very low mean RR (between 0 and 0.20) (daily calcium intake below versus above 20 g/d). The main problem in implementing the low-Ca principle is difficulties in formulating rations sufficiently low in calcium when using commonly available feeds. The use of large doses of vitamin D metabolites and analogues for milk fever prevention is controversial. Due to toxicity problems and an almost total lack of recent studies on the subject this principle is not described in detail. A few management related issues were discussed briefly, and the following conclusions were made: It is important to supply the periparturient cow with sufficient magnesium to fulfil its needs, and to prevent the dry cows from being too fat. Available information on the influence of carbohydrate intake, and on the effect of the length of the dry period and prepartum milking, is at present insufficient to include these factors in control programmes.

Animal Feed↗
PubMed1997

Strategies for preventing milk fever in dairy cattle.

Milk fever is a complex metabolic disorder that occurs at the onset of lactation. Clinical symptoms of this disease include inappetence, tetany, inhibition of urination and defecation, lateral recumbency, and eventual coma and death if left untreated. The hallmark of this disease is severe hypocalcemia, which probably accounts for most of the clinical signs associated with a milk fever episode. Several factors have been consistently associated with increased incidence of milk fever, including parturition and initiation of lactation, advancing age, breed, and diet. Of the various methods used in attempts to control the disease, the most progress has been made in dietary management. Until recently, most attention has focused on manipulating the levels of dietary calcium to control milk fever incidence; results, however, have been inconsistent, except for those diets containing very low (8 to 10 g/d) concentrations of Ca. During the past decade, there has been renewed interest and research in the use of dietary anions (Cl- and SO4(2-) in controlling milk fever. An outgrowth of this research has been the surprising realization that dietary K is significant (perhaps more significant than Ca) in determining the susceptibility of dairy cows to milk fever. This knowledge has expanded the understanding of the pathogenesis of milk fever and has focused attention on research designed to study methods for neutralizing the detrimental effects of dietary K excess on periparturient animal health. This report discusses various practical strategies and potential research areas for managing the dietary forage components to minimize the effects of K on milk fever incidence.

Animals↗
PubMed2001

Milk fever and subclinical hypocalcaemia--an evaluation of parameters on incidence risk, diagnosis, risk factors and biological effects as input for a decision support system for disease control.

The present review analyses the documentation on incidence, diagnosis, risk factors and effects of milk fever and subclinical hypocalcaemia. It is hereby evaluated whether the existing documentation seems sufficient for further modelling in a decision support system for selection of a control strategy. Several studies have been carried out revealing an incidence of milk fever most often in the level of 5-10%. Few studies indicate that the incidence of subclinical hypocalcaemia is several times higher than milk fever. The diagnosis based on clinical or laboratory methods or based on presence of risk factors is outlined. The clinical symptoms of milk fever are highly specific and the disease level may thus be determined from recording of treatments. Diagnosis of subclinical hypocalcaemia needs to include laboratory examinations or it may be determined by multiplying the incidence of milk fever by a certain factor. From the documentation on risk factors, it is very complex to predict the incidence from the exposure level of the risk factors. Due to uncertainty, sensitivity analyses over a wide range of values for each parameter are needed. The documentation of cow characteristics, nutrition, environment and management as risk factors are described. Among cow characteristics, parity or age, body condition and production level were found to be important. Risk factors associated with nutrition included most importantly dietary cation-anion difference and calcium level whereas the importance of general feeding related factors like type of feed stuff and feeding level were less clear. Environment and management included season, climate, housing, pasturing, exercise, length of dry period and prepartum milking. Several of the parameters on environment and management were confounded among each other and therefore firm conclusions on the importance were difficult. The documentation of the effect of milk fever includes the downer cows, reproductive disorders, occurrence of other diseases and the effect on milk production, body weight and culling. The reproductive disorders included most importantly dystocia, uterine prolapse, retained placenta, metritis and repeat breeding, and occurrence of other diseases included ketosis, displaced abomasum and mastitis. The documentation was substantial and often quantifiable within certain limits. Overall it is concluded that the present documentation on milk fever concerning incidence, diagnosis, risk factors and effects seems sufficient for a systematic inclusion in a decision support system. A model on milk fever should take into consideration the variation in biological data and individual herd characteristics. The inclusion of subclinical hypocalcaemia would be more uncertain and probably should await further documentation on possibilities of determining the herd level incidence and also the effect of this condition on production.

Animals↗
PubMed2005

[Double-blind randomized trial of the effect of Bidro on hay fever in children].

INTRODUCTION: The natural product royal jelly (trade name Bidro) is widely used for the treatment and prevention of allergic symptoms. Several case reports suggest marked clinical benefits. Our aim was to assess whether treatment with royal jelly modifies the development of allergic hay fever symptoms in children with pollen allergy. MATERIALS AND METHODS: Eighty children aged 5-16 years with hay fever symptoms due to birch, grass and/or mugwort participated in a placebo-controlled, double-blind, randomized, controlled trial. Treatment with royal jelly or placebo was administered three to six months before and throughout the pollen season. RESULTS: The primary outcome was the occurrence of symptoms of rhinitis and conjunctivitis in the pollen season. A secondary outcome was symptom severity, as measured by symptom score, by visual analog scale (VAS) and by the need for additional hay fever treatment. Sixty-four children completed the study; 34 of them had been treated with royal jelly and 30 with placebo. All of the patients in both groups developed hay fever symptoms during in the pollen season. The severity of hay fever symptoms was similar in the two groups (VAS = 1.6 in the placebo group and 1.4 in the royal jelly group; the mean number of combined daily nasal symptoms was 2.83 in the placebo group and 2.82 in the royal jelly group). The need for additional hay fever treatment was similar in the two groups. DISCUSSION: We conclude that royal jelly has no effect on the occurrence of hay fever in the pollen season, nor does it modify the severity of hay fever symptoms.

Child↗
PubMed2000

Emergency department presentations of typhoid fever.

Typhoid fever, a systemic infectious disease caused by Salmonella typhi, is classically characterized by fever, paradoxical bradycardia, abdominal pain, and a rose colored rash. This was a retrospective review of 21 confirmed cases over a 5-year period. Mean age was 32.6 years (range 2-60 years), and Mexico (7/21) and El Salvador (3/21) represented the most common countries of origin. Recent travel to an endemic area was noted in 14 patients. The most common complaints were fever (15/21), headache (10/21), abdominal pain (9/21), and diarrhea (6/21). Average duration of symptoms before presentation to the Emergency Department (ED) was 7.9 days. High fever associated with bradycardia was noted in 12 patients. Leukopenia was present in 7 patients. Blood culture was the most sensitive confirmatory test while the Widal test was positive in 7 out of 11 cases. Fever of unknown origin (12/21), followed by presumed typhoid fever (3/21) were the most common ED diagnoses. It is important to recognize that patients with typhoid fever may present to EDs in the US and this disease should be included in the differential diagnosis of febrile patients from Latin America or those with a history of recent travel to endemic countries.

Abdominal Pain↗
PubMed2003

PFAPA syndrome mimicking familial Mediterranean fever: report of a Turkish child.

The PFAPA (Periodic Fever, Aphthous stomatitis, Pharyngitis, Adenitidis) syndrome is characterized by periodic fever, adenitis, pharyngitis, and aphthous stomatitis. Herein, we present a Turkish child with PFAPA syndrome mimicking familial Mediterranean fever because of a rare presentation. A 9-year-old boy was admitted with recurrent fever, aphthous stomatitis, sore throat, headache, and general body pains, lasting 2 to 3 days since 3.5 years of age. He was completely symptom-free between the attacks. He was diagnosed as having familial Mediterranean fever according to the clinical findings when he was 6 years of age and Colchicum tablet was administrated. Despite colchicines therapy for 8 months, his attacks did not subside; therefore, the drug was discontinued. He had high fever, a painful cervical lymphadenopathy, aphthous stomatitis, and tonsillo-pharyngitis. The patient was then diagnosed as having PFAPA syndrome. He was given a single dose of prednisolone (0.35 mg/kg/dose). His complaints dramatically and completely disappeared 3 h after administration of the drug. During the 8th month of follow-up, a similar febrile attack lasting only 1 day was noted and it was controlled with a single dose of prednisolone (0.5 mg/kg/day). At this writing the patient is in the 12th month of follow-up, and there have been no symptoms after the second attack. In conclusion, our patient shows that PFAPA syndrome can be confused with familial Mediterranean fever. We also would like to emphasize that the typical PFAPA syndrome can be easily diagnosed by detailed history-taking and physical findings.

Child↗
PubMed2006

[Recurrent febrile episodes--normal, periodic fever syndrome or immunodeficiency?].

Fever is one of the main symptoms leading to medical evaluation. Not only infections cause fever but also inflammatory disorders. To distinguish one from another, a thorough medical history and clinical evaluation are needed. Sometimes, only the clinical course will reveal the diagnosis. PFAPA-Syndrome (periodic fever, aphthous stomatitis, pharyngitis, adenitis) is the most frequent periodic fever syndrome in Switzerland. No diagnostic test is available to support the diagnosis. Some important diseases have to be ruled out, such as Immunodeficiency, cyclic neutropenia, chronic viral infections and rheumatologic disorders. To know the diagnosis of the PFAPA-Syndrome can help avoiding antibiotic courses for febrile episodes in infants. There is a clinical overlap to hereditary periodic fever syndromes as familial Mediterranean fever (FMF), Hyper-IgD and fever syndrome (HIDS), Tumor-necrosis factor receptor associated periodic syndrome (TRAPS) and others, in which a genetic basis for the disease has already been found.

Child↗
PubMedDate not supplied

Clinical aspects of African viral hemorrhagic fevers.

Three hemorrhagic fevers occur in southern Africa: Rift Valley fever, Marburg virus disease, and Crimean-Congo hemorrhagic fever. The patient's history of travel in Africa, visits to rural areas, contact with sick animals or their carcasses, or contact with a tick-infested environment or tick bites is important. Rift Valley fever is characterized by an incubation period of approximately 3 or 4 days, sudden onset of fever with a biphasic course, and signs and symptoms of liver and kidney disorder. The commonest complication is retinitis with a central scotoma. Severe cases may develop a hemorrhagic state, which may be fatal. Marburg virus disease was studied in two Australian students after a tour of Rhodesia (now Zimbabwe) and in a nurse who cared for them. The incubation period of approximately 7 days is followed by sudden onset of fever (typically lasting 7 days) and the appearance of a maculopapular petechial rash on the 5th day. A hemorrhagic state develops about the same time and may be fatal. Crimean-Congo hemorrhagic fever is widespread in South Africa; it may be transmitted by tick bite of the species Hyalomma, by contact with the tissues of animals, or by contact with infected patients.

Africa, Southern↗
PubMed1995

Increase in interleukin-6 serum level preceding fever in granulocytopenia and correlation with death from sepsis.

Serum interleukin (IL)-6 levels measured by ELISA were correlated with the clinical course of 53 adults with hematologic malignancies in 95 episodes of chemotherapy-induced leukocytopenia (< 1000/microL). The median IL-6 level was 15 pg/mL (range, < 3-123) in 27 episodes without fever. This level was 14.5 pg/mL (range, < 3-187) 72-48 h before onset of fever, 78 pg/mL (range, < 3-170) 24 h before fever in episodes with unexplained fever (FUO), and 182 pg/mL (range, 63-1076) 24 h before fever in episodes with positive blood cultures (P < .001). Within 24 h after onset of fever, median IL-6 level was 171 pg/mL (range, 53-1134) in episodes of FUO, 444 pg/mL (range, 38-7973) in episodes with gram-negative bacteremia, and 2017 pg/mL (range, 76-7253) with gram-positive bacteremia (P < .01). IL-6 levels increased before death in all 13 patients who died of sepsis. Median level was 7253 pg/mL (range, 445-95,906) within 3 days of death. Determination of IL-6 may be useful for early assessment and as a prognostic tool in leukocytopenic fever.

Adult↗
PubMed2000

Periodic fever syndromes.

The term periodic fever syndrome has been used in a restricted sense to denote two diseases in which episodic fevers occur with a regular periodicity: cyclic neutropenia and the periodic fever, aphthous stomatitis, pharyngitis, and adenopathy (PFAPA) syndrome. Other authors have used the term in a more general sense to encompass a larger group of disorders characterized by recurrent episodes of fever that do not necessarily follow a strictly periodic pattern. These include familial Mediterranean fever, the autosomal dominant familial fevers (also known as Hibernian fever), and the hyperimmunoglobulin D syndrome. This article follows the latter usage, and reviews recent advances in our understanding of the genetics and molecular pathology of this group of diseases, as well as their clinical characterization and treatment.

Child↗