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PubMed2002

Fever and rash in a 3-year-old girl: Rocky Mountain spotted fever.

Initial symptoms of Rocky Mountain spotted fever (RMSF), a tick-borne illness caused by Rickettsia rickettsii, are nonspecific and include headache, gastrointestinal disturbances, malaise, and myalgias, followed by fever and rash. The classic triad of fever, rash, and history of tick exposure is uncommon at presentation. Clinical manifestations of RMSF range from virtually asymptomatic to severe. Because of the potentially fatal outcome of RMSF, presumptive clinical diagnosis and empiric antimicrobial therapy can be critical. We present the case of a 3-year-old girl from New York State who presented with fever and rash.

Child, Preschool↗
PubMed2005

[Flavivirus infections: yellow fever, dengue fever and Japanese encephalitis].

Flavivirus infections, such as dengue fever, yellow fever and Japanese encephalitis, are untreatable. As a result of the high prevalence of dengue fever in endemic areas, it poses a substantial risk for travellers to those areas. When it comes to Japanese encephalitis and yellow fever, the risk for travellers is limited but the diseases are extremely serious, creating a dilemma for the physician when it comes to deciding whether to vaccinate against them. The vaccines against both potentially have side effects. The indications and contraindications for vaccination are described in detail.

Adult↗
PubMed1993

[Yellow fever epidemic in the extreme North of Cameroon in 1990: first yellow fever virus isolation in Cameroon].

Some two years ago, suspicious cases of yellow fever (YF) were reported in northern Cameroon. A deadly epidemic broke out during the second half of the rainy season (from 15 September to 22 December 1990) with 180 known cases, of which 125 died. The real figures could have been between 5000 and 20,000 cases with between 500 and 1000 deaths. The affected area was within the yellow fever belt, which is situated around latitude 11 degrees North and 14 degrees East. In this mountainous area (altitude, about 800 m) the rural inhabitants are scattered, with a high density of 200,000 people per 1000 km2. Investigations began at the start of the dry season and a strain of yellow fever virus was isolated for the first time in Cameroon. A study of 107 serum samples (23 families in 11 villages) was carried out by immunofluorescence and ELISA, which showed 20% IgM carriers for yellow fever virus and nothing for the three other flaviviruses, although these were largely present; there were up to 98% crossed reactions in IgG with dengue 2 and West Nile strains. The under-10 age group represented 63% of the IgM carriers. An entomological study was carried out at the same time. It permitted the capture of Aedes aegypti, A. furcifer, A. luteocephalus and the identification of numerous potential larval sites, at times still in the productive phase of A. aegypti which is considered to be the principal vector.(ABSTRACT TRUNCATED AT 250 WORDS)

Aedes↗
PubMed1979

Rocky mountain spotted fever in Connecticut: human cases, spotted-fever group rickettsiae in ticks, and antibodies in mammals.

Three parameters were used in 1976 and 1977 to assess the status of Rocky Mountain spotted fever (RMSF) in Connecticut--compilation and review of clinical data on suspected human cases for the 13-year period 1965--1977, examination of tick tissues for spotted fever-group rickettsiae by the hemolymph test and direct immunofluorescence, and analyses of mammalian sera for antibodies against Rickettsia rickettsii. There were six presumptive RMSF cases which probably originated in Connecticut. Four of these cases occurred in areas where the American dog tick, Dermacentor variabilis, abounds. A total of 2994 ticks were examined by the hemolymph test. Rickettsia-like organisms were observed in 67 (2.9%) of 2330 D. variabilis and two (0.6%) of 351 Ixodes sp. near scapularis. Fewer than one-half of these organisms stained positively with spotted fever-group conjugate. Microagglutination tests on 1093 mammalian sera indicated that eight (16%) of 49 raccoons, 14 (2.6%) of 549 white-tailed deer, eight (1.7%) of 470 white-footed mice, and one of two gray squirrels had agglutinins in titers greater than or equal to 1:8 against R. rickettsii. Spotted fever-group rickettsiae are present at low frequency in inland as well as coastal regions of Connecticut.

Adult↗
PubMed1996

Sump bay fever: inhalational fever associated with a biologically contaminated water aerosol.

OBJECTIVE: To investigate the clinical, serological, and environmental features of a work related inhalational fever associated with exposure to an aerosol generated from a biologically contaminated 130,000 gallon water pool in a building used for testing scientific equipment. METHOD: Cross sectional survey of all exposed subjects (n = 83) by symptom questionnaire, clinical examination, spirometry, and serology for antibody to Pseudomonads, pool water extract, and endotoxin. In symptomatic patients diffusion capacity was measured, and chest radiology was performed if this was abnormal. Serial peak flow was recorded in those subjects with wheeze. Bacterial and fungal air sampling was performed before and during operation of the water pool pump mechanism. Endotoxin was measured in the trapped waters and in the pumps. Serum cotinine was measured as an objective indicator of smoking. RESULTS: Of the 20 symptomatic subjects, fever was most common in those with the highest exposure (chi 2 42.7, P < 0.001) in the sump bay when the water was (torrentially) recirculated by the water pumps. Symptoms occurred late in the working day only on days when the water pumps were used, and were independent of the serum cotinine. Pulmonary function was normal in most subjects (spirometry was normal in 79/83, diffusion capacity was low in five subjects, chest radiology was normal). Peak flow recording did not suggest a work relation. The bacterial content of the aerosol rose from 6 to > 10,000 colony forming units per cubic metre (cfu/m3) (predominantly environmental Pseudomonads) when the pumps were operating. High endotoxin concentrations were measured in the waters and oil sumps in the pumps. Low concentrations of antibody to the organisms isolated were detected (apart from two subjects with high antibody) but there was no relation to exposure or the presence of symptoms and similar antibody was found in the serum samples from a non-exposed population. The fever symptoms settled completely with the simple expedient of changing the water and cleaning the pumps. CONCLUSION: Given the results of our study, the development of inhalational fever in this unique environment and clearly restricted cohort was closely related to the degree of exposure to contaminated aerosol and mainly occurred in the absence of distinct serological abnormality and independent of cigarette smoking.

Adult↗
PubMed1982

Absence of endotoxin fever but not prostaglandin E2 fever in the Brattleboro rat.

Changes in colonic temperature following intracerebroventricular injection (icv) of bacterial endotoxin or prostaglandin E2 (PGE2) were measured in Long-Evans (LE) and Brattleboro (DI) rats. Indwelling cannulas were implanted into the brains of rats for subsequent microinjection into a lateral cerebral ventricle. Microinjection of 1 microgram of bacterial endotoxin into a lateral cerebral ventricle produced a fever in the LE rat but not in the DI rat. Daily injections of 1 microgram of endotoxin icv in the DI rat did not result in a fever. Intraperitoneal injections of 50 micrograms of bacterial endotoxin resulted in a fever in the LE rat, but the DI rat showed no such response. Both groups of animals did produce a fever in response to icv administration of 200 ng of PGE2. The lack of arginine vasopressin in the DI rat may be related to the animal's failure to show a febrile response to endotoxin.

Animals↗
PubMed1992

Periodic fever compatible with familial Mediterranean fever.

A 55-year-old male presented with a recurrent fever of over 38 degrees C, occurring at irregular intervals 1-6 times a month with chest, back or abdominal pain. After admission to our hospital, we found the following characteristics: 1) the febrile attacks were accompanied by obvious inflammatory findings and pleuritis or peritonitis; 2) the patient's elder sister had a similar periodic fever; and 3) there were no apparent causative factors responsible for his symptoms. Therefore, we diagnosed this as a case compatible with familial Mediterranean fever. The febrile attacks have been completely suppressed by daily colchicine. This is the seventh case of familial Mediterranean fever reported in Japan.

Abdominal Pain↗
PubMed2004

Inflammatory processes in Kawasaki disease reach their peak at the sixth day of fever onset: laboratory profiles according to duration of fever.

We evaluated the inflammatory indices according to the fever duration in children with Kawasaki disease (KD), and determined duration when the inflammatory processes in KD reach their peak. Children with KD (n=152) were classified into 7 groups according to fever duration: at the third day or earlier (n=20), fourth (n=33), fifth (n=46), sixth (n=15), seventh (n=15), eighth (n=9), and at the ninth day or later after fever onset (n= 14). The levels of various laboratory indices were determined 3 times: before, 24 hr and 7 days after intravenous immunoglobulin administration (2 g/kg). WBC and neutrophil counts, and C-reactive protein level were the highest at the sixth day. Levels of hemoglobin, albumin, and high density lipoprotein cholestrol were the lowest at the sixth day. Although these indices were not significant statistically between groups, the indices showed either bell-shaped or U-shaped distribution of which peak or trench were at the sixth day. These findiugs showed that the inflammatory processes in KD reach peak on the sixth day of fever onset. This finding is important because a higher single-dose intravenous immunoglobulin treatment before the peak day may help reduce the coronary artery lesions in KD.

Child, Preschool↗
PubMed1975

Antigenic relationships among phlebotomus fever group arboviruses and their implication for the epidemiology of sandfly fever.

The antigenic relationships of 21 known or presumed Phlebotomus fever group serotypes and of 2 ungrouped, solvent sensitive, sandfly-associated arboviruses (Pacui and Charleville) were studied by complement fixation, plaque neutralization, and hemagglutination-inhibition methods. Results of complement fixation and neutralization tests were specific, allowing clear separation of the various serotypes, while those of the hemagglutination-inhibition test showed broader crossing and lack of specificity. Pacui virus was shown to be a member of the Phlebotomus fever serogroup. Six new Phlebotomus fever group serotypes are also described, increasing the known members of the group to 22. The implications of these and other recent data about the epidemiology of sandfly fever are discussed.

Animals↗
PubMed2003

[Turkish children with recurrent abdominal pain and fever: familial Mediterranean fever].

Four children of Turkish origin, three boys aged 12, 8 and 7 years, and a girl aged 5 years, presented with clinical symptoms of familial Mediterranean fever. They had the characteristic episodes of fever combined with abdominal pain, thoracic pain, general malaise or arthralgia. Familial Mediterranean fever is an autosomal recessive genetic disorder restricted to people originating from the Middle East. The causative gene (MEFV) and many missense mutations have been identified. The clinical syndrome is characterised by self-limiting febrile episodes accompanied by inflammation of the serous membranes, resulting in peritonitis, pleuritis or synovitis. In untreated patients systemic amyloidosis may develop, which manifests as renal insufficiency. The diagnosis is based on the characteristic medical history and is confirmed by DNA analysis. Meanwhile, treatment with colchicine can be started. This is effective in 90% of affected patients. Being aware of the prevalence of familial Mediterranean fever in immigrant populations can improve the quality of life and prevent long-term complications.

Abdominal Pain↗
PubMed2004

[Effects of fever education on changing parental concepts and management of fever in childhood].

"Fever phobia" has been found to decrease parents' ability to assess and manage febrile children appropriately, increase the utilization of emergency health care services, and add to the burden of family finances. Educational intervention is an important means of changing parents' knowledge, attitudes, and practices in order to counteract their misconceptions and over-anxiety, and improve the children's health. Parent-oriented education programs can be conducted in various ways, both inside and outside the clinic. However, evidence of the efficacy of given interventions from systematic evaluation of the literature is required to convince pediatric experts what content to teach and what methods to employ daily. The relevant literature from 1980 to 2004 were collected and reorganized to present the theories, contents, methods, effects, and influencing factors of various fever educational interventions. Accordingly, this article could provide healthcare professionals more information about the efficacy, accurate and reliable of various fever education programs. Thus, impel healthcare professionals provide more information to parents for improving parents' actions and decision making on fever management.

Child↗
PubMed1991

Allergic reactions to long-term benzathine penicillin prophylaxis for rheumatic fever. International Rheumatic Fever Study Group.

1790 patients from 11 countries were enrolled in a prospective international study to determine the incidence of allergic reactions to monthly intramuscular benzathine penicillin (penicillin G benzathine) injections to prevent recurrences of rheumatic fever. After 32,430 injections during 2736 patient years of observation, 57 of the 1790 patients (3.2%) had an allergic reaction. 4 had anaphylaxis, an incidence of 0.2% (1.2/10,000 injections), all in patients over 12 years of age, and 1 patient died, a fatality incidence of 0.05% (0.31/10,000 injections). These rates are similar to those described for patients without rheumatic fever who receive short-term treatment with parenteral penicillin. Rheumatic fever recurred in 8 of 1790 patients (0.45%) who received benzathine penicillin prophylaxis compared with 11 of 96 (11.5%) who did not comply with treatment. Life-threatening allergic reactions are rare in patients on long-term parenteral benzathine penicillin to prevent recurrences of rheumatic fever; the long-term benefits of such prophylaxis by far outweigh the risk of a serious allergic reaction.

Adolescent↗
PubMed1989

Trench fever in Belfast, and the nature of the 'relapsing fevers' in the United Kingdom in the nineteenth century.

Some evidence is assembled to suggest that trench fever, an infection with a strain of Rochalimaea, if not quintana, then vinsonii, was present in Belfast in the first half of the nineteenth century in endemic and epidemic form. It may have amounted at times to one half or more of 'fever'. This may account for the comparatively low mortality in some years from 'fever'. The phrase 'relapsing fever' in the nineteenth and twentieth century medical literature of the United Kingdom should not be taken necessarily to mean infection with Borrelia recurrentis. Much or most may have been infection with Rochalimaea, quintana or vinsonii. The newly discovered Irish vole should be examined to see if it carries a Rickettsia or Rochalimaea infection.

Animals↗
PubMed1987

Brazilian purpuric fever: epidemic purpura fulminans associated with antecedent purulent conjunctivitis. Brazilian Purpuric Fever Study Group.

In late 1984, 10 children in a small, rural town in Brazil had high fever associated with vomiting and abdominal pain. Within 12-48 h of the onset of fever, purpura developed associated with vascular collapse and peripheral necrosis. All 10 children died. Cerebrospinal fluid examinations did not suggest meningitis and, when done, tests were negative for Neisseria meningitidis. Other culture, serological, and necropsy examinations did not reveal a cause. Case-finding uncovered another cluster of similar illness in children in a second town and sporadic cases in five other cities. Two case-control studies demonstrated that children who became ill were significantly more likely than control children to have had conjunctivitis during the month before illness. This conjunctivitis was purulent, preceded the onset of more severe disease by 3-15 days, and had resolved before fever began. Although no conjunctival cultures were obtained from case-children, Haemophilus aegyptius was the most common pathogen isolated from other conjunctival cultures during the epidemic. This organism was also isolated from a non-aseptic skin scraping from 1 case child. A 25-megadalton plasmid distinguished the H aegyptius isolates epidemiologically associated with illness from other Brazilian conjunctival isolates. Brazilian purpuric fever is a newly recognized syndrome of epidemic purpura fulminans associated with antecedent purulent conjunctivitis, possibly caused by H aegyptius.

Acute Disease↗
PubMed1988

[Fever caused by metapramine. Diagnosis of fever caused by psychotropic drugs].

Because of two hyperthermias, due to metapramine a french antidepressives of the tricyclic family, international literature concerning drug fever induced by psychotropics was reviewed. This study stresses the fact that apart from neuroleptics which are frequently involved in that type of accident, other psychotropics are very rarely responsible of hyperthermia. One hundred and five cases published since 1970 and sufficiently well documented to be analysed according to Dangoumeau's french method of imputation of side effects of drugs, were reviewed. Among these cases, one hundred (95%) corresponded to malignant syndrome of neuroleptics, 89 concerned neuroleptics alone, and 11, neuroleptics associated with other psychotropics. Regarding the different mechanisms which can explain drug fever as described by Lipsky, it seems that concerning psychotropics two types may be retained: Fever due to central dysregulation directly induced by drugs, and mainly, immunoallergic fever, the most frequently seen as described in our two cases.

Aged↗
PubMed1983

[Seroimmunologic studies in boutonneuse fever. I. Evaluation of a commercial micro-immunofluorescence kit in the serodiagnosis of boutonneuse fever].

The diagnosis of Boutonneuse Fever usually depends on clinical evidence (summer occurrence, fever, tache noire at the site of the tick bite, in 30-70% of cases, erythemato -papular rash, prompt response to chloramphenicol or tetracycline treatment). Serological confirmation is difficult since the only diagnostic procedure currently feasible, the Weil-Felix test, is not specific. Other more specific diagnostic procedures (agglutination, complement fixation, ELISA, indirect immunofluorescence tests) are beyond the possibilities of most laboratories (antigens are not available from the market). In the present paper, results obtained with a new commercially produced kit for indirect immunofluorescence are reported. Sera from patients with infectious and non infectious diseases as well as Boutonneuse Fever (at various stages of illness, from 6 days to 12 months) were examined. Sera from blood donors were also included. Specificity and sensitivity were satisfactory as well as reproducibility of results. Some apparently false positivities must be related to the present epidemiological pattern in western Sicily, and namely to the incidence of asymptomatic cases of Boutonneuse Fever, as demonstrated by recent works.

Antibodies, Bacterial↗
PubMed1993

Malaria as a cause of prolonged fever among children in Mansoura fever hospital.

Prolonged fever represents a diagnostic dilemma in small age group. Little attention was given as regard parasitic infections and prolonged fever. The objective of this study was to throw some light upon the role of malaria infection as a cause of prolonged fever. The study revealed malaria by blood film in 5 out of 129 children by IFA test 8 patients were seropositive intermittent fever was the main symptom of presentation.

Adolescent↗
PubMed2005

Clinicopathologic manifestations and outcome of dengue fever and dengue haemorrhagic fever.

During the peak period of outbreak from July through October, during the year 2000 through 2002, a total of 390 cases of either dengue fever (DF) or dengue haemorrhagic fever (DHF) were collected from medicine outpatient department (MOPD) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka to study their clinicopathologic manifestations and management outcome. Data were collected using a structured questionnaire. Almost all of the patients presented with fever (100%), headache (98.2%), bodyache (97.7%), anorexia (100%) and nausea (100%) and the vast majority had skin rash (78.5%), backache (78.2%) and retro-orbital pain (79.7%). Mean +/-SD of duration of total illness was 7.57 +/- 1.11 days and that of fever and skin rash were 5.40 +/- 0.86 and 3.02 +/- 0.78 days respectively. Mean +/-SD of platelet count was 69643.59 +/- 32043.97/mm3 of blood and that of haematocrit was 41.18 +/- 2.65%. Almost all of the patients (97.7%) developed thrombocytopenia but only 4.1% developed leucopenia at sometime during the course of the disease and anaemia was found in 49.4% of the patients. Both anti-dengue IgG and anti-dengue IgM were positive in 55.1% of patients and either anti-dengue IgG or anti-dengue IgM was positive in 23.6% and 21.3% of patients respectively. Management outcome of the patients was quite satisfactory without any case fatality.

Adolescent↗