Acute Febrile Stage Research Articles

Effectiveness of prophylaxis treatment in the acute febrile stage of febrile seizure in children under five years old.

ObjectivesIn children suffering from febrile seizure, the likelihood of recurrence seems to be high in the early hours following the first episodes in the absence of proper interventions. The present study was aimed at assessing and comparing the outcomes of different preventive interventions in the acute stage after febrile seizure in children.Materials & Methods This randomized clinical trial study was performed between September 2015 and September 2016. We enrolled patients aged between 6 and 60 months suffered from febrile seizure and referred to the Pediatric Emergency Department at Besat Hospital in Hamadan. The eligible patients were randomly assigned to the following four receive one of the following groups: group 1 (not receiving any anti-seizure drugs), group 2 (receiving a single dose of phenobarbital) on admission, group 3 (receiving a single dose of phenobarbital on admission continued until the fever is resolved), and group 4 (receiving diazepam until the disappearance of fever). Results:The study population consisted of 248 children. The recurrence rate of seizure in the acute stage was 4.84%. Also, the impact of diazepam and phenobarbital (either as a single dose or as continuous) on the prevention of febrile seizure recurrence in the acute stage has been established. None of the patients had febrile status epilepticus. Conclusion:Controlling seizures without prescribing anti-seizure drugs increases the risk for the recurrence of febrile seizure in the acute stage. Different drug regimens for controlling seizure, including diazepam and phenobarbital (as stat or maintenance), may play a similar role in preventing the occurrence of febrile seizure.

Gene Expression Profiling of Early Acute Febrile Stage of Dengue Infection and Its Comparative Analysis With Streptococcus pneumoniae Infection.

Infectious diseases are the disorders caused by organisms such as bacteria, viruses, fungi, or parasites. Although many of them are permentantly hazardous, a number of them live in and on our bodies and they are normally harmless or even helpful. Under certain circumstances, some organisms may cause diseases and these infectious diseases may be passed directly from person to person or via intermediate vectors including insects and other animals. Dengue virus and Streptococcus pneumoniae are the critical and common sources of infectious diseases. So, it is critical to understand the gene expression profiling and their inferred functions in comparison to the normal and virus infected conditions. Here, we have analyzed the gene expression profiling for dengue hemorrhagic fever, dengue fever, and normal human dataset. Similar to it, streptococcus pneumoniae infectious data were analyzed and both the outcomes were compared. Our study leads to the conclusion that the dengue hemorrhagic fever arises in result to potential change in the gene expression pattern, and the inferred functions obviously belong to the immune system, but also there are some additional potential pathways which are critical signaling pathways. In the case of pneumoniae infection, 19 pathways were enriched, almost all these pathways are associated with the immune system and 17 of the enriched pathways were common with dengue infection except platelet activation and antigen processing and presentation. In terms of the comparative study between dengue virus and Streptococcus pneumoniae infection, we conclude that cell adhesion molecules (CAMs), MAPK signaling pathway, natural killer cell mediated cytotoxicity, regulation of actin cytoskeleton, and cytokine-cytokine receptor interaction are commonly enriched in all the three cases of dengue infection and Streptococcus pneumoniae infection, focal adhesion was enriched between classical dengue fever — dengue hemorrhagic fever, dengue hemorrhagic fever—normal samples, and SP, and antigen processing and presentation and Leukocyte transendothelial migration were enriched in classical dengue fever —normal samples, dengue hemorrhagic fever—normal samples, and Streptococcus pneumoniae infection.

The Mysteries That Surround Kawasaki Disease: A Literature Review

Kawasaki disease (KD) or Mucocutaneous Lymph node Syndrome is a systemic vasculitis, which mainly affects children under five years of age with Asian descent, but can also reach other age groups, as well as any other breed. The clinical picture of KD has three stages: acute febrile stage, in which conjunctival congestion, oral mucositis, erythema, flaking, polymorphic rash and laterocervical lymphadenopathy, appear as main symptoms; the subacute stage, which occurs at the end of fever, and leads to the appearance of skin flaking in the limbs, arthritis, arthralgia and thrombocytosis and finally the stage of convalescence that arises when symptoms are almost dissipating and continues until their normalization. The most used treatment occurs from the administration of intravenous immunoglobulin, which for better prognosis of the pathology should be initiated early.

Pathogenic Parameters Derived from Activated Platelets in Dengue Patients

Platelets have been recognized to be an integral part of human immune system. Hematologic disfunction, such as thrombocytopenia, is one of the most salient clinical features in dengue patients. Understanding the parameters released from activated platelets, involving in maintaining the delicate network, can provide a better picture of pathogenic cause of dengue. Ninety four dengue confirmed patients, 24 other febrile patients, and 12 healthy controls were enrolled to study. The parameters including the levels of polyphosphates, bradykinin, thyroxine, nitrite/ nitrate, platelet factor 4 (PF4), and serotonin, from the circulation of dengue patients were quantified by commercial ELISA kits and then compared to that from patients with other febrile illnesses, follow-up samples, and healthy controls. The following results were documented. Results 1. The levels of polyphosphates were on average 30% higher in acute dengue samples than healthy controls. 2. The levels of thyroxine, and nitrite/nitrate were significantly higher in acute dengue samples compared to that of other febrile, follow-up and healthy samples, while bradykinin was significantly lower. 3. The levels of PF4 were not different among samples of acute dengue, other febrile illness and follow-up, but were all significantly higher than the healthy controls. 4. The levels of serotonin were significantly higher in acute febrile stage compared to convalescent stage; while significantly lower than healthy subjects. The dynamic network of biochemical programs that coordinate to maintain hemostasis become unbalanced during and following dengue virus infection. Factors released from activated platelets may influence the vascular permeability

Nonstructural protein NS1 immunodominant epitope detected specifically in dengue virus infected material by a SELDI‐TOF/MS based assay

Dengue virus (DV) infection is the most common mosquito-born viral disease of public health significance. Though most patients only suffer from flu-like symptoms, a small group of patients experiences more severe forms of the disease. The viral nonstructural protein 1 (NS1), a secreted protein correlating with viremia, is a key element used for dengue diagnosis with potential implications in severe dengue prognosis. Capture-ELISAs for the early detection of the NS1 protein in the sera during the acute febrile stage are commonly used in routine by diagnostic laboratories. In this study, the detection of NS1 protein in DV-infected material was assessed by an alternative method combining a single NS1-directed monoclonal antibody and the SELDI-TOF/MS technology. According to the epitope mapping, the antibodies used are mainly directed against an immuno-dominant peptide located on the C-terminal part of the protein. The NS1 SELDI-TOF assay is specific, has a sensitivity level close to capture-ELISAs and is potentially useful for a coupled serotyping/detection assay or for the detection of subtle post-translational modifications on the protein.

Gene Expression Profiling during Early Acute Febrile Stage of Dengue Infection Can Predict the Disease Outcome

BackgroundWe report the detailed development of biomarkers to predict the clinical outcome under dengue infection. Transcriptional signatures from purified peripheral blood mononuclear cells were derived from whole-genome gene-expression microarray data, validated by quantitative PCR and tested in independent samples.Methodology/Principal FindingsThe study was performed on patients of a well-characterized dengue cohort from Recife, Brazil. The samples analyzed were collected prospectively from acute febrile dengue patients who evolved with different degrees of disease severity: classic dengue fever or dengue hemorrhagic fever (DHF) samples were compared with similar samples from other non-dengue febrile illnesses. The DHF samples were collected 2–3 days before the presentation of the plasma leakage symptoms. Differentially-expressed genes were selected by univariate statistical tests as well as multivariate classification techniques. The results showed that at early stages of dengue infection, the genes involved in effector mechanisms of innate immune response presented a weaker activation on patients who later developed hemorrhagic fever, whereas the genes involved in apoptosis were expressed in higher levels.Conclusions/SignificanceSome of the gene expression signatures displayed estimated accuracy rates of more than 95%, indicating that expression profiling with these signatures may provide a useful means of DHF prognosis at early stages of infection.

Brucellar Lumbar Epidural Abscess

Brucellosis is an infectious disease characterized by an acute febrile stage with few or no localizing signs and a chronic stage with relapses of fever, weakness, sweats, and vague symptoms. Brucellosis is one of the major causes of spondylitis in the Mediterranean area. We present a 46-year-old woman who had pain in the low back and both legs for 2 months. The diagnosis was performed on clinical presentation, laboratory findings (Rose Bengal and Wright agglutination tests), and magnetic resonance imaging. Magnetic resonance imaging revealed an extradural mass compressing the thecal sac at the L5-S1 level. The mass was isointense to hypointense compared with the spinal cord on T1WI and heterogenic hyperintense on T2WI. With contrast material, heterogeneous enhancement was seen. The patient was treated with surgery and 3 antibiotics. In an endemic area, brucellosis should be included in the differential diagnosis of any patient complaining of back or leg pain.

Cardiac and coronary arterial involvement in infants and children from new England with mucocutaneous lymph node syndrome (Kawasaki disease): Angiocardiographic-echocardiographic correlations

Forty-four patients, aged 6 months to 11 years, meeting the clinical criteria for mucocutaneous lymph node syndrome (Kawasaki disease) were studied from March 1980 to March 1981. A protocol was designed for evaluation of cardiac involvement including electrocardiogram, chest X-ray film, cardiac enzyme determinations and M mode and two dimensional echocardiograms. Aspirin was given during the acute febrile period as an anti-inflammatory agent in a dosage of 100 mg/kg per day; followed by 30 mg/kg per day for 10 weeks or longer if platelet counts were elevated. Angiocardiography was performed in 38 patients. Twenty-one patients (48 percent) showed abnormal M mode echocardiographic findings (flat or greatly decreased ventricular septal motion, pericardial effusion or decreased left ventricular function) during the acute febrile stage. Coronary artery disease developed in seven patients, all of whom had abnormal M mode echocardiographic abnormalities in the acute stage. Five patients had coronary aneurysms and two patients had dilated coronary arteries. Two dimensional echocardiograms identified coronary arterial lesions accurately if present proximally but failed to detect aneurysms beyond 1.5 cm from the aortic root. The study shows that serial M mode and two dimensional echocardiograms provide sufficient information to rule out cardiac involvement in Kawasaki disease. Echocardiograms should be obtained every 3 to 4 days during the acute febrile stage because all patients with coronary artery disease detected with angiography had abnormal echocardiographic findings during that period.

The Pathogenesis of Ocular Lesions of Infectious Canine Hepatitis: 1. Pathology and Virological Observations

Disease-free dogs, known to be susceptible to infectious canine hepatitis, were inoculated with this virus subcutaneously or intravenously. Antibody and virus titers were measured in the aqueous humor and blood serum. Ocular tissue was examined for the presence of virus by fluorescence microscopy. During the acute febrile stage of illness there was mild iridocyclitis without corneal involvement. The latter supervened during convalescence. Two fundamentally different modes of pathogenesis are postulated for the ocular lesions of infectious canine hepatitis. During the acute phase of illness, prior to the onset of circulating antibody, uveitis occurs that is related directly to effects of viral growth in vascular endothelium, and in reticuloendothelial elements of the anterior uvea. The severe iridocyclitis with corneal opacification that occurs in clinically recovered dogs possess characteristics of the Arthus-type of ocular hypersensitivity.

Hepatic dysfunction in human trypanosomiasis: I. Abnormalities of excretory function, seroflocculation phenomena and other tests of hepatic function with observations on the alterations of these tests during treatment and convalescence

1. 1) Though clinical jaundice is uncommon in T. rhodesiense infections in man, an increase in the total serum bilirubin is common in early cases in the acute febrile stage. A raised serum bilirubin level was common even in very early cases with a trypanosome chancre. The serum bilirubin was not raised in six consecutive chronic late cases. 2. 2) Excess urobilinogen in the urine was found in 83 per cent. of early cases, 67 per cent. of the intermediate and only 40 per cent. of the late cases. Bilirubinuria occurred in 80 per cent. of the early cases but was less common and less severe in the late. 3. 3) The bromsulphthalein tolerance test was always abnormal in the acute febrile early case, but was normal in clinically mild apyrexial cases. The test became normal rapidly after treatment. Those late cases of T. rhodesiense and T. gambiense infections which were examined, showed abnormalities of BSP tolerance, which also became normal rapidly after treatment. 4. 4) The BSP tolerance test became normal before the serum bilirubin had returned to normal. 5. 5) The seroflocculation abnormalities in 46 early cases and in 10 late cases of T. rhodesiense infections are described. Similar abnormalities were noted in two late cases due to T. gambiense. The improvements of these tests during recovery are described. 6. 6) Abnormal hippuric acid synthesis was noted in one late case due to T. gambiense, and in another due to T. rhodesiense. This test became normal soon after treatment was begun. 7. 7) The clinical and biochemical investigations indicated that, in T. rhodesiense infections in man, there is a parenchymatous disorder of the liver of greatly varying severity which is reversible by specific treatment with suramin or mel B. Hepatic dysfunction may be responsible for the intolerance of severely ill cases to mel B. Because of this, Apted's (1953, 1957) cautious approach to treatment is to be commended.

Hepatic dysfunction in human trypanosomiasis: II. Serum proteins in Trypanosoma rhodesiense infections and observations on the alterations found after treatment and during convalescence

1. 1) The results of the analysis of serum proteins by electrophoresis are described in 26 early cases and 10 late cases of T. rhodesiense infection in man. 2. 2) In early cases in the acute febrile stage there is a reduction in total protein and serum albumin. This reduction precedes any rise in γ-globulin and is corrected during treatment and subsequently. 3. 3) Individual early cases may show an increase in serum γ-globulin on admission, which declines on treatment and subsequently. 4. 4) Some early cases show a rise in γ-globulin after treatment, which declines subsequently. 5. 5) Other disorders of hepatic function are described in a very early case with a trypanosome chancre. The associated serum protein alterations are also described. The abnormalities of the hippuric acid synthesis test, the bromsulphthalein tolerance test and serum bilirubin are described; these tests became normal before the serum proteins. 6. 6) In late cases the serum albumin is low and the serum γ-globulin is high. Very high γ-globulin levels are found characteristically in the chronic “tolerant” late case. The “intolerant” very wasted case showed marked reduction in serum albumin and very low total protein. 7. 7) Seroflocculation tests improve concurrently with serum proteins and reflect the “balance” of these proteins but a quantitative relationship could not be determined. 8. 8) The pathogenesis of serum protein changes is discussed.

The rapid-rocking bed: its effect on the ventilation of poliomyelitis patients with respiratory paralysis.

RECENT improvements in the management of respiratory insufficiency in patients with acute poliomyelitis have considerably reduced mortality in this stage of the disease. As a result, increasing numbers of patients have required artificial respiration for long periods after the acute febrile stage of poliomyelitis has passed. Although tank-type "iron-lung" respirators are life-saving for acutely ill patients, their continued use over periods of many weeks or months is associated with certain disadvantages. These include fixation and fibrosis of the diaphragm, restriction of motion of the extremities and difficulty in inducing patients to rely on their own recovering ventilatory mechanisms. A device . . .

Indications for and limitations of treatment of poliomyelitis

Summary Poliomyelitis is self-limited and if deformities are prevented the end result is determined largely by the damage done to the motor cells during the acute febrile stage. Many patients recover completely without treatment and others remain extensively paralyzed in spite of the best treatment. No known treatment affects the degree or extent of the initial paralysis, but we are able to ameliorate the effects of the disease. In the acute febrile stage the treatment is general medical care plus protection of the patient from irritation. If the respiratory function is affected, efforts must be made to save the patient's life. In the subacute stage rest and immobilization dominate the treatment. We relieve the patient's pain, protect paralyzed muscles from stretching, prevent early deformities due to the contracture of painful muscles, and give the injured nerve cells the best possible chance to recover. In the convalescent stage we protect and restore the maximum of power to the weakened muscles, stretch the contracted muscles and restore normal movement to the parts, and train the patient to use his weak extremities. In the chronic stage we prevent or minimize late deformities and increase function by braces and surgery.

LEUKOCYTIC RESPONSE TO MEASLES

The precise nature of the leukocytic reactions during measles still remains a subject concerning which there are surprising differences of opinion. Although it is generally held that a leukocytosis is present during the incubation period, followed as a rule by a leukopenia during the acute febrile stage,¹there is a lack of agreement regarding the changes in the differential count. It was early pointed out by several investigators²that the fall in the blood count was due chiefly to a diminution in the number of lymphocytes. Diametrically opposed to this finding, however, have been the reports of a lymphocytosis occurring simultaneously with the rash.³Moreover, it has been maintained⁴that variations in the number of polymorphonuclear cells principally account for the leukocytosis or the leukopenia observed in the different phases of the disease. More recent workers,⁵on the other hand, have laid great stress on

TULAREMIA

The four cases reported here are the first to be reported from this vicinity. Two of the cases emphasize the fact that the patient may first present himself to the physician long after the acute febrile stage, complaining only of tender swellings along the course of the lymphatics or in the lymph glands. All the cases were verified by agglutination tests done at the Hygienic Laboratory, Washington, D. C. <h3>Case 1.</h3> —E. D., a white man, aged 40, employed as a market man, handled, among other things, wild rabbits, which he dressed himself. The patient complained of not feeling well, Dec. 7, 1925, and went to bed the next day. At this time he had fever, chills and sweats, headache, and severe pains in the back. There was pain in both axillae. Prostration was fairly marked. The temperature was 103 F.; the pulse, 84. The throat was moderately injected,