Central Fever Research Articles

Thrombotic Thrombocytopenic Purpura in Pregnancy: Successful Treatment with Plasma Exchange

Thrombotic thrombocytopenic purpura (TTP) is a rare syndrome which presents typically with thrombocytopenia, microangiopathic hemolytic anemia, central nervous system symptoms, fever, and renal abnormalities. The diagnosis of TTP in pregnancy previously carried a poor prognosis and a high fetal mortality when presenting early in gestation. This case report describes the earliest presentation of TTP in pregnancy (6 weeks of gestation) we could identify in the literature treated successfully with a prolonged course of plasma exchange. The differential diagnosis and the pathogenesis of TTP in pregnancy are reviewed. Therapeutic options and data regarding the removal of pregnancy-related hormones by plasma exchange are presented.

Hyperpyrexia associated with sustained muscle contractions: An alternative diagnosis to central fever

Muscle activity is the principal source of body heat production, and elevated core body temperatures may occur in healthy exercising persons. Hyperpyrexia from sustained tonic muscle contractions can also occur in a number of pathological conditions. The present case of hyperpyrexia associated with dystonic posturing and sustained muscle contraction in a child with encephalopathy illustrates the importance of recognizing muscular activity in the generation of fever of unknown origin following central nervous system injury. The pathophysiology, clinical features, and management of this uncommon cause of fever are discussed.

Glial cell-specific mechanisms of TGF-β1 induction by IL-1 in cerebral cortex

Transforming growth factor beta-1 (TGF-β1) immunoreactive product (IRP) has recently been detected in autopsied brains of individuals who died with central nervous system diseases and/or fever but not in normal individuals or in normal rodent brain. However, the mechanism(s) of induction of TGF-β1 in brain and the identity of cells expressing TGF-β1 need to be understood before a role, if any, for this potent pleiotropic cytokine in neuropathogenesis can be discerned. Towards this end we determined that IL-1 stimulated the production of TGF-β1 IRP in cells and TGF-β1 activity in culture fluids of all glial cells, astrocytes, microglial cells, and oligodendrocytes, derived from neonatal rat cortex and grown in cell type-enriched cultures. TGF-β1 production in vitro varied with the cell type and isoform of IL-1. Oligodendrocytes produced the most and astrocytes the least amount of TGF-β1. IL-1α stimulated TGF-β1 production in all glial cell types, whereas IL-1β did not. In vivo, TGF-β1 IRP was detected in human tissues from cerebral frontal cortex and subcortical white matter only when interleukin-1 (IL-1) was elevated in the same tissues. Moreover, the amount of detectable TGF-β1 was positively correlated with the amount of detectable IL-1 (rho = 0.605; P = 0.003), as determined by morphometry. Double-labelling of cells for their phenotypic markers and expression of TGF-β1 indicated that all glial cells, but not neurons, expressed TGF-β1. IL-1α and IL-1β IRPs were also detected in all three glial cell types, most frequently in astrocytes and least frequently in microglial cells. The cells containing both cytokine IRPs were also detected. These results indicate that TGF-β1 may be induced by IL-1 in all glial cells of the frontal cortex, by both autocrine and paracrine mechanisms.

1012 Ep1 receptor is involved in the central prostaglandin E2-induced fever in rats

1012 Ep1 receptor is involved in the central prostaglandin E2-induced fever in rats

Identification of central Kenyan Rift Valley Fever virus vector habitats with landsat TM and evaluation of their flooding status with airborne imaging radar

Rift Valley Fever (RVF) is a mosquito-borne virus that affects livestock and humans in Africa. Landsat Thematic Mapper (TM) data are shown to be effective in identifying dambos, intermittently flooded areas that are potential mosquito breeding sites, in an area north of Nairobi, Kenya. Positive results were obtained from a limited test of flood detection in dambos with airborne high resolution L, C, and X band multipolarization synthetic aperture radar (SAR) imagery. L and C bands were effective in detecting flooded dambos, but LHH was by far the best channel for discrimination ( p < 0.01) between flooded and nonflooded sites in both sedge and short grass environments. This study demonstrates the feasibility of a combined passive and active remote sensing program for monitoring the location and condition of RVF vector habitats, thus making future control of the disease more promising.

Large-scale collection of circulating haematopoietic progenitors in cancer patients treated with high-dose cyclophosphamide and recombinant human GM-CSF

Circulating haematopoietic progenitors from 36 cancer patients were collected by continuous-flow leukapheresis during the phase of rapid haematopoietic recovery after pancytopenia induced by high-dose cyclophosphamide and then cryopreserved for autologous transplantation. 20 of the patients also received intravenous infusion of recombinant human granulocyte macrophage-colony stimulating factor (rhGM-CSF) for 7, 10 or 14 days after cyclophosphamide. 106 leukapheresis procedures were done for 2–5 consecutive days. Leukapheresis was started significantly earlier in patients receiving rhGM-CSF. In these patients, yields of peripheral blood elements (leucocytes, mononuclear cells, haematopoietic progenitors and platelets) were significantly higher than in controls treated with cyclophosphamide only. In particular, the mean number of granulocyte-monocyte colony-forming cells was 43.88 × 10 4 vs. 6.16 × 10 4 per kg patient body weight per leukapheresis. Side-effects of leukapheresis were limited to central venous catheter occlusion and fever in 4% and 2% of all procedures, respectively.

Web of deceit: A literature review of Munchausen syndrome by proxy

Munchausen syndrome by proxy (MSBP) is a form of child abuse wherein the mother falsifies illness in her child through simulation and/or production of illness, and presents the child for medical care, disclaiming knowledge as to etiology of the problem. From the literature, 117 eases of MSBP were reviewed. The most common presentations of MSBP were bleeding, seizures, central nervous system depression, apnea, diarrhea, vomiting, fever, and rash. Short-term morbidity rate was 100%; long-term morbidity rate was 8%. Mortality rate was 9%. Failure to thrive was associated with MSBP in 14% of cases. All perpetrators of MSBP were the mothers. The origins of this type of aberrant maternal behavior remain abstruse, as do the long-term psychological effects on the child victims. Guidelines for medical, social service, and legal management are provided.

Vigs: Implikasies vir Suid-Afrikaanse verpleegkundiges — Deel 1

At present the number of AIDS victims in South Africa has been small with only 19 cases reported by 19 July 1985. Nurses in South Africa should however understand AIDS (Auto Immune Deficiency Syndrome) so that a possible sudden increase in the number of cases does not Find them unprepared. AIDS is a disease characterised by the development of an inexplicable immune deficiency. These patients develop fatal opportunistic infections and a specific malignancy — Kaposi Sarcoma. AIDS is believed to be caused by a retro-virus named HTLV-III. It seems to be spread through sexual contact, blood, blood products, syringes of drug-addicts and to a baby during the birth process. The diagnosis of AIDS is made on the basis of an opportunistic infection or the development of a malignancy. Four patterns have been identified including the pulmonary, central nervous system, gastro-intestinal and fever o f unknown origin patterns. (Next issue: Nursing patients with AIDS).

Influence of sex and age on febrile responses to peripheral and central administration of pyrogens in the rabbit.

1. Intravenous injections of leucocytic pyrogen in doses of 15, 30 and 60 mul./kg caused febrile reactions in male rabbits that were related to age of the animal: rabbits under 2 yr of age developed fevers that were related to dose of pyrogen, while rabbits 2-3 yr old showed large febrile responses which were not dose-related.2. Female rabbits of comparable ages generally showed smaller febrile reactions to I.V. leucocytic pyrogen, and still older females (3-5 yr) developed fever only after the largest dose.3. Dose-related febrile responses to 2.5, 5 and 10 mul. leucocytic pyrogen given intracerebroventricularly (I.C.V.) were greater in male rabbits 1-3 yr old than in females of comparable age. Female rabbits 3-5 yr old showed dose-related fevers that were smaller than those of younger animals of both sexes.4. There were no major differences in response to 125, 250 and 500 ng PGE(2), given I.C.V., between male and female rabbits under 2 yr of age. Females 2-3 yr of age had greater responses to PGE(2) than males of comparable age whilst the oldest females showed smaller responses.5. It is concluded that the febrile response of the rabbit to peripheral and central leucocytic pyrogen varies with both age and sex. Differences in sensitivity of central fever controls to endogenous pyrogen in animals of different ages and sexes may account for the different responses to peripheral pyrogen.

Central synaptic interference and experimental fever.

Central synaptic interference and experimental fever.

Thrombotic thrombocytopenic purpura. Antemortem diagnosis: use of paraffin sections of sternal bone-marrow aspirate.

While the number of reported cases of thrombotic thrombocytopenic purpura, first described by Moschcowitz in 1925, has steadily increased during the past 15 years, the diagnosis has been established in most instances only on postmortem demonstration of the characteristic vascular lesion. Although clinical suspicions are now frequently aroused by patients presenting with evidences of progressive disseminated disease including thrombocytopenia, hemolytic anemia, transitory disturbances of the central nervous system, fever, and mild to moderate nephropathy, definite studies of the pathogenesis of this unexplained disorder have been hampered by the infrequency with which a conclusive diagnosis is established. Bernheim,1in 1943, suggested that since necropsy had revealed the presence of widespread vascular lesions in a case of thrombotic thrombocytopenic purpura, antemortem biopsy might have established the diagnosis. The site for such biopsy was not indicated. Fitzgerald and co-workers,2in 1947, reported an additional 3 cases, in each of which necropsy