Common Cause Of Fever Research Articles

Kikuchi-Fujimoto disease co-occuring with Hashimoto thyroiditis: A case report and literature review.

We introduce a 16-year-old female who presented with tender cervical lymphadenopathy, prolonged fever, and hypothyroidism. After excluding common causes of fever of unknown origin, a surgical biopsy of cervical lymph nodes revealed Kikuchi-Fujimoto disease. The patient showed improvement with a short-term course of NSAIDs. An increased titre of thyroperoxidase antibody led to a diagnosis of Hashimoto's thyroiditis during stable condition. This report underscores the importance of considering Kikuchi-Fujimoto disease in the differential diagnosis of prolonged fever of unknown origin with lymphadenopathy and highlights the association with Hashimoto's thyroiditis, advocating for vigilance regarding hypothyroidism in long-term follow-up after Kikuchi-Fujimoto disease recovery.

Determinants of antibiotic prescription in children with adenovirus respiratory tract infections

We performed this study to evaluate factors associated with antibiotic prescriptions in children with adenovirus infection, since no studies have attempted to address this aspect in the pediatric population. Retrospective study of children younger than 18 years of age tested positive for adenovirus on a syndromic nasopharyngeal test from 2018 to 2023. We compared the need of pediatric intensive care unit (PICU), invasive ventilation, and other respiratory support, viral etiologies, clinical presentations, imaging, and laboratory results in the precovid (2018–2019) and covid (2020–2022) period. The use of antibiotics was studied with multivariable logistic regression including demographic as well as clinical data as covariates. Two hundred fifty-eight patients were enrolled. One hundred fifty-eight patients received an antibiotic (mean duration 6.2 (±2.7) days (median 4; IQR: 4–7)). Presence of seizures and C-reactive protein values as predictors for antibiotic prescription (OR for seizures: 12.17; 95% CI: 1.42–103.91; p = 0.022; OR for CrP: 1.03; 95% CI: 1.01–1.04; p = 0.001). Seventy-four patients received intravenous antibiotics (74/156, 47.4%). Risk factors for intravenous antibiotic were the presence of decay (OR: 3.74; 95% CI: 1.25–11.71; p = 0.018), CrP values (OR: 1.02; 95% CI: 1.00–1.03; p = 0.001), and presence of seizures (OR: 16.34; 95% CI: 2.65–100.83; p = 0.003). Duration of intravenous antibiotics correlated with the presence of seizures (Coeff: 1.6; 95% CI: 0.41–2.89; p = 0.009) even when adjusted for CrP values. Conclusion: The clinical presentation of adenovirus infection in children is non-specific, leading to frequent antibiotic prescription despite bacterial co-infections was rare. Higher CrP values and presenting with seizures are significantly associated with a higher risk of receiving antibiotics. Rapid microbiological tests and newer biomarkers can help clinicians to improve antibiotic prescription in this cohort of children.What is Known:•Adenovirus infection is a common cause of fever and respiratory tract infections in children.•Children with adenovirus infections frequently receive antibiotics, but determinants of this practice are poorly established.What is New:• Higher C-reactive protein values and presenting with seizures are significantly associated with antibiotic prescription. • Since the beginning of COVID-19 and implementation of rapid diagnostics, less children with adenovirus infection received antibiotics.

Síndrome febril asociado a lesiones ocupantes de espacio hepáticas

The most common causes of fever associated with space-occupying liver lesions are liver abscesses (pyogenic and amoebic), granulomatous diseases, or other systemic infections and malignant neoplasms such as metastatic and primary neoplasms (hepatocellular carcinoma and cholangiocarcinoma).

Correlation between interleukin 17 (IL-17) levels and malondialdehyde (MDA) levels in patients with chronic suppurative otitis media

Background: Otitis media is one of the most common causes of fever in the pediatric population. CSOM or also called chronic otitis media is an ear disease condition where a chronic infection is found in the middle ear without an intact tympanic membrane. Oxygen free radical levels and deficiency of antioxidant defense complexes may be involved in the pathogenesis of chronic suppurative otitis media. The IL-17 pathway plays an important role in the pathogenesis of otitis media by increasing ROS including MDA levels. Purpose: To analyze the levels of interleukin 17 (IL-17) and malondialdehyde (MDA) in chronic suppurative otitis media patients. Method: Analytical observational research with a cross sectional approach was conducted in December 2022 at RSUD Dr. Moewardi, the research sample was a patient with chronic suppurative otitis media without active phase cholesteatoma. Sampling used consecutive sampling, namely a non-random sampling method, so that a sample size of 40 participants was obtained, divided into two groups, namely the CSOM group and the healthy group. The data analysis used is univariate and bivariate analysis using parametric tests, namely the product moment correlation test and if it is not normally distributed (p-value <0.05) then use the Spearman rank correlation test. Results: The mean IL-17 level in the CSOM group was 78.76 ± 28.01 and the healthy group was 47.68 ± 21.75 with p = 0.000 < 0.05. The mean MDA value in the CSOM group was 138.37 ± 123.96 and in the healthy group was 55.84 ± 47.37 with a p value = 0.008 < 0.05. Because the p value is <0.05 for the IL-7 and MDA variables, there is a significant difference between CSOM and the group of healthy people. The product moment correlation test obtained a correlation coefficient value of 0.623 with a p value = 0.000. Because the p value is <0.05, there is a significant positive relationship between IL-17 levels and MDA in the blood of chronic suppurative otitis media (CSOM) patients. Conclusion: There is a significant positive relationship between IL-17 levels and MDA in the blood of chronic suppurative otitis media (CSOM) patients.

Distinct patterns of postoperative fever in paediatric neurosurgery patients.

Postoperative fever is a common problem following neurosurgery but data on the causes among paediatric patients is sparse. In this report, we determined the incidence, causes, and outcomes of postoperative fever in paediatric neurosurgical patients (< 18years), and contrasted the findings with an adult cohort published recently from our unit. We recruited 61 patients who underwent 73 surgeries for non-traumatic neurosurgical indications over 12months. A standard protocol was followed for the evaluation and management of postoperative fever. We prospectively collected data pertaining to operative details, daily maximal temperature, clinical features, and use of surgical drains, urinary catheters, and other adjuncts. Elevated body temperature of > 99.9 °F or 37.7°C for > 48h or associated with clinical deterioration or localising features was considered as "fever"; elevated temperature not meeting these criteria was classified as transient elevation in temperature (TET). Twenty-six patients (35.6%) had postoperative fever, more frequent than in adult patients. TET occurred in 12 patients (16.4%). The most common causes of fever were aseptic meningitis (34.6%), followed by urinary tract infections (15.4%), pyogenic meningitis, COVID-19, and wound infections. Postoperative fever was associated with significantly longer duration of hospital admission and was the commonest cause of readmission. In contrast to adults, early temperature elevations in paediatric patients may portend infectious and serious non-infectious causes of fever, including delayed presentation with aseptic meningitis, a novel association among paediatric patients. Investigation guided by clinical assessment and conservative antibiotic policy in keeping with the institutional microbiological profile provides the most appropriate strategy in managing paediatric postoperative fever.

Determination of the prevalence of fever after congenital cardiac surgery in children

undergoing congenital heart surgery and causes anxiety in the surgeon and the patient's parents. Proper diagnosis and management of fever requires careful preoperative patient evaluation, targeted physical examination, and comprehensive knowledge about the prevalence and common causes of fever. The aim of this study was to determine the prevalence of fever after congenital heart surgery in children. Subjects and Methods This was a descriptive-analytical study on children under 10 years of age undergoing congenital heart surgery in the cardiac operating room of Golestan Hospital of Ahvaz in 2021. Data collection tools included a two-section checklist. The first section was related to demographic characteristics and the second addressed patients' clinical status and causes of fever. Data were analyzed using SPSS software. Results After surgery, 21 patients (31.8%) developed fever and the prevalence of fever was not significantly associated with age, sex, presence of genetic syndrome, type of disease, type of operation, cardio pulmonary bypass, duration of aortic cross clamp, duration of cardiopulmonary bypass, or duration of operation. However, it was significantly correlated with the mean length of ICU stay (P&gt; 0.05). Conclusion The prevalence of fever in patients undergoing congenital heart surgery was relatively high and had a significant relationship with the length of ICU stay.

Prospective cross-organ analysis for the causes of fever and increased inflammatory response after endoscopic resection.

Fever and increased inflammatory responses sometimes occur following endoscopic resection (ER). However, the differences in causes according to the organ are scarcely understood, and several modified ER techniques have been proposed. Therefore, we conducted a comprehensive prospective study to investigate the cause of fever and increased inflammatory response across multiple organs after ER. We included patients who underwent gastrointestinal endoscopic submucosal dissection (ESD) and duodenal endoscopic mucosal resection at our hospital between January 2020 and April 2022. Primary endpoints were fever and increased C-reactive protein (CRP) levels following ER. The secondary endpoints were risk factors for aspiration pneumonia. Blood tests and radiography were performed on the day after ER, and computed tomography was performed if the cause was unknown. Among the 822 patients included, aspiration pneumonia was the most common cause of fever and increased CRP levels after ER of the upper gastrointestinal tract (esophagus, 53%; stomach, 48%; and duodenum, 71%). Post-ER coagulation syndrome was most common after colorectal ESD (38%). On multivariate logistic regression analysis, lesions located in the esophagus (odds ratio [OR] 3.57; P < 0.001) and an amount of irrigation liquid of ≥1 L (OR 3.71; P = 0.003) were independent risk factors for aspiration pneumonia. Aspiration pneumonia was the most common cause of fever after upper gastrointestinal ER and post-ER coagulation syndrome following colorectal ESD. Lesions in the esophagus and an amount of irrigation liquid of ≥1 L were independent risk factors for aspiration pneumonia.

Dengue convalescent rash

Dengue is one of the common causes of fever in tropical countries like India. It is self-limiting fever with recovery in almost all cases unless patient develop hepatic failure or haemorrhagic fever. Few of the patients developed convalescent rash during the recovery phase. We are reporting convalescent rashes in dengue which are very common but very few published literatures are available so we are reporting this case.

A Short Communication: An Imported Case of &lt;i&gt;Plasmodium falciparum&lt;/i&gt; Malaria Infection from Ivory Coast leave to Iran

Malaria is the most common cause of fever in travellers returning from malaria-endemic areas. Imported malaria can hinder the progress of elimination programs. In the present study, we describe an imported malaria case in a 45-year-old Iranian man from Ivory Coast who had returned to Iran after taking annual leave. He was hospitalized in Kamkar-Arabnia Hospital, Qom, central Iran, in January 2023. Symptoms were fever, chills, sweating, cough, myalgia, sweating, anorexia, diarrhoea, and headache. Rapid detection test and blood smears were positive for Plasmodium falciparum gametocyte. The patient was treated with an antimalarial drug and discharged from the hospital with normal vital signs. Health education is recommended for people before leaving and screening after returning from travel. In addition, using RDT tests for screening people who return to the country is suggested to health staff and organizations.

Study of the Relative Frequency of Different Disease in Fever with Thrombocytopenia

Background: Thrombocytopenia is a common biological sign, and in severe situations, bleeding can ensue. Thrombocytopenia caused mostly by platelet immunological destruction, decreased platelet synthesis in bone marrow, and a delay in megakaryocyte maturation. Dengue fever haemostasis disruption is exacerbated by thrombocytopenia and platelet dysfunction. Objective: To determine the relative prevalence of various diseases in fever with thrombocytopenia. Materials and Methods: This observational, cross-sectional study was carried out by the Department of Medicine at the 100-bed district hospital in Narsingdi between July 2021 and June 2022. Total 100 adult patients (over the age of 18) who had thrombocytopenia and presented with fever were included in this study. We excluded patients who had a fever but no thrombocytopenia. Additionally, patients with thrombocytopenia but no fever were excluded from the research. Results: Malaria was the most prevalent cause of fever (44.0%), followed by dengue (27.0%), viral fever (18.0%), enteric fever (5.0%), dengue + malaria (3.0%), septicemia (2.0%), and hematologic malignancy (1.0%). Conclusion: Dengue fever and malaria are common causes of fever with thrombocytopenia because of seasonal and regional variations.

Effectiveness of In Vivo T-Cell Depleted Regimen Containing Porcine Antilymphocyte Globulin and Rabbit Antithymocyte Globulin in Preventing Acute Gvhd after Haploid Hematopoietic Stem Cell Transplantation

Objective To compare the clinical efficacy of porcine antilymphocyte globulin (p-ALG) and rabbit antithymocyte globulin (r-ATG) in the treatment of hematologic malignancies using haploid hematopoietic stem cell transplantation (haplo- HSCT), this study was conducted. Methods This was a single center retrospective analysis of 178 subjects who received haplo-HSCT with p-ALG or r-ATG from January 2020 to December 2022. The patients were divided into three groups according to the doses of p-ALG or r-ATG used in the conditioning regimens. The study evaluated and compared the occurrence of early fever, graft versus host disease (GVHD), infection, and survival among the three groups of patients. Results A total of 178 patients were enrolled in the study with a median age of 30 (14-61) years, including 95 men and 83 women. The median follow-up time post-transplantation was 20.1 (1.7-36.9) months. The study included 57 patients in the p-ALG 75mg/kg group, 49 patients in the p-ALG 90mg/kg group, and 72 patients in the r-ATG 7.5mg/kg group, respectively. The incidences of neutrophil and platelet engraftment, respectively, were 100%,93.5%, and 91.3% (p=0.133); 100%, 93.6%, 90.3% (p=0.033) in P-ALG 75mg/kg, P-ALG 90mg/kg and r-ATG 7.5mg/kg. The median time to neutrophil engraftment was 11 days for the P-ALG 75mg/kg group, 12 days for the P-ALG 90mg/kg group, and 12 days for the r-ATG 7.5mg/kg group (p=0.133). The median time to platelet engraftment was 12 days for the P-ALG 75mg/kg group, 14 days for the P-ALG 90mg/kg group, and 13 days for the r-ATG 7.5mg/kg group (p=0.033). In the p-ALG 75mg/kg, p-ALG 90mg/kg, and r-ATG 7.5mg/kg groups, 16 patients (28.1%), 24 patients (49.0%) and 35 patients (48.6%) developed fever within 14 days after transplantation, respectively. Cytokine release syndrome was found to be the most common cause of fever. The incidence of grades Ⅱ-Ⅳ acute GVHD (aGVHD) and grades Ⅲ-Ⅳ aGVHD, respectively, were 15.8%, 12.2%, and 12.5% (p=0.853); 5.3%, 2.0%, and 5.6% (p=0.523) in P-ALG 75mg/kg, P-ALG 90mg/kg and r-ATG 7.5mg/kg. The cumulative incidence of chronic GVHD at 1 year was 14.0%, 10.2%, and 15.3% (p=0.731) in the three groups. 43.9%, 71.4%, and 61.1% of patients in the p-ALG 75mg/kg, p-ALG 90mg/kg and r-ATG 7.5mg/kg groups, respectively, experienced at least one infection within 1 year after haplo-HSCT (p=0.0.13). Notably, the CMV infection rate in the p-ALG 75mg/kg group was significantly lower than in the p-ALG 90mg/kg and r-ATG 7.5mg/kg groups. The 2-year overall survival (OS) rates of p-ALG 75mg/kg, p-ALG 90mg/kg and r-ATG 7.5mg/kg groups were 78.2%, 70.6%, and 72.3% (p=0.491). The cumulative incidence of 2-year relapse were 33.0%, 29.8%, and 30.0% (p=0.834). ConclusionsCompared with r-ATG group, the p-ALG 75mg/kg group showed a lower incidence of infection. However, there were no significant differences between the two groups in terms of the incidence of grades Ⅱ-Ⅳ aGVHD, 2-year overall survival (OS), and 2-year cumulative incidence of relapse. p-ALG (75mg/kg) has a comparable effect on the prevention of GVHD after haplo-HSCT with a lower incidence of infection. Keywords: Porcine antilymphocyte globulin; Rabbit antithymocyte Globulin; Haploidentical hematopoietic cell transplantation; Graft versus host disease; Infection

The Most Common Cause of Fever in International Travelers Visiting Kasih Ibu Hospital Denpasar for the 2019-2020 Period

Background: Fever is one of the most common symptoms that international travelers complain of due to various causes. Fever is associated with mild to severe illnesses, such as Coronavirus Disease 19, typhoid fever, dengue fever, malaria, chikungunya, or gastrointestinal infection. Purpose: This study aimed to determine the most common cause of fever in international travelers visiting Kasih Ibu Hospital Denpasar from 2019 to 2020. Methods: This cross-sectional study using medical records of international travelers with chief complaints of fever uses purposive sampling. Result: The age of the subject was dominated by the adult age group in 2019 (77.3%) and 2020 (77.1%), with more females in 2019 (50.8%) while more males in 2020 (57.8%), 2019 the most common cause of fever was dengue infection (50.8%) while in 2020 the most common cause of fever was COVID-19 (53.5%). Conclusion: Dengue was the most common cause of fever in 2019, and COVID-19 was the most common cause of fever in 2020.

The role of infectious disease consultations in the management of patients with fever in a long-term care facility.

Infectious disease (ID) clinicians can provide essential services for febrile patients in tertiary hospitals. The aim of this study was to evaluate the role of ID consultations (IDC) in managing hospitalized patients with infections in an oriental medical hospital (OMH), which serves as a long-term care facility. To our knowledge, this is the first study on the role of IDCs in managing patients in an OMH. This retrospective study was conducted in an OMH in Seoul, Korea, from June 2006 to June 2013. Among the 465 cases of hospital-acquired fever, 141 (30.3%) were referred for ID. The most common cause of fever was infection in both groups. The peak body temperature of the patient was higher in IDC group (38.8±0.6°C vs. 38.6±0.5°C, p<0.001). Crude mortality at 30 days (14.6% vs. 7.8%, p = 0.043) and infection-attributable mortality (15.3% vs. 6.7%, p = 0.039) were higher in the No-IDC group. Multivariable analysis showed that infection as the focus of fever (adjusted Odd ratio [aOR] 3.49, 95% confidence interval (CI) 1.64-7.44), underlying cancer (aOR 10.32, 95% CI 4.34-24.51,), and multiorgan dysfunction syndrome (aOR 15.68, 95% CI 2.06-119.08) were associated with increased 30-day mortality. Multivariate analysis showed that in patients with infectious fever, appropriate antibiotic therapy (aOR 0.19, 95% CI 0.05-0.76) was the only factor associated with decreased infection-attributable mortality while underlying cancer (aOR 7.80, 95% CI 2.555-23.807) and severe sepsis or septic shock at the onset of fever (aOR 10.15, 95% CI 1.00-102.85) were associated with increased infection-attributable mortality. Infection was the most common cause of fever in patients hospitalized for OMH. Infection as the focus of fever, underlying cancer, and MODS was associated with increased 30-day mortality in patients with nosocomial fever. Appropriate antibiotic therapy was associated with decreased infection-attributable mortality in patients with infectious fever.

Travel-Associated Dengue Cases — United States, 2010–2021

Dengue, the leading cause of arboviral disease worldwide, can be fatal without appropriate treatment. Among 7,528 confirmed or probable travel-associated U.S. dengue cases reported during 2010–2021, one in five (1,474, 20%) was reported in 2019. This is 168% higher than the annual average number of cases reported during 2010–2018 and 2020–2021 (approximately 550 per year) and 61% higher than the 913 cases reported in 2016, the second highest year on record. The number of cases as a fraction of air traffic volume to international destinations outside North America or Europe was also highest in 2019, with 41.9 cases per million trips, compared with 21.0 per million in other years during 2010–2021. This report compares the number and characteristics of travel-associated dengue cases reported to national surveillance in the United States in 2019 with cases reported during 2010–2018 and 2020–2021. Areas with conditions suitable for dengue transmission as well as the population at risk for dengue are expected to increase, placing U.S. travelers at higher risk for infection. Health care providers should be aware that dengue is a common cause of fever in the returning traveler and be familiar with its signs and symptoms, testing, and management. Dengue vaccines are not currently recommended for U.S. travelers; therefore, persons should review areas of dengue risk and follow guidance for preventing mosquito bites.

Scrub Typhus Re-Emergence of The Neglected, Silent Killer in Himachal Pradesh (India)

Scrub typhus is one of the common causes of fever in the foothills of the Himalayan region of India, affecting almost all age groups of patients. Scrub typhus is a zoonotic mite-borne bacterial disease that is transmitted to the population by the bite of larvae of the infected trombiculid mites that bite humans. Currently, scrub typhus appears to be re-emerging and spreading in the non-endemic areas with alarming antibiotic resistance patterns. It is a threat to more than a billion people and causes significant mortality worldwide. Clinical features can present in a variety of ways in patients suffering with scrub typhus. It causes multiple organ dysfunction syndrome and mortality can range 60-70% without effective therapy. Scrub Typhus presenting with bicytopenia, pancytopenia, hepatomegaly, and splenomegaly. This present study aims to know the varied clinical presentation in scrub typhus patients with Pancytopenia and Bicytopenia and the incidence of hepatomegaly and splenomegaly in the paediatric age group. Prospective observational study conducted in the Department of Paediatrics in Dr. RPGMC Tanda Himachal Pradesh (India). The study included all patients except those falling in the exclusion criteria and only after informed written consent. A total of 37 children admitted with scrub typhus bicytopenia and pancytopenia were enrolled for one year, that is from March 2013 to March 2014. Bicytopenia was observed in 30 patients (81.08%) and pancytopenia in 7 (18.91%) cases in typhus patients. Hepatomegaly was observed in 28 patients (73.68%) and splenomegaly in 16 patients (42.10%). Anaemia was seen in 35 (94.59%) patients. Males 13 were less affected than females 24 with a male-to-female ratio of .54 to 1. The most common age group affected was 11-15 years with female prudence with a male: female ratio of 0.54:1. Pallor was the most common sign in 35 (94.59%) followed by hepatomegaly 28(73.68%) and splenomegaly in 16(42.10%) patients. It is very important to start empirical therapy in a patient with fever and multiorgan dysfunction syndrome for scrub typhus to reduce mortality. There is an urgent need to establish next-generation metagenomic sequencing centers in the region at the tertiary-level institutes for the detection of new antigenic variations.

Evaluation of the Most Common Viral Causes of Fever and Neutropenia in Children Hospitalized in Abuzar Children’s Medical Center in Ahvaz, Iran

Background: Viral infections are the most common cause of fever and neutropenia in children without underlying disease, and data are still limited in this regard. Objective: This study aimed to identify the most common viral causes of fever and neutropenia in pediatrics. Methods: This descriptive-analytical study was conducted on pediatric patients younger than 18 years old referred to the pediatric emergency ward with fever as the chief complaint and no underlying diseases; patients with neutropenia and no evidence of bacterial infections in terms of different cultures were included in the study. After obtaining parental consent, nasopharyngeal swab specimens were taken from patients during the coronavirus disease 2019 (COVID-19) pandemic, and blood samples were analyzed to detect viruses in each patient. Results: Fifty patients (54.3%) had mild neutropenia (absolute neutrophil count (ANC): 1000 - 1500/μL), 40 patients (43.5%) had moderate neutropenia (ANC: 1000 - 500/μL), and 2 cases (2.2%) had severe neutropenia (ANC &lt; 500/μL). Among all the cases, 19 cases were positive in terms of virus examination, including adenovirus (6.5%), enterovirus (5.4%), cytomegalovirus (CMV) (3.3%), Epstein-Barr virus (EBV) (3.3%), and Herpes virus 6 (2.2%). A significant correlation was found between enterovirus and neutropenia (P = 0.005). Conclusions: The most common viruses found in neutropenic children hospitalized due to fever without any underlying disease were adenovirus and enterovirus, respectively. Considering the good general condition and relatively quick recovery, consideration of viral causes is recommended in this category of patients, and it is better to avoid prescribing broad-spectrum antibiotics, and careful follow-up should be carried out.

Clinico-epidemiological aspects of fever of unknown origin in children: tertiary hospital study

Background Fever of unknown origin (FUO) is one of the most complex diagnostic quandaries in infectious diseases and tropical medicine. When treating patients having prolonged opaque fever, clinicians should base their diagnostic decisions on the frequency distribution of the illnesses that cause FUO. Patients reported with FUO are extremely given unnecessary excessive investigations and antimicrobial treatments, making FUO a difficult problem in clinical practice. There is no gold standard protocol for establishing the cause of FUO. Aim The aim of the current study was to determine the common causes of fever of unknown origin in children and its prevalence according to demographic data which may guide the pediatricians to narrow the diagnostic approach and the priority of work-up. Patients and methods This was an observational retrospective study conducted on a total of 134 children aged 1 to 17 years old, of both sexes admitted at Mansoura University Children’s Hospital (MUCH) from January 2015 to December 2020 and fulfilling the FUO definition (Classic FUO is as fever with a body temperature greater than and equal to 38.3°C for at least 3 weeks duration with a failure to reach a diagnosis after 1 week of inpatient investigations. Results Total 134 patients were identified. Confirmed diagnosis was attained in 108 patients (80.6%). Among them, infectious diseases (n=50, 37.3%) were the most common, followed by collagen vascular diseases (n=15, 11.2%), malignancies (n=10, 7.5%), and miscellaneous (n=33, 24.6%). Whereas 19.4% of cases (n=26, 19.4%) remained undiagnosed. Respiratory infections were the most common among the infectious diseases, juvenile idiopathic arthritis and acute leukemia were common causes of collagen vascular diseases and malignancies, respectively. Conclusion The current study concluded that; infectious diseases were the main cause for fever of unknown origin in children and respiratory infections were the most infectious cause.

Clinical Profile and Antibiotic Sensitivity Pattern of Community Acquired Urinary Tract Infections in Children Attending a Tertiary Care Hospital in Assam, India

Introduction: Urinary Tract Infection (UTI) is a common problem in children. It is a very common cause of fever in children after gastrointestinal and respiratory diseases. Uropathogens causing community acquired UTI is increasing due to changing antibiotic sensitivity pattern over time. Appropriate choice of antibiotic is crucial to prevent complications related to UTI. Aim: To study the clinical profile, risk factors, associated pathogen spectrum and their antibiotic sensitivity pattern in community acquired UTI. Materials and Methods: A cross-sectional observational study with 150 sample size was conducted in the Department of Paediatrics, Gauhati Medical College and Hospital, Guwahati, Assam, India and was carried out among children (1 month to 12 years of age) with community acquired UTI, over a period of one year in the state of Assam. Fresh urine samples were collected by clean catch mid-stream method for toilet trained children and by transurethral catheterisation for infants and young children. It was followed by routine urine examination and culture and sensitivity testing to diagnose UTI. Descriptive statistics was used to describe the results. Proportion test was used for statistical evaluation. Results: Majority of UTI cases were in the age group 1 to 5 years (57.3%) and there was female preponderance (59.3%). Fever was the most common presentation (55.3% cases) in the present study. This was followed by poor feeding (12.6%), lower abdominal pain (10.6%), failure to gain weight (10.6%). In urinalysis, 87 cases (58%) showed pyuria, 6 cases (4%) showed significant haematuria. Most prevalent uropathogens in the present study was Escherichia coli (E.coli) (66%cases), followed by Enterococcus sp. (16.7%), Klebsiella sp. (14%). E.coli had maximum sensitivity for nitrofurantoin (90.9%). It was followed by amikacin (80%), co-trimoxazole in 64.6% and gentamycin in 62.6% cases. Conclusion: All fever cases in children should be screened to rule out UTI. All UTI cases should undergo culture and sensitivity testing to determine the sensitivity pattern.

Differential diagnostic performance of PET/CT in adult-onset still’s disease and lymphoma: a retrospective pilot study

Adult-onset still's disease (AOSD) and lymphoma are the common causes of fever of unknown origin (FUO) and show some similar clinical symptoms. This study aimed to establish a reliable and easy-to-used scoring model based on clinical information, laboratory characteristics and 18F-fluorodeoxyglucose positron emission tomography/computer tomography (18F-FDG PET/CT) images for the differential diagnosis of these two diseases. A development cohort including 70 AOSD and 37 lymphoma patients was used to establish a scoring model based on the features of PET/CT images. The scoring model was then validated in a validation cohort of 15 AOSD and 12 lymphoma patients. The features of involved bone marrow, spleen, lymph nodes, and other organs or tissues displayed on PET/CT images were compared. Multiple logistics regression and decision tree analysis were used to establish the scoring model. Four features that could significantly differentiate these two diseases were selected to establish a scoring model discriminating AOSD from lymphoma, including (I) white blood cell (WBC) count ≤10×109/L (1 point); (II) ferritin ≤ upper limit of normal (ULN) (1 point); (III) no abnormal bone marrow metabolism (1 point); (IV) total lesion glycolysistotal (TLGtotal) >9.0 (1 point). After decision tree analysis, it showed that a score ≤1 indicates AOSD. A score ≥3 strongly suggested lymphoma, with a sensitivity of 81.1% and specificity of 90.0% in the development cohort, and a sensitivity of 58.3% and specificity of 100% in the validation cohort. Our scoring model showed good diagnosis performance in distinguishing AOSD from lymphoma.

Multifocal Neonatal Osteomyelitis: Case Report

Neonatal osteomyelitis may present with very few clinical signs and symptoms, which makes prompt diagnosis challenging. Delayed treatment may result in serious long-term consequences. Moreover, all patients should be followed up for orthopaedic sequelae. Here we describe a case of neonatal osteomyelitis, at multiple sites. A preterm male presented with fever and mild abdominal distension on the 14th day of life. Investigations were done to rule out sepsis, meningitis and other common cause of fever. Despite starting empiric antibiotic coverage immediately, fever continued followed by respiratory distress, tachypnea and tachycardia. Three weeks later baby became pale and irritable with cell count of 34,450/cumm and was shifted to neonatal intensive care unit. In subsequent days, baby developed swelling in right thigh and knee region with paucity of movements, however ultrasonography failed to detect any pathology. Blood culture revealed methicillin resistant staphylococcus aureus, after which injection vancomycin was started, after which fever subsided and the baby’s general condition improved clinically. Ultrasonography suggested effusion in left shoulder and right knee, probably of infective etiology. Drainage and decompression with arthrotomy helped us evacuate sero-sanguinous turbid fluid and granulation tissue, which were sent for histopathological examination which diagnosed pyogenic synovitis. On 40th day of life the patient was discharged healthy.