Days Of Febrile Illness Research Articles

Significance of nested PCR testing for the detection of low-density malaria infection amongst febrile patients from the Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh, India

BackgroundLow-density malaria infections (LDMI) are defined as infections that are missed by the rapid diagnostic test (RDT) and/or microscopy which can lead to continued transmission and poses a challenge in malaria elimination efforts. This study was conducted to investigate the prevalence of LDMI in febrile cases using species-specific nested Polymerase Chain Reaction (PCR) tests in the Malaria Elimination Demonstration Project, where routine diagnosis was conducted using RDT.MethodsEvery 10th fever case from a cross-sectional community based fever surveillance was tested with RDT, microscopy and nested PCR. Parasite DNA was isolated from the filter paper using Chelex based method. Molecular diagnosis by nested PCR was performed targeting 18SrRNA gene for Plasmodium species.ResultsThe prevalence of malaria was 2.50% (436/17405) diagnosed by PCR, 1.13% (196/17405) by RDT, and 0.68% (118/ 17,405) by microscopy. Amongst 17,405 febrile samples, the prevalence of LDMI was 1.51% (263/17405) (95% CI 1.33–1.70), which were missed by conventional methods. Logistic regression analysis revealed that illness during summer season [OR = 1.90 (p < 0.05)] and cases screened within three days of febrile illness [OR = 5.27 (p < 0.001)] were the statistically significant predictors of LDMI.ConclusionThe prevalence of malaria among febrile cases using PCR was 2.50% (436/17405) as compared to 1.13% (196/17405) by RDT. Higher number of the LDMI cases were found in subjects with ≤ 3 days mean duration of reported fever, which was statistically significant (p < 0.001). This observation suggests that an early detection of malaria with a more sensitive diagnostic method or repeat testing of the all negative cases may be useful for curtailing malaria transmission. Therefore, malaria elimination programme would benefit from using more sensitive and specific diagnostic methods, such as PCR.

A rare case of dengue encephalopathy complicating a term pregnancy

BackgroundDengue fever has an expanded clinical spectrum ranging from an asymptomatic infection to life threatening dengue hemorrhagic fever and refractory shock. Dengue infection in pregnancy can be a diagnostic dilemma, particularly considering the physiological changes in pregnancy and the obstetric complications encountered in clinical practice. Hence the knowledge of its diagnosis and management in its atypical presentations is of paramount importance. Here we report an unusual case of uncomplicated dengue encephalopathy in a term mother, probably the first to be reported from the Indian subcontinent.Case PresentationA 28 year old woman, 37 weeks of pregnancy presented with fever of four days duration. She eventually developed irritability, altered sensorium, somnolence, and unresponsiveness to commands by the 5th day of febrile illness without any circulatory compromise. Physical examination and investigations including serology confirmed dengue fever. After excluding all other possible causes, the transient neurological deterioration was finally attributed to dengue encephalopathy which is an uncommon manifestation of the disease, particularly in pregnancy. Her deteriorated neurological status which had lasted for 6 days improved spontaneously with the convalescence of dengue infection. Cautious fluid management was carried out in correlation to clinical and hematological parameters. The pregnancy was continued uncomplicated till the platelet count had risen to more than 50,000 cells/cumm. She delivered vaginally a healthy male baby.ConclusionsDengue fever in pregnancy is increasingly being encountered due to its rising disease burden. Dengue encephalitis/encephalopathy must be suspected in the differential diagnosis of fever and altered sensorium, even in pregnancy, in the tropical countries where the infection is rampant. Management of dengue infection in term pregnancy is a challenge for both the clinician and obstetrician. Further discussion and research are mandatory to decide on optimal management of these patients, with regard to monitoring, fluid management, and the precise timing and mode of delivery in order to prevent fatal morbidity and mortality to both mother and fetus.

Serum Ferritin: A Backstage Weapon in Diagnosis of Dengue Fever.

Aims This retrospective study evaluates ferritin as a surrogate marker for dengue infection (NS1 and IgM negative stage) as opposed to other febrile illnesses of infective or inflammatory etiology (OFI). Methodology Data of all patients admitted to medical ward and medical ITU during the dengue outbreak were collected. Patients admitted between 5 and 10 days of febrile illness without a diagnosis were included. Patients with NS1 positivity (Days 2–8) and/or positive IgM for dengue (Days 6–10) were considered to be dengue cases and those with other confirmed diagnoses were considered in the OFI group. Ferritin, CRP, TC of WBC, platelet count, SGOT, SGPT, and albumin levels were analysed for both groups. Results We examined 30 cases of clinically and serologically confirmed dengue fever and 22 cases of OFI. Ferritin level in dengue cohort was significantly higher than the OFI group (p < 0.0001). The best cut-off for ferritin level to differentiate dengue from OFI was found to be 1291. The sensitivity at this cut-off is 82.6% and the specificity at this cut-off is 100%. Conclusion Ferritin may serve as a significant marker for differentiating between dengue fever and OFI, in absence of a positive NS1 antigen or a positive IgM antibody for dengue.

Dengue fever triggering systemic lupus erythematosus and lupus nephritis: a case report

We report a rare case of dengue fever triggering systemic lupus erythematosus and lupus nephritis. The patient presented herself during a large outbreak of dengue fever in December 2012 in Maharashtra, India. The diagnosis of dengue fever was confirmed by the presence of NS-1 antigen during the first few days of febrile illness. Eight weeks later, kidney tissue biopsy studies revealed evidence of lupus nephritis on microscopic examination and immunofluorescence. The report interpreted it as focal proliferative glomerulonephritis and segmental sclerosis (Stage IIIC). The case was also found positive for perinuclear antineutrophil cytoplasmic antibodies by indirect immunofluorescence assay. An active and effective management of a case essentially calls for clear perception of differentiating dengue-induced lupus flare, antineutrophil cytoplasmic antibody-related nephropathy, and/or dengue-induced de-novo lupus disease. Dengue viremia may be the trigger for immune complex formation in patients who are predisposed to developing autoimmune diseases. The present case explains the importance of considering the diagnosis of dengue-related lupus nephritis as an atypical occurrence in appropriate situations, as in this case. It would not be improper to regard this escalating disease as an expanded feature of dengue.

Frequency and complications of falciparum malaria among febrile staff members of UN deployed to Northern Sudan

Malaria is a mosquito-borne parasitic disease, common around the globe especially in poorest countries. It is inevitable and remediable, yet it is still killing many people every year, 90% of them are in Africa. Malaria is an important threat to tourists, soldiers and employees travelling or working in endemic areas. The present study was carried out among UN staff members working in regions of Damazin, AL Obayid, kosti and areas of Blue and White Nile States. Study period comprised five years from Jan 2006 to Dec 2010. Febrile patients both males and females were screened for malaria. Thereafter, the malaria positive patients were further screened for Plasmodium falciparum andPlasmodium vivax. P. falciparum was found in 80% of febrile patients. Most of the patients (63.6%) presented in the first two days of febrile illness and the largest number ofFalciparum malaria cases was reported from July to October each year. Mean index offalciparum malaria at presentation was a major factor in determining hematological and liver functions derangements and the time taken for fever to settle after starting either of two antimalarial drugs, that is, quinine or artemether. Key words: Plasmodium falciparum, plasmodium vivax, quinine, artemether, falciparumIndex.

Intermittent Clonazepam in The Prevention of Recurrent Febrile Seizures

Objective To evaluate the efficacy and common side effects of intermittent clonazepam in febrile seizures. Materials & Methods This study was an experimental trial designed to determine the efficacy of intermittent clonazepam in febrile seizures .Thirty patients with an age range of 6 months to 5 years (60% male, 40% female) were studied. Children with a history of psychomotor delay, abnormal neurological examination, a history of antiepileptic drug consumption, and afebrile seizures were excluded from the study. Patients received a single dose of prophylactic Clonazepam (0.05 mg/kg/ day) on the first day of febrile illness and twice daily during the course of fever. An antipyretic medication (Acetaminophen) was advised if fever exceeded 38oC. Patients were followed up for one year after the study inclusion date. Results Three patients were excluded from study since they didnot follow the tritment and three patients experienced afebrile seizures. Twenty four patients had 162 febrile episodes during the course of the study and all patients were seizure-free after 1 year. Conclusion Clonazepam was 100% effective but lethargy and ataxia were common side effects in patients. Fortunately, their parents continued treatment because they had prior awareness of the possible side effects of clonazepam. Clonazepam is efficacious as an intermittent therapy for febrile seizures if parents are informed of its side effects.

Identification and validation of clinical predictors for the risk of neurological involvement in children with hand, foot, and mouth disease in Sarawak

BackgroundHuman enterovirus 71 (HEV71) can cause Hand, foot, and mouth disease (HFMD) with neurological complications, which may rapidly progress to fulminant cardiorespiratory failure, and death. Early recognition of children at risk is the key to reduce acute mortality and morbidity.MethodsWe examined data collected through a prospective clinical study of HFMD conducted between 2000 and 2006 that included 3 distinct outbreaks of HEV71 to identify risk factors associated with neurological involvement in children with HFMD.ResultsTotal duration of fever ≥ 3 days, peak temperature ≥ 38.5°C and history of lethargy were identified as independent risk factors for neurological involvement (evident by CSF pleocytosis) in the analysis of 725 children admitted during the first phase of the study. When they were validated in the second phase of the study, two or more (≥ 2) risk factors were present in 162 (65%) of 250 children with CSF pleocytosis compared with 56 (30%) of 186 children with no CSF pleocytosis (OR 4.27, 95% CI2.79–6.56, p < 0.0001). The usefulness of the three risk factors in identifying children with CSF pleocytosis on hospital admission during the second phase of the study was also tested. Peak temperature ≥ 38.5°C and history of lethargy had the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 28%(48/174), 89%(125/140), 76%(48/63) and 50%(125/251), respectively in predicting CSF pleocytosis in children that were seen within the first 2 days of febrile illness. For those presented on the 3rd or later day of febrile illness, the sensitivity, specificity, PPV and NPV of ≥ 2 risk factors predictive of CSF pleocytosis were 75%(57/76), 59%(27/46), 75%(57/76) and 59%(27/46), respectively.ConclusionThree readily elicited clinical risk factors were identified to help detect children at risk of neurological involvement. These risk factors may serve as a guide to clinicians to decide the need for hospitalization and further investigation, including cerebrospinal fluid examination, and close monitoring for disease progression in children with HFMD.

Low frequency electrical stimulation through subdural electrodes in a case of refractory status epilepticus

Objective We delivered low frequency stimulation through subdural electrodes to suppress seizures in a case of refractory status epilepticus (RSE). Methods A 26-year-old female developed RSE after several days of febrile illness. Seizure control required continuous infusion of two anesthetics plus high doses of 2–4 enteral antiepileptic drugs. After 3 months of RSE, subdural strips were placed to determine surgical candidacy. Five independent ictal onset zones were identified. Because she was a poor candidate for epilepsy surgery and had a poor prognosis, the implanted subdural electrodes were used to administer 0.5 Hz stimulations to the ictal onset zones in 30 min trains daily for 7 consecutive days in an attempt to suppress seizures. Results After 1 day of stimulation, one anesthetic agent was successfully discontinued. Seizures only returned by the 4th day when the second anesthetic had been reduced by 60%. Upon returning, seizures arose from only one of the 5 original ictal onset zones. Unfortunately, RSE persisted, and she eventually died. Conclusions In this case of RSE, low frequency stimulation through subdural electrodes transiently suppressed seizures from all but one ictal onset zone and allowed significant reduction in seizure medication. Significance Low frequency cortical stimulation may be useful in suppressing seizures.

Safety, efficacy and effectiveness of the influenza virus vaccine, trivalent, types A and B, live, cold-adapted (CAIV-T) in healthy children and healthy adults

Influenza is a major cause of illness. We have assessed the safety, efficacy, and effectiveness of CAIV-T vaccine. A two year, multicenter, double-blind, placebo-controlled, efficacy field trial in pre-school aged children was conducted; 1602 enrolled in Year One and 1358 (85%) returned in Year Two. In both study years combined, the overall vaccine efficacy against culture-confirmed influenza was 92% (95% CI: 88, 94). The vaccine efficacy was 95% (95% CI: 62, 99) against lower respiratory illness, 94% (95% CI: 90, 96) against febrile illness and 96% (95% CI: 88, 99) against otitis media associated with culture-confirmed influenza. A multicenter, double-blind, placebo-controlled, effectiveness field trial was conducted in 4561 working adults aged 18 to 64 years. Episodes and days of febrile illness (FI), severe febrile illness (SFI), febrile upper respiratory illness (FURI), work loss, and health care use were assessed. Vaccination significantly reduced the numbers of SFI, 18.8% reduction (95% CI: 7, 29), and FURI, 26.3% reduction (95% CI: 13, 33); and led to fewer days of illness (22.9% reduction for FI, 27.3% reduction for SFI), fewer days of work lost (17.9% reduction for SFI, 28.4% for FURI), and fewer days of health care provider visits (24.8% for SFI, 40.9% for FURI). Prescription antibiotics and over-the-counter medications were also reduced. The vaccine was generally safe and well tolerated with no vaccine related serious adverse events. LAIV represents an additional important option for the control of influenza.

Kawasaki disease: A diagnostic dilemma

Kawasaki Disease (KD) is an acute multisystem illness of unknown origin that usually affects children less than 5 years of age.l KD is now recognized as the most common cause of acquired heart disease among this age group.2,3 When KD is left untreated, coronary aneurysms may develop in 15% to 25% of children, whereas early intervention can reduce this complication to fewer than 7%.2 These cardiac sequelae may develop as early as the 9th day of febrile illness, necessitating early recognition and therapeutic intervention.2 Head and neck manifestations including cervical lymphadenopathy, conjunctival injection, and oral mucosal changes are common presenting signs of KD, placing the otolaryngologist at the forefront of early diagnosis. Differentiating relatively common surgical conditions, such as a neck abscess, from the uncommon medical condition of KD can challenge the most astute clinician. We describe an unusual case of KD, presenting as a retropharyngeal abscess, and highlight interesting aspects and clinical practices that may help in distinguishing these two entities.

Early Diagnosis of Rocky Mountain Spotted Fever

Diagnosis of Rocky Mountain spotted fever was made as early as the fourth day of febrile illness in rhesus monkeys (Macaca mulatta), with a monocyte culture technique that is easily amenable to use in humans. Rickettsia rickettsii were identified by direct immunofluorescent and Gimenez staining of cultures of circulating monocytes from four experimentally infected monkeys, even in the presence of a mild or inapparent disease in three. Levels of rickettsemia were estimated by the plaque-assay technique, and specific antibody titers were determined by complement fixation.