Differential Diagnosis Of Fever Research Articles

Kikuchi–Fujimoto disease: A rare cause of cervical lymphadenopathy

Kikuchi–Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare and generally self-limiting disease of uncertain etiology that presents with fever and cervical lymphadenopathy in both the pediatric and adult populations. Here, we present the case of a 5-year-old male who presented with acute onset of fever and cervical lymphadenopathy which was initially diagnosed and managed as staphylococcal lymphadenitis. He underwent an excisional biopsy when symptoms persisted, which confirmed the diagnosis of KFD and was managed conservatively. This case study emphasizes awareness of this entity in the differential diagnosis of fever with persistent lymphadenopathy. Due to its characteristic overlap with other disorders such as tuberculous lymphadenitis, and lymphoma, KFD remains an arduous diagnosis for physicians. Therefore, awareness about its symptoms helps in minimizing potentially harmful unnecessary evaluations and thereby preventing misdiagnosis and inappropriate treatment.

Differential diagnosis of fever and rash cases negative for measles and rubella to complement surveillance activities.

In the quest to eliminate measles virus (MV) and rubella virus (Ruv), every suspected case must be properly identified and diagnosed. Since 2017, in Milan (Italy), a total of 978 measles and rubella suspected cases (fever and rash) were investigated and 310 were not laboratory confirmed (discarded cases). To improve surveillance activities, we investigated the presence in discarded cases of 8 other viral pathogens commonly associated with rash: human herpesvirus 6 (HHV-6) and 7 (HHV-7), parvovirus B19 (B19V), enterovirus (EV), Epstein-Barr virus (EBV), human adenovirus (HAdV), cytomegalovirus (HCMV), and SARS-CoV-2. Differential diagnosis was carried out on 289 discarded cases by multiplex real-time PCR assays. At least one pathogen was detected in 188 cases (65.1%) with HHV-7 being the most frequently detected virus. No difference in the number of detected infections overtime was observed and infections were identified in all age groups. As expected, most HHV-6, EV, HAdV, and HCMV-positive cases were found in children aged 0-4 years and HHV-7 was most frequent in the 15-39 age group. In light of the World Health Organizationmeasles elimination goal, the introduction of laboratory methods for differential diagnosis is required for the final classification of clinically compatible cases. The used screening panel allowed us to increase the percentage of virus-positive cases to 87.5%, allowing us to clarify viral involvement and epidemiology, improve diagnosis, and strengthen surveillance activities. As all investigated pathogens were detected, this diagnostic panel was a suitable tool to complement MV and RuV surveillance activities.

A Case Report on Perinephric Abscess Caused by Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae

Perinephric abscess is a rare life-threatening condition. It can complicate a urologic infection or occur secondary to hematogenous seeding. We report a case of a 49-year-old diabetic female who came to the outpatient department with complaints of right-sided abdominal pain for 2 days. It was associated with fever, headache, vomiting, and generalized weakness. Non-contrast computerized Tomography (NCCT) showed a subcapsular collection measuring 6.1× 5.7 × 4.4 cm noted adjacent to the lateral aspect of the right kidney. Following percutaneous nephrostomy, thick pus was drained from the abscess and sent for culture and sensitivity in the microbiology laboratory. Culture grew extended-spectrum beta-lactamase-producing (ESBL) Klebsiella pneumoniae which was sensitive to Carbapenems, Piperacillin Tazobactam, Fluoroquinolones, Netilmicin, Amikacin, and Tetracycline. The patient improved on treatment with the appropriate antibiotics. Perinephric abscesses should be considered as a differential diagnosis of fever with abdominal pain or flank pain since its non-specific nature can delay the diagnosis. Underlying diabetes mellitus (DM), urinary tract abnormalities, and immunodeficiency should be considered in a patient with a perinephric abscess. Ultrasonography (USG) and Computerized Tomography with contrast enhancement are crucial for diagnosis. The drainage of the abscess, either percutaneous or open, should be done. Klebsiella pneumoniae is a frequent cause of perinephric abscesses and mostly follows a complicated urinary tract infection. With high mortality rates, early diagnosis, and effective treatment of perirenal abscesses are required to improve the prognosis of patients.

Kikuchi-Fujimoto Hastalığı mı, Lenfoma mı?

Kikuchi-Fujimoto disease is a rare, idiopathic and usually self-limiting disease caused by lymphadenitis. The main symptoms are lymphadenopathy and fever, and less frequent symptoms are night sweats, arthralgia, weight loss and rashes. A case of a 16 years old boy is presented. His complaints were cervical mass presenting for about three weeks, night sweats, weight loss and fatigue. Our aim is that in the differential diagnosis of fever and lymphadenopathy of unknown origin, diseases such as lymphoma and tuberculosis, as well as rare and mostly very benign Kikuchi-Fujimoto disease should be remembered.

Akutní infekce u pacientů po transplantaci ledviny

Immunosuppressed kidney transplant recipients have a high risk of infectious complications. A variety of infections of viral, bacterial, or mycotic etiology, including opportunistic infections, occur in this group of patients, but bacterial infections are primarily responsible for the high infection-related mortality. Of the bacterial infections, urinary tract infections and pneumonia are the most common, often requiring hospitalization and temporary reduction of immunosuppressive therapy after consultation of the transplant center. In addition to symptoms due to the location of the infection, fever is often present. The differential diagnosis of fever and/or high inflammatory activity is specific to patients after kidney transplantation. In addition to infectious causes, we consider drug-related fever, a rejection episode, a relapse of systemic disease or in patients with graft failure in dialysis treatment graft intolerance syndrome (“symptomatic graft”). Saving the patients life, which often requires a significant reduction in immunosuppressive therapy, always takes precedence over preventing a rejection episode. Infection prevention is an integral part of the care of transplant patients, including the recommendation of vaccination where possible.

An exceptional prostate cancer case: Importance of cancer screening

AbstractProstate cancer is a common type of malignancy in male population. It may present with various clinical findings including urinary retention. Here, we present a prostate cancer case in an elderly man who investigated for the origin of long‐term fever and weight loss. A 69‐year‐old man presented to our institution for a fever lasting more than a month. He had no other signs of infection. He lost about 15 kg within 3 months. Total prostate‐specific antigen (PSA) measurement in serum and prostate biopsy revealed advanced prostate cancer. His complaints diminished with prostate cancer treatment. In conclusion, we suggest that prostate cancer should be kept in mind in the differential diagnosis of fever and weight loss in men over 50 years of age whether he is symptomatic or not.

COVID-19 in kidney transplant recipients; an Indian experience

Introduction: Kidney transplant recipients appear to be at high risk for severe COVID-19 illness due to chronic immunosuppression and coexisting conditions. Objectives: We aimed to study the clinical characteristics, laboratory and radiological results, treatment aspects and clinical outcomes of kidney transplant patients with COVID-19. Patient and Methods: Twenty consecutive kidney transplant patients with COVID-19 pneumonia from two tertiary care centers from India were retrospectively studied from July 1 to Oct 31, 2020. Results: Of 20 patients, 18 required admission; mean age was 42.8±9.39 years and 18 out of 20 (90%) were male. Symptom onset to testing time was a mean of 3.05±1.47 days. All patients were on triple immunosuppression. The median time since transplantation to COVID-19 was 3.75 years (IQR 2.37-5.41). Fever, cough and breathlessness were the most common presenting symptoms. Nine out of twenty (45%) had severe COVID-19 while six out of 20 (30%) required intensive care. Twelve (60%) patients had lymphopenia. Additionally mycophenolate was withheld in seventeen out of twenty (85 %) and enoxaparin and intravenous methylprednisolone were administered in all hospitalized patients while remdesivir was prescribed in 16 out of 20 (80%). Moreover, acute kidney injury (AKI) was seen in five out of 20 (25%) since one of died (5%). After a median hospital stay of 8.5 days (IQR 6.75-15.5), seventeen patients were discharged from the hospital. Conclusion: COVID-19 infection in kidney transplant recipients is usually a moderate-severe form. COVID-19 should be a differential diagnosis for fever in this high-risk population however lymphopenia may not be seen in all. Antimetabolite withdrawal, intravenous steroid, anticoagulation and early remdesivir were all found to be safe and effective strategies for improving outcomes. Early diagnosis and timely treatment may decrease mortality in this high-risk population.

Clinicolaboratory Profile and Outcome of Serologically Confirmed Scrub Typhus among Children from Sub Himalayan Tribal District of India: A Hospital-based Cross-sectional Study

Introduction: Scrub typhus is transmitted by the bite of the larva (chigger) of a microscopic trombiculidae mite (Leptotrombidium) found in moist areas and vegetation, which serves as both vector and reservoir. Scrub typhus is an often neglected and misdiagnosed febrile illness; clinical suspicion is the only key to diagnosis. Aim: To study clinicolaboratory profile and outcome of serologically confirmed scrub typhus in children from sub Himalayan tribal district of India. Materials and Methods: This cross-sectional observational study was conducted in Department of Paediatrics at Government District Hospital, Chamba, Himachal Pradesh, India, from May 2019 to April 2020. Children upto 18 years admitted with positive Immunoglobulin M (IgM) antibodies for scrub typhus were enrolled. The observational data including detail history and examination, relevant laboratory investigation and treatment was analysed by Statistical Package for Social Sciences (SPSS) software version 18.0 and Chi-square test with p-value <0.05 was considered statistically significant. Results: There were total 55 patients with scrub typhus, mean age was 9.2 years, most common age group was 7-12 years, 51% were male. Fever was most common complaint, followed by vomiting (27.3%), abdomen pain (25.4%), respiratory (1.8%), and rash (9%). Clinical examination findings were generalised lymphadenopathy in 46 (83.6%) patients and splenomegaly in 29 (52.7%). Eight patients presented with respiratory signs and tachypnea at the time of admission. Eschar was present in only 3 (5.5%) patients. Sign of meningeal irritation was present in 4 (7.3% cases and low GCS score (below 9) observed in 7 (12.7%) patients. Eight patients required mechanical ventilatory support. Nineteen patients were prescribed doxycycline alone; while 34 were given both azithromycin and doxycycline. There were total five deaths; on multivariate logistic regression, respiratory complaint, need for mechanical ventilation, pain abdomen with liver damage, history of seizures and duration of fever more than 4 days before presentation to hospital were associated with adverse outcome. Conclusion: The prevalence of scrub typhus is considerably high during rainy season, and should be considered as a differential diagnosis of fever among children in this period regardless of the presence of an eschar. Immediate medical care, treatment with doxycycline with early defervescence of fever reduce mortality

Leptospirosis as a cause of fever associated with jaundice in the Democratic Republic of the Congo.

BackgroundFever with jaundice is a common symptom of some infectious diseases. In public health surveillance within the Democratic Republic of the Congo (DRC), yellow fever is the only recognized cause of fever with jaundice. However, only 5% of the surveillance cases are positive for yellow fever and thus indicate the involvement of other pathogens. Leptospira spp. are the causative agents of leptospirosis, a widespread bacterial zoonosis, a known cause of fever with jaundice. This study aimed to determine the seropositivity of anti-Leptospira antibodies among suspected yellow fever cases and map the geographical distribution of possible leptospirosis in the DRC.MethodsWe conducted a retrospective study using 1,300 samples from yellow fever surveillance in the DRC from January 2017 to December 2018. Serum samples were screened for the presence of IgM against Leptospira spp. by a whole cell-based IgM ELISA (Patoc-IgM ELISA) at the Institut National de Recherche Biomedicale in Kinshasa (INRB) according to World Health Organization (WHO) guidance. Exploratory univariable and multivariable logistic regression analyses were undertaken to assess associations between socio-demographic factors and the presence of Leptospira IgM.ResultsOf the 1,300 serum samples screened, 88 (7%) showed evidence of IgM against Leptospira spp. Most positive cases (34%) were young adult males in the 20–29-year group. There were statistically significant associations between having Leptospira IgM antibodies, age, sex, and living area. Observed positive cases were mostly located in urban settings, and the majority lived in the province of Kinshasa. There was a statistically significant association between seasonality and IgM Leptospira spp. positivity amongst those living in Kinshasa, where most of the positive cases occurred during the rainy season.ConclusionsThis study showed that leptospirosis is likely an overlooked cause of unexplained cases of fever with jaundice in the DRC and highlights the need to consider leptospirosis in the differential diagnosis of fever with jaundice, particularly in young adult males. Further studies are needed to identify animal reservoirs, associated risk factors, and the burden of human leptospirosis in the DRC.

Determining the Relationship Between Fever of Without focus and Latent Pneumonia in Feverish Children in Bandar Abbas, Iran

Background: Fever is one of the most common causes of children’s referral to the emergency department, for which in 20% of cases no clear source is found. Latent pneumonia is not easily differentiable as one of the differential diagnoses of fever of unknown origin (FUO). This study aimed to determine the relationship between FUO and latent pneumonia in feverish children referring to pediatric emergency department. Materials and Methods: The present analytical research was carried out on 220 children with FUO aged 3-36 months referred to pediatric hospital of Bandar Abbas, Iran in 2019. To find the signs and symptoms, demographic information, history, and physical examination results were recorded by a physician using a predetermined checklist. Chest x-ray and blood sample were prepared for white blood cell (WBC) count, C-reactive protein (CRP), and absolute neutrophil count (ANC). Results: The mean age of the patients was 18.38±8.6 months. There was no significant difference between the mean fever, pulse rate, respiratory rate, WBC count, erythrocyte sedimentation rate (ESR), and ANC among the three groups differentiated by their diagnosis. The mean CRP in the bacterial pneumonia group was 68.17±24.13, while it was 35.00±20.43 in the viral infection group and 35.71±26.20 in the group of other diseases; the difference was statistically significant (P=0.004). Conclusion: Although there was no significant difference between WBC, ANC, and ESR and latent pneumonia, there was a significant difference between CRP and latent pneumonia, whose value was larger in these patients.

Scrub Typhus among Febrile Children in a Tertiary Care Center of Central Nepal: A Descriptive Cross-sectional Study.

Scrub typhus is a mite borne infectious disease caused by Orientia tsutsugamushi, obligate intracellular bacteria, transmitted by chigger mites. Scrub typhus is an emerging febrile illness with clinical suspicion being the only key to diagnosis. This study was conducted to find out the prevalence of Scrub typhus among febrile children in a tertiary care center of central Nepal. A descriptive cross-sectional study was conducted from January 2018 to December 2019 in the pediatric inpatients of a tertiary care hospital after obtaining ethical clearance from Institutional Review Committee of Institute (Reference number 2020-105). Convenient sampling method was used. Data was analyzed using Statistical Packages for the Social Science version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 1024 febrile patients, prevalence of scrub typhus among febrile children was 55 (5.37%) (3.66-7.08 at 90% Confidence Interval). Of 55 patients, mean age was 9.2 years with 52 (94.6%) of cases diagnosed between July to November. Among 55 patients, other symptoms were vomiting 33 (60%), headache 22 (40%), abdominal pain 19 (34.5%), cough 15 (27.3%), nausea (25.5%), seizure 11 (20 %), and dyspnea 6 (10.9%). Major clinical signs was lymphadenopathy 29 (52.7%). Major complication noted was meningitis 11 (20%). The prevalence of scrub typhus is considerably high during July to November so it should be considered as a differential diagnosis of fever particularly in this period.

Cutaneous Findings in SARS-CoV-2-Associated Multisystem Inflammatory Disease in Children.

Rash is a common feature of multisystem inflammatory syndrome in children (MIS-C), a postinfectious hyperinflammatory disease associated with prior severe acute respiratory syndrome coronavirus 2 infection. Because the differential diagnosis of fever and rash in children is broad, understanding clinical characteristics of MIS-C may assist with diagnosis. Here we describe the cutaneous findings observed in a series of children with MIS-C-associated rash.

Doença de Kawasaki incompleta com apresentação de febre de origem indeterminada

INTRODUCTION: Kawasaki disease (KD) is a systemic vasculitis that mainly affects small and medium-sized vessels. OBJECTIVES: To present the case of a child with incomplete KD describing the investigation process until diagnosis. CASE REPORT: A 2-year and 4-month-old female patient with daily two-week persistent fever associated with right unilateral cervical adenomegaly initially treated as bacterial adenitis. Due to the persistence of fever, she returned to the emergency unit with edema in both feet and periungual desquamation in the right hand. After investigation, the diagnosis of incomplete KD was confirmed late. DISCUSSION: KD is one of the differential diagnoses of unknown origin fever. The incomplete form of the disease evolves with the absence of classic clinical signs. Given the severity of the disease and its possible complications, an early treatment it is essential. CONCLUSION: It is necessary to consider Kawasaki disease as a differential diagnosis of fever of unknown origin in children.

Lyme disease, An Emerging Infection in Nepal: A Case Report

ABSTRACT
 Lyme disease, an infectious multisystemic disease is caused by "Borrelia burgdorferi". It is a spirochete transmitted by the Ixodes tick. Until today, only one case has been reported from Nepal. Here we report case of a 50-year female from Gulmi, who presented with a history of fever, multiple joint pain, tiredness, tingling sensation, and a painful brownish raised lesion over the neck and anterior chest. The clinical diagnosis was confirmed by histological findings typical of erythema chronicum migrans and by serology. The patient was treated successfully with doxycycline. This is the second case report of Lyme disease from Nepal and the first documented case who presented with typical erythema chronicum migrans. We suspect that Lyme disease might not have been considered in the differential diagnosis of fever with rash and joint pain in Nepal and suggest that it is to be kept as a differential in the given scenario.

“DENGUE ENCEPHALITIS – A RARE MANIFESTATION OF DENGUE FEVER.”

We report a case of dengue fever with features of encephalitis from Northern India. A 22 years female presented with history of high-grade fever with chills for 2 days followed by altered sensorium and MRI brain, revealed characteristic changes consistent with Encephalitis with hemorrhage mainly involving the bilateral thalami. The diagnosis of dengue was confirmed by the presence of dengue antigen in the serum and the presence of dengue antibodies in the serum as well as cerebrospinal fluid. Dengue is not primarily a neurotropic virus and encephalopathy is an uncommon finding in dengue. This case explains the importance of considering dengue encephalitis as the differential diagnosis of fever with altered sensorium, especially in countries like India where dengue is rampant.

Large vessel vasculitis secondary to granulocyte-colony stimulating factor.

Aortitis is a rare entity that may cause fever of unknown origin. This entity has a wide various etiologies, which main cause is rheumatologic, but not only. Iatrogenia has also been described, including chemotherapy and supporting treatment (like granulocyte-colony stimulating factor in oncological patients. The evidence in favour of this pharmacological link is growing. The differential diagnosis of fever, in febrile neutropenia setting, can be difficult to itemize.

Underdiagnoses of Rickettsia in patients hospitalized with acute fever in Indonesia: observational study results

BackgroundReports of human rickettsial infection in Indonesia are limited. This study sought to characterize the epidemiology of human rickettsioses amongst patients hospitalized with fever at 8 tertiary hospitals in Indonesia.MethodsAcute and convalescent blood from 975 hospitalized non-dengue patients was tested for Rickettsia IgM and IgG by ELISA. Specimens from cases with seroconversion or increasing IgM and/or IgG titers were tested for Rickettsia IgM and IgG by IFA and Rickettsia genomes using primers for Rickettsia (R.) sp, R. typhi, and Orientia tsutsugamushi. Testing was performed retrospectively on stored specimens; results did not inform patient management.ResultsR. typhi, R. rickettsii, and O. tsutsugamushi IgG antibodies were identified in 269/872 (30.8%), 36/634 (5.7%), and 19/504 (3.8%) of samples, respectively. For the 103/975 (10.6%) non-dengue patients diagnosed with acute rickettsial infection, presenting symptoms included nausea (72%), headache (69%), vomiting (43%), lethargy (33%), anorexia (32%), arthralgia (30%), myalgia (28%), chills (28%), epigastric pain (28%), and rash (17%). No acute rickettsioses cases were suspected during hospitalization. Discharge diagnoses included typhoid fever (44), dengue fever (20), respiratory infections (7), leptospirosis (6), unknown fever (6), sepsis (5), hepatobiliary infections (3), UTI (3), and others (9). Fatalities occurred in 7 (6.8%) patients, mostly with co-morbidities.ConclusionsRickettsial infections are consistently misdiagnosed, often as leptospirosis, dengue, or Salmonella typhi infection. Clinicians should include rickettsioses in their differential diagnosis of fever to guide empiric management; laboratories should support evaluation for rickettsial etiologies; and public policy should be implemented to reduce burden of disease.

Diagnostic utility of procalcitonin in children with infectious complications during chemotherapy-induced neutropenia: single center experience, literature review

Background. Infectious complications cause significant mortality in children with oncological diseases during chemotherapy-induced neutropenia. The absence of sensitive and specific signs and symptoms of infectious conditions as well as its microbiological identification, leads to inappropriate antibiotic exposure. The use of laboratory biomarkers (procalcitonin (PCT) and C-reactive protein (CRP)) may be helpful for differential diagnostics of inflammatory conditions and for rational antimicrobial therapy.Objective: to assess the current value of PCT as an additional marker for differentiating inflammatory conditions in children with chemotherapy-induced neutropenia.Materials and methods. We presented the analysis of infectious complications in pediatric patients with oncological and onco- / hematological diseases between 2017–2020 (54 patients from 2 mnths – 17 years). PCT and CRP with clinical and instrumental diagnostic data were used for differential diagnosis of fever and development of antimicrobial therapy decision rules. Literature review concerning the discussed theme from 2006–2018 was done.Results. Eighty-five infectious episodes in 36 months were registered, among them 42 in pts with onco- / hematological diseases and 43 – with solid tumors. In the group of bacterial infectious complications mean CRP and PCT values were significantly higher than in group of nonbacterial, moreover the discriminative value was higher for PCT. We revealed the correlation between severity of infectious complications and values of markers of acute-phase reactions. In case of non-severe bacterial complications and other types of infections significant difference was revealed only for PCT mean values.Conclusion. Specificity of PCT concentration in bacterial infections exceeds that of CRP, which confirms the hypothesis of advantages in using PCT as differential marker of inflammatory conditions in children with malignancies.

Prevalence of Rickettsial infections in a tertiary care centre

: Rickettsial infections are the most covert re-emerging infections of the present times. They are considered one of the important causes of Pyrexia of Unknown origin (PUO). They are often under diagnosed due to low index of suspicion, nonspecific signs and symptoms and absence of widely available sensitive and specific diagnostic tests. These diseases have a high mortality, which can be averted if diagnosed and treated early. Weil- Felix test is the cheapest and widely used test for diagnosis in India.The present study was undertaken with the objective of evaluating the patients with Febrile illness, for rickettsial infection using Weil- Felix test and study their demographic and clinical profile.: Weil-Felix test was done on serum samples of 120 patients with fever since 7-10 days, from October 2017 to October 2019 and evaluated for Rickettsial infection. Detailed history, signs, symptoms were recorded.: Out the 120 patients, 25 showed a titre of >1:80 in OX2, OX19 and 5 cases showed titre of >1:160 in OX K. The disease was more common in children and in the cooler months. Fever, rash, headache, vomiting and pain abdomen were common symptoms. Most common signs were rash (27 cases) and conjunctival congestion (19 cases).: Though the sensitivity and specificity of Weil-Felix test is low, it is done even today as it is the most convenient and economical test available for the diagnosis of Rickettsial infections. Prevalence of Rickettsial diseases is significant in this region and greater clinical awareness in the differential diagnosis of fevers is required for early diagnosis and treatment.

Fever in systemic lupus erythematosus: disease exacerbation or infection?

The differential diagnosis of fever, especially in the context of autoimmune diseases is broad. Accordingly, the spectrum of diagnostic procedures is extensive and the therapeutic consequences are partly contradictory. Fever is basically the manifestation of an increased cell proliferation, such as classically seen in tumors, infections or autoimmune inflammation. Systemic lupus erythematosus (SLE) is one of the most multifaceted rheumatological diseases. Fever is one component of the new classification criteria which help to classify and possibly diagnose SLE. The differential work-up of fever is a special challenge for clinicians particularly in the context of the initial diagnosis of SLE or another autoimmune disease and also in the course of the disease in patients with autoimmune diseases. Based on a case report this article discusses differential diagnostic considerations and proposes a concrete differential diagnostic procedure. The patient's history is highlighted as an extremely important source of relevant information. Without claiming completeness various factors are listed, which help to differentiate fever as a consequence of SLE activity versus fever as a consequence of an infection.