Etiology Of Fever Research Articles

A case\u2013control study of the causes of acute respiratory infection among hospitalized patients in Northeastern Laos

With the advent of highly sensitive real-time PCR, multiple pathogens have been identified from nasopharyngeal swabs of patients with acute respiratory infections (ARIs). However, the detection of microorganisms in the upper respiratory tract does not necessarily indicate disease causation. We conducted a matched case–control study, nested within a broader fever aetiology project, to facilitate determination of the aetiology of ARIs in hospitalised patients in Northeastern Laos. Consenting febrile patients of any age admitted to Xiengkhuang Provincial Hospital were included if they met the inclusion criteria for ARI presentation (at least one of the following: cough, rhinorrhoea, nasal congestion, sore throat, difficulty breathing, and/or abnormal chest auscultation). One healthy control for each patient, matched by sex, age, and village of residence, was recruited for the study. Nasopharyngeal swabs were collected from participants and tested for 33 pathogens by probe-based multiplex real-time RT-PCR (FastTrack Diagnostics Respiratory pathogen 33 kit). Attributable fraction of illness for a given microorganism was calculated by comparing results between patients and controls (= 100 * [OR − 1]/OR) (OR = odds ratio). Between 24th June 2019 and 24th June 2020, 205 consenting ARI patients and 205 matching controls were recruited. After excluding eight pairs due to age mismatch, 197 pairs were included in the analysis. Males were predominant with sex ratio 1.2:1 and children < 5 years old accounted for 59% of participants. At least one potential pathogen was detected in 173 (88%) patients and 175 (89%) controls. ARI in admitted patients were attributed to influenza B virus, influenza A virus, human metapneumovirus (HMPV), and respiratory syncytial virus (RSV) in 17.8%, 17.2%, 7.5%, and 6.5% of participants, respectively. SARS-CoV-2 was not detected in any cases or controls. Determining ARI aetiology in individual patients remains challenging. Among hospitalised patients with ARI symptoms presenting to a provincial hospital in Northeastern Laos, half were determined to be caused by one of several respiratory viruses, in particular influenza A virus, influenza B virus, HMPV, and RSV.

Etiology and clinical characteristics of fever of unknown origin in 357 pediatric patients

Objective: To explore the etiologies and clinical characteristics of fever of unknown origin (FUO) and to provide clues for early diagnosis of FUO. Methods: The data about etiology, age, sex, clinical course, length of hospital stays and the expression levels of inflammatory factors in fever phase of 357 pediatric inpatients who were diagnosed with FUO in Children's Hospital of Fudan University from 1 January 2016 to 31 December 2020 were collected and retrospectively analyzed. Participants were grouped into infectious disease, inflammatory disease, malignancy and others and according to the classification of diseases and also grouped into those aged<1 year, 1-<3 years,3-<6 years, 6-<12 years and 12-<18 years. Comparisons between groups were performed using the Mann-Whitney U test, Kruskal-Wallis H test and χ² test. Results: Among the 357 patients (217 males and 140 females). The age of onset was 3.9 (1.3, 9.2) years and visiting age was 5.1 (2.0, 9.3) years. The time-consuming of diagnosis was 94 (66, 213) days. The hospital stay was 8 (6, 14) days. The most frequently identified cause of FUO was infectious diseases (163 cases, 45.7%), followed by non-infectious inflammatory diseases (133 cases, 37.2%), malignancy (21 cases, 5.9%) and others (40 cases, 11.2%). The patients at younger age were more likely to be attacked by malignancy, oncologic diagnoses, and others, nevertheless patients at older age were more likely to be attacked by non-infectious inflammatory diseases oppositely (9.8 (3.6, 11.5) vs. 3.0 (1.2, 7.0), 2.3 (1.0, 5.2), 0.9 (0.5, 1.8) years, U=41.30, 15.94, 37.08, all P<0.01);106 (65%) patients were male, and 57 (35%) patients were female. This result indicated that boys were more susceptible to infectious diseases (χ²=14.73, P<0.01). Analysis of inflammatory factors in serum among 103 patients, interleukin (IL)-6 level in 40 infectious diseases patients (9 (2, 38) ng/L) was significantly lower than those of 6 tumor patients (89 (64, 599) ng/L) and 57 non-infectious inflammatory diseases patients (25 (8, 78) ng/L, U=51.05, 15.70, both P<0.05), no significant difference was observed in IL-2, IL-4, IL-10, tumor necrosis factor α and interferon among the groups (all P>0.05). The patients grouped into those aged 1-<3 years and 3-<6 years were more likely to be attacked by infectious diseases (51.3% (59/115) and 57.1% (40/70)), while patients grouped into those aged 6-<12 years and 12-<18 years were more likely to be attacked by non-infectious inflammatory diseases (55.6% (65/117) and 72.4% (21/29)). Conclusions: Infectious disease is still the main cause of FUO in children and the boys are more susceptible to infectious diseases. However, the morbidity of non-infectious inflammatory diseases increases to number 1 in FUO of children over 6 years of age.

Influence of Intrapartum Fever on Pregnancy Outcomes and Its Prevention and Treatment

Intra-partum fever usually complicates the delivery process, and its occurrence is often considered synonymous with chorioamnionitis. This inevitably leads to the use of antibiotics for the affected mother. A review of the literature suggests that this approach is not always appropriate. Most cases of intra-partum fever are secondary to non-infectious factors. Both infectious and non-infectious maternal fevers are associated with transient adverse neonatal complications, while maternal fever at delivery is an important risk factor for long-term neonatal developmental outcomes, including encephalopathy, cerebral palsy, and neonatal death. Also prenatal antibiotic exposure increases the risk of developing allergic diseases in children such as asthma and eosinophilic esophagitis. Timing of intrapartum antibiotic administration is very challenging. More research is needed to explore the etiology of intra-partum fever, to discover ways to prevent and control maternal hypothermia, and the proper use of intra-partum antibiotics to reduce unnecessary antibiotic exposure to the fetus. Therefore, the purpose of this study was to review the prenatal and intra-partum factors associated with fever during labor and delivery and to find ways to prevent and treat them to reduce maternal and fetal complications. Effective measures were taken for management to reduce maternal and fetal complications.

Application of Machine Learning for the Prediction of Etiological Types of Classic Fever of Unknown Origin.

Background: The etiology of fever of unknown origin (FUO) is complex and remains a major challenge for clinicians. This study aims to investigate the distribution of the etiology of classic FUO and the differences in clinical indicators in patients with different etiologies of classic FUO and to establish a machine learning (ML) model based on clinical data.Methods: The clinical data and final diagnosis results of 527 patients with classic FUO admitted to 7 medical institutions in Chongqing from January 2012 to August 2021 and who met the classic FUO diagnostic criteria were collected. Three hundred seventy-three patients with final diagnosis were divided into 4 groups according to 4 different etiological types of classical FUO, and statistical analysis was carried out to screen out the indicators with statistical differences under different etiological types. On the basis of these indicators, five kinds of ML models, i.e., random forest (RF), support vector machine (SVM), Light Gradient Boosting Machine (LightGBM), artificial neural network (ANN), and naive Bayes (NB) models, were used to evaluate all datasets using 5-fold cross-validation, and the performance of the models were evaluated using micro-F1 scores.Results: The 373 patients were divided into the infectious disease group (n = 277), non-infectious inflammatory disease group (n = 51), neoplastic disease group (n = 31), and other diseases group (n = 14) according to 4 different etiological types. Another 154 patients were classified as undetermined group because the cause of fever was still unclear at discharge. There were significant differences in gender, age, and 18 other indicators among the four groups of patients with classic FUO with different etiological types (P < 0.05). The micro-F1 score for LightGBM was 75.8%, which was higher than that for the other four ML models, and the LightGBM prediction model had the best performance.Conclusions: Infectious diseases are still the main etiological type of classic FUO. Based on 18 statistically significant clinical indicators such as gender and age, we constructed and evaluated five ML models. LightGBM model has a good effect on predicting the etiological type of classic FUO, which will play a good auxiliary decision-making function.

ETIOLOGICAL PROFILE OF CHILDREN ADMITTED WITH FEVER WITHOUT FOCUS FOR LESS THAN 7 DAYS DURATION AT TERTIARY CARE CENTER

Objective: The objective of the study was to know about the etiology of acute undifferentiated febrile illness (AUFI) or fever without focus in children admitted at tertiary care hospital. Methods: A study was conducted at medical college, Jhalawar, for a period of 3 months. Pediatric patients presenting with fever for less than or equal to 7 days duration without focus, who required hospitalization were included in this study. Results: A total of 200 children enrolled in study. Male-to-female ratio was 1.9:1. Mean age of children was 7.21±4.2 years. About 142 (71%) patients presented after 3 days of fever. Average duration of fever before admission was 4.62±1.78 days. The most common cause of fever of short duration (less than 7 days) was dengue fever 74 (37%) followed by malaria 58 (29%) and typhoid fever 36 (18%). About 26 (13%) patients had mixed infection. Out of 200 patients, 70 (35%) patients had splenomegaly, 66 (33%) had hepatomegaly, and 26 (13%) patients had both hepatosplenomegaly. Conclusion: The common etiology of AUFI with short duration in children was dengue, malaria, and typhoid. Vector control measures, drinking water supply, and sanitation should be improved to prevent vector-borne and water-borne diseases.

A study on viral haemorrhagic fever due to dengue, chikungunya and Crimean Congo haemorrhagic fever virus among patients attending tertiary care hospital in North East India

PurposeThe present study was undertaken with the objective to study the common etiology of Viral Haemorrhagic Fever (VHF) among patients attending tertiary health care centre in NE India and also to study the clinico-demographic profile of such patients. The agents of VHF included in the study were dengue, chikungunya and Crimean Congo haemorrhagic fever (CCHF) virus. The inclusion of CCHF was based on evidence of seroprevalence in livestock (bovine, sheep and goat) in various North Eastern states. Materials and methodsSerum samples were collected from 51 suspected VHF patients. MAC-ELISA was done to detect dengue and chikungunya specific IgM antibody. The samples were also tested by real-time RT-PCR for detection of dengue, chikungunya and CCHF specific nucleic acid. The laboratory and clinico-demographic profile of these patients were noted in detail. ResultsSerum samples of 16 of 51 suspected cases were confirmed to be suffering from VHF. Among these confirmed cases, 12 were diagnosed with dengue haemorrhagic fever, one was diagnosed with chikungunya and three were diagnosed with dengue-chikungunya co-infection. Based on severity, DHF was further classified into- DHF I- (4,26.6%), DHF II (6,40%), DHF III (3,20%) and DHF IV (2,13.3%). There was no CCHFV infection detected in our study. Retro-orbital pain (P ​= ​0.02) and haematocrit level (P ​= ​0.03) were found to be statistically significant. ConclusionsThis study reiterates the fact that CCHF virus infection is still probably absent in human population of NE India and haemorrhagic symptoms, though rare maybe one of the atypical manifestations of chikungunya infection.

The Fever in the Emergency Department: before Versus after COVID-19

A high body temperature, i.e. fever, is a crucial vital sign, and suggests the patient’s infection or inflammation. COVID-19 has changed the lifestyle, and led to the changes in medical use behavior of febrile patients. We investigated the change in etiologies of fever in the emergency department (ED) before and after COVID-19. The medical records of patients with fever who visited the ED of a university hospital before and after the outbreak of COVID-19 in Daegu metropolitan city, South Korea. The cause of fever and its classification were carefully decided and established by agreement through a discussion among board-certified clinicians in emergency medicine, neurology, general surgery, and internal medicine. The etiology of fever and its prevalence in ED were compared between before and after COVID-19. A total of 3,041 patients with fever (> 37.7°C) in the ED were investigated, with 1,400 men (46.0%). Their mean age was 55.88 ± 20.59, and the average number of patients with fever in ED was 8.16 ± 3.94 per a day. The most common etiology before COVID-19 was respiratory system infection (n = 535, 30.5%), followed by gastrointestinal (n = 313, 17.8%) and urinary tract infection (n = 209, 11.9%). However, after COVID-19, gastrointestinal cause became the most common (n = 247, 27.3%), followed by respiratory system (n = 126, 13.9%) and urinary tract infection (n = 102, 11.3%). There has been paradigm-shifting in fever etiology in the emergency department. It is necessary to cope with the changed fever etiology in the COVID-19 era. Keywords: COVID-19, Emergency service, hospital, Etiology, Fever

Measuring temperature in children, conveniently and accurately: a comparative study on different modalities of thermometry

Background: Fever is one of the most common complaints in children in day-to-day practice. The pattern and grade of fever provide some evidence in determining the etiology of fever. Equally important is the identification and documentation of hypothermia in neonates. Hence there is need for an accurate thermometry mode, which should also be convenient to use in children.Methods: This was a cross-sectional observation study on all the neonates and children satisfying the inclusion criteria. Infrared forehead thermometer and digital axillary thermometer were used to record temperature and compared with Infrared tympanic temperature which was taken as gold standard.Results: A total of 240 neonates and children were evaluated. Strong positive correlation was observed between Means of Forehead Thermometer (FT) and Ear Thermometer (ET) with correlation coefficient of 0.777 and p value &lt;0.001. Similar correlation was also observed with Axillary Temperature (AT) with correlation coefficient of 0.944 and p&lt;0.001.Conclusions: Non-contact Infrared thermometer may be used in neonates and children without causing discomfort. It gives instant and comparable readings which are especially significant in the current coronavirus disease (COVID) pandemic setting.

A study of etiology of fever of unknown origin in children aged 2 months to 18 years

Background: In an era of advance science of modern technologies, many diseases are diagnosed and excluded rapidly and now Fever of Unknown Origin (FUO) has been redefined for any fever of 380C lasting for more than 7 days without any clear cause. The aetiology varies according to different geographical regions, socioeconomical status, age, prevalence of resistance to antimicrobial drugs and genetic susceptibility.Methods: It was a descriptive cross sectional, hospital-based study, carried out on 150 children from August 2018 to May 2020. All cases in the age group of 2 months to 18 years with fever of &gt;38.0°C, lasting for more than 7 days without a clear source were included.Results: The mean age of presentation was 5.8 years±Standard Deviation of 3.7 years with male to female ratio was 1.4:1. Nearly half of the cases, presented with the duration of fever between 8-14 days. Enteric fever in 52%, tuberculosis in 13.3% and acute lymphoblastic leukemia (ALL) in 8.5% were three common etiologies found in this study. Amongst all cases of FUO, infective causes were seen in 113 (75.3%) followed by malignancies in 15(10%) cases. In 10 (6.7%) cases, cause could not be established.Conclusions: Enteric fever and tuberculosis were the leading etiologies from infective subgroup of FUO. ALL was the commonest cause from malignancies sub group. FUO presenting with low haemoglobin, platelet is a pointer towards malignancy. Occurrence of FUO with infectious diseases and malignancies was found in younger age group as compared to connective tissue diseases.

The Association Between Vitamin D Level and PFAPA Syndrome: A Systematic Review.

Periodic Fever, Aphthous Ulcers, Pharyngitis and Adenitis (PFAPA) Syndrome's etiology is not well understood. The objective of this study is to explore the association between vitamin D level and PFAPA syndrome. A systematic review of all publications addressing the association between vitamin D level and PFAPA syndrome prior to May 2019 was conducted. Data were collected from online medical databases namely, PubMed, Ovid Medline, Embase, Cochrane Library, Google Scholar, and Scopus. The review adhered to the PRISMA statement and was performed in 3 main phases; an initial screening review of abstracts was performed, followed by a detailed review of full articles based on inclusion and exclusion criteria, and lastly a final review to extract data from selected articles. 3 prospective review-based and one case report articles were included with a total of 281 patients, 98 of whom were cases of PFAPA, while 183 were controls. Vitamin D levels were deficient in 27% of PFAPA group as compared with the control. Vitamin D supplementation was given as an initial treatment in 25/98 of the patients. Only 1 patient received it as a second treatment. After vitamin D supplementation, a marked reduction of the number of febrile episodes and modification of the mean duration were recognized. There may be an association between Vitamin D deficiency and a higher frequency of PFAPA episodes. Vitamin D supplementation in children with PFAPA may reduce the frequency of episodes and help manage the condition.

FEVER OF UNKNOWN ORIGIN IN THE ICU: A CASE OF "GOUTY SEPSIS"

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Gout associated with systemic inflammatory response syndrome is well described but underappreciated in clinical practice. A prospective analysis of cases admitted to the hospital estimate that 4.5% are associated with fever. We present a case of a critically ill patient with persistent fever of unknown origin diagnosed with polyarticular gout two months into his hospitalization. CASE PRESENTATION: A 67-year-old man with a history of gout, atrial fibrillation, and type 2 diabetes was admitted with a left MCA territory stroke and underwent emergent thrombectomy. He had a period of relative neurologic recovery but became encephalopathic necessitating intubation for airway protection. He developed aspiration pneumonia and progressive renal failure requiring dialysis and underwent percutaneous tracheostomy. Over a period of several weeks, he demonstrated recurrent fevers and persistent leukocytosis and received multiple courses of empiric broad spectrum antimicrobials. Serial cultures, evaluation for atypical pathogens, cross-sectional imaging, lumbar puncture, and autoimmune serologies did not identify an etiology, and he was trialed on bromocriptine for presumed central fever. Repeat physical exam elicited multiple swollen and tender joints. Arthrocentesis was performed and notable for monosodium urate crystals. Acute polyarticular gout was diagnosed, and he was started on dexamethasone and later switched over to anakinra (due to uncontrolled hyperglycemia), with resolution of fevers and articular symptoms. After defervescing his neurologic status significantly improved and he was able to successfully liberate from the ventilator. He was ultimately discharged to rehab on hospital day 112. DISCUSSION: Fever is present in up to 70% of ICU patients and when prolonged is associated with increased morbidity and mortality. This case highlights the difficulty of recognizing non-infectious etiologies of fever in the critically ill patient and the potential harms in a missed diagnosis. These include unnecessary antimicrobial exposure, invasive procedures, and prolonged hospital stay. Sedation and encephalopathy often complicate history-taking and diagnosis. Here, careful physical examination led to the diagnosis of an underappreciated manifestation (fever) of a common condition (gout). While the incidence of gout flares in the ICU is unknown, medical stress, dehydration, and diuretics are frequent triggers and common in critically ill patients. Treatment may be challenging as high rates of renal insufficiency can preclude the use of common therapies such as NSAIDs or colchicine, and steroids may potentiate issues with glycemic control. CONCLUSIONS: Polyarticular gout should be routinely considered as a possible cause of fever in the ICU. REFERENCE #1: Schäfer VS. Systemic Inflammatory Polyarticular Gout Syndrome - Description of a Previously Neglected Entity. JSM Arthritis. 2017;2(2): 1024. REFERENCE #2: Circiumaru B, Baldock G, Cohen J. A prospective study of fever in the intensive care unit. Intensive Care Med. 1999. Jul;25(7): 668-73. REFERENCE #3: Raddatz DA, Mahowald ML and Bilka PJ. Acute polyarticular gout. Ann Rheum Dis. 1983;42: 112-117. DISCLOSURES: Speaker/Speaker's Bureau relationship with Boehringer-Ingelheim Pharmaceuticals Please note: $5001 - $20000 by Jaime Betancourt, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Vapotherm, Inc Please note: $5001 - $20000 by Jaime Betancourt, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boehringer-Ingelheim Pharmaceuticals Please note: 2014-Present Added 04/21/2021 by Jaime Betancourt, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Vapotherm, Inc Please note: 2019-Present Added 04/21/2021 by Jaime Betancourt, source=Web Response, value=Honoraria Advisory Committee Member relationship with Vapotherm, Inc Please note: 2020 Added 04/21/2021 by Jaime Betancourt, source=Web Response, value=Honoraria No relevant relationships by Tracey Liu, source=Web Response No relevant relationships by Scott Oh, source=Web Response No relevant relationships by Jared Wilkinson, source=Web Response

Nosocomial Fever in General Medical Wards: A Prospective Cohort Study of Clinical Characteristics and Outcomes.

PurposeNosocomial fever (NF) is a common sign of healthcare-associated infection; however, infection is not always followed up. We studied the etiology, clinical characteristics, and outcomes of nosocomial fever in hospitalized patients.Patients and MethodsBetween October 2019 and December 2020, we enrolled subjects from general medical wards who developed fever ≥48 hours after hospital admission or who were admitted with fever, defervesced, and then developed a fever ≥7 days later that was unrelated to the cause for admission. Subjects with NF underwent a comprehensive clinical evaluation and laboratory investigations.ResultsEighty-six cases of NF were identified and completely followed, the mean age was 69.29 years, and 35 were male. Fifty-seven were from infectious etiologies, 28 from non-infectious etiologies, and one case was unable to be determined. Hospital-associated pneumonia (47.4%) and urinary tract infection (22.8%) were the most common infectious causes, and malignancy (17.8%) and large hematoma (14.3%) were the most common non-infectious causes. The median day of onset of NF following hospitalization was 12 (4.7–21.2) days. Acute physiology and chronic health evaluation II (APACHE II) score (14.70 vs 11.97, p = 0.02), sequential organ failure assessment (SOFA) scores (4 vs 2, p < 0.01), pertinent clinical findings (82.5% vs 42.9%, p < 0.01), blood urea nitrogen (BUN) (37.30 vs 21.10, p = 0.03) and creatinine (1.41 vs 0.97, p = 0.05) levels, and abnormal chest radiography (45.6% vs 3.6%, p < 0.01) had significant differences between infectious and non-infectious etiologies. Twenty-three subjects (26.7%) died. The presence of end-stage renal disease (ESRD) [OR 19.49 (1.77–214.18), p = 0.015], SOFA score >6 [OR 5.18 (1.04–25.90), p = 0.045], and abnormal chest radiography [OR 3.45 (1.16–10.29), p = 0.026] were significantly associated with mortality.ConclusionNosocomial infections, malignancy, and hematoma were the leading causes of NF. Severity scores, clinical findings, renal function tests, and chest radiography were distinguishing features between infectious and non-infectious etiologies. ESRD, high SOFA scores, and abnormal chest radiography were associated with mortality.

Spectrum of Multiorgan Dysfunction in Scrub Typhus Infection.

We planned this study to determine the clinical spectrum and compare incidence of multiorgan dysfunction in children hospitalized with scrub typhus with other etiologies of tropical fever. Prospective cohort study. Pediatric emergency and PICU services of a university teaching hospital situated in the sub-Himalayan region. Children aged 2 months to 14 years with acute undifferentiated fever of more than 5 days. Detailed fever workup was performed in all children. We compared scrub typhus IgM positive children (cases) with remaining febrile children who were negative for scrub IgM assay (controls) for mortality and morbidity. We enrolled 224 febrile children; 76 children (34%) were positive for scrub typhus IgM ELISA. Scrub typhus group had a significantly higher incidence of multiorgan dysfunction [OR 3.5 (95% CI 2.0-6.3); p < 0.001] as compared to non-scrub typhus group requiring supportive care. The incidence of altered sensorium [OR 8.8 (95% CI 3.1-24.9)], seizures [OR 3.0 (95% CI 1.1-8.3)], acute respiratory distress syndrome [OR 17.1 (95% CI 2.1-140.1)], acute renal failure (5% vs. 0%), meningitis [OR 6.2 (95% CI 1.2-31.6)], thrombocytopenia [OR 2.8 (95% CI 1.5-5.1)], transaminitis [OR 2.7 (95% CI 1.6-4.8)], requirement of oxygen [OR 17.8 (95% CI 4.0-80.3)], positive pressure support [OR 3.7 (95% CI 1.2-10.5)] and shock requiring inotropes [OR 3.0 (95% CI 1.3-6.7)] was significantly higher in scrub typhus group as compared to the non-scrub typhus group (Table 1). Pediatric scrub typhus who were hospitalized had severe systemic manifestations when compared to other causes of fever.

Microbiological etiology and management approach of febrile neutropenia

Many etiologies have been proposed to predispose neutropenic fever, and infections have been reported in less than one-third of the reported cases. However, etiologies might have a significant impact on the prognostic, and can even lead to mortality. In this literature review, the aim to discuss the different microbiological etiologies of neutropenic fever, and the management approaches of such conditions, including the proper assessment and evaluation of patients. Additionally, the goal of this literature review to discuss the appropriate treatment and prophylaxis measures based on the assessment results. Many bacterial pathogens could be isolated from patients suffering from neutropenic fever, including both the gram-positive and negative organisms, such as pseudomonas aeruginosa, E. coli, Klebsiella spp, actinobacteria spp, in addition to many other bacteria such as staph. Nevertheless, Aureus was commonly isolated from the infected patients, and it has been reported with increased morbidity and mortality rates. Assessment of the severity of the condition and identification of the microbiological activity can significantly lead to enhance management of the infected patients. Detailed information about the etiology and management are provided within the main text of this study. Further efforts are needed to increase awareness related to the hazards of the inadequate and incomplete assessments of patients with neutropenic fever, which might lead to delayed or inadequate management and worsened prognosis.

Benign course and clinical features of COVID-19 in hospitalised febrile infants up to 60 days old.

AimMinimal data exist regarding the severity of COVID‐19 in febrile infants under 60 days old. This multicentre prospective study explored the clinical course and outcomes of this hospitalised patient population, as, to date, the best approach has not been specifically addressed.MethodsThis study focused on the clinical features, laboratory parameters and outcomes of febrile infants up to 60 days old who tested positive for the virus and were hospitalised in Israel from March 2020 to January 2021. The data were extracted from a real‐time prospective surveillance network for COVID‐19 that includes 20 of the country's 26 hospitals.ResultsWe identified 75 febrile young infants (60% female) with COVID‐19 at a median age of 28 days (range 8–56 days). Of these, 84% had an unremarkable medical history, 29% had respiratory symptoms, and 96% had a mild illness. The Rochester criteria showed that 44% were considered at high‐risk for serious bacterial infections, and we found that eight infants actually had concomitant bacterial infections. Outcomes were excellent, and no complications or fatalities were reported.ConclusionThe excellent outcomes of young febrile infants with COVID‐19 closely resembled other respiratory viral aetiologies of fever in this age group, and there were no fatalities.

Comparison of the Power of Procalcitonin and C-Reactive Protein to Differentiate between Different Etiologies of Febrile Neutropenia in Patients with Prolonged Profound Neutropenia

Background: The management of febrile neutropenia in case of prolonged profound neutropenia remains challenging as there are many possible infectious and non-infectious causes for fever in these patients. In more than 60% of cases there is no documented infectious etiology and unresolved febrile neutropenia often results in multiple empirical modifications of antibacterial therapy and/or addition of antifungal therapy. Unfortunately, indiscriminate use of broad-spectrum antibiotics can lead to important collateral damage including toxicity, selection of multidrug resistant pathogens and an increased predisposition to other infections such as Clostridium difficile or yeasts/fungi. In this study, we investigated whether procalcitonin (PCT) is superior to C-reactive protein (CRP) in discriminating between different etiologies of fever.Methods: CRP and PCT were tested daily during 93 neutropenic episodes in 66 patients (Table 1). A linear mixed model was performed to evaluate the effects of different variables on the values of CRP and PCT over time. A total of 121 febrile episodes occurred during this study period and were classified into four categories based on clinical and microbiological findings: microbiologically documented infection (MDI); clinically documented infection (CDI); proven or probable invasive fungal disease (IFD); fever of unknown origin (FUO). The values of PCT and CRP on day 2 after onset of fever were considered for analysis of their performance in distinguishing etiologies of fever in receiver operating characteristic (ROC) curves and by calculation of sensitivity, specificity, positive & negative predictive values and efficiency.Results: In 61 out of 93 neutropenic episodes (66.7%) the evolution of PCT and CRP was clearly different. CRP seemed to be a more volatile parameter, rising above its ULN (3 mg/dL) during every neutropenic episode. Its reactivity to stimuli was also quite pronounced with a median of 2 surges above 100 mg/dL per neutropenic episode. In contrast, PCT did not rise above its ULN (0.5 ng/mL) in 50 out of 93 neutropenic episodes (53.8%). The only confounding factor on the evolution of CRP and PCT with a clinically relevant large effect size was administration of antithymocyte globulin (ATG), which led to an 11-fold increase of PCT versus a 2-fold increase of CRP.On the day of fever onset no significant difference in PCT values was observed between different etiologies of fever (p=0.314), whereas median CRP values were significantly higher in IFD versus all other etiologies (median 98.8 mg/dL vs 28.8 mg/dL, p=0.027). Both PCT and CRP reached their peak at a median of 2 days after onset of febrile neutropenia. Median PCT values on day 2 showed no statistically significant difference when comparing etiologies of fever (Figure 1A). There was a tendency towards higher median PCT values in MDI and IFD where they rose > 0.25 ng/mL, while they did not in CDI or FUO without prior administration of ATG. Median CRP values on day 2 after fever onset were significantly higher in IFD versus all other etiologies (median 172 mg/dL vs 78.4 mg/dL, p=0.002). In MDI median CRP values rose > 100 mg/dL, whereas they did not in CDI or FUO (Figure 1B).The discriminatory power between IFD and FUO of CRP on day 2 after onset of febrile neutropenia was superior to that of PCT. With the cut-off set at 200 mg/dL, CRP has a positive predictive value of 66.7% and a negative predictive value of 97% for the diagnosis of IFD versus FUO, leading to an efficiency of 94.5%.Conclusions: Both CRP and PCT are not able to predict neither etiology nor severity of infection at the onset of fever. When performing reassessment of antibiotic therapy 2 days after onset of febrile neutropenia, CRP has the better discriminatory power between etiologies of fever and shows higher peak values in clinically severe infections. As such we conclude that PCT has no added value over CRP for clinical management of febrile neutropenia. In our study a CRP value above 200 mg/dL has a positive predictive value of 66.7% and a negative predictive value of 97% for the diagnosis of IFD versus FUO (when MDI and CDI were ruled out by diagnostic workup). A high CRP in the absence of a clear focus of infection might prompt earlier investigation for IFD, leading to earlier treatment initiation and lower mortality. In view of the low numbers of IFD in our study it is important to note that this finding should be confirmed in a larger patient population. [Display omitted] DisclosuresVerlinden:MSD - Merck: Research Funding. Gadisseur:Bayer: Research Funding.

Assessment of the burden of malaria and bacteraemia by retrospective molecular diagnosis in febrile illnesses and first-line anti-infectives in Côte d'Ivoire

BackgroundThe aetiologies of fever are poorly understood in sub-Saharan Africa. We aimed to assess the burden of malaria and bacteria in Côte d’Ivoire. MethodsBlood samples from 438 febrile and 346 afebrile people were screened using molecular tools. ResultsPlasmodium falciparum was the most common microorganism associated with fever (46.8% in febrile, 23.4% in afebrile people; p < 0.001). Bacteraemia was detected in 21.7% of febrile people and 12.7% of afebrile people (p = 0.001). Streptococcus pneumoniae was the main cause of bacteraemia (7.1% of febrile and 0.6% of afebrile individuals; p < 0.001). Non-typhoidal Salmonella spp. was detected in 4.5% of febrile people and 1.2% of afebrile individuals (p < 0.001). Salmonella enterica Typhi and S. enterica Paratyphi were only detected in febrile subjects (1.4% and 2.1%), as well as Tropheryma whipplei (0.9%), Streptococcus pyogenes (0.7%), and Plasmodium ovale (4.6%). The prevalence in febrile and afebrile people was similar for Staphylococcus aureus (3.6–4.9%), Rickettsia felis (5.5–6.4%), Mansonella perstans (3.0–3.2%), and Plasmodium malariae (1.6–2.3%). Comorbidities were higher in febrile than in afebrile subjects (10.3% versus 5.5%; p = 0.01); 82% involving P. falciparum. All patients co-infected with P. falciparum and S. pneumoniae were febrile whereas 30% of those infected by P. falciparum alone were not (p = 0.02). Among febrile participants, 30.4% with malaria and 54.7% with bacteraemia had received neither antimalarial nor antibiotic therapy. ConclusionIdentification of etiologies of acute febrile diseases in sub-Saharan Africa proposes keys to successful treatment and prevention of infectious diseases. Vaccination campaigns may decrease the morbidity of mono- and co-infections by preventable microorganisms.

The Etiology of Fever in Adults Presenting in Department of General Medicine in IGIMS

The Etiology of Fever in Adults Presenting in Department of General Medicine in IGIMS

Febrile infants in the emergency department of a public hospital in India: respiratory infections lead the pack

Background: The objective of study was to find the etiology, signs and symptoms of fever of 4-7 days in the age group of 91 days 2 years and their outcome following treatment in a tertiary care hospital.Methods: This was a prospective study conducted at the Emergency Department (ED) of a public hospital in New Delhi between April, 2018 and January, 2019. 150 children aged 3 months to 2 years with 4-7 days of fever were included. Demographic, clinical and diagnostic data were collected, and children were managed using ACEE-INDIA guidelines, telephonic follow-up was done for those discharged from ED.Results: Out of 150 children, respiratory tract infections were most common etiological group (64%), followed by gastrointestinal infections (16.7%) and CNS infections (9.3%). Fever with cough (with respiratory distress-27.3%) was the most common symptom in these children. Overall, 61% were admitted; majority (58%) being with respiratory problems. Median (IQR) duration of stay in admitted children was 2 (0, 3) days. Mortality was observed in 12 (8%) children. Mortality was 4 times higher in children with CNS infections as compared to other conditions [RR=4.14 (1.4 to 12.4); P=0.01].Conclusions: Fever in the ED among Indian infants at a public hospital was mainly due to respiratory infection, which could be managed on outpatient-basis in the majority using the ACEE-INDIA (Academic College of Emergency Experts in India) guidelines. However, among those admitted, neurological conditions were the most common cause of death.

Etiological Trends and Epidemiological Profile of Tropical Fever in Children Presenting with Acute Undifferentiated Fever at a Tertiary Care Centre in North India

&#x0D; &#x0D; &#x0D; &#x0D; Introduction: The objective of this study was to determine the etiology of acute undifferentiated fevers (AUF) in hospitalised children with in a tertiary care centre in North India. The various causes of acute undifferentiated fevers included dengue, malaria, scrub typhus, enteric fever, leptospirosis and Chikungunya. The clinical spectrum and therapeutic outcome of these cases was also studied.&#x0D; Methods: This retrospective study was conducted over a period of 6 months from June 2019 to December 2019. The clinical information of 126 children who tested positive for any of the causes of AUF namely dengue, malaria, scrub typhus, enteric fever, chikungunya and leptospirosis was obtained from the Paediatrics Department. The information was recorded in a predesigned proforma. Various tests performed for the diagnosis of these illnesses were noted. They included dengue NS1 antigen ELISA and IgM ELISA, peripheral blood smear (PBS) for malarial parasite and rapid malarial antigen detection test (RMAT), scrub typhus IgM ELISA, leptospira IgM ELISA, and Chikungunya IgM ELISA.&#x0D; Results: The diagnosis of AUF were dengue (55.5%; 70/126), malaria (19%; 24/126) and scrub typhus (19%; 24/126), enteric fever (4.7%;6/126) and Chikungunya (1.5%; 2/126). The most common presenting symptom was fever or pyrexia followed by myalgia, generalised aches and pains in the body and vomiting. Commonly observed complications included thrombocytopenia, hepatitis and shock.&#x0D; Conclusions: Dengue, malaria and scrub typhus are the major causes of AUF in the hospitalised children with dengue being the most prevalent infection. The study further emphasises the need to develop a systematic approach to the diagnosis of AUFs. This should be using a combination of clinical, epidemiological and laboratory parameters, which will be very useful for developing a relevant action plan for treatment and prevention of such fevers in any hospital setup.&#x0D; &#x0D; &#x0D; &#x0D;