Fever In Adult Patients Research Articles

Clinical presentation and outcome of enteric fever in adult patients with cancer: a perspective from Pakistan.

Introduction. Enteric fever is a significant health concern in endemic countries. While extensive research has been conducted to understand its presentation and outcomes in non-cancer patients, limited data exist on its impact on cancer patients. This descriptive study aims to investigate the clinical presentation and outcome in cancer patients. Methodology. This retrospective observational study analysed 90 adult cancer patients from a single centre in Pakistan from January 2017 to December 2022. Inclusion criteria involved documented blood culture infections with Salmonella typhi or paratyphi A, B, or C. We examined clinical presentation, laboratory parameters, antimicrobial resistance, complications, and outcomes. Additionally, we explored the effects of chemotherapy, comorbidities, type of malignancy, and patient age on complications and mortality. Results. Salmonella typhi was the most prevalent organism (72.2 %), followed by Salmonella paratyphi A (22.2 %) and B (5.5 %). Variably-resistant isolates constituted 51.5 %, multi-drug resistant (MDR) isolates accounted for 20 %, extensively drug-resistant (XDR) for 14.4 % and ESBL-producers for 15.5 %, of all enteric fever infections. Enteric fever-associated complications were observed in 21.1 % of cases. Chemotherapy in the preceding month did not affect mortality, nor did age, gender, or malignancy type. However, comorbidities were statistically significant for mortality (p-value 0.03). A total of 8.8 % of patients required ICU care, and the all-cause 30 day mortality rate was 13.3 % Conclusion. Enteric fever remains prevalent in our geographical region. Unlike non-typhoidal Salmonella (NTS), enteric fever does not behave differently in an immunocompromised population, including cancer patients.

Executive Summary: Guidelines for Evaluating New Fever in Adult Patients in the ICU.

Executive Summary: Guidelines for Evaluating New Fever in Adult Patients in the ICU.

NEUTROPHIL-LYMPHOCYTE RATIO AS A PROGNOSTIC INDICATOR IN DENGUE FEVER PATIENTS AT TERTIARY CARE HOSPITAL IN NORTHWEST-MAHARASHTRA

Introduction- Dengue is regarded as the most important arthropod-borne viral infection in humans and is the second most important re-emerging tropical disease. Dengue infections are increasing resulting in more illness and death and in 2012 World Health Organization (WHO) reclassified dengue as the most important mosquito-borne viral disease in the world. Given the heterogeneous nature of the clinical presentation of dengue, identifying robust and sensitive clinical or laboratory predictors of dengue fever and its severity has not been an easy task. Neutrophil-to-lymphocyte ratio (NLR) can be easily calculated based on a complete blood count by dividing the Neutrophil percentage by Lymphocyte percentage. There is enough literature to suggest that NLR has prognostic significance in various diseases. However, no studies have focussed on NLR as a prognostic marker for dengue. Aim- To study NLR in dengue patients and assess its role in relation with age, gender,serological tests for dengue and platelet count. Materials and Methods- This retrospective observational study was carried out at Tertiary care hospital in Northwest Maharashtra. 100 diagnosed and admitted cases of dengue were included in this study. Clinical data and laboratory data were reviewed and analysed. Chi Square test was done and its significance noted. Results- In our study, Ns1Ag dengue serology test was found to be more common in males indicating recent infection and Ns1Ag, IgM and IgG more common in females indicating recent and past infection. NLR < 2 strongly correlates with low platelets indicating severity of disease and reversal of NLR > 2 correlates with improvement of disease. NLR < 2 was more common in 0-20 years age group, younger the age lesser the NLR and hence more severe the disease. Conclusion- From our study we found that there is a significant relation between NLR to the severity of dengue fever in adult patients and by keeping an eye on the NLR we can predict the prognosis and the severity of the disease in patient. Lower the NLR ratio severe the disease. Hence NLR can be used as a prognostic indicator in dengue patients.

Acute rheumatic fever in adult patients.

Acute rheumatic fever (ARF) is considered as a disorder of children, and attacks in adults are usually a recurrence of disease acquired in the child’s life. Although the incidence of ARF in children has a decreasing trend in developed countries, resurgent and sporadic epidemics still occur in adults. The first attacks of ARF in adult patients without a childhood history can lead to a diagnostic dilemma.A medical record review in adults at least 18 years of age with an arthralgia complaint fulfilling 2015 revised Jones criteria was performed from January 1, 2000 to December 31, 2019.Eleven ARF patients were identified, including 8 with initial attacks (6 females aged 26–42 years, 33.9 ± 5.3) and 3 pre-existing valvular heart disease with recurrent attacks (2 females aged 38–52 years, 45.0 ± 7.0). In addition to febrile pharyngitis and migratory polyarthritis in initial attacks, pericarditis was encountered in 1, valvulitis in 2, prolong PR interval in 3 and skin involvement in 2 patients with erythema marginatum and IgA vasculitis. All responded to antibiotics and nonsteroidal anti-inflammatory drugs therapy with normalized clinical and laboratory abnormalities, no new-onset carditis, and no recurrent disease during a long-term follow-up (3.8–19.8 years, 12.7 ± 5.4).A sporadic occurrence of adult ARF is observed in southern Taiwan. This disease should be considered by physicians for the differential diagnosis of febrile pharyngitis with arthritis and/or carditis in adults, even in areas with a low incidence of ARF.

Serum Aminotransferase Levels as a Marker in Assessment of Severity of Dengue Fever in Adult Patients- A Cross-sectional Study

Introduction: Dengue Fever (DF) is the most common rapidly spreading mosquito-borne arboviral disease with a wide clinical spectrum that includes both severe and nonsevere clinical manifestations. Most patients with DF have liver involvement in the form of elevated serum Aminotransferase (AST). Severity of the disease is more in patients with elevated serum ASTs. Hence, this study was taken-up to assess the correlation with the elevated serum ASTs and severity of the disease. Aim: To measure and associate the serum AST levels as a marker in assessing severity of DF in adults. Materials and Methods: The cross-sectional study was conducted on 100 patients of DF admitted to General Medicine wards from May 2019 to April 2020 in Hassan Institute of Medical Sciences and hospital, Hassan, Karnataka, India. Serum AST levels were estimated at admission, on the day of discharge of the patient and correlated to prognosis of patient in DF. A pre-determined proforma was used to record the details of history, physical examination and investigation and results were recorded in a Microsoft excel master chart. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) software, version 20.0, ANOVA and student t-test were used for calculation of significance in all parameters within the groups while Fischer’s-exact test was used to compare the significance between the groups. The p-value <0.05 was to be considered level of significance. Results: In this study, 100 (mean age: 31.65±12.08 years) patients of dengue Nonstructural protein 1/Immunoglobulin M (NS1/IgM) positive patients were studied. Out of this 60% NS1 Antigen (Ag), 22% NS1 Ag and IgM Antibody (Ab) and 18% were IgM Ab positive. 63 were males and 37 were females. AST/SGOT values were on day 1 was 203.76±360.87 U/L and on day of discharge was 55.96±31.76 U/L (p-value<0.001). And ALT/SGPT on day 1 was 109.63±146.01 U/L and on day od discharge was 41.05±20.78 U/L (p-value <0.001). Indicating dengue patients had raised AST/SGOT values on day 1 as compared to day of discharge. There was a significant difference (p-value <0.001) found on day 1 and at the time of discharge. Conclusion: Hepatic involvement, characterised by elevation of liver enzymes, is very common finding in Dengue Fever. Serum Aminotranferase (AST) levels are elevated more as compared to serum Alanine aminotransferase (ALT) . The present study found significant association of serum AST levels with the hospital stay and prognosis of the patient. Hence, serum AST levels are mandatory in DF to look for complications and it is of prognostic value.

Comparative evaluation of the efficacy of intravenous paracetamol and ibuprofen on the treatment of tonsillopharyngitis with fever: A prospective, randomized controlled, double-blind clinical trial.

OBJECTIVE:Tonsillopharyngitis is one of the constituents of upper respiratory tract infection (URTI). Fever is a URTI symptom requiring treatment due to the occurrence of discomfort and high fever-based complications. This study primarily sets out to observe and compare the efficacy of intravenous administration of paracetamol and ibuprofen drugs on fever in adult patients with tonsillopharyngitis.METHODS:This study was performed in a prospective, randomized controlled, double-blind design. The study population was divided as Group 1 (treated with paracetamol) and as Group 2 (treated with ibuprofen). While the first group was treated with paracetamol as 1000 mg in 150 ml normal saline, the second group was treated with ibuprofen as 400 mg in 150 ml normal saline. The primary outcome was the decrease in fever at 15, 30, and 60 min, while the secondary outcome was the need for additional treatment after 60 min.RESULTS:One hundred and eighty-five patients were included in the final analysis. The mean age of the paracetamol group (57.4% male) was 28.36 ± 9.6, whereas that of the ibuprofen group (54.9% male) was 27.45 ± 7.98. Fever was reduced significantly between 0 and 60 min in both groups (P ≤ 0.001 and P ≤ 0.001, respectively). Although the antipyretic effect of ibuprofen was more pronounced in the early period than that of paracetamol, no significant difference was noted between the two groups in terms of fever drop between 0 and 60 min (P = 0.350).CONCLUSION:Although both drugs prove effective in controlling fever at the 60 min, stronger efficacy of ibuprofen in the first 15 min may enable rapid discharge from the emergency department.

A systematic approach for studying the signs and symptoms of fever in adult patients: the fever assessment tool (FAST)

BackgroundAlthough body temperature is one of four key vital signs routinely monitored and treated in clinical practice, relatively little is known about the symptoms associated with febrile states. The purpose of this study was to assess the validity, reliability and feasibility of the Fever Assessment Tool (FAST) in an acute care research setting.MethodsQualitative: To assess content validity and finalize the FAST instrument, 12 adults from an inpatient medical-surgical unit at the National Institutes of Health (NIH) Clinical Center participated in cognitive interviews within approximately 12 h of a febrile state (tympanic temperature ≥ 38° Celsius). Quantitative: To test reliability, validity and feasibility, 56 new adult inpatients completed the 21-item FAST.ResultsThe cognitive interviews clarified and validated the content of the final 21-item FAST. Fifty-six patients completed the FAST from two to 133 times during routine vital sign assessment, yielding 1,699 temperature time points. Thirty-four percent of the patients (N = 19) experienced fever at one or more time points, with a total of 125 febrile time points. Kuder-Richardson 20 (KR-20) reliability of the FAST was 0.70. Four nonspecific symptom categories, Tired or Run-Down (12), Sleepy (13), Weak or Lacking Energy (11), and Thirsty (9) were among the most frequently reported symptoms in all participants. Using Generalized Estimating Equations (GEE), the odds of reporting eight symptoms, Warm (4), Sweating (5), Thirsty (9), General Body Aches (10), Weak or Lacking Energy (11), Tired or Run Down (12) and Difficulty Breathing (17), were increased when patients had a fever (Fever Now), compared to the two other subgroups—patients who had a fever, but not at that particular time point, (Fever Not Now) and patients who never had a fever (Fever Never). Many, but not all, of the comparisons were significant in both groups.ConclusionResults suggest the FAST is reliable, valid and easy to administer. In addition to symptoms usually associated with fever (e.g. feeling warm), symptoms such as Difficulty Breathing (17) were identified with fever. Further study in a larger, more diverse patient population is warranted.Trial RegistrationClinical Trials Number: NCT01287143 (January 2011)

Fever in Acute and Critical Care

Determining the underlying cause of a fever can be a daunting task. Multiple reasons have been found for a patient to have a fever, but the use of an organized approach will assist clinicians in reaching a correct diagnosis. The first step in this process is a complete assessment, including a thorough physical assessment and an evaluation of the history of present illness as well as a detailed review of all the patient’s medications. Infection should always be a primary consideration for the cause of a fever. Evaluating each body system can match symptoms with a possible cause for fever, and proper testing and imaging can be pursued. Noninfectious causes of fever need to be included in the differential diagnostic process. This article provides an analytic approach to fever in adult patients in the acute and critical care environment.

Fever in Acute and Critical Care

Determining the underlying cause of a fever can be a daunting task. Multiple reasons have been found for a patient to have a fever, but the use of an organized approach will assist clinicians in reaching a correct diagnosis. The first step in this process is a complete assessment, including a thorough physical assessment and an evaluation of the history of present illness as well as a detailed review of all the patient's medications. Infection should always be a primary consideration for the cause of a fever. Evaluating each body system can match symptoms with a possible cause for fever, and proper testing and imaging can be pursued. Noninfectious causes of fever need to be included in the differential diagnostic process. This article provides an analytic approach to fever in adult patients in the acute and critical care environment.

Risk Factors for Fatality among Confirmed Adult Dengue Inpatients in Singapore: A Matched Case-Control Study

ObjectivesTo identify demographic, clinical and laboratory risk factors for death due to dengue fever in adult patients in Singapore.MethodsMulti-center retrospective study of hospitalized adult patients with confirmed dengue fever in Singapore between 1 January 2004 and 31 December 2008. Non-fatal controls were selected by matching age and year of infection with fatal cases. World Health Organization 1997, 2009 criteria were applied to define dengue hemorrhagic fever (DHF), warning signs and severe dengue. Statistical significance was assessed by conditional logistic regression modeling.ResultsSignificantly more fatal cases than matched controls had pre-existing co-morbid conditions, and presented with abdominal pain/tenderness. Median pulse rates were significantly higher while myalgia was significantly less frequent in cases. . Fatal cases also had higher leucocyte counts, platelet counts, serum sodium, potassium, urea, creatine and bilirubin levels on admission compared to controls. There was no statistical significant difference between the prevalence of DHF and hematocrit level among cases and controls. Multivariate analysis showed myalgia and leucocyte count at presentation were independent predictors of fatality (adjusted odds ratios 0.09 and 2.94 respectively). None of the controls was admitted to intensive care unit (ICU) or given blood transfusion, while 71.4% and 28.6% of fatal cases received ICU admission and blood transfusion.ConclusionsAbsence of myalgia and leucocytosis on admission were independently associated with fatality in our matched case-control study. Fatalities were also commonly associated with co-morbidities and clinicians should be alarmed if dengue patients fulfilled severe dengue case definition on admission.

Features of rheumatic fever in adult patients in modern Kyrgyzstan

Features of rheumatic fever in adult patients in modern Kyrgyzstan

Plasminogen-1 Activator Inhibitor Gene 4G/5G Promotor Polymorphism and Blood Level of Its Protein Product in Hemorrhagic Fever with Renal Syndrome

The dynamics of plasma level of plasminogen-1 activator inhibitor (PAI-1) and frequency distribution of PAI-1 gene polymorphic locus 4G/5G genotypes and alleles were studied in male and female patients of different age with hemorrhagic fever complicated by renal syndrome of different severity. A significant elevation of PAI-1 level was recorded during fever in adult patients of mature age groups I and II with medium severe and severe uncomplicated disease, the elevation being followed by a significant reduction, except the oliguric and polyuric periods of medium severe form. In complicated disease, the concentration of PAI-1 was low during fever in patients of mature age group I, after which it increased significantly until the period of diuresis recovery; in patients of mature age group II it remained low, except the polyuria period. No appreciable age- or gender-related differences in frequency distributions of PAI-1 gene polymorphic locus 4G/5G genotypes and alleles in patients with disease of different severity were found; no differences from the control group by these parameters were revealed. The dynamics of PAI-1 plasma level in different forms of hemorrhagic fever with renal syndrome were not genetically determined and represented an adequate metabolic response to endotheliotropic virus.

The disease and economic burden of neutropenic fever in adult patients in Australian cancer treatment centres 2008: analysis of the Victorian Admitted Episodes Dataset

Although the incidence of neutropenic fever (FN) is estimated to be up to 80% for some malignancies, the epidemiological characteristics and economic burden are not well understood for Australian patients. To describe underlying malignant conditions, potential aetiologies, clinical outcomes and healthcare utilization for an Australian population with FN, and to estimate the economic burden of this condition within the Australian healthcare sector. Epidemiological features of FN were extracted from a population-based hospital morbidity dataset, the Victorian Admitted Episodes Dataset (VAED), for a 12-month period (2008). These were analysed according for a range of malignancy categories. Economic burden of hospitalizations was estimated according to data presented in the Round 12 National Hospital Cost Data Collection Report. A total of 2599 admitted episodes across 92 Victorian hospitals fulfilled inclusion criteria for FN. Metropolitan hospitalizations accounted for 79% episodes. FN illness comprised underlying solid tumours diagnoses (40%), followed by leukaemia (29.3%), lymphoma (22%) and myeloma (8.5%). Length of hospital stay was >15 days for approximately one-third of hospitalizations. intensive care unit admission rates were 5.9-11.7%. Weighted average costs of hospitalization (AUD) for solid tumours, lymphoma, myeloma and leukaemia were $8309 ± $391, 18,145 ± $1602, $21,764 ± $1289 and $22,596 ± $2618 respectively. Using VAED indices, epidemiological features of Australian patients with FN appear comparable with international reports. In contrast to US data, estimated healthcare costs are up to 50% lower in the Australian healthcare sector. These data offer important insights for prioritizing of research agendas and resource allocation.

Fever In Hospitalized Adult Patients with Sickle Cell Disease

AbstractAbstract 2652 Background:Sickle cell disease is complicated by veno-occlusive crises leading to pain crises, chronic end-organ damage and early mortality. With recent advances in the management of sickle cell disease in childhood, sickle cell patients are living longer. However, our understanding of the clinical course of adult sickle cell disease remains limited and is based largely on extrapolation of knowledge from children with sickle cell disease. Unfortunately, adult patients remain at an elevated risk of infections due to encapsulated organisms in the setting of functional asplenia. This risk is exacerbated by possible indwelling catheters and exposure to the health care environment. Fever in these patients can herald a serious infection. Alternatively, brisk hemolysis can be associated with fever. Wierenga, et. al. (2001) described that fevers to 39F in children were associated with acute chest syndrome (21%), painful vaso-occlusive crisis (27%), and bacteremia in 6%. To our knowledge, no such review of fever in hospitalized adult sickle cell patients has been published in the medical literature. Therefore, the clinician is placed in a diagnostic dilemma regarding the management of fever in adult patients with sickle cell disease. Objective:To determine the etiologies of fevers in hospitalized adult patients with sickle cell disease in an urban tertiary hospital setting. Methods:We performed an IRB-approved retrospective analysis of 143 admissions between 1995–2008 with sickle cell pain crisis and had a fever greater than 38.5C during the admission. The aim was to determine the prevalence of fevers due to infectious versus hemolysis-related causes in the population of interest. Elevated white blood cell count (defined as greater than 1.5x upper limit of normal), radiologic and/or culture data were used to classify a fever as due to infection. Elevated LDH and total bilirubin (defined as greater than 2x upper limit of normal) were used to classify a fever as due to hemolysis. The risks of infection in patients on hydroxyurea as well as indwelling catheters (including central lines and foley catheters) were assessed. We also evaluated the risk of hemolysis in patients on hydroxyurea. Finally, the use of antibiotics and duration of the fever in patients with hemolysis and infection were also evaluated. Results:Among patients admitted with sickle cell pain crisis and had a fever during their hospitalization, we found evidence of infection in 65% and hemolysis in 58%. Interestingly, 35% had evidence of both infection and hemolysis. Approximately, 11.8% had no significant evidence of infection or hemolysis. Antibiotics were used in 66% of all patients with pain crisis and fever. Among the patients who received antibiotics, 81% had evidence of infection and 19% had no evidence of infection. Approximately 1/5 patients with fevers received antibiotics despite the absence of evidence of infection. Infections were not increased among hydroxyurea users (61.5% with fever) over non-hydroxyurea users (67.9% with fever), p = 0.4. Fevers due to documented infections were found in 78% of patients with indwelling catheters compared with 62% of patients without catheters, p≤0.05. The risk of fever due to hemolysis was not significantly different between hydroxyurea and non-hydroxyurea users at 58% versus 57% respectively, p=0.9. Of patients with fevers for more than one day, infection was found in 69% of patients compared with 31% of patients who had no evidence of infection p=0.5. Whereas, of patients with fevers for more than one day, hemolysis was found in 57% of patients compared with 42% of patients who did not have evidence of hemolysis with p=0.9. Conclusions:Among adult sickle cell patients hospitalized with pain crisis and fever, hemolysis accounted for 58% of cases while infections accounted for 65% with 35% evidence of both. Infections were not increased among hydroxyurea users. Indwelling catheters did increase the risk of fevers due to infection. The risk of fever due to hemolysis was not significantly increased among patients on hydroxyurea. Finally, in patients with fevers for more than one day, hemolysis accounted for 57% of cases and infection accounted for 45%. These findings provide initial investigation of the etiologies of fevers in adult hospitalized sickle cell patients and further studies are necessary to confirm these findings. Disclosures: No relevant conflicts of interest to declare. Disclosures:No relevant conflicts of interest to declare.

Acute Q fever in adult patients: report on 63 sporadic cases in an urban area.

We report here 63 sporadic urban cases of acute Q fever diagnosed in 1985-1997. Fifty-eight men and five women were included; the mean age (+/- SD) was 35.6 (+/- 10.2) years. Twenty-six patients had pneumonia, 30 had hepatitis, and 7 had a self-limited febrile illness. The most frequent radiological abnormalities were lobar or segmental alveolar opacities involving right lower lobes. Chronic bronchitis was significantly more frequent among patients with pneumonic Q fever (P = .01). Thirty-two patients' illnesses were diagnosed through seroconversion, 12 by a fourfold increase in serum antibody titer, and 19 by initial high titers. Patients who initially received doxycycline had a significantly shorter duration of fever than those treated with erythromycin or other antibiotics (P = .0001 and P = .0004, respectively). No patient died. Acute Q fever affects mainly urban men, most frequently causing hepatitis, except in those with chronic bronchitis, who more frequently develop pneumonia. Hepatic Q fever presented with more pronounced increases in liver function test values than did pneumonic Q fever. Treatment with doxycycline caused a significant reduction in the duration of fever.