Fever Peak Research Articles

Seasonality of clustering of fever and diarrhea in Beijing, 2009-2015

Objective: To understand the seasonal distribution of the clustering of fever and diarrhea. Methods: Concentration degree and circular distribution methods were used to analyze the seasonal distribution of the clustering of fever and diarrhea in Beijing from 2009 to 2015. The information were collected from the Infectious Disease Surveillance Information System of Beijing. Results: The M values of the clustering of fever and diarrhea were 0.57 and 0.47. Circular distribution results showed that the clustering of fever and diarrhea angle dispersion index R values were 0.57 and 0.46 respectively, the sample average angle of Rayleigh' s test Z values were 414.14, 148.09 respectively (all P<0.01). The clustering of fever and diarrhea had seasonality. The incidence peak of fever was on October 13, and the epidemic period was during August 13-December 14. The incidence peak of diarrhea was on July 31, and the epidemic period was during May 20-October 11. Conclusion: The clustering of fever had obvious seasonality in Beijing, which mainly occurred in autumn and winter. The cluster of diarrhea had certain seasonality, which mainly occurred in summer and autumn.

Neonatal Immunization with a Single IL-4/Antigen Dose Induces Increased Antibody Responses after Challenge Infection with Equine Herpesvirus Type 1 (EHV-1) at Weanling Age.

Neonatal foals respond poorly to conventional vaccines. These vaccines typically target T-helper (Th) cell dependent B-cell activation. However, Th2-cell immunity is impaired in foals during the first three months of life. In contrast, neonatal basophils are potent interleukin-4 (IL-4) producers. The purpose of this study was to develop a novel vaccine triggering the natural capacity of neonatal basophils to secrete IL-4 and to evaluate if vaccination resulted in B-cell activation and antibody production against EHV-1 glycoprotein C (gC). Neonatal vaccination was performed by oral biotinylated IgE (IgE-bio) treatment at birth followed by intramuscular injection of a single dose of streptavidin-conjugated gC/IL-4 fusion protein (Sav-gC/IL-4) for crosslinking of receptor-bound IgE-bio (group 1). Neonates in group 2 received the intramuscular Sav-gC/IL-4 vaccine only. Group 3 remained non-vaccinated at birth. After vaccination, gC antibody production was not detectable. The ability of the vaccine to induce protection was evaluated by an EHV-1 challenge infection after weaning at 7 months of age. Groups 1 and 2 responded to EHV-1 infection with an earlier onset and overall significantly increased anti-gC serum antibody responses compared to control group 3. In addition, group 1 weanlings had a decreased initial fever peak after infection indicating partial protection from EHV-1 infection. This suggested that the neonatal vaccination induced a memory B-cell response at birth that was recalled at weanling age after EHV-1 challenge. In conclusion, early stimulation of neonatal immunity via the innate arm of the immune system can induce partial protection and increased antibody responses against EHV-1.

Statistical models for fever forecasting based on advanced body temperature monitoring

Body temperature monitoring provides health carers with key clinical information about the physiological status of patients. Temperature readings are taken periodically to detect febrile episodes and consequently implement the appropriate medical countermeasures. However, fever is often difficult to assess at early stages, or remains undetected until the next reading, probably a few hours later. The objective of this article is to develop a statistical model to forecast fever before a temperature threshold is exceeded to improve the therapeutic approach to the subjects involved. To this end, temperature series of 9 patients admitted to a general internal medicine ward were obtained with a continuous monitoring Holter device, collecting measurements of peripheral and core temperature once per minute. These series were used to develop different statistical models that could quantify the probability of having a fever spike in the following 60 minutes. A validation series was collected to assess the accuracy of the models. Finally, the results were compared with the analysis of some series by experienced clinicians. Two different models were developed: a logistic regression model and a linear discrimination analysis model. Both of them exhibited a fever peak forecasting accuracy greater than 84%. When compared with experts' assessment, both models identified 35 (97.2%) of 36 fever spikes. The models proposed are highly accurate in forecasting the appearance of fever spikes within a short period in patients with suspected or confirmed febrile-related illnesses.

Enterovirus Infections of the Central Nervous System in Children: An Update.

Enterovirus Infections of the Central Nervous System in Children: An Update.

Clinical Characteristics of Severe Histiocytic Necrotizing Lymphadenitis (Kikuchi-Fujimoto Disease) in Children

To analyze the clinical characteristics of children with Kikuchi-Fujimoto disease focusing on cases with prolonged fever. This was a retrospective study of children diagnosed with Kikuchi-Fujimoto disease from March 2003 to February 2015 in South Korea. Electronic medical records were searched for clinical and laboratory manifestations. Among 86 histopathologically confirmed cases, the mean age was 13.2 (SD ± 3.1) years, and male to female ratio was 1:1.32. Cervical lymph node enlargement, found in 85 of the patients (99%), was predominantly unilateral in 64 (75%), and involved the cervical lymph node level V in 67 (81%). Fever was present in 76% of the cases, with a median duration of 9 days (IQR 0.25-17.0). Multivariate analysis revealed that a high fever peak ≥ 39.0°C (P = .010) and presentation with ≥ 2 systemic symptoms other than fever (P = .027) were factors that were significantly associated with longer fever duration. As the size of the largest lymph node's short diameter increased, the fever duration increased (P = .015). Leukopenia (P = .022) also had a significant association with a longer fever duration. Patients with sonographic findings of conglomerated enlarged lymph nodes had a longer median duration of fever compared with those with separate enlarged lymph nodes (11 vs 4.5 days, P = .019). Patients with high fever, more systemic symptoms, leukopenia, and larger lymph nodes with a conglomerated distribution may benefit from early recognition and selective consideration of corticosteroid therapy.

The Ibanez Property Ring: A Surprising Hidden Story Behind a Significant Foreclosure Lawsuit

In late 2005, at the peak of property fever in Massachusetts and of loose mortgage lending standards nationwide, a man sat down with the same seller, the same lender, and the same notary to buy two houses at once. The same man repeated the same steps with two new properties the following month, and did so yet again the month after that.Property records suggest that he defaulted on all six mortgages within a year. Within a year and half after the first purchase, lenders had foreclosed on all six properties. The chance observation of a particularly attentive judge led one of those properties to become the subject of a landmark case, which enforced a Massachusetts property doctrine inherited from medieval England.This essay documents the serial purchase of all half dozen properties and describes the facts as they are available in the public record. These details tell a side of the story that is shockingly different than the narrative portrayed by the justices of the high court.The fuller picture reflects an incredible array of questionable decision-making. This is true not only of the buyers, sellers, and banks, but also of the media, of the public-minded organizations and individuals that represented or supported the buyers, and of the courts that chose to invalidate the foreclosure in question.

Pentraxin 3 as a clinical marker in children with lower respiratory tract infection

SummaryBackgroundPentraxin 3 (PTX‐3) is an acute‐phase protein that increases in the plasma during inflammation.ObjectiveWe aimed to evaluate the usefulness of PTX‐3 as a clinical marker in children with lower respiratory tract infection (LRTI) and examine the correlation of PTX‐3 with other biomarkers such as C‐reactive protein (CRP) and procalcitonin (PCT).MethodsWe enrolled 117 consecutive patients admitted to Seoul St. Mary's Hospital with LRTI using the WHO criteria. We recorded data on fever duration and peak temperature before admission, duration of fever after admission, respiratory rate, heart rate, oxygen saturation upon admission, duration of oxygen supplementation, and duration of hospital stay. Upon admission, white blood cell (WBC) count, erythrocyte sedimentation rate, CRP level were measured. Multiplex respiratory virus polymerase chain reaction was performed using nasal swabs. PTX‐3, PCT, and various cytokines were measured after the study had been completed.ResultsWe found that there was no significant difference in the level of PTX‐3 according to the type of viral infection. PTX‐3 levels showed a significant correlation with PCT levels, but not with levels of CRP. The level of PTX‐3 showed a significant correlation with peak temperature and duration of fever before admission as well as interleukin (IL)‐6 levels. PCT levels showed a significant correlation with IL‐6 and granulocyte‐colony stimulating factor levels, peak temperature, and duration of fever before admission, and duration of hospital stay. CRP levels showed a significant correlation with duration of fever before admission, total WBC count, and neutrophil count. PCT levels significantly predicted a hospital stay of 7 days or more. PTX‐3, PCT, and CRP levels showed no correlation with any other clinical features.ConclusionPTX‐3 reflected disease severity but failed to predict length of hospital stay. Further studies evaluating the use of PTX‐3 as a biomarker in mild LRTI would be useful. Pediatr Pulmonol. 2016;51:42–48. © 2015 Wiley Periodicals, Inc.

Targeted knockout of the Rickettsia rickettsii OmpA surface antigen does not diminish virulence in a mammalian model system.

ABSTRACTStrains of Rickettsia rickettsii, the causative agent of Rocky Mountain spotted fever (RMSF), differ dramatically in virulence despite >99% genetic homology. Spotted fever group (SFG) rickettsiae produce two immunodominant outer membrane proteins, rickettsial OmpA (rOmpA) and rOmpB, which are conserved throughout the SFG and thought to be fundamental to pathogenesis. rOmpA is present in all virulent strains of R. rickettsii but is not produced in the only documented avirulent strain, Iowa, due to a premature stop codon. Here we report the creation of an isogenic ompA mutant in the highly virulent strain Sheila Smith by insertion of intronic RNA to create a premature stop codon 312 bp downstream of the 6,747-bp open reading frame initiation site (int312). Targeted insertion was accomplished using an LtrA group II intron retrohoming system. Growth and entry rates of Sheila Smith ompA::int312 in Vero cells remained comparable to those of the wild type. Virulence was assessed in a guinea pig model by challenge with 100 PFU of either ompA::int312 Sheila Smith or the wild type, but no significant difference in either fever peak (40.5°C) or duration (8 days) were shown between the wild type and the knockout. The ability to disrupt genes in a site-specific manner using an LtrA group II intron system provides an important new tool for evaluation of potential virulence determinants in rickettsial disease research.

Effects of fever on haemodynamic parameters in neurosurgical intensive care unit patients

To investigate the effects of fever on the haemodynamic parameters (pulse rate, arterial oxygen saturation, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure) of patients in a neurosurgical intensive care unit. A prospective, repeated-measures study. This study was performed in the neurosurgical intensive care unit of a University Hospital in the West of Turkey. The research sample included all patients with at least two occurrences of fever in the postoperative period. Body temperature and haemodynamic parameters of patients were measured on admission, one hour before the onset of fever and during fever (peak temperature). Increase of body temperature during fever episodes was followed by a significant increase in pulse rate (p = 0.001) with significant decreases in systolic blood pressure (p = 0.002) and arterial oxygen saturation (p = 0.001). Furthermore fever episodes were followed by a non-significant increase in diastolic blood pressure (p = 0.074) and a non-significant decrease in mean arterial blood pressure (p = 0.097). In this study, a degree celsius (1 °C) increase in body temperature, was associated with a decline of 4.43 mmHg in systolic blood pressure, 0.166 mmHg mean arterial blood pressure and 0.64% arterial oxygen saturation, respectively. It was also associated with an increase of 1.61 mmHg in diastolic arterial blood pressure and 7.46 beats/per minute pulse rate, respectively. The findings from this research have demonstrated the effects that fever can have on haemodynamic parameters of patients in one neurosurgical intensive care unit. Hence the study highlights the importance for intensive care unit (ICU) nurses to appreciate the physiological effects of fever which have the potential to cause complications in febrile patients. Increasing knowledge about the effects of fever on haemodynamic parameters can therefore be of benefit to nurses in terms of quality and efficacy of patient care.

Lipopolysaccharide-Induced Sickness Behavior in Lactating Rats Decreases Ultrasonic Vocalizations and Exacerbates Immune System Activity in Male Offspring

Objective: The present study analyzed the effects of lipopolysaccharide (LPS) on maternal behavior during lactation and possible correlations with changes in emotional and immune responses in offspring. Methods: Lactating rats received 100 μg/kg LPS, and the control group received saline solution on lactation day (LD) 3. Maternal general activity and maternal behavior were observed on LD5 (i.e. the day that the peak of fever occurred). In male pups, hematological parameters and ultrasonic vocalizations (USVs) were assessed on LD5. At weaning, an additional dose of LPS (50 µg/kg, i.p.) was administered in male pups, and open-field behavior, oxidative burst and phagocytosis were evaluated. Results: A reduction in the time in which dams retrieved the pups was observed, whereas no effects on maternal aggressive behavior were found. On LD5, a reduction of the frequency of USVs was observed in pups, but no signs of inflammation were found. At weaning, an increase in immune system activity was observed, but no differences in open-field behavior were found. Conclusion: These results indicate that inflammation in lactating mothers disrupted mother/pup interactions and may have produced short- and long-term effects on pup behavior as well as biological pathways that modulate inflammatory responses to bacterial endotoxin challenge in pups.

The bronchial hyperactivity in children with pollinosis (834.9)

Aim of the study was to develop an easy available technique of lung function monitoring in pollinosis patients to predict the clinical course of disease both in seasonal exacerbation period and during the winter remission. Material: We studied 98 children with pollinosis aged 6‐14 years. Peak flow (PF) parameters were studied 3 times per day, namely in the morning, lunch time and in the evening, from the first of April to 30th October. Patients’ history records included hay fever symptoms and peak flow data. The curves of PF were drawn for disease monitoring and prediction. Results: Analyzing the daily changes of peak expiratory flow parameters, we estimated that in children with hay fever sensibilization to Artemisia species without evident asthma symptoms already at the second season peak expiratory flow decreased by 15‐20% and during the third season decreased further by 30% from the best parameters of the first year.Most striking in our studies was the finding that after the pollination season especially in children with disease duration more than 3 years and who did not receive the specific immunotherapy the level of changes decreased, but the type of PF curve didn’t change. In prognosis the most important was the possibility of pollen asthma appeared in most children already during the second hay fever season and was easy predictable by “bad” peak expiratory flow curves ‐ second and third type.

English

This study aimed to investigate the antifebrile and anti-inflammatory effect of Huanglian Jiedu Decoction (HLJDD). The rabbits received intravenous injection of lipopolysaccharide (LPS) after orally administered with HLJDD and the rectal temperatures of rabbits were monitored. The concentrations of interleukin-1 beta (IL-1&beta;) and tumor necrosis factor alpha (TNF-&alpha;) in serum were assayed using rabbit IL-1&beta; and TNF-&alpha; enzyme-linked immunosorbent assay (ELISA) kits. Carrageenan-induced paw edema in rats and the anti-inflammatory effects of HLJDD were also explored. HLJDD treatment group resulted in a significant fall in body temperature in biphasic fever peak (p &lt; 0.05), and there were no significant differences between HLJDD treatment group and Ibuprofen (IBR) treatment group in biphasic fever peak at time 1 and 3 h (p &gt; 0.05). HLJDD treatment group reduced the concentrations of IL-1&beta; in serum at time 1 and 3 h to control febrile responses. Moreover, paw edema of carrageenan-treated rats were significantly attenuated in rats pretreated with HLJDD. Mechanistic studies showed that HLJDD effectively decreased expressions of COX-2 and inducible nitric oxide synthase (iNOS) proteins. These results suggested that HLJDD would be a valuable candidate for further investigation as a new anti-arthritic drug. Key words: Lipopolysaccharide, Huanglian Jiedu Decoction (HLJDD), anti-inflammatory, interleukin-1 beta, tumor necrosis factor alpha.

Correction: The Application of the Grey Disaster Model to Forecast Epidemic Peaks of Typhoid and Paratyphoid Fever in China

Correction: The Application of the Grey Disaster Model to Forecast Epidemic Peaks of Typhoid and Paratyphoid Fever in China

Study on antipyretic effect of Reduning injection on lipopolysaccharide-induced fever rats

To observe the antipyretic effect of Reduning injection (RDN) on lipopolysaccharide (LPS)-induced fever rats and its impact on centric fever medium. Rats were randomly divided into the blank control group, the model group, the Metamizole group, and high and low-dose RDN groups. Except for the blank control group, all of the rats were injected intraperitoneally with LPS (80 microg x kg(-1)) to observe their body temperature changes. The double-antibody sandwich ELSIA method was adopted to determine cAMP content in hypothalamus and MPO in lung tissues of fever peak rats. The high-dose RDN group can obviously reduce the temperature rise in fever rats, and cAMP and MPO content in hypothalamus. RDN showed significant antipyretic effect, which may be related with the reduction of cAMP content in hypothalamus and MPO in lung tissues.

Febrile Response Following Megaprosthesis Replacement for Primary Bone Sarcoma

The presence of early postoperative fever after megaprosthesis replacement surgery is a concern for orthopedic oncologists due to the possibility of infection. The aims of the current study were to determine the incidences and patterns of fever and factors associated with its development and to determine the clinical significance of fever after megaprosthesis replacement surgery. Seventy-one patients who had undergone megaprosthesis reconstruction for previously unoperated localized lower-extremity osteosarcoma were reviewed. No patient had evidence of infection preoperatively. Mean patient age was 23.72±16.84 years (range, 6.7-74 years), and average follow-up was 59.5 months (range, 4-240 months). Five postoperative surgical wound infections (4 deep, 1 superficial) occurred on postoperative days 5, 13, 14, 20, and 21. Fevers (body temperature of 38 °C or higher) were present in 62 patients (87.3%) at some point during the first 2 postoperative weeks. Peak body temperature was observed on postoperative day 1 in 62% of the febrile patients. Of the 62 febrile patients, 94% were relieved of fever by postoperative day 5. No significant association was observed between the presence of fever and surgical wound infection. Body temperature curves in patients with infection showed that several atypical patterns, such as multiple fever peaks and persistent fever, were accompanied by physical findings within the normalization period. Fever during the first 5 postoperative days is common after megaprosthesis replacement for bone sarcomas and seems to be a normal physiologic response to surgery. However, atypical fever patterns or additional physical findings require investigation.

The Application of the Grey Disaster Model to Forecast Epidemic Peaks of Typhoid and Paratyphoid Fever in China

ObjectiveThe objectives of this study were to forecast epidemic peaks of typhoid and paratyphoid fever in China using the grey disaster model, to evaluate its feasibility of predicting the epidemic tendency of notifiable diseases.MethodsAccording to epidemiological features, the GM(1,1) model and DGM model were used to build the grey disaster model based on the incidence data of typhoid and paratyphoid fever collected from the China Health Statistical Yearbook. Model fitting accuracy test was used to evaluate the performance of these two models. Then, the next catastrophe date was predicted by the better model.ResultsThe simulation results showed that DGM model was better than GM(1,1) model in our data set. Using the DGM model, we predicted the next epidemic peak time will occur between 2023 to 2025.ConclusionThe grey disaster model can predict the typhoid and paratyphoid fever epidemic time precisely, which may provide valuable information for disease prevention and control.

Ten-year Audit of Kawasaki Disease in a District General Hospital

Background: This audit aimed to evaluate the cases Kawasaki disease (KD) seen in the pediatric department of a community hospital over a 10-year-period. In particular, length of time to diagnosis and variations in treatment were reviewed. Possible effects of these factors on patient outcome in the acute and chronic phase of KD were analyzed. Methods: Data were obtained from the hospital information and coding departments. The following parameters were studied: demographic characteristics, presenting signs and symptoms, duration and peak of fever, hemoglobin and platelet count, coagulation times, C-reactive protein, urine dipstick analysis, length of hospital admission and cardiovascular abnormalities. The data were compared using standard computer software. Results: Eleven patients were identified. Seven of them were male, and the mean age was 35 months. Mean length of hospital stay was 5 days. Mean time from admission to diagnosis was 4 days. All but one patient were given one course of immunoglobulin upon diagnosis. Two developed coronary artery aneurysms and were still receiving aspirin therapy at the time of the audit. Eight of the 11 patients were treated with antibiotics during their time in hospital, all prescribed to treat suspected infections. Once KD had been confirmed antibiotics were stopped. Conclusion: A retrospective case note audit was performed which found that delay in diagnosis may be associated with cardiac complications. The data analyzed highlight the importance of early diagnosis and adequate treatment of KD. It is likely that new genetic tests will help clinicians achieve these goals in the near future.

Fever and rhomboid target lesion in decompensated cirrhosis

A 53-year-old woman with Child-Pugh B, hepatitis C virus-related cirrhosis presented with a 3 day history of high fever (peak 39·5°C) and a non-itchy rash. On admission, physical examination showed mild ascites, and a temperature of 38·5°C, a pulse rate of 88 beats per min, and a respiratory rate of 18 breaths per min were recorded. Many large (about 15 cm diameter) target lesions were present on the patient’s trunk and arms and legs, seen as concentric rings of a dull red, pink, or violet colour surrounding a clear centre (fi gure). No mucosal lesions were noted. Laboratory tests recorded a white-blood-cell count of 12×109 cells per L and a C-reactive protein concentration of 3·4 mg/L. Abdominal ultrasound confi rmed the presence of ascites, and echocardiography did not indicate endocarditis. Treatment with oral levofl oxacin was started; 2 days later, the patient’s fever was reduced, all lesions gradually ameliorated acquiring a rhomboid aspect, and liver decompensation diminished progressively. Meanwhile, two blood cultures yielded Grampositive bacteria identifi ed as Erysipelothrix rhusiopathiae. The patient attended the outpatient’s clinic at the Clinical and Molecular Hepatology Unit of the University Hospital of Messina 1 month after discharge from hospital and every 3 months thereafter. At the last visit (January, 2012) no signs of worsening liver disease were noted and the skin lesions had not reappeared. E rhusiopathiae is a common commensal or pathogen of many vertebrate and invertebrate species. Pigs are a major reservoir. Human disease is mainly an occupationally acquired zoonosis. The portal of entry is typically a puncture wound or abrasion on the hand; however, it can also be acquired from eating contaminated food. The patient does not work with animals and denied any injuries while preparing food. However, the week before she became unwell she ate raw pork meat. Liver dysfunction could be associated with E rhusiopathiae bacteraemia because of the noted impairment of reticuloendothelial function in the patient. Three clinical forms of infection with E rhusiopathiae have been reported in human beings: a localised cutaneous form, or erysipeloid of Rosenbach; a diff use cutaneous form; and a bacteraemic form that occurs with or without endocarditis. The diff use cutaneous form constitutes a rare situation in which violaceous cutaneous lesions can arise at remote areas as widespread urticaria with the rhomboid pattern characteristic of swine erysipelas. In our patient, the pattern was associated with bacteraemia without endocarditis.

Transient apical ballooning accompanying respiratory infection

We report the case of a 75-year-old man, referred for worsening dyspnea and fever. The electrocardiography (ECG) showed mild ST-elevation in anterior leads, while cardiac echography severe left ventricular (LV) systolic dysfunction with apical ballooning. Later on, ECG showed negative T-waves and QT-prolongation in the same anterior leads and T-waves positivization during fever peak. Ten days later, LV ejection fraction completely recovered, apical ballooning and fever disappeared. We, therefore, hypothesize that transient apical ballooning found in our patient may have been induced by a respiratory infection, not detectable at seriate blood cultures.

Febrile response induced by cecal ligation and puncture (CLP) in rats: involvement of prostaglandin E2 and cytokines

The purpose of the present study was to better understand the events involved in the febrile response induced by cecal ligation and puncture (CLP), a complex infectious process. To this end, we conducted in vivo experiments in rats examining (1) fever development, (2) bacterial number in the infection focus and in blood, (3) peripheral and hypothalamic synthesis of cytokines, (4) hypothalamic and cerebrospinal fluid (CSF) synthesis of prostaglandin E(2) (PGE(2)), (5) the effect of anti-IL-6 antibody on fever, and (6) the effect of celecoxib on fever and hypothalamic synthesis of PGE(2) after CLP induction. We found that CLP promotes fever and animal death depending on the number of punctures. The peak of CLP-induced fever overlapped with the maximal increase in the number of bacteria in the infectious focus and blood, which occurred at 6 and 12 h. The peak of the febrile response also coincided with increased amounts of interleukin (IL)-1β, IL-6 and IL-10 in the peritoneal exudate and serum; IL-6 in the hypothalamus and PGE(2) in the CSF and predominantly in the hypothalamus. Moreover, intracerebroventricularly injected anti-IL-6 antibody reduced the febrile response while celecoxib reduced the fever and PGE(2) amount in the hypothalamus induced by CLP. Tumor necrosis factor (TNF)-α peaked at 3 h at all sites studied. Conversely, IL-10 concentration decreased in the hypothalamus. These findings show that the peak of CLP-induced fever is accompanied by an increase of bacteria in peritoneal fluid (local infection) and blood; local synthesis of pyrogenic (IL-1β, IL-6) and antipyretic (IL-10) cytokines and central production of IL-6 and PGE(2), suggesting that these last are the central mediators of this response.