Fewer Days Of Fever Research Articles

Randomized Trial of Pulsed Corticosteroid Therapy for Primary Treatment of Kawasaki Disease

Treatment of acute Kawasaki disease with intravenous immune globulin and aspirin reduces the risk of coronary-artery abnormalities and systemic inflammation, but despite intravenous immune globulin therapy, coronary-artery abnormalities develop in some children. Studies have suggested that primary corticosteroid therapy might be beneficial and that adverse events are infrequent with short-term use. We conducted a multicenter, randomized, double-blind, placebo-controlled trial to determine whether the addition of intravenous methylprednisolone to conventional primary therapy for Kawasaki disease reduces the risk of coronary-artery abnormalities. Patients with 10 or fewer days of fever were randomly assigned to receive intravenous methylprednisolone, 30 mg per kilogram of body weight (101 patients), or placebo (98 patients). All patients then received conventional therapy with intravenous immune globulin, 2 g per kilogram, as well as aspirin, 80 to 100 mg per kilogram per day until they were afebrile for 48 hours and 3 to 5 mg per kilogram per day thereafter. At week 1 and week 5 after randomization, patients in the two study groups had similar coronary dimensions, expressed as z scores adjusted for body-surface area, absolute dimensions, and changes in dimensions. As compared with patients receiving placebo, patients receiving intravenous methylprednisolone had a somewhat shorter initial period of hospitalization (P=0.05) and, at week 1, a lower erythrocyte sedimentation rate (P=0.02) and a tendency toward a lower C-reactive protein level (P=0.07). However, the two groups had similar numbers of days spent in the hospital, numbers of days of fever, rates of retreatment with intravenous immune globulin, and numbers of adverse events. Our data do not provide support for the addition of a single pulsed dose of intravenous methylprednisolone to conventional intravenous immune globulin therapy for the routine primary treatment of children with Kawasaki disease. (ClinicalTrials.gov number, NCT00132080 [ClinicalTrials.gov].)

Direct E-Test (AB Biodisk) of Respiratory Samples Improves Antimicrobial Use in Ventilator-Associated Pneumonia

Ventilator-associated pneumonia is the most frequently observed nosocomial infection in intensive care units, and it is associated with high morbidity and mortality. Early microbiological diagnosis and the initial administration of appropriate antimicrobial therapy are associated with decreased mortality and potentially reduced costs. Our study evaluates the clinical and financial impact of performing rapid antimicrobial susceptibility tests directly on samples obtained from the lower respiratory tract. A prospective, randomized study was performed over a 2-year period. Patients who had a lower respiratory tract infection that was acquired during mechanical ventilation and for whom samples obtained from the respiratory tract were sent for culture were randomized to 1 of 2 groups. Samples were cultured for the control group, and results were reported using standard procedures. Samples were also cultured for the test subject group using standard procedures, but in addition, a rapid antibiogram was immediately performed by placing E-test antibiotic strips (AB Biodisk) directly on respiratory tract samples. Patients in the E-test group received a preliminary laboratory report when it became available. The 2 patient groups were compared according to the following variables: type and severity of underlying conditions, total days of antimicrobial use, number of defined daily doses, cost of acquisition of the antimicrobial agent per episode, days of fever, days receiving mechanical ventilation, days in the intensive care unit, incidence of Clostridium difficile-associated diarrhea, and mortality. Reporting a rapid E-test was associated with fewer days of fever, fewer days of antibiotic administration until resolution of the episode of ventilator-associated pneumonia, decreased antibiotic consumption, less C. difficile-associated diarrhea, lower costs of antimicrobial agents, and fewer days receiving mechanical ventilation. A rapid E-test of respiratory tract samples improves antimicrobial use in cases of ventilator-associated pneumonia.

Nontyphoid salmonellosis in taiwan children: clinical manifestations, outcome and antibiotic resistance.

The purposes of this study were to investigate the epidemiologic, clinical, and microbiologic features of patients with nontyphoid salmonellosis and to elucidate the impact of resistance on the outcome of nontyphoid salmonellosis in Taiwan. The authors also sought to develop a severity score to derive an objective guideline for antibiotic use in nontyphoid salmonellosis in the era of increasing antibiotic resistance. The authors prospectively monitored 311 children with nontyphoid salmonellosis in Kaohsiung, Taiwan. The demographic, clinical, and microbiologic features, underlying diseases, treatment regimen, complications, and outcome were analyzed. In vitro susceptibility testing of the isolates was performed. The median age of affected patients was 15 months. Salmonella enteritidis B caused 68.5% of episodes, followed by S. enteritidis C1 (11.9%), D (7.7%), C2 (7.1%), E (2.6%), S. choleraesuis (1.6%), and S. paratyphi (0.6%). Sixty percent of isolates were resistant to ampicillin. Patients with bacteremia could not be differentiated from patients without bacteremia on clinical grounds. Patients receiving antibiotics that were inactive in vitro (discordant therapy) had more days of fever and longer hospital stay compared with patients receiving antibiotics that were active in vitro (concordant therapy). Patients receiving no antibiotic treatment had the fewest days of fever and shortest hospital stays, especially among patients with mild illness (severity score, 0-1). Blood culture should be obtained in patients with nontyphoid salmonellosis to detect bacteremia. In treating antibiotic-resistant nontyphoid salmonellosis, antibiotics are still not mandatory for patients who present with primarily gastrointestinal symptoms and limited signs of systemic inflammation reflected by a low severity score (low C-reactive protein, fewer band cells in peripheral blood, and fewer days of fever before admission). Susceptibility data should be promptly obtained because use of discordant antibiotics appears to prolong illness.

Nontyphoid Salmonellosis in Taiwan Children: Clinical Manifestations, Outcome and Antibiotic Resistance

ABSTRACTObjectives:The purposes of this study were to investigate the epidemiologic, clinical, and microbiologic features of patients with nontyphoid salmonellosis and to elucidate the impact of resistance on the outcome of nontyphoid salmonellosis in Taiwan. The authors also sought to develop a severity score to derive an objective guideline for antibiotic use in nontyphoid salmonellosis in the era of increasing antibiotic resistance.Methods:The authors prospectively monitored 311 children with nontyphoid salmonellosis in Kaohsiung, Taiwan. The demographic, clinical, and microbiologic features, underlying diseases, treatment regimen, complications, and outcome were analyzed. In vitro susceptibility testing of the isolates was performed.Results:The median age of affected patients was 15 months. Salmonella enteritidis B caused 68.5% of episodes, followed by S. enteritidis C1 (11.9%), D (7.7%), C2 (7.1%), E (2.6%), S. choleraesuis (1.6%), and S. paratyphi (0.6%). Sixty percent of isolates were resistant to ampicillin. Patients with bacteremia could not be differentiated from patients without bacteremia on clinical grounds. Patients receiving antibiotics that were inactive in vitro (discordant therapy) had more days of fever and longer hospital stay compared with patients receiving antibiotics that were active in vitro (concordant therapy). Patients receiving no antibiotic treatment had the fewest days of fever and shortest hospital stays, especially among patients with mild illness (severity score, 0–1).Conclusion:Blood culture should be obtained in patients with nontyphoid salmonellosis to detect bacteremia. In treating antibiotic‐resistant nontyphoid salmonellosis, antibiotics are still not mandatory for patients who present with primarily gastrointestinal symptoms and limited signs of systemic inflammation reflected by a low severity score (low C‐reactive protein, fewer band cells in peripheral blood, and fewer days of fever before admission). Susceptibility data should be promptly obtained because use of discordant antibiotics appears to prolong illness.

Open randomised trial of prescribing strategies in managing sore throat

Objective: To assess three prescribing strategies for sore throat.Design: Randomised follow up study.Setting: 11 general practices in the South and West region.Subjects: 716 patients aged 4 years and over with...

Encephalitis with acute Parkinsonian syndrome and bilateral inflammatory necrosis of the substantia nigra

Eleven cases are described, 4 with post-mortem examination. All patients suffered from a sporadic form of encephalitis, occurring mainly in females in the age range 4.5–33 years. The onset was with fever, the temperature curve usually showing a biphasic pattern. An acute Parkinsonian syndrome developed in the first few days of fever and reached its peak of intensity in 1–3 weeks. Then 7 cases showed a remission of symptoms and signs. Four of these 7 patients recovered completely, in the 3 others some residual symptoms and signs persisted. The CSF showed slight charges of a lymphocytic meningitis. Another 3 of our patients died at about the 3rd week of the illness, at the height of the Parkinsonian manifestations. A 4th case, a child 4.5 years old, died from a progressive myocarditis, 3 months after the full remission of the Parkinsonian syndrome. Pathological examination of the brains of the 4 fatal cases revealed a severe inflammatory necrosis of the substantia nigra with proliferation of phagocytic cells and abundant plasmacytes and lymphocytes. A variable number of glio-mesenchymal nodules and areas of perivascular round cell infiltration were found in the inferior olive, the dentate nucleus, the cerebellar cortex, the basal nuclei and the thalamus. There was no demyelination. The cerebral cortex, the striate body and the spinal cord were spared. Virological and serological tests were negative. It is suggested that this disorder is a polioencephalitis of viral origin.

Chloramphenicol in paratyphoid A; observations with a note on the clinical aspects of the disease.

Chloramphenicol (Chloromycetin) at present is the best therapeutic agent available for typhoid. Because it is not the ideal one, some early observers felt that the drug was useful chiefly in the first few days of fever. Given later it presumably controlled the symptoms without significantly influencing the pattern of recovery. Salmonella typhosa may persist in the blood and feces, and relapse may occur during treatment.* It was thought also that early treatment retarded the immune response to infection. The incidence of relapse was unchanged in treated patients and in some instances was actually higher.3Nine per cent of Watson's 110 patients responded poorly or not at all to therapy, and toxicity from the drug occurred in 10% in the form of nausea, vomiting, urticaria, and oral moniliasis. Large initial doses seemed to be harmful in severe cases. Despite the reported shortcomings of antibiotic therapy just mentioned, statistics compiled from