Major Cause Of Fever Research Articles

Febrile responses in patients with pediatric rheumatic diseases

Fever is one of the critical symptoms of patients in pediatrics field. It indicates inflammatory focus somewhere in the body, and the major causes of fever are infectious diseases. Recent progresses of our knowledge about autoinflammatory syndrome promoted the investigation of the mechanism of fever, and suggested that the pro-inflammatory cytokines are the direct causative agents of fever. The basic science revealed that cooperation of IL-6 and IL-1β induces febrile response. Fever of unknown origin (FUO) remains a challenging problem. Rheumatic diseases, rare infectious diseases, and benign tumors and malignancies are diagnoses to be differentiated. FDG-PET is recently proved a valuable tool for the identification of the etiology in patients with FUO. Since the introduction of biological response modifiers into the treatment of patients with pediatric rheumatic diseases has shifted the therapeutic paradigm, a new concept that the blockade of a unique pro-inflammatory cytokine brings cessation of whole inflammatory responses affected tremendously the clinical medicine. A more investigation of inflammation and its pathophisiology will be needed in pediatric rheumatology.

Microorganisms cultured from sputum and blood in association with episodes of fever during anti-cancer therapy in patients with lung cancer

We examined the clinical features and significance of pathogenic microbes isolated from sputum and blood of patients with lung cancer during anti-cancer therapy. Pathogenic bacteria were more likely to be isolated from patients with episodes of fever than from afebrile patients. The major species of bacteria isolated from sputum were Staphylococcus aureus, including methicillin-resistant strains, and Gram-negative bacilli, which are known to be frequently involved in hospital-acquired infections. The presence of an indwelling central venous catheter for intravenous hyperalimentation was an important risk factor for the development of a febrile episode, which indicates that bacteremia was a major cause of fever. In one quarter of the blood cultures from the patients with persistent fever, various species of pathogenic microbes were recovered, one-third of which were fungi. Bacteriological examinations done before and after the introduction of granulocyte-colony stimulating factor (G-CSF) revealed that strains of Klebsiella spp. decreased and those of methicillin-resistant S. aureus increased. There was no firm evidence that G-CSF decreased the incidence of episodes of fever. However, remains G-CSF may a allow the dose intensity of anti-cancer agents to be increased, which would lead to severe leukocytopenia. However, more detailed investigation is needed to clarify the role of G-CSF against bacterial infection during anti-cancer therapy.

Etiology of travel-related fever

Many potentially life-threatening infections cause fever. Several recent large studies help to define causes of fever in returned travelers. The destination of travel determines the relative likelihood of the different major causes of fever. Systemic febrile illness occurs disproportionately among ill travelers returning from sub-Saharan Africa. Malaria remains the most important overall cause of systemic febrile illness in travelers to tropical regions; dengue fever is now the most prominent cause of fever in travelers to certain regions, most notably Asia. Chikungunya fever has emerged as a major cause of fever in travelers to Indian Ocean islands off Africa and to India itself. Causes of fever vary by the time of presentation after travel. Vivax malaria is an important cause of fever with onset more than a month after return; recently studies have shown that parasites causing relapse are genetically distinct from those causing primary infection. At expert referral centers up to 25% of febrile patients have no specific cause of fever determined. Knowledge of predominant causes of febrile infections by geographic region, traveler characteristics, and time of presentation can assist the clinician in guiding posttravel diagnosis and empiric therapy of ill returned travelers and is also valuable in pretravel preparation.

Typhoid and paratyphoid fever: a 10-year retrospective study of 41 cases in a Parisian hospital.

Enteric fever remains a major cause of fever in travelers. We evaluated new trends in enteric fever. We reviewed the epidemiological, clinical, biological, bacteriological data, and outcome of all cases of typhoid and paratyphoid fever seen in our department over the last decade. The inclusion criteria were the presence of signs compatible with enteric fever and isolation of Salmonella typhi or Salmonella paratyphi A, B, or C from blood or stool cultures or any other site. Among the 41 patients, 38 (93%) had travel-associated enteric fever. The main geographic source of contamination was the Indian subcontinent. One patient had been vaccinated with parenteral Vi vaccine 1 year previously. Fever and headaches were the only signs which were present in more than 80% of patients. The Widal test at inclusion was positive in 27%, and a second serological test was found to be positive in 50% of evaluated cases. Blood cultures and stool cultures were positive in 34 cases and 10 cases, respectively. Salmonellae spp were isolated in both hemocultures and stool cultures in 4 cases and in urine in 1 case. Two strains of S. typhi were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole. One strain of S. typhi and one of S. paratyphi B were nalidixic acid resistant. All evaluable patients were cured with the exception of 2 patients (1 failure, 1 relapse). We observed 3 toxic reactions. No patients died. The diagnosis and outcome of enteric fever are hampered by the lack of specificity of clinical and biological signs, the increasing rates of antimicrobial resistance, and the occurrence of toxic reactions during treatment.

Fever, C-Reactive Protein, and Other Acute-Phase Reactants During Treatment of Infective Endocarditis

Fever and sustained elevations of levels of C-reactive protein, erythrocyte sedimentation rate, and other inflammatory markers are common problems during treatment of infective endocarditis. We studied the value of these measurements during an 8-year period in all episodes of infective endocarditis treated in 1 university-affiliated institution. A total of 193 consecutive episodes that fulfilled the criteria for infective endocarditis were prospectively enrolled during 2 periods, 1984 through 1988 and 1993 through 1995. Fever and results of serial measurements of C-reactive protein, erythrocyte sedimentation rate, white blood cell counts, and platelet counts were related to the clinical course of infective endocarditis. Fever persisted or recurred in 108 episodes (57%) despite appropriate antibiotic treatment. The causes of persistent fever and recurrent fever were different. Persistent fever that lasted 7 days or longer was caused by a complicating cardiac infection in 56% of these episodes. Recurrent fever, noted in 31% of all episodes and the major cause of fever during the third and fourth treatment weeks, was caused most often by hypersensitivity reactions to beta-lactams. Elevations in C-reactive protein levels were significantly prolonged in the episodes with complicated courses compared with the episodes with uncomplicated courses, while mean erythrocyte sedimentation rate remained unchanged during treatment, not differentiating between complicated and uncomplicated episodes. Fever during treatment must be analyzed in terms of persistence and recurrence to provide a basis for clinical decisions. Serial measurements of C-reactive protein are useful to monitor the response to antimicrobial therapy and to detect complications, while serial determinations of erythrocyte sedimentation rate are of no value.

Neoplastic Fever

Neoplastic fever is a well-recognized phenomenon occurring in certain patients with cancer. It has been seen in Hodgkin's disease, non-Hodgkin's lymphomas, acute and chronic leukemias, multiple myeloma, and other solid tumors.^1-10Neoplastic fever has been also observed during severe granulocytopenia following intensive cytotoxic chemotherapy for cancer.^11-14In about 20% of patients with fever of undetermined origin, fever has been caused by cancer,²and neoplastic fever has been the major cause of fever of undetermined origin in patients with cancer.¹⁵Since fever is a very common problem in patients receiving cytotoxic chemotherapy and can be caused not only by infection but also by cancer itself, it is crucial for the clinician to be able to establish a definite diagnosis of neoplastic fever during management of cancer. In this article, fever-producing conditions in patients with cancer are discussed, and clinical features of neoplastic fever are reviewed. On the

Letter to the Editor

Until Dr. Heller's letter arrived, I had been disappointed not to have received a single letter regarding my paper on children with fever, because I was sure that others might disagree with some of the things I wrote. The differences in the major causes of fever seen by private practitioners as compared with those of us in full-time hospital practice interest me greatly. I would be delighted to cooperate with Dr. Heller in a prospective study to compare our experience with his.

The challenge of North Queensland fevers.

SUMMARYThe distribution of fevers in North Queensland may largely be correlated with latitude, altitude and rainfall.In the Gulf country and on mining fields in the early days, typhcid and malaria were major causes of fever. Other cases were commonly designated “typho‐malaria”.On the Pacific coast, the incidence of fevers has been high since the eighties. At first obscure in nature, they have been shown to consist mainly of leptospirosis and scrub typhus.Many minds contributed to the elucidation of the northern fevers ; the staff of the Australian Institute of Tropical Medicine at Townsville played a notable part from 1910 to 193o. Repeatedly, an advance had to await the coming of the right man.The disappearance of typhoid and malaria from the mainland of North Queensland is a public health victory. The means to prevent dengue and to lessen scrub typhus are to hand, but the prevention of leptospirosis is an unsolved problem.