Manifestations Of Fever Research Articles

The Influence of Age, Gender, and Race on Pediatric Upper Respiratory Infections of COVID-19 and RSV in Mississippi

Abstract Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Respiratory Syncytial Virus (RSV) are significant respiratory viruses that adversely affect pediatric patients in Mississippi. SARS- CoV-2, a positive-strand RNA virus, causes COVID-19, a contagious respiratory disease that carries profound morbidity and mortality. Infection with RSV, a negative-strand RNA virus, has recently experienced increased inter-seasonal activity in the Southern US, particularly in Mississippi. Symptoms of COVID-19 and RSV commonly overlap within pediatric patients and include clinical manifestations of fever, cough, sore throat, and shortness of breath. Both viruses are spread person-to-person via aerosol penetration into the upper respiratory tract and lungs via inhalation. Of the two viruses, RSV has previously been shown to impact children more frequently. However, the emergence of SARS-CoV-2 has led to a resurgence of interest in upper respiratory viruses within pediatric patients. Methods Nasopharyngeal and buccal samples were collected from pediatric patients at the University of Mississippi Medical Center, a large tertiary referral hospital, from May 2021 to November 2022. The cohort was prospectively enrolled and consisted of 132 patients who reported upper respiratory symptoms such as cough, fever, wheezing, dyspnea, and nasal congestion. Ultimately, 72% of these symptomatic patients tested positive for a viral respiratory infection of RSV or SARS-CoV-2. Results The data showed three specific trends in: age, gender, and race. First, a higher prevalence of certain respiratory viruses was demonstrated amongst specific age groups. In the age cohort of 0-2 years old, there were fewer cases of SARS-CoV-2 and an increased number of cases of RSV. In the age cohort of 7-12 years old, there were an increased number of cases of both SARS-CoV-2 and RSV. Furthermore, the age cohort of 13-17 years old demonstrated an increased number of cases of SARS-CoV-2 and a reduced number of cases of RSV. A two-tailed t-test indicated a significant difference between the mean age of patients infected with RSV verses SARS-CoV-2 (t=2.05, p=.04). Secondly, while analyzing gender and race, black males were disproportionately represented by increased positive viral results, comprising 46% of the positive viral detection results, while only making up 29% of the total patient cohort. Conversely, white females comprised 29% of the total patient cohort, but only 14% of the positive viral testing results. Figure 1: Illustration of the processing of nasopharyngeal swabs utilizing single-cell RNA sequencing. Conclusions This data potentially points to differences in immunologic makeup of different groups within the pediatric population that would protect one age group or racial group from a certain respiratory illness but make them more susceptible to another. Additionally, the collected nasopharyngeal and buccal samples are being further characterized using single cell RNA sequencing. While many efforts to blunt the effects of these viruses in pediatric populations rely on prevention strategies and public awareness, this empirical information could allow scientists to better target the presence of these viruses within high-risk populations.

Post-COVID Symptoms and Multisystem Inflammatory Syndrome in Children (MIS-C) in India: A Review

This review article focuses on the post-COVID symptoms and Multisystem Inflammatory Syndrome in Children (MIS-C) observed in India. The study sheds light on the various clinical characteristics and outcomes associated with these conditions by examining available literature and data. The findings highlight the diverse range of symptoms experienced by children, including fever, gastrointestinal and respiratory manifestations, and skin rash. Additionally, rare observations such as HSP-like rash, gangrene, and arthritis were noted. The severity of MIS-C is evident, with a significant proportion of children experiencing shock and requiring mechanical ventilation. However, the review also emphasizes the favorable outcomes observed among children without preexisting comorbidities, indicating the potential for recovery in these cases. The review also provides reassuring findings regarding coronary outcomes during follow-up. This review underscores the urgent need for ongoing research, surveillance, and effective management strategies to address the long-term implications of post-COVID symptoms and MIS-C in Indian children. The insights presented in this article contribute to a better understanding of the impact of MIS-C and inform future strategies to mitigate its effects on the health and well-being of affected children in India.

RANCANG BANGUN SISTEM MONITORING DAN CONTROLLING SUHU COOL BOX VAKSIN MENINGITIS MPSV4 BERBASIS IoT

Meningitis is generally an infectious disease of the lining of the brain and spinal cord with manifestations of fever and stiff neck. Prevention efforts for meningitis include vaccination. Meningococcal polysaccharide vaccine (MPSV4) is a type of quadrivalent meningitis vaccine recommended to control meningitis outbreaks. In storage, this vaccine uses a cold chain and cool box with a temperature between 2-8˚C. For vaccination activities, the vaccine is stored in a cool box with a cool pack provided to maintain temperature stability in the cool box. A cool pack itself is a rectangular plastic container that is filled with water and then cooled in a refrigerator at a temperature of 2-8°C for a minimum of 24 hours. From the existing problems, the author had the idea to create an IoT-based MPSV4 Meningitis Vaccine Cool Box Temperature Monitoring and Controlling System Design. The working system of this tool, namely TEC, will maintain the cool box temperature according to needs. If the dht11 detects that the temperature is too high then both TECs will turn on, whereas if the temperature is stable then one of the TECs will turn off. The temperature inside the cool box will be displayed on the LCD and also sent via the NodeMCU ESP8266 to the Firebase database which will then be displayed on the smartphone in real time.

Early biomarkers for prediction of severe manifestations of dengue fever: a systematic review and a meta-analysis

Early identification of dengue patients at risk of adverse outcomes is important to prevent hospital overcrowding in low- to middle- income countries during epidemics. We performed a systematic review to identify which biomarkers measured in first 96 h of fever could predict dengue haemorrhagic fever (DHF, World Health Organization 1997 clinical classification) or severe dengue (SD, WHO 2009, clinical classification). PubMed, Scopus, CINAHL, Web of Science, and EMBASE databases were searched for prospective cohort and nested case–control studies published from 1997 to Feb 27, 2022. The protocol for the study was registered in PROSPERO (ID: CRD42021230053). After screening 6747 publications, and analysing 37 eligible studies reporting on 5925 patients, elevated C-reactive protein, aspartate aminotransferase, interleukin-8 and decreased albumin levels were strongly associated with dengue haemorrhagic fever (by meta-analyses of multiple studies, p < 0.05), while elevated vascular cell adhesion protein 1, syndecan-1, aspartate aminotransferase and C-reactive protein levels were strongly associated with severe dengue (by meta-analyses of multiple studies, p < 0.05). Further 44 and 28 biomarkers were associated with the risk of DHF and SD respectively, but only in a single study. The meta-analyses suggest the importance of early acute inflammation with hepatic involvement in determining the subsequent course of illness in dengue.

Zoning of the Territory of the Saratov Region by the Intensity of Epidemic Manifestations of HFRS using GIS Analysis

The aim of the study was to zone the territory of the Saratov Region using indicators that influence the intensity of epidemic manifestations of hemorrhagic fever with renal syndrome (HFRS), and to assess the risk of infection of people for a differentiated approach to the organization of anti-epidemic measures in natural foci.Materials and methods. When calculating the intensity of epidemic manifestations of HFRS in the administrative-territorial units (ATUs) of the Region, the indicators that have the greatest impact on the risk of infection were selected: the intensive rate of morbidity among population, the rate of infection of carriers with the HFRS virus, the number of recreational facilities, and the forest cover rate. The paper presents personalized data of HFRS patients, the results of epizootiological monitoring, information about recreational facilities and the forest fund of the Saratov Region. All the data considered cover the period of 2010–2022 for each of the administrative districts of the Region and the city of Saratov. To calculate the intensity of epidemic manifestations, the dimension method and the decimal logarithm were used.Results and discussion. As a result of calculations, 8 ATU of the Regions have been classed as the territories with the highest intensity of epidemic manifestations and the risk of HFRS infection, with high intensity – 9, with medium – 10 and low – 12. Epidemiological geo-information analysis made it possible to establish that the territories with the highest intensity of epidemic manifestations of HFRS occupy 15.8 % of the area of the region, high – 23.8 %, medium – 28.5 %, low – 31.9 %. Based on the findings of the study, 16 districts of the Region and the city of Saratov were identified as the most dangerous in terms of HFRS infection. Namely these territories that primarily require targeted epizootiological monitoring for early and effective management of preventive activities.

Mucocutaneous manifestations of chikungunya fever: an update.

Chikungunya is a viral disease transmitted by female Aedes mosquitoes that has been increasingly reported in many parts of the world across the geographical borders. In addition to fever and joint pain, mucocutaneous manifestations of chikungunya have been reported in 40-75% of infected patients. Dermatological manifestations of chikungunya are often under-recognized and misdiagnosed as clinicians are not sensitized or educated regarding these. The early-onset cutaneous manifestations of chikungunya fever, occurring within 1 month of the fever, include maculopapular rashes, vesiculobullous eruptions, Steven-Johnson syndrome/toxic epidermal necrolysis-like eruptions, flagellate lesions, scrotal dermatitis, oro-genital ulcers, and exacerbation of preexisting dermatoses like psoriasis. Hyperpigmentation, lichenoid eruptions, diffuse hair fall, and exacerbation of acne usually occur as a late manifestation. Diagnosis of these mucocutaneous manifestations can be challenging as they often resemble other common dermatoses. This review article elaborates on various mucocutaneous manifestations of chikungunya fever, based on literature review and authors' clinical experience.

Re-emergence of Lassa fever in Nigeria: A new challenge for public health authorities.

The Lassa virus is an RNA virus belonging to the Arenaviridae family. It is responsible for Lassa fever, an acute viral zoonosis of the severe hemorrhagic fever type with manifestations of fever, muscle pain, sore throat, nausea, vomiting, and chest and abdominal pain. Lassa fever is endemic in West Africa, where the first case was reported in 1969 in Lassa, a town in Nigeria, more than 50 years ago, and it is estimated that nearly 5000 deaths occur in West Africa each year. Nigeria is one of the endemic hotspots and has experienced numerous recurrent outbreaks of Lassa fever due to the increased multiplication of the host reservoir, Mastomys natalensis. For the Lassa epidemics in 2022 and January 2023 alone, Nigeria accounts for a quarter of the annual deaths from this disease. Poor lifestyle and hygiene, difficulty in diagnosis due to nonspecific symptomatology, lack of effective treatment based on clinical evidence, an ineffective human immunization program combined with a health system that is not adapted or equipped to control and prevent recurrent deadly epidemics, and an outdated regional disease surveillance system in West Africa are some of the challenges that must be overcome to rapidly and effectively eradicate this disease, whose area of spread is constantly expanding as a result of the movement of populations in the context of economic and socio-cultural activities.

Association between endothelin-1 and systemic lupus erythematosus: insights from a case–control study

Systemic lupus erythematosus (SLE) is a chronic rheumatic disorder. Endothelin-1, a vasoconstrictor, belongs to the endothelin family and is associated with vascular-related damages. To date, association between ET-1 and pathogenesis of SLE remains unclear. This case–control study was carried out by 314 SLE, 252 non-SLE diseases patients and 500 healthy controls. Serum ET-1, CCN3, IL-28B levels were detected by ELISA, and ET-1 gene polymorphisms (rs5369, rs5370, rs1476046, rs2070699, rs2071942, rs2071943, rs3087459, rs4145451, rs6458155, rs9369217) were genotyped with Kompetitive Allele-Specific PCR. SLE patients had high levels of ET-1, which were correlated with some clinical, laboratory features. Serum CCN3, IL-28B levels were higher in SLE patients, and ET-1 levels were positively correlated with the two cytokines. Rs5370, rs1476046, rs2070699, rs2071942, rs2071943, rs3087459, rs6458155 and rs2070699 were associated with SLE risk. Rs2070699 (T, TT) was related to SLE patients with alopecia. Rs5370 (T, TT, TG), rs1476046 (G,GA), rs2071942 (G,GA) and rs2071943 (G,GA) were associated with SLE patients with pericarditis, pyuria and fever manifestation, respectively. Rs3087459 (CC) and rs9369217 (TC) were related to SLE patients with positive anti-SSB antibody. Rs5369 (AA) was associated with IgG and CRP levels in SLE patients. In conclusion, elevated serum ET-1 in SLE patients may be a potential disease marker, and its gene polymorphisms were related to SLE susceptibility.

Associations Between Core Temperature Disorders and Outcomes of Pediatric Intensive Care Unit Patients.

The few studies of associations between fever and outcomes in pediatric intensive care unit (PICU) patients have conflicting findings. Associations between hypothermia and patient outcomes have not been studied. To investigate the incidence and characteristics of fever and hypothermia and their associations with adverse outcomes among PICU patients. Patients consecutively admitted to 2 PICUs in a 2-year period were prospectively studied. Core temperature was mainly measured by rectal or axillary thermometry. Fever and hypothermia were defined as core temperatures of greater than 38.0 °C and less than 36.0 °C, respectively. Prolonged mechanical ventilation, prolonged PICU stay, and PICU mortality were the adverse patient outcomes studied. Associations between patient outcomes and core temperature disorders were evaluated with univariate comparisons and multivariate analyses. Of 545 patients enrolled, fever occurred in 299 (54.9%) and hypothermia occurred in 161 (29.5%). Both temperature disorders were independently associated with prolonged mechanical ventilation and prolonged PICU stay (P < .001) but not with PICU mortality. Late onset of fever (P < .001) and hypothermia (P = .009) were independently associated with prolonged mechanical ventilation, fever magnitude and duration (both P < .001) were independently associated with prolonged PICU stay, and fever magnitude (P < .001) and infectious cause of hypothermia (P= .01) were independently associated with higher PICU mortality. These findings provide evidence that the manifestation and characteristics of fever and hypothermia are independent predictors of adverse outcomes in PICU patients.

Development of a rapid lateral flow assay for detection of anti-coccidioidal antibodies.

Coccidioides spp. are dimorphic fungi that are capable of infecting human and non-human mammals and can cause diverse manifestations of coccidioidomycosis or Valley fever (VF). In combination with clinical symptoms and radiographic findings, antibody-based diagnostic tests are often used to diagnose and monitor patients with VF. Chitinase 1 (CTS1) has previously been identified as the seroreactive antigen used in these diagnostic assays to detect anticoccidial IgG. Here, an indirect enzyme-linked immunosorbent assay to detect IgG to CTS1 demonstrated 165 of 178 (92.7%) patients with a positive result by immunodiffusion (ID) and/or complement fixation (CF) had antibodies to the single antigen CTS1. We then developed a rapid antibody lateral flow assay (LFA) to detect anti-CTS1 antibodies. Out of 143 samples tested, the LFA showed 92.9% positive percent agreement [95% confidence interval (CI), 84.3%-96.9%] and 97.7% negative percent agreement (95% CI, 87.9%-99.6%) with ID and CF assays. Serum or plasma from canines, macaques, and dolphins was also tested by the CTS1 LFA. Test line densities of the CTS1 LFA correlated in a linear manner with the reported CF and ID titers for human and non-human samples, respectively. This 10-min point-of-care test for the rapid detection of anti-coccidioidal antibodies could help to inform healthcare providers in real-time, potentially improving the efficiency of healthcare delivery.

West Nile fever as a relevant health hazard: The history of studying measures of and its prevention in Russia

The review generalizes data on West Nile fever manifestations in Russian between 1963 and 2022. Researchers have deter-mined peculiarities of the endemic process typical for this arboviral infection: cyclic rises in incidence with an interval of 1 to 8 years; the disease cases being predominantly registered in the south of the European part of the country; elevated risks of the disease for people aged 60 years and older; most West Nile fever cases without affecting the central nervous system with a continuous steady increase in the share of neuroinvasive forms. There are ongoing discussions of a considerable growth in an area where West Nile fever spreads as the incidence of the disease has been registered in Central Russia and this calls for assessment studies aimed at determining the northern borders of the infection area. The reviewed studies also systematize data on the WNV carriers and vectors and highlight the necessity to conduct large-scale experimental studies with their focus on examining susceptibility of various species of vertebrates and arthropods to the West Nile virus and assessing the efficiency of its transmission. The West Nile virus population that circulates in Russia has been shown to be heterogeneous and represented by the genotypes 1, 2, and 4, of which the genotype 2 is prevailing at present. The review also provides the findings of our own research with its focus on the genomes of the West Nile virus isolates indicating circulation of various genetic variants of the pathogen belonging to the genotype 2. The reviewed studies consider issues related to establishing epidemiological surveillance and sanitary-anti-epidemic (preventive) measures regarding West Nile fever in Russia and the principles of their organization at the present stage.

COVID-19 and post-covid syndrome in patients with rheumatoid arthritis

Objective: to study the course of COVID -19 and post-covid syndrome (PCS) in patients with rheumatoid arthritis (RA).Material and methods. The study included 32 adult patients with a confirmed diagnosis of RA, who met ACR/EULAR criteria. All patients had COVID-19. Material for analysis was obtained by means of a questionnaire developed at the V.A. Nasonova Research Institute of Rheumatology, which patients completed during their interview with the researcher.Results and discussion. The study group consisted mainly of women (n=29, 90%). The mean age of the patients was 50.75±16.48 years. Among the clinical manifestations of COVID-19, weakness/fatigue (90.6%; p&lt;0.0001), fever (71.9%; p=0.0005) and anosmia (62.5%; p=0.045) were significantly more common. Almost half of the patients had dysgeusia (59.4%), increased arthralgia (53.1%), dyspnea on exertion (50%), and cough (46.9%). A significant positive association was found between increased arthralgia during COVID-19 and RA activity (r=0.72; p&lt;0.05). Hospitalisation was required in 37.5% of patients with COVID-19. In 12.5% of cases, COVID-19 progressed with complications. Patients with higher RA activity were more likely to have an increase in arthralgia as a symptom of infection. PCS was registered in 47.8% of patients who underwent COVID-19. Retrospective evaluation of patients with PCS revealed a higher rate of hospitalisation in infectious disease departments and a more severe course of COVID-19. Subsequently, repeated cases of COVID-19 were more common in this group.Conclusion. Risk assessment of PCS development is necessary to appropriately distribute the burden on the health care system and to develop a strategy for prevention, timely diagnosis, and treatment of this syndrome in patients with rheumatic diseases. To achieve this goal, new studies in a larger cohort of patients with RA and rheumatic diseases in general are needed.

An Adult Woman Diagnosed with Recurrent Rheumatic Fever and Infective Endocarditis with Manifestations of Prolonged Fever and Heart Murmur

An Adult Woman Diagnosed with Recurrent Rheumatic Fever and Infective Endocarditis with Manifestations of Prolonged Fever and Heart Murmur

The phenotype and genotype of Chinese adult patients with NLRP3-associated autoinflammatory disease.

NLRP3-associated autoinflammatory disease (NLRP3-AID) is a spectrum of autosomal dominant inherited diseases associated with NLRP3 gene mutations. Reports of Chinese NLRP3-AID cases are limited to date. In the present study, we aim to describe the phenotype and genotype of a cohort of Chinese adult NLRP3-AID patients METHODS: This single-center study included sixteen adult patients diagnosed with NLRP3-AID at Department of Rheumatology, Peking Union Medical College Hospital from April 2015 to September 2021. Whole-exome sequencing using next-generation sequencing was performed in each patient. Clinical data and mutational information were compared with a European cohort. The median age of disease onset was 16 (0-46) years old, and adult-onset was observed in 4 patients (25%). The median time of diagnosis delay was 20 (0-39) years. Five patients (31.3%) had family history of similar symptoms. The most common clinical manifestations were recurrent fever (93.8%), arthralgia/arthritis (81.3%), skin rash (75%), myalgia (62.5%), and central nervous system manifestations (50%). Heterozygous NLRP3 variants detected in these patients were p.T348M (n = 4, 25%), Q703K, V70M, K129R, M116I, P38S, V442I, D303G, G326E, A439V, K829T, L632F and V198M (n = 1, separately). All the variants were missense mutations. We reported the largest case series of Chinese adult NLRP3-AID patients. The distinct symptoms of NLRP3-AID patients suggest the heterogeneity of disease. P38S, M116I, K129R, V442I and K829T were identified as novel NLRP3 variants. These data expand the clinical phenotypic and genotypic profiles of NLRP3-AID. Key Points • We characterized the clinical and genetic features of sixteen Chinese adult NLRP3-AID patients. • Thirteen NLRP3 gene variants were confirmed in this cohort, and P38S, M116I, K129R, V442I and K829T were identified as novel variants. • Clinical data and mutation information were compared with a European cohort. • We hope these data would expand the phenotypic and genotypic profile of NLRP3-AID and raise the awareness of early diagnosis and accurate treatment among rheumatologists.

Sweet’s Syndrome: A Rare Case Report

Sweet’s Syndrome, also known as acute febrile neutrophilic dermatosis is a rare disease of unknown etiology, but has been associated with autoimmune processes, malignancies, infections, GI disorders and drug reactions. It is more prevalent in women than men, except in case of malignancy associated origin. Clinical features of this disorder include acute onset of painful plaques on skin, neutrophilic leukocytosis, fever, dermal infiltrations by neutrophils. Usually, sweet’s syndrome is presented in three main clinical settings which includes: the classical (idiopathic), malignancy-associated, and drug induced. Classical Sweet’s Syndrome (CSS) is usually seen in women between the age of 30 to 50 years. It is frequently preceded by an upper respiratory illness and could be linked to pregnancy, inflammatory bowel disease, and both. Recurrence of the dermatosis is usually seen in one third of the patients experiencing classical sweet’s syndrome. Malignancy associated Sweet’s Syndrome (MASS) is usually present in patients with confirmed cancer and manifested as a paraneoplastic syndrome. Also occurs in those whose solid tumor or hematologic dyscrasia associated with sweet’s syndrome was previously undetected. Drug induced Sweet’s Syndrome (DISS) occurs in patients being treated with granulocyte-colony stimulating factor. Various other drugs including antibiotics like Minocycline, Trimethoprim Sulfamethoxazole, nitrofurantoin, antiepileptics like Carbamazepine, Diazepam, NSAIDS, Diuretics and Retinoids can also cause DISS. Diagnosis of sweet syndrome is usually done by two major criteria (histopathology and acute cutaneous lesion), and four minor criteria’s (infection, malignancy, medications, fever, and extra cutaneous manifestations like leukocytosis and corticosteroid response. Systemic corticosteroids are the golden standard of treatment for Sweet’s Syndrome. Systemic corticosteroids (0.5mg to 1mg/kg/day) for 4-6 weeks improves the systemic symptoms and reduce the skin lesions. For treating localized lesions, topical application of high potency corticosteroids or intralesional corticosteroids are effective. Other first line agents including potassium iodide and colchicine are also used. Second line agents include Indomethacin, Cyclosporine, Dapsone and Clofazimine. Keywords: Sweet’s Syndrome, Corticosteroids, Malignancy, Leukocytosis

Expansion of hantavirus infection during the SARS-CoV-2 pandemic in Bosnia and Herzegovina, 2021.

Introduction. Bosnia and Herzegovina (B and H) has been recognized for decades as a country with a high risk of diseases caused by hantaviruses.Gap statement. The severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) pandemic has diverted attention from many pathogens, including hantavirus.Aim. To provide a socio-demographic, temporal, geographical and clinical laboratory overview of the expansion of hantavirus infection cases during the SARS-CoV-2 pandemic in B and H in 2021.Methodology. The RecomLine HantaPlus IgG, IgM immuno-line assay (Mikrogen, Germany) was used to detect IgG and IgM antibodies to hantavirus serotypes in human sera from clinically suspected cases.Results. In 2021 (January-October), the number of confirmed cases of hantavirus infection and tested persons (92/140; 65,71 %) was higher than in the previous 2 years, 2020 (2/20; 10.00 %) and 2019 (10/61; 16.39 %). Most of the infected persons were men (84/92; 91.30 %). Hantavirus infections were recorded from January to October 2021, and the peak was reached in July (25/92; 27.17 %). Six out of 10 cantons in the Federation of Bosnia and Herzegovina (FB and H) were affected, namely Sarajevo Canton, Central Bosnia Canton, Neretva Canton, Zenica-Doboj Canton, Posavina Canton and Bosnian-Podrinje Canton Goražde, in descending order. Of the 38/92 (41.30 %) infected patients with characteristic clinical manifestations of haemorrhagic fever, including renal (mainly) or pulmonary syndrome, 32/92 (34.78 %) were hospitalized in the Clinical Center of the University of Sarajevo. Two cases were detected with dual infection, hantavirus (Puumala) with Leptospira in one and SARS-CoV-2 in another case. The largest number of infections was related to Puumala (PUUV) (83/92; 90.22 %), while the rest of the infections were caused by the hantavirus Dobrava serotype (DOBV).Conclusion. The reported infections were probably caused by exposure of individuals to at-risk areas inhabited by contaminated rodents as natural reservoirs of hantavirus. As a highly endemic area, B and H requires continuous monitoring and increased awareness of this problem.

A case of Familial Mediterranean Fever presented with recurrent infection.

The periodic fever syndrome Familial Mediterranean Fever (FMF) is caused by mutations in MEFV, which promote inflammation and present with uncontrolled systemic and organ-specific inflammation that can resemble infectious conditions. It is diagnosed based on clinical criteria, including frequent symptoms such as abdominal and thoracic pain, family history, and response to treatment with colchicine, which is confirmed by genetic assessment. Herein, we present a case of FMF with a relatively uncommon presentation. A 22-month-old female was referred to the allergy and clinical immunology clinic with eczematoid skin rashes. She was admitted to the hospital several times since the 2nd day of life with different complaints like fever, seizure, and restlessness, and treated with the diagnosis of septicemia. Endoscopy and colonoscopy were done at the age of 6 months due to poor weight gain and bloody diarrhea, which revealed active crypt-destructive colitis with foci of erosion in favor of infectious or allergic colitis. The colon biopsy was negative for Cytomegalovirus (CMV). Regarding family history, she was the second child of the first cousins parents and had a healthy 12-year-old sister. There was a history of death for unknown reasons of her cousin, whose parents were related. The immunologic evaluation was done, which showed a relatively normal immunoglobulin level, antibody response, flow cytometry, and lymphocyte transformation test. Nonetheless, a genetic study was done, which showed a homozygote mutation in exon 10 of the MEFV gene in the patient and a heterozygote mutation in both her parents. The periodic fever syndrome Familial Mediterranean Fever (FMF) is caused by mutations in MEFV, which promote inflammation and present with uncontrolled systemic and organ-specific inflammation that can resemble infectious conditions. The patient was diagnosed with FMF, and treatment was started using colchicine, which successfully controlled the patient's symptoms and prevented the recurrence of fever and other inflammatory manifestations.

(463) The Increasing &amp; Lethal Spectrum of the Genitourinary Syndrome of Menopause

Abstract Introduction In 2014, the Genitourinary Syndrome of Menopause replaced the previous concept of vaginal and genital atrophy. The spectrum of this syndrome includes and is not limited to atrophy, dryness, recurrent UTI, dyspareunia, anal incontinence, pelvic organ prolapse, vaginal stenosis, labial fusion, and/or vulvar obliteration. However, with time and the continuous exposure to women who have reached more advanced ages, such as centenarians, the spectrum of the GSM has been increasingly showing new entities and disorders never described before. Objective To update and expand the literature on the spectrum of GSM affecting the well-being, sexual functioning, and quality of life of postmenopausal women including the new observations seen in centenarians. Methods Multiple peer reviewed articles of both cohort and observational studies were evaluated to assess the increased spectrum of GSM symptoms in the centenarian women population. Results Nearly 60% of women in menopause experience GSM. Despite a vast majority of signs and symptoms, only 7% of providers ask women about this condition implying that GSM continues to be underdiagnosed and undertreated. In the early extreme of the spectrum of GSM, we show the new finding of the presence of false abnormal cervical dysplasia in women who have never had an abnormal PAP smear and have maintained a stable sexual relationship with their partner. This misconstrue is due to early vaginal and cervical atrophy which produces cells that, under the microscope, are very similar to dysplastic cells to the pathologist. This scenario is frequently seen in more than 80% of cases with those epidemiological characteristics, which is extremely easy to resolve with 4 months of regular local estrogen therapy. In the other extreme of the spectrum of GSM, in the elderly, the combination of lack of HRT and sex for prolonged periods of times produced the partial or total obliteration of the labia majora or minora with fusion in several women. Thus, preventing the exit of urine through the urethra with significant retention of fluid affecting the urinary bladder, ureters, and kidneys. Finally, having been exposed to the care of centenarian women in home care (women over 90 years old), we have realized that a significant number of them died with the diagnosis of pneumonia. However, when reviewing the analyzed cases retrospectively, we found that the real diagnosis was undiagnosed recurrent UTIs with poor clinical manifestations (which is common in these types of patients). The algorithm goes as follows: undiagnosed recurrent UTIs with poor clinical manifestations such as fever, leukocytosis, and poor verbal manifestations due to the age of patients, that progress to sepsis and the pneumonia that has been the part that really draws the attention of the physician. Conclusions The new findings of this review highlight the clinical implications when analyzing the two extremes of the spectrum of GSM throughout women’s lives. In all these cases, local or systemic HRT was never used. Appropriate management of GSM will enhance the quality of life and sexual function of these women. Disclosure No

Exploring the Complex Associations Between Prenatal and Early-Life Infections and Obsessive-Compulsive and Tic-Related Disorders

An association between rheumatic fever and chorea was first posited at the beginning of the 19th century, but it was not until the mid–19th century that these observations crystalized into a widely accepted understanding that rheumatism caused Sydenham chorea ( 1 Martino D. Tanner A. Defazio G. Church A.J. Bhatia K.P. Giovannoni G. Dale R.C. Tracing Sydenham’s chorea: Historical documents from a British paediatric hospital. Arch Dis Child. 2005; 90: 507-511 Crossref PubMed Scopus (13) Google Scholar ). Advances in diagnostic methods, including the use of the stethoscope to detect cardiac manifestations of rheumatic fever, partially explain this discovery. However, perhaps an even more significant factor was the gradual shift during this period in the locus of medical care from the home to specialized centers, such as children’s hospitals, which led to case-based registries ( 1 Martino D. Tanner A. Defazio G. Church A.J. Bhatia K.P. Giovannoni G. Dale R.C. Tracing Sydenham’s chorea: Historical documents from a British paediatric hospital. Arch Dis Child. 2005; 90: 507-511 Crossref PubMed Scopus (13) Google Scholar ). It was from examination of these registries that British researchers were initially able to show a temporal relationship between seasonal spikes in rheumatic fever and chorea in children. SEE CORRESPONDING ARTICLE ON PAGE 1023 SEE CORRESPONDING ARTICLE ON PAGE 1023 Prenatal and Early Childhood Infections and Subsequent Risk of Obsessive-Compulsive Disorder and Tic Disorders: A Nationwide, Sibling-Controlled StudyBiological PsychiatryVol. 93Issue 11PreviewPostinfectious autoimmune processes are hypothesized to be causally related to both obsessive-compulsive disorder (OCD) and tic disorders, but current evidence is conflicting. This study examined whether prenatal maternal (and paternal, as an internal control) infections and early childhood infections in the offspring (i.e., during the first 3 years of life) were associated with a subsequent risk of OCD and Tourette syndrome or chronic tic disorder (TS/CTD). Full-Text PDF Open Access

Clinico-microbiological profile of adults with enteric fever

Background: Enteric fever is a major public health problem; the burden of disease worldwide is approximately 11.9–26.9 million cases and 129,000–217,000 deaths each year. The burden of disease in India is approximately 6 million per year. Enteric fever is caused by Gram-negative bacteria Salmonella typhi or Salmonella paratyphi A, B or C, which is a bloodstream infection. The re-emergence of susceptibility of old antibiotics such as ampicillin, co-trimoxazole, and chloramphenicol in S. typhi has been observed. Aims: The objective of the study was to study the antibiotic sensitivity pattern of S. typhi, S. paratyphi A and S. paratyphi B and also the clinical and laboratory profile of enteric fever with respect to blood counts, liver function tests and typhoid serology in adult patients with enteric fever. Materials and Methods: The study was conducted in the Department of Internal Medicine and Microbiology at Sir Ganga Ram Hospital in 76 adult patients of blood culture-positive enteric fever. Clinical and laboratory profile of patients was recorded. Antibiotic sensitivity patterns were studied in all cases and the prevalence of multidrug-resistant strains, if the present was established. Results: The mean age in this study was 31.46 + 11.29 years. There were 46 male patients and 30 female patients. Fever was present amongst all patients (100%). Myalgia/headache was present amongst the majority of patients (98.7%). Pain in the abdomen (57.9%) was present. Leucopenia and leucocytosis were present in 25% and 2.6% of patients, respectively. Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase were abnormal amongst 36.8% and 38.2% of patients, respectively. Complications, such as ileal perforation and gastrointestinal (GI) bleed, were not seen in the patients of enteric fever in this study. Typhidot IgM was positive in 50% of patients. S. typhi (blood culture) was amongst more than half of the patients (69.7%) and S. paratyphi A was 30.3%. Ampicillin was resistant to 5.3% and chloramphenicol and cotrimoxazole each were resistant to 2.6%. Levofloxacin was resistant to 38.2%. Ceftriaxone, azithromycin and cefixime were sensitive to 100%. Multidrug resistance (resistance to ampicillin, chloramphenicol and cotrimoxazole) was seen in 2.6% of cases, which was associated with S. typhi. There was no multidrug resistant (MDR) strain seen with S. paratyphi A. Conclusions: This study showed that fever, myalgia/headache, pain in the abdomen, nausea/vomiting and diarrhoea were the common clinical manifestations of enteric fever. Other important conclusions were low percentages of comorbidities, low occurrence of leucocytosis, high typhidot IgM positivity, low MDR and most of the drugs were 100% sensitive. Ileal perforation and GI bleeding were not found in any case of enteric fever in this study.