Recent Fever Research Articles

Genetic clustering of recent classical swine fever virus isolates from Karnataka, India revealed the emergence of subtype 2.2 replacing subtype 1.1.

The phylogenetic analysis of 11 CSFV isolates from Karnataka, India obtained during the year 2012-13 was undertaken to obtain the most reliable genetic typing of the CSFV isolates based on E2, NS5B and 5'UTR genomic regions. The study indicated that all the 11 CSFV isolates belonged to subgroup 2.2. The most reliable classification was obtained with sequence data from the NS5B region which separated all the isolates based on the history of outbreak and geographic origin. Analysis of full length E2 amino acid sequences revealed different genetic makeup of Indian 2.2 isolates compared to 2.2 isolates from different countries. The group 2.2 viruses are gradually spreading as confirmed by frequent detection/ isolation of group 2.2 viruses in the recent years and replacing the subgroup 1.1 viruses, which were hitherto predominantly involved in CSF outbreaks in India.

Dizziness With Exertion In An Ice Hockey Athlete

HISTORY: 20 yo women’s ice hockey athlete with hx of absence seizures presents with dizziness, SOB & palpitations with exertion. Pt developed symptoms during first practice after winter break. Initially thought she was “out of shape”. When she could not continue due to symptoms she reported to the Athletic Trainer. Irregular rhythm noted; 140-150bpm. Remainder of the evaluation by AT was normal. Pt began to feel normal after 30 minutes in supine. Prior episode of mental status changes one month prior felt to be related to seizure disorder. No hx of syncope/pre-syncope, CP. PMH: Partial complex seizures dx 2nd grade, grand mal sz 2010. ROS: (-) recent fever, chills, illness. Meds: Keppra, recently started on Lamictal, Sorynx. Allergies: Dilantin (rash). SH: student, no ETOH/drugs. FH: F-HTN, valve dz. PHYSICAL EXAMINATION: WDWN; NAD; 120/60; HR 74; HEENT wnl; Thyroid nm; Cardiac- PMI nml, RRR, no M/R/G, normal HJR; Lungs clear; Abd nml; Ext nml. DIFFERENTIAL DIAGNOSIS: Cardiac vs Neurologic vs Metabolic vs Infectious TESTS AND RESULTS: Initial: Lab- CBC, Chem panel, TFTs nml. EKG- NSR, 53bpm, nml intervals, ST-T wave abnormalities Referral to Cardiology: Echo- nml valves, chambers, EF 45%, mild global LV hypokinesis WORKING DIAGNOSIS: Cardiomyopathy- Post-infectious, arrhythmia-induced, infiltrative, anomalous coronary, vs. CAD Additional Tests: CT angio- normal coronary arteries; Ca+ score 0; LVEF 43%; no evidence of RV dysplasia ETT- Resting PVC’s which normalize with higher levels exertion; Into Stage V Bruce asymptomatic 30d Holter monitor: NSR, avg HR 58 (40-169), 5312 PVC’s (6.8 %). 12 couplets. Multiform PVS’s noted MRI: Bi-ventricular mod enlargement, ED dimension 67mm, low nml systolic fn. No regional wall motion abnormalities. LV trabeculated myocardium, ratio 3:1. No perfusion defects. No myocardial delayed enhancement. EF 58% LV, 52% RV Labs: EBV panel, Coxsackie, Lyme, CMV, TFT’s, ESR/CRP, Chem panel, CBC, Iron studies FINAL DIAGNOSIS: Non-compaction Cardiomyopathy TREATMENT AND OUTCOMES: Pt referred to heart failure specialist. Pt initially treated with Beta-blocker, and dc OCP. Did not return to competitive sport. When seen by second specialist, dc B-blocker and initiated baby ASA and ACE inhibitor. Pt has been followed by second specialist.

Typhoid fever in young children in Bangladesh: clinical findings, antibiotic susceptibility pattern and immune responses.

BackgroundChildren bear a large burden of typhoid fever caused by Salmonella enterica serotype Typhi (S. Typhi) in endemic areas. However, immune responses and clinical findings in children are not well defined. Here, we describe clinical and immunological characteristics of young children with S. Typhi bacteremia, and antimicrobial susceptibility patterns of isolated strains.MethodsAs a marker of recent infection, we have previously characterized antibody-in-lymphocyte secretion (TPTest) during acute typhoid fever in adults. We similarly assessed membrane preparation (MP) IgA responses in young children at clinical presentation, and then 7-10 days and 21-28 days later. We also assessed plasma IgA, IgG and IgM responses and T cell proliferation responses to MP at these time points. We compared responses in young children (1-5 years) with those seen in older children (6-17 years), adults (18-59 years), and age-matched healthy controls.Principal FindingsWe found that, compared to age-matched controls patients in all age cohorts had significantly more MP-IgA responses in lymphocyte secretion at clinical presentation, and the values fell in all groups by late convalescence. Similarly, plasma IgA responses in patients were elevated at presentation compared to controls, with acute and convalescent IgA and IgG responses being highest in adults. T cell proliferative responses increased in all age cohorts by late convalescence. Clinical characteristics were similar in all age cohorts, although younger children were more likely to present with loss of appetite, less likely to complain of headache compared to older cohorts, and adults were more likely to have ingested antibiotics. Multi-drug resistant strains were present in approximately 15% of each age cohort, and 97% strains had resistance to nalidixic acid.ConclusionsThis study demonstrates that S. Typhi bacteremia is associated with comparable clinical courses, immunologic responses in various age cohorts, including in young children, and that TPTest can be used as marker of recent typhoid fever, even in young children.

Guideline on the management of acute chest syndrome in sickle cell disease.

1. Department of Haematology, Guy’s and St Thomas’ NHS Foundation Trust 2. Lane Fox Respiratory Unit, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust 3. Department of Haematology, North Middlesex Hospital 4. Department of Paediatric Haematology, Bristol Royal Hospital for Children 5. Department of Haematological Medicine, King’s College Hospital 6. Department of Haematology, Whittington Hospital

INFECTIVE VEGETATION IN THE INTERVALVULAR FIBROSA: 3D-TRANSESOPHAGEAL ECHO AIDS ACCURATE DIAGNOSIS AND TRACKS THE NATURAL HISTORY

A 75-year-old male with prior bioprosthetic aortic valve replacement (AVR) presented with chest pain and elevated troponins. Coronary angiogram was normal. A cardiac MRI revealed an inferolateral infarct, presumed embolic. CT-abdomen showed new splenic and renal infarcts. He endorsed recent fevers/

Population Status of Primates in the Atlantic Forest of Argentina

To guide future conservation actions and management decisions, it is crucial to assess the population status and identify the environmental or anthropogenic variables that affect species’ abundance and persistence. The main goal of our study was to evaluate the population and conservation status of the three primate species inhabiting the Atlantic Forest of Misiones, Argentina: the brown howler monkey (Alouatta guariba), the black-and-gold howler monkey (Alouatta caraya), and the black-horned capuchin monkey [Sapajus (= Cebus) nigritus]. We conducted repeated surveys at 31 transects in the central-eastern portion of Misiones province where the three species co-occur, and used occupancy models to assess the effect of human accessibility on black-horned capuchins. In addition, we carried out interviews with local people to assess the status of all three species and the extent to which yellow fever outbreaks may have affected each of them. During the surveys we found no direct or indirect evidence of the presence of brown howlers or black-and-gold howlers in the study area, while we recorded 18 direct and indirect signs of presence of black-horned capuchins in a total of 12 sites. Based on interviews and comparisons with previous density estimates, we conclude that the abundance of both howler species has dropped drastically, possibly due to recent yellow fever outbreaks. Conservation action is thus urgent, especially for the endangered brown howler population. Although black-horned capuchins are not currently considered threatened, we found them to be sensitive to anthropogenic disturbance. In the next few decades, the predictable spread and increasing intensity of human activities in this region may cause a drastic decline of this capuchin population.

The influence of environmental factors on childhood fever during the rainy season in an African city: a multilevel approach in Dakar, Senegal

In African growing cities, vector-borne diseases (such as malaria and dengue) contribute to a large burden of childhood morbidity and mortality. During the peak of transmission, environmental factors can have an influence on those fevers, apart from the individual and household characteristics. A household survey conducted in 2008 in Dakar was completed by a community questionnaire on environmental threats that could be factored into multilevel analyses. Using a randomized sample of 7,300 children from 3,000 households dispatched within 50 neighborhoods, a three-level modeling process is presented. Rates of recent fever varied substantially from one neighborhood to another, ranging between 10 and 37 %. Findings indicate that the onset of fever is influenced by factors from all three hierarchical levels, with neighborhood factors playing a relatively lower role than the other two. Among the environmental factors, the effect of environmental sanitation is particularly interesting.

English

BACK GROUND: In recent days fever with Thrombocytopenia is a common clinical presentation in the medical wards. This study has been undertaken to know the modes of clinical presentations and possible causes of fever with Thrombocytopenia. OBJECTIVE: 1. To determine possible infective etiology for fever with Thrombocytopenia. 2. To correlate clinical features, laboratory studies and infective etiology. METHODS: Case record analysis of fever with Thrombocytopenia admitted to medical wards from june-2013 to December- 2013. RESULTS & CONCLUSION: Dengue, enteric fever and viral fever were the common causes for the Thrombocytopenia.

SM 엔터테인먼트의 글로벌 시장 진출 특성

Korean entertainment companies like SM entertainment, YG and JYP contribute enormously to the recent K-pop fever. They expand their businesses aggressively to foreign markets which has been successful. This paper seeks to find out their precise strategies to succeed in the global market. Our study focus on SM entertainment which manages successively in the Asian market. As a result, one of their successful strategies on the global market is localization. They rearrange a group with in the members to suit into the local market : for instance, Super Junior, representative boy group, has rearranged and reformed to Super Junior M (mandarin), Super Junior happy (for Japan market), etc. Coopration with SNS (Social Network Service) is another successful strategies of SM Entertainment : page views of K-pop on Youtube achieved more than 0.8 billion in 2013. Furthermore, for marketing, many members play an advertizing model for global products.

FROM ATAXIA TO BILATERAL FACIAL PALSY DUE TO ONE VIRUS

<h3>Case reports</h3> Two patients attended our hospital emergency department during one month and were referred to neurology. Patient 1 was a 43-year-old man who presented with facial drooping developing over three days. On review, he had recent jaundice, malaise, fever and sweats. Examination showed a bilateral lower motor neuron facial weakness. Abdomen ultrasound showed hepatosplenomegaly and atypical lymphocytes were present on a blood film. Serum Epstein-Barr virus (EBV) IgM antibodies were positive with negative EBV IgG antibodies. Patient 2 was a 17-year-old man with headache, nausea and light-headedness who presented after loss of consciousness. On examination, he had bilateral dysdiadochokinesis, intention tremor, slurred speech and a broad-based gait. Cerebrospinal fluid EBV DNA polymerase chain reaction test was positive. <h3>Discussion</h3> Neurological complications occur in up to 8% of patients with EBV infection. Although viral meningitis is the commonest presentation, it may result in encephalitis, cerebellitis, cranial nerve palsies, myelitis and neuropathies. Cerebrospinal fluid viral DNA testing is often negative and the diagnosis requires careful history-taking for preceding systemic symptoms.

Baby With a Rash

A 13-month-old boy without any medical history presented to the pediatric emergency department with 3 days of nonpruritic rash (Figures 1 and 2). Initially, the rash consisted of purple lesions that started on the back and then developed into red and raised lesions to his face, chest, and abdomen. He had no history of recent fever, respiratory symptoms, vomiting, diarrhea, or new exposures to food, travel, lotions, or detergents. Amoxicillin was begun 1 week ago for otitis media. Physical examination revealed a well-appearing child with multiple erythematous, serpiginous, and raised border lesions on his back, forehead, and trunk.

Does this adult patient have early HIV infection?: The Rational Clinical Examination systematic review.

Timely identification of human immunodeficiency virus (HIV) infection in adults can contribute to reduced mortality and likelihood of further HIV transmission. During the first 6 months after infection, known as early HIV infection, patients often report a well-described constellation of symptoms and signs. However, the literature examining utility of the clinical examination in identifying early infection has not been systematically assessed. To assess the accuracy of symptoms and signs in identifying early HIV infection among adults. We searched MEDLINE and EMBASE (1981-May, 2014) for articles investigating symptoms and signs of early HIV infection in adults and searched reference lists of retrieved articles. We retained original studies that compared symptoms and signs among patients with early HIV infection in comparison to HIV-negative individuals. Data were extracted and used to calculate sensitivity, specificity, and likelihood ratios (LRs), and meta-analysis was used to calculate summary LRs. Of 1356 studies, 16 studies included data that were eligible for meta-analysis and included a total of 24,745 patients and 1253 cases of early HIV infection. Symptoms that increased the likelihood of early HIV infection the most included genital ulcers (LR, 5.4; 95% CI, 2.5-12), weight loss (LR, 4.7; 95% CI, 2.1-7.2), vomiting (LR, 4.6; 95% CI, 2.5-8.0), and swollen lymph nodes (LR, 4.6; 95% CI, 1.3-8.0). No symptoms had an LR that was 0.5 or lower, but the absence of recent fever (LR, 0.74; 95% CI, 0.64-0.84) slightly decreased the likelihood of early HIV infection. The presence of lymphadenopathy on physical examination was the most useful sign (LR, 3.1; 95% CI, 1.0-5.2). No sign had an LR of 0.5 or less, but the absence of lymphadenopathy slightly decreased the likelihood of early HIV infection (LR, 0.70, 95% CI, 0.49-0.92). Using data from studies that considered combinations of findings (range of possible findings, 4-17), the summary LR for individuals with 0 findings was 0.47 (95% CI, 0.38-0.58). The limited utility of the clinical examination to detect or rule out early HIV infection highlights the importance of routine testing for HIV infection among adults.

Yellow Fever in Africa: estimating the burden of disease and impact of mass vaccination from outbreak and serological data.

Yellow fever is a vector-borne disease affecting humans and non-human primates in tropical areas of Africa and South America. While eradication is not feasible due to the wildlife reservoir, large scale vaccination activities in Africa during the 1940s to 1960s reduced yellow fever incidence for several decades. However, after a period of low vaccination coverage, yellow fever has resurged in the continent. Since 2006 there has been substantial funding for large preventive mass vaccination campaigns in the most affected countries in Africa to curb the rising burden of disease and control future outbreaks. Contemporary estimates of the yellow fever disease burden are lacking, and the present study aimed to update the previous estimates on the basis of more recent yellow fever occurrence data and improved estimation methods. Generalised linear regression models were fitted to a dataset of the locations of yellow fever outbreaks within the last 25 years to estimate the probability of outbreak reports across the endemic zone. Environmental variables and indicators for the surveillance quality in the affected countries were used as covariates. By comparing probabilities of outbreak reports estimated in the regression with the force of infection estimated for a limited set of locations for which serological surveys were available, the detection probability per case and the force of infection were estimated across the endemic zone. The yellow fever burden in Africa was estimated for the year 2013 as 130,000 (95% CI 51,000-380,000) cases with fever and jaundice or haemorrhage including 78,000 (95% CI 19,000-180,000) deaths, taking into account the current level of vaccination coverage. The impact of the recent mass vaccination campaigns was assessed by evaluating the difference between the estimates obtained for the current vaccination coverage and for a hypothetical scenario excluding these vaccination campaigns. Vaccination campaigns were estimated to have reduced the number of cases and deaths by 27% (95% CI 22%-31%) across the region, achieving up to an 82% reduction in countries targeted by these campaigns. A limitation of our study is the high level of uncertainty in our estimates arising from the sparseness of data available from both surveillance and serological surveys. With the estimation method presented here, spatial estimates of transmission intensity can be combined with vaccination coverage levels to evaluate the impact of past or proposed vaccination campaigns, thereby helping to allocate resources efficiently for yellow fever control. This method has been used by the Global Alliance for Vaccines and Immunization (GAVI Alliance) to estimate the potential impact of future vaccination campaigns.

Phylogenetic analysis of recent classical swine fever virus isolates (CSFV) from Karnataka, India

Classical swine fever (CSF) outbreaks are detected throughout the year. Tissue (spleen and lymph nodes) samples (6) collected from 5 classical swine fever outbreaks in different districts of Karnataka state were subjected to virus isolation in PK–15 cells and virus could be recovered from all the 6 samples. Virus isolation was confirmed by reverse transcription-PCR using primers specific to 5’UTR region and sequenced. Alignment of 150 nucleotides of 5’UTR region with that of 33 published sequences available in Genbank, including 22 Indian CSFV sequences was done to get better epidemiological information on classical swine fever virus (CSFV). Based on the phylogenetic analysis, the isolates from Karnataka could be grouped into subgroup 2.2. Phylogenetic tree confirmed that members of 2.2 subgroup show higher divergence among themselves when compared to other cluster within subgroup 1.1. The study also revealed involvement of 2 different isolates in an outbreak. Most of the outbreaks in our study are due to recent introduction of new stocks of pigs from other places. Even though group 1 viruses are predominant in India, the group 2 viruses are also gradually spreading as confirmed by frequent detection/ isolation of group 2 viruses in the recent years. It appears that subgroup 2.2 viruses are gradually replacing the subgroup 1.1 viruses, indicating the changing epidemiological scenario.

Left atrial myxoma complicated with acute embolism of left ulnar artery

A 74-year-old woman presented to the emergency department with acute onset of pallor, pain and numbness over her left hand. She had a history of right hemicolectomy for colon cancer. There was no history of trauma or recent fever. On examination, paleness, coldness and weak pulses were noted along the ulnar side of her left forearm and hand (Figure 1A). Radial artery pulses at the wrist were normal. The neurologic …

Building a Species Conservation Strategy for the Brown Howler Monkey (Alouatta Guariba Clamitans) in Argentina in the Context of Yellow Fever Outbreaks

The brown howler monkey ( Alouatta guariba clamitans) is endemic to South America's Atlantic Forest, with a small population extending into the northern portion of Misiones province in northeastern Argentina. In 2012, the species was classified as Critically Endangered in Argentina due to its highly restricted distribution, low population density and dramatic declines from recent Yellow Fever outbreaks. In March 2013, we organized an international workshop in Misiones to evaluate population status in Argentina and conduct a threat analysis. We developed population viability models using Vortex and Outbreak software packages. These tools allowed us to explore how several biological and demographic parameters of brown howlers, as well as factors related to Yellow Fever epidemiology, affect the probability of species extinction. The discussion among diverse specialists and analysis of model results identified Yellow Fever as the main threat to brown howler population persistence in Argentina. Our threat analysis, focused on the dynamics of Yellow Fever outbreaks and their impact on howler populations, led to the identification of gaps in knowledge that helped prioritize objectives and actions for the development of a Species Conservation Strategy in Argentina.

A rare cause of hypercalcemia: Questions

A previously well 12-year-old boy presented with a 1month history of polydipsia, polyuria, and lethargy. Over that period, he had been drinking at least 3 l of water daily, reported feeling thirsty, and needed to pass urine approximately every 30 min. His parents also reported that he had weight loss over the previous month with reduced appetite secondary to nausea. Of note, he had a long-standing history of drinking approximately 1 l of cow’s milk daily. He had no recent acute illnesses or fevers and reported no pain, discomfort, or respiratory distress. He had been treated with azathioprine for 3 years in the past for intractable eczema. His blood glucose level checked by his general practitioner was normal. Physical examination revealed significant bilateral inguinal lymphadenopathy and a 2-cm palpable liver edge. There were patches of dry skin attributed to previously diagnosed eczema. His cardiovascular, respiratory, neurological, ENT, and musculoskeletal examinations were otherwise unremarkable. There was an evident BCG scar. Vital signs were within normal limits. Laboratory investigations revealed acute renal impairment, hypercalcemia, and a mild transaminitis: urea 15.2 mmol/l, creatinine 149 mmol/l, serum calcium 3.38 mmol/l, ionized calcium 1.78 mmol/l, serum phosphate 1.42 mmol/l, sodium 139 mmol/l, potassium 3.7 mmol/l, AST 76 U/l, ALT 114 U/l, and lactate dehydrogenase 416 U/l. Serum intact parathyroid hormone levels were suppressed at <6 ng/l. Serum 25(OH)-cholecalciferol level was reduced at 38 nmol/l. Urinalysis revealed significant hypercalciuria (calcium/ creatinine ratio of 2.91). Full blood count measurements were within normal limits, while blood film revealed only occasional atypical lymphocytes and monocytes. An abdominal ultrasound revealed bilateral hyperechogenic kidneys, which were otherwise unremarkable; and mild hepatosplenomegaly with bulky inguinal lymph nodes bilaterally with speckled hyperechogenicity. A chest radiograph revealed clear lung fields, normal-sized cardiac silhouette with no evidence of a widened mediastinum.

Lung abscesses in a dromedary camel (Camelus dromedarius)

A case of pulmonary abscesses in an adult female dromedary camel was reported with history of recent parturition, recurrent fever and recumbency. The necropsy findings revealed congestion and multiple abscesses of varying sized ranging from 5–10 cm in diameter on its caudal lobe containing large amount of fetid grey purulent material. The histopathology revealed exudate in the alveolar spaces and bronchial and bronchiolar lumens. Some alveoli showed presence of Gram negative bacilli. However, the purulent material when cultured aerobically on nutrient and blood agar was found negative for growth of any bacteria. The pus cultured on Sabouraud dextrose agar also found negative for growth of any fungus. Based on the literature search, which showed high association of anaerobic bacteria in cases of lung abscess, it is imperative to further explore their role in cases of pulmonary abscesses in camels and other animal species.

Massive Coronary Aneurysm After Multiple Percutaneous Interventions: An Iatrogenic or Unpreventable Disaster?

A 38-year-old man presented at the emergency department with severe chest pain. He had no history of recent trauma or fever but had undergone percutaneous coronary intervention (PCI) several times for 3-vessel disease. Repeat in-stent restenosis (ISR) was detected during his last angioplasty 1 year

Bacteremia as a Cause of Fever in Ambulatory, HIV-Infected Mozambican Adults: Results and Policy Implications from a Prospective Observational Study

Fever is typically treated empirically in rural Mozambique. We examined the distribution and antimicrobial susceptibility patterns of bacterial pathogens isolated from blood-culture specimens, and clinical characteristics of ambulatory HIV-infected febrile patients with and without bacteremia. This analysis was nested within a larger prospective observational study to evaluate the performance of new Mozambican guidelines for fever and anemia in HIV-infected adults (clinical trial registration NCT01681914, www.clinicaltrials.gov); the guidelines were designed to be used by non-physician clinicians who attended ambulatory HIV-infected patients in very resource-constrained peripheral health units. In 2012 (April-September), we recruited 258 HIV-infected adults with documented fever or history of recent fever in three sites within Zambézia Province, Mozambique. Although febrile patients were routinely tested for malaria, blood culture capacity was unavailable in Zambézia prior to study initiation. We confirmed bacteremia in 39 (15.1%) of 258 patients. The predominant organisms were non-typhoid Salmonella, nearly all resistant to multiple first-line antibiotics (ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole). Features most associated with bacteremia included higher temperature, lower CD4+ T-lymphocyte count, lower hemoglobin, and headache. Introduction of blood cultures allowed us to: 1) confirm bacteremia in a substantial proportion of patients; 2) tailor specific antimicrobial therapy for confirmed bacteremia based on known susceptibilities; 3) make informed choices of presumptive antibiotics for patients with suspected bacteremia; and 4) construct a preliminary clinical profile to help clinicians determine who would most likely benefit from presumptive bacteremia treatment. Our findings demonstrate that in resource-limited settings, there is urgent need to expand local microbiologic capacity to better identify and treat cases of bacteremia in HIV-infected and other patients, and to support surveillance. Data on the prevalence and susceptibility patterns of important pathogens can guide national formulary and prescribing practices.