difference between prolonged fever and saddleback fever

Our observational study observed the 24-h continuous tympanic temperature pattern of 15 patients with dengue fever and . All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. This study was funded by the National Medical Research Council COVID-19 Research Fund (COVID19RF-001) and Agency for Science, Technology and Research (A*STAR) COVID-19 Research funding (H/20/04/g1/006) provided to the Singapore Immunology Network by the Biomedical Research Council (BMRC), A*STAR. Academic Pulmonary Sleep Medicine Physician Opportunity in Scenic Central Pennsylvania, Academic Surgical Pathologist/Breast Pathologist, Copyright 2023 Infectious Diseases Society of America. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. Saddleback fever refers to biphasic fever with an initial peak that remits and appears again. Respiratory syncytial virus disease burden in community-dwelling and long-term care facility older adults in Europe and the United States: A prospective study, Viral aetiology and clinical characteristics of acute respiratory tract infections in hospitalized children in Southern Germany (2014-2018), Coronary Artery Plaque Composition and Severity Relate to the Inflammasome in People with Treated HIV, Sustained Virologic Suppression With Dolutegravir/Lamivudine in a Test-and-Treat Setting Through 48 Weeks, Impact of hypoalbuminemia on ceftriaxone treatment failure in patients with Enterobacterales bacteremia: a propensity matched, retrospective cohort study, About the Infectious Diseases Society of America, https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200430-sitrep-101-covid-19.pdf?sfvrsn=2ba4e093_2, https://www.moh.gov.sg/news-highlights/details/confirmed-imported-case-of-novel-coronavirus-infection-in-singapore-multi-ministry-taskforce-ramps-up-precautionary-measures, https://www.moh.gov.sg/news-highlights/details/seven-more-confirmed-cases-of-novel-coronavirus-infection-in-singapore, https://sso.agc.gov.sg/Act/IDA1976#pr25A-, https://doi.org/10.1101/2020.03.02.20029975, https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html, https://www.straitstimes.com/singapore/9-in-10-coronavirus-patients-housed-in-isolation-facilities, https://www.moh.gov.sg/news-highlights/details/56-more-cases-discharged-528-new-cases-of-covid-19-infection-confirmed, http://creativecommons.org/licenses/by-nc-nd/4.0/, Receive exclusive offers and updates from Oxford Academic. A. The https:// ensures that you are connecting to the Plasma fractions were isolated from blood samples of COVID-19 patients collected during the acute phase (median post-illness onset, 6 days). Communicable Diseases Surveillance in Singapore 2005. -. The 2011 dengue haemorrhagic fever outbreak in Lahore - an account of clinical parameters and pattern of haemorrhagic complications. Methods: Please check for further notifications by email. There was progression of infiltrates on the CXR for 72.2% (13/18) of cases with prolonged fever and 38.5% (5/13) in those with saddleback fever. government site. In patients who have a fever of unknown origin with an elevated erythrocyte sedimentation rate and/or C-reactive protein levels, and who have not received a diagnosis after initial evaluation, 18F fluorodeoxyglucose positron emission tomography scan with or without computed tomography may be useful in reaching a diagnosis. Available at: Ministry of Health (MOH) Singapore. Statistical analyses were performed with the Mann-Whitney. aInvestigations were repeated at the point at which they satisfied criteria for prolonged or saddleback fever. However, unlike RA, rheumatic . Previous testing (ESR, complete blood count, electrolyte panel, chest radiography, urinalysis, blood culture) may be repeated periodically to evaluate for trends as the illness evolves. No overall differences in safety or effectiveness . The site is secure. History and physical examination alone are often sufficient to diagnose uncomplicated infectious causes of fever . Bookshelf Repeat laboratory investigations and CXR were done for those with prolonged or saddleback fever and collected. 40-year-old woman fever rash arthralgia Dx? However, as the number of patients with prolonged fever requiring ICU admission is small in this cohort, further studies should be done to prove this correlation. doi: 10.1371/journal.pone.0167025. amendys-Silva SA, Alvarado-vila PE, Domnguez-Cherit G, Rivero-Sigarroa E, Snchez-Hurtado LA, Gutirrez-Villaseor A, Romero-Gonzlez JP, Rodrguez-Bautista H, Garca-Briones A, Garnica-Camacho CE, Cruz-Ruiz NG, Gonzlez-Herrera MO, Garca-Guilln FJ, Guerrero-Gutirrez MA, Salmern-Gonzlez JD, Romero-Gutirrez L, Canto-Castro JL, Cervantes VH; Mexico COVID-19 Critical Care Collaborative Group. The author(s) received no specific funding for this work. Fever of unknown origin (FUO) in adults is one of the most vexing clinical conditions for clinicians and patients. For cases with saddleback fever, fever recurred at a median (IQR) of 10 (812) days after symptom onset. Figure 1 outlines a diagnostic approach to patients with prolonged febrile illness and FUO.1,2,47,1520,23,27, Hospitalization may be considered at any time during the evaluation, especially if the patient exhibits signs of a critical illness. This study demonstrates that prolonged fever may be associated with various warning signs and more severe forms of dengue (SD, DSS, DHF), while saddleback fever showed associations with DHF. 2 A diagnosis of classic KD is made in patients with prolonged fever (five or more days) and four or more of the following principal . Rash. Geneva: World Health Organization, Special Programme for Research and Training in Tropical Diseases, Geneva: 2000. Viruses, bacteria, fungi, and parasites can cause infections. The mean duration of symptoms and signs before diagnosis (28.4 13.2 versus 45.0 30.8 days; P < 0.05), . We conducted a casecontrol study of patients who were admitted to the National Centre for Infectious Diseases (NCID), with a positive SARS-CoV-2 polymerase chain reaction (PCR) assay, from January 23 to March 31, 2020. Am J Dis Child 1972; 124:544. doi: 10.1371/journal.pntd.0004575. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. A, Heatmap showing the relative concentration of cytokines across patients with different fever patterns. The 4 cases who were excluded from the primary analysis demonstrated a saddleback pattern of fever that lasted >24 hours. doi: 10.9778/cmajo.20200250. Differences Between Prolonged Fever and Nonprolonged Fever Groups. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (. Adverse outcomes were hypoxia, intensive care unit (ICU) admission, mechanical ventilation, and mortality. The findings of the study are useful for informing the optimal placement of patients with COVID-19, the researchers pointed out. 2020 Oct 1;180(10):1345-1355. doi: 10.1001/jamainternmed.2020.3539. The Author(s) 2020. Elevated lactate dehydrogenase levels can be indicative of infectious and malignant causes of FUO, including malaria, lymphoma, and leukemia.15,21 Measurement of ferritin levels may also be helpful.33 An elevated ferritin level in prolonged febrile illness may indicate malignancy (especially myeloproliferative disorders) and other noninfectious inflammatory diseases, such as systemic lupus erythematosus or temporal arteritis.21,33 One study established a ferritin level of 561 ng per mL (1,261 pmol per L) as the optimal cutoff value to predict that FUO was due to a noninfectious cause.22 Extreme elevation of ferritin levels (greater than 1,000 ng per mL [2,247 pmol per L]) can point to adult Still disease.34 Infection is the most common reason ESR is extremely elevated, but if there is no evidence of infectious causes, clinicians should consider malignancy, renal disease, and inflammatory disorders if the ESR is 100 mm per hour or greater.29. See permissionsforcopyrightquestions and/or permission requests. Angela Chow Li Ping, Brenda Sze Peng Ang, Chen Seong Wong, Cheng Chuan Lee, Ding Ying, Jun-Yang Tay, Kalisvar Marimuthu, Lawrence Soon U. Lee, Yee-Sin Leo, Li Min Ling, Li Wei Ang, Lin Cui, Mark I-Cheng Chen, Monica Chan, Mucheli Sharavan Sadasiv, Oon-Tek Ng, Pei Hua Lee, Poh Lian Lim, Sapna Pradip Sadarangani, Shawn Vasoo, Stephanie Sutjipto, Tsin Wen Yeo, Tze Minn Mak. Dengue fever is an acute febrile illness with a duration of 2-12 days. However, there were no significant differences in the admission laboratory values between the control and saddleback fever groups. The Significance of Prolonged and Saddleback Fever in Hospitalised Adult Dengue. In particular, fever was reported in about 72%98.6% of patients, usually lasting <7 days [4, 710]. Lancet 2020; 395:497506. Statistical analyses were performed with the Mann-Whitney U test (*P<.05; **P<.01; ***P<.001). Comparing the difference between prolonged fever cases and saddleback fever cases, we found an increased IL-1 level and lower IP-10 level on admission. 2015 Sep 30;15:399. doi: 10.1186/s12879-015-1141-3. Those with prolonged fever had a median duration of fever for 10 days (IQR 9-11 days) for prolonged fever cases, while fever recurred at a median of 10 days (IQR 8-12 days) for those with saddleback fever. . Seven more confirmed cases of novel coronavirus infection in Singapore. A more recent qualitative definition requires only a reasonable diagnostic evaluation. Please enable it to take advantage of the complete set of features! A larger cohort might help to improve our understanding of these patients. Meanwhile, the levels of IP-10 in patients with saddleback fever was lower than those with prolonged fever (p<0.001) at a level almost matching that in controls. While prolonged fever was associated with a higher rate of ICU admission vs controls (11.1 percent vs 0.9 percent; p=0.05), saddleback fever was not, despite both being associated with hypoxia. Fever duration was longer in patients 6 to 12 months old and 12 to 18 . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. eCollection 2022. The clinical features of classic KD are shown in Table 1. When compared with controls, both prolonged and saddleback fever were associated with hypoxia, with the highest rate seen in cases with prolonged fever (27.8 percent and 14.3 percent vs 0.9 percent for prolonged and saddleback fever vs control, respectively; p<0.01 and p=0.03 for each respective comparison). A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. COVID-19 and sinus infections share several symptoms like nasal congestion, fever, and coughing. Lohr JA, Hendley JO. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Clinical characteristics of coronavirus disease 2019 in China, Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore, Clinical features and dynamics of viral load in imported and non-imported patients with COVID-19, Singapore 2019 Novel Coronavirus Outbreak Research Team, Investigation of three clusters of COVID-19 in Singapore: implications for surveillance and response measures, Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study, Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial, The pathogenesis and treatment of the cytokine storm in COVID-19, De-isolating COVID-19 suspect cases: a continuing challenge, Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China, Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China, Magnitude and prevention of nosocomial infections in the intensive care unit, Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China, Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia, Plasma IP-10 and MCP-3 levels are highly associated with disease severity and predict the progression of COVID-19, Exuberant elevation of IP-10, MCP-3 and IL-1ra during SARS-CoV-2 infection is associated with disease severity and fatal outcome, Interleukin-1 receptor antagonist: role in biology, Biologic activities of IL-1 and its role in human disease, Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study, IL-21 is required to control chronic viral infection, Interferon--induced protein 10 in dengue virus infection, Cytokine and chemokine levels in patients with severe fever with thrombocytopenia syndrome virus, The regulation of seventeen inflammatory mediators are associated with patient outcomes in severe fever with thrombocytopenia syndrome, Overview of the IL-1 family in innate inflammation and acquired immunity, IL-1 and IL-1 recruit different myeloid cells and promote different stages of sterile inflammation, Blocking the interleukin-1 receptor inhibits leukotriene B4 and prostaglandin E2 generation in human monocyte cultures, A dynamic immune response shapes COVID-19 progression, Centers for Disease Control and Prevention. Duration of fever was calculated from the date of first symptom onset to the date of defervescence (defined as temperature <37.5C for at least 24 hours) during the hospital admission. PLoS Negl Trop Dis. The site is secure. Thank you for submitting a comment on this article. Patient samples that are not detectable are presented as the value of logarithm transformation of limit of quantification (LOQ), indicated by the blue dotted line. In one review, an ESR of 100 mm per hour or greater had a high specificity for malignancy (96%) and infection (97%), and its positive predictive value was 90%.29 A normal ESR has a high negative predictive value for temporal arteritis.28,30 An ESR that is not elevated has no diagnostic value and does not rule out neoplastic or other disorders.27 CRP level is a sensitive marker for infection and inflammation, but it is not sensitive enough to discriminate between disease processes.28 However, a more recent prospective study found that the chance of establishing a diagnosis was higher in patients who had an elevated CRP level and ESR.15, Procalcitonin is a newer marker specific for bacterial infection. Several diagnostic algorithms have been suggested for FUO, but few are supported by evidence from prospective studies.17 Region-specific serologic tests, more advanced radiologic studies, and more invasive diagnostic procedures can be guided by potentially diagnostic clues. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are nonspecific acute-phase reactants that are routinely part of the evaluation of febrile patients.5,28 An extremely elevated ESR (100 mm per hour or greater) suggests etiologies such as abdominal or pelvic abscess, osteomyelitis, and endocarditis. Huy NT, Van Giang T, Thuy DH, Kikuchi M, Hien TT, Zamora J, Hirayama K. PLoS Negl Trop Dis. McClung HJ. In many cases, no specific cause of the fever is found, 2 . In this study, we aim to examine the characteristics of patients who developed these patterns of fever and their correlation to cytokine levels, as well as the association with adverse outcomes in COVID-19. 2021 Mar 8;9(1):E181-E188. Empiric antibiotics or steroids are generally discouraged in patients with fever of unknown origin. Empiric trials of antibiotics or steroids rarely establish a diagnosis and are discouraged in the management of patients with FUO, unless there are clinical indications.5,17,19,21,22 Consultation with a subspecialist (e.g., infectious disease specialist, rheumatologist, hematologist/oncologist) is appropriate at any point in the evaluation. Demographic and comorbidity data, symptoms and signs, vital signs, and laboratory and radiology results were obtained from electronic medical records. Corticosteroids for treating mild COVID-19: opening the floodgates of therapeutic misadventure. https://www.who.int/docs/default-source/coronaviruse/situation-reports/2 https://www.moh.gov.sg/news-highlights/details/confirmed-imported-case-o https://www.moh.gov.sg/news-highlights/details/seven-more-confirmed-case World Health Organization. Bookshelf In contrast, cases with saddleback fever showed no significant change upon repeating their laboratory tests. Two remained in the general ward throughout their stay without any complications, while 2 were admitted to the ICU, 1 of whom died from acute respiratory distress syndrome. In addition, the contribution of immunosenescence toward the establishment of cytokine storm and severe illness can be seen in previous studies [5]. Fever, face edema, fatigue, fungal infection, malaise, . But there are some important differences. For most people, a temperature of 98.6 F or 37 C is baseline. This site needs JavaScript to work properly. Epub 2022 Aug 27. One case with prolonged fever had concomitant infection with ventilator-associated pneumonia, with Klebsiella pneumoniae grown from his endotracheal aspirate on day 8 of ICU admission (day 15 of illness). This corresponded with a rise in CRP and LDH seen in cases with prolonged fever, which are known to be associated with adverse prognostic factors in COVID-19 [15, 16]. Age-appropriate or potentially diagnostic clueguided cancer screening should be performed (e.g., colonoscopy in patients 50 years or older). Rheumatic fever mostly affects children aged 5-15 years, but it is rare in adults and children aged under 3 years. Extreme poverty first: An argument on the equitable distribution of the COVID-19 vaccine in Peru. Ahmed S, Mohammad WW, Hamid F, Akhter A, Afzal RK, Mahmood A. J Coll Physicians Surg Pak. Blue and red represent low and high concentrations, respectively. However, this view of fever is merely an oversimplification as a growing body of evidence now suggests that fever represents a complex adaptive response of the host to various immune challenges whether infectious or non-infectious. Home or community isolation facilities are commonly used globally for less sick patients such that hospital beds are free up to cater for sicker patients. PLoS Negl Trop Dis 2012; 6(8): e1760 10.1371/journal.pntd.0001760 In conclusion, we reported on the prevalence, risk factors, cytokine profiles, and outcomes of patients with COVID-19 who had saddleback or prolonged fever. The differences in cytokine and chemokine profiles among [the three groups] suggest that different immunological responses could result in the differences in the clinical phenotype observed, said Ng and co-authors.

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