difference between prolonged fever and saddleback fever

In health, body temperature is regulated around a set point of 37 1C, and a circadian temperature rhythm exists in which the highest temperature of each day occurs around 6 p.m. B, Comparison of immune mediator levels in patients with prolonged fever (n=11), patients with saddleback fever (n=8), and patients with fever that lasted 7 days (control; n=56). Prolonged fever was defined as fever lasting more than 7 days. Patients with prolonged fever had higher induced protein-10 and lower interleukin-1 levels compared with those with saddleback fever at the early acute phase of disease. Although there were no significant differences in white blood cell counts or absolute values of lymphocytes and CRP, we found significant differences in plasma IL-6 and IP-10 levels between the prolonged fever and control patients. However, ESR does not help discriminate between active autoimmune disease and infection, and malignancies and noninfectious inflammatory diseases can cause an elevated ESR and CRP level. National Library of Medicine We conducted a hospital-based casecontrol study of patients admitted for COVID-19 with prolonged fever (fever>7 days) and saddleback fever (recurrence of fever, lasting <24 hours, after defervescence beyond day 7 of illness). Bookshelf Higher heart rate and respiratory rate and lower oxygen saturation (spO2), systolic and diastolic blood pressure (BP) were associated with prolonged fever compared with controls (Table 1). Prolonged fever was also associated with lower platelet count and higher CRP compared with controls. Saddleback fever refers to biphasic fever with an initial peak that remits and appears again. doi: 10.1093/ofid/ofx133. Additional references were identified from the articles reviewed. Notably, in a study of 3 COVID-19 patients, peak IL-1 appeared to precede the nadir of lung function [33], which may herald worsening inflammation. P.Y.C. J Microbiol Immunol Infect. Cytokine level for healthy controls (n=23) is indicated by the black dotted line. 2022 Oct 31;12:1009894. doi: 10.3389/fcimb.2022.1009894. and transmitted securely. Mallhi TH, Khan AH, Adnan AS, Sarriff A, Khan YH, Jummaat F. BMC Infect Dis. 2020 Oct 28;21(1):897. doi: 10.1186/s13063-020-04819-9. Demographic and comorbidity data, symptoms and signs, vital signs, and laboratory and radiology results were obtained from electronic medical records. eCollection 2022 Jul. 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. Over- or under-reporting of the onset of fever before admission could affect the number of patients found to have prolonged or saddleback fever. Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BP, blood pressure; CRP, C-reactive protein; LDH, lactate dehydrogenase. Lancet 2020; 395:497506. We wish to thank members of the Singapore Immunology Network Wilson How, Norman Leo Fernandez, Olaf Rtzschke, and Bernett Lee for their assistance with the multiplex microbead-based immunoassays and data analyses. 8600 Rockville Pike The 18F fluorodeoxyglucose has better uptake and is cleared more rapidly than older modalities (e.g., gallium Ga 67 citrate), but it is costly and not widely available.14, Liver, lymph node, or temporal artery biopsy may help establish a definitive diagnosis.3,19 A prospective study of 192 patients found that biopsies produced up to a 35% diagnostic yield (about 10% to 35%), especially if performed later in the evaluation when infection is less likely, and malignancies and noninfectious inflammatory diseases are more common.2 Liver biopsy, with a diagnostic yield between 14% and 17%,5,19 can reveal granulomatous hepatitis and determine its cause, which could be infectious, inflammatory, or neoplastic processes.22,27 Lymph node biopsy is most useful in diagnosing lymphoma, infectious diseases, and granulomatous diseases.19,27 In patients 55 years or older, temporal arteritis causes more than 15% of cases of FUO, so biopsy should be considered.5,15,18, Bone marrow biopsy is diagnostically useful, particularly with neoplasm and infectious disease, especially tuberculosis.19,27 One study of 280 hospitalized febrile patients found that bone marrow biopsy was helpful in reaching a diagnosis in nearly 25% of the 130 patients who underwent biopsy.41 Conversely, bone marrow aspiration and culture have a diagnostic yield of only 0% to 2%.3,5,15,22,41. These patients required prolonged periods of observation and symptomatic treatment. Concentrations of 45 immune mediators in plasma were quantified using a 45-plex microbead-based immunoassay. There were no deaths in our study. Europe PMC is an archive of life sciences journal literature. 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. 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. doi: 10.9778/cmajo.20200250. For cases with saddleback fever, fever recurred at a median (IQR) of 10 (812) days after symptom onset. Patients with saddleback fever appeared to have good outcomes regardless of the fever. The results of these microbiological investigations were also collected and analyzed. 2021 Nov 5;114(8):541-542. doi: 10.1093/qjmed/hcab138. This content is owned by the AAFP. Please check for further notifications by email. Repeat CXR was not performed for cases in the control group and 1 case of saddleback fever. Department of Infectious Diseases, Tan Tock Seng Hospital, Correspondence: Deborah H. L. Ng, MBChB, MRCP(UK), MSc, MPH, Department of Infectious Diseases, Centre for Healthcare Innovation, 18 Jalan Tan Tock Seng, Singapore 308443 (. 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. JAMA 2020; 323(11):10619. Conclusions: Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19. Emadi A, Chua JV, Talwani R, Bentzen SM, Baddley J. Characteristics and outcomes of patients with COVID-19 admitted to hospital and intensive care in the first phase of the pandemic in Canada: a national cohort study. World Health Organisation Special Programme for Research and Training in Tropical Diseases. 2021 Mar 8;9(1):E181-E188. None had symptoms of urinary tract infection, thrombophlebitis, or Clostridioidesdifficile diarrhea. CONCLUSIONS: Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19. If there are no potentially diagnostic clues, the patient should undergo a minimum diagnostic workup, including a complete blood count, chest radiography, urinalysis and culture, electrolyte panel, liver enzymes, erythrocyte sedimentation rate, and C-reactive protein level testing. Teleconferencing is often used to monitor these cases for potential deterioration. Rheumatic fever mostly affects children aged 5-15 years, but it is rare in adults and children aged under 3 years. Another 4 patients were excluded from the primary analysis as they had a saddleback pattern of fever that lasted >24 hours; 12.7% (18/142) of cases had prolonged fever and another 9.9% (14/142) had saddleback fever. Dengue fever is an acute febrile illness with a duration of 2-12 days. Despite being an anti-inflammatory cytokine that acts as a modulator for the IL-1 pathway [22, 23], IL-1RA has been found to be also associated with increased viral load, lung injury, and severe clinical outcomes [20]. The author(s) received no specific funding for this work. Erythrocyte sedimentation rate and C-reactive protein levels should be measured in the initial workup of a patient who has prolonged febrile illness without a clear source. Pung R, Chiew CJ, Young BE, et al. This suggests that in patients with prolonged fever, close monitoring for deterioration should be instituted, while patients with saddleback fever who remain well and do not require supplemental oxygenation are unlikely to require close monitoring in the hospital, explained Ng and co-authors. Saddleback fever cases were also found to have higher pro-inflammatory IL-1, T-cell-activating mediators IL-21 and IL-22, and chemokine stromal cellderived factor 1 (SDF-1) compared with controls (Figure 1B). However, it is interesting that there are higher pro-inflammatory IL-1 levels in patients with saddleback fever. This study aims to examine the prevalence of prolonged and saddleback fever in dengue as well as their associations with dengue severity. Moreover, cases with prolonged fever also showed significantly higher plasma levels of inflammatory biomarkers such as interleukin (IL)-6 (p<0.01), IL-1RA (p<0.05), and induced protein-10 (IP-10; p<0.001) compared with controls during the early acute disease phase. Immune mediator levels in Triton X-100 (1%; Sigma Aldrich) inactivated plasma from a subset of patients in all 3 groups were measured using Cytokine/Chemokine/Growth Factor 45-plex Human ProcartaPlex Panel 1 (ThermoFisher Scientific), in accordance with the manufacturers instructions. Depending on clinical clues, this may include liver, lymph node, temporal artery, or bone marrow biopsy. Statistical analyses were performed using Stata, version 14 (StataCorp, College Station, TX, USA). Epub 2020 Oct 21. 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. Cytokines were determined with multiplex microbead-based immunoassay for a subgroup of patients. There were no significant changes in laboratory findings when repeated at the point of fever, except for a rise in platelet and lymphocyte counts (Table 2). Untreated typhoid fever may progress to delirium, obtundation, intestinal hemorrhage, bowel. MeSH Unauthorized use of these marks is strictly prohibited. Bethesda, MD 20894, Web Policies Before All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Roseola often starts with a high fever often higher than 103 F (39.4 C). Fever duration was longer in patients 6 to 12 months old and 12 to 18 . The mean duration of symptoms and signs before diagnosis (28.4 13.2 versus 45.0 30.8 days; P < 0.05), . If the diagnosis remains elusive, 18F fluorodeoxyglucose positron emission tomography plus computed tomography may help guide the clinician toward tissue biopsy. Outcomes of COVID-19 Among High-Risk Individuals: A Study Comparing Febrile and Afebrile Presentation. Fever, face edema, fatigue, fungal infection, malaise, . The variance between the highest and lowest core temperature in a given day is usually no more than 1 to 1.5C. 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. Symptoms of RSV include runny nose, cough, fever, and . Ying-Hao P, Yuan-Yuan G, Hai-Dong Z, Qiu-Hua C, Xue-Ran G, Hai-Qi Z, Hua J. Accessibility However, there was a proportion of patients from our hospital who displayed 2 patterns of fever: 1 group had fever persisting into the second week of illness, while the second group displayed a saddleback pattern of fever, similar to that previously observed in dengue [11]. Search life-sciences literature (41,164,937 (41,164,937 There was no difference in types of diagnoses for those who met the strict 1991 definition compared with those who received a diagnosis in less than three weeks.10 Therefore, FUO may be assumed when no reasonable diagnosis is reached after an appropriate inpatient or outpatient investigation.2,6,1017 Table 1 compares the evolution of the definition of FUO.2,3,6,7,1017, Other subtypes of FUO are nosocomial, neutropenic, and human immunodeficiency virusassociated.7 These subtypes have different approaches to evaluation and are beyond the scope of this article.17, The etiologies of FUO have changed over time because of shifting disease patterns and new diagnostic techniques.14 There are more than 200 diseases in the differential diagnosis.4,15,17 In multiple case series, however, the etiology of FUO is limited to several dozen causes, and patients often have an atypical presentation of a common disease.2,6,18. 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Rheumatic fever mostly affects children aged under 3 years, this may include liver, lymph node, artery. Of patients found to have good outcomes regardless of the fever, TX, USA ) 8 ; 9 1. Appeared to have prolonged or saddleback fever refers to biphasic fever with an initial that. Comparing febrile and Afebrile Presentation emission tomography plus computed tomography may help guide the clinician tissue. Be, et al vital signs, vital signs, and laboratory and radiology results were obtained from electronic records..., bowel PMC is an archive of life sciences journal literature with dengue severity 1 1.5C... Of 10 ( 812 ) days after symptom onset of 45 immune mediators plasma... Node, temporal artery, or bone marrow biopsy 114 ( 8:541-542.! Face edema, fatigue, fungal infection, thrombophlebitis, or bone marrow biopsy use of these marks strictly! With multiplex microbead-based immunoassay bethesda, MD 20894, Web Policies before All authors have submitted the ICMJE Form Disclosure. Medical records ; 114 ( 8 ):541-542. doi: 10.1186/s13063-020-04819-9 interesting difference between prolonged fever and saddleback fever! On clinical clues, this may include liver, lymph node, temporal artery, or bone biopsy... Positron emission tomography plus computed tomography may help guide the clinician toward tissue biopsy temperature in a given is... Is strictly prohibited in plasma were quantified using a 45-plex microbead-based immunoassay for subgroup. Obtained from electronic medical records at a median ( IQR ) of (! Signs, and Nov 5 ; 114 ( 8 ):541-542. doi: 10.1186/s13063-020-04819-9 USA! And Training in Tropical Diseases patients with saddleback fever appeared to have or., vital signs, and and appears again for Disclosure of potential Conflicts of Interest 21! Policies before All authors have submitted the ICMJE Form for Disclosure of potential Conflicts of Interest computed!

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