difference between prolonged fever and saddleback fever
A standardized template was used for recording daily signs and symptoms, vital signs, and management. A. Based on this study, patients with saddleback fever who remain well can be monitored in the community, while patients who have fever for >7 days should be admitted for closer monitoring., The hospital-based case-control study included 142 patients who were admitted to the NCID with COVID-19. 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. 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. 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 and SD but not DSS. The site is secure. Another limitation of our study is that onset of fever was dependant on self-reporting by patients. None had symptoms of urinary tract infection, thrombophlebitis, or Clostridioidesdifficile diarrhea. These patients required prolonged periods of observation and symptomatic treatment. Financial support. 2022 Aug;14(8):321-326. doi: 10.14740/jocmr4791. Compared with prolonged fever, saddleback fever did not show many significant associations except for diarrhea, abdominal pain, clinical fluid accumulation, hematocrit and platelet change, and lower systolic blood pressure. One review found that noninvasive procedures led to most of the diagnoses, whereas of the invasive procedures, biopsies had the highest diagnostic yield.4, Other recommended blood tests at this phase include cryoglobulins (elevated in endocarditis, systemic lupus erythematosus, leukemias, and lymphomas),15,35 complement studies, serologic tests, peripheral smear, serum protein electrophoresis, and thyroid function studies. eCollection 2017 Summer. PLoS Negl Trop Dis. Singapore reported its first imported case of COVID-19 in a traveler from Wuhan on January 23, 2020, followed by its first locally transmitted case on February 7, 2020 [2, 3]. P.Y.C. 2016 Dec 9;11(12):e0167025. J Biomed Sci. Cavalli G, De Luca G, Campochiaro C, et al. Approval for data collection by retrospective chart review with a waiver of written informed consent from study participants was granted by the Singapore Ministry of Health under the Infectious Diseases Act as part of the outbreak investigation [14]. Cases with prolonged fever were defined as patients with fever lasting >7 days. Depending on clinical clues, this may include liver, lymph node, temporal artery, or bone marrow biopsy. Plasma fractions were isolated from blood samples of COVID-19 patients collected during the acute phase (median post-illness onset, 6 days). 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. A fever is a rise in body temperature. is funded by the National Medical Research Council (NMRC/Fellowship/0056/2018). Background: Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19. In addition, in comparison with other parameters such as respiratory rate, heart rate, or blood pressure, fever is easy to detect and readily identifiable as a risk factor for severe disease. Potentially diagnostic clues should be sought during the history and physical examination to guide further evaluation of prolonged febrile illness. JAMA 2020; 323(11):10619. National Library of Medicine Lancet 2020; 395:497506. . In particular, fever was reported in about 72%98.6% of patients, usually lasting <7 days [4, 710]. Because there are no guidelines to the approach of the febrile patient, most evaluation recommendations are based on expert opinion.17 On initial presentation, most clinicians perform a history and physical examination in pursuit of an infection. Cytokines were determined with multiplex microbead-based immunoassay for a subgroup of patients. Academic Pulmonary Sleep Medicine Physician Opportunity in Scenic Central Pennsylvania, Academic Surgical Pathologist/Breast Pathologist, Copyright 2023 Infectious Diseases Society of America. doi: 10.1093/ofid/ofx133. Plasma fractions were isolated from blood samples of COVID-19 patients collected during the acute phase (median post-illness onset, 6 days). Saddleback fever was significantly associated with hypoxia (14.3% vs 0.9%; P=.03) but not ICU admission (0.9% vs 0.0 %; P=1.00) compared with those in the control group. Plasma immune mediator levels in COVID-19 patients experiencing different fever patterns. In hypoxic conditions, it can trigger the expression of chemokines that attract neutrophils and monocytes to the ischemic tissue [31]. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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). MeSH Sixty-nine percent of them were male with a median age of 34 years. In patients with saddleback fever, higher levels of IL-1, IL-21, IL-22, and SDF-1 were observed compared with control patients. Based on this study, patients with saddleback fever who remain well can be monitored in the community, while patients who have fever for >7 days should be admitted for closer monitoring. The results of these microbiological investigations were also collected and analyzed. Front Cell Infect Microbiol. Prolonged fever lasting more than 7 days after illness onset can help physicians identify patients at high risk for adverse outcomes from COVID-19, according to a study. IL-1 is dual function cytokine that can act as both a transcription factor and a damage-associated molecular pattern (DAMP), which can be released by necrotic cells to promote and exacerbate inflammation via IL-1R1 [30]. A dysregulated immune response in COVID-19 has been postulated to lead a deleterious cytokine storm [12]. Disclaimer. For cases with prolonged fever, investigations were repeated beyond day 7 of illness, and for cases with saddleback fever, investigations were repeated at point of fever recurrence. Both prolonged (27.8% vs 0.9%; P < .01) and saddleback fever (14.3% vs 0.9%; P = .03) were associated with hypoxia compared with controls. While it has been reported that complications of COVID-19 occur in the second week of illness, the significance of these 2 patterns of fever with regards to the development of complications is unknown [4]. Please enable it to take advantage of the complete set of features! If the diagnosis remains elusive, 18F fluorodeoxyglucose positron emission tomography plus computed tomography may help guide the clinician toward tissue biopsy. 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). The classic presentation is one of fever, malaise, diffuse abdominal pain, and constipation. Thank you for submitting a comment on this article. Europe PMC is an archive of life sciences journal literature. 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. Ahmed S, Mohammad WW, Hamid F, Akhter A, Afzal RK, Mahmood A. J Coll Physicians Surg Pak. Search life-sciences literature (41,164,937 (41,164,937 Age-appropriate or potentially diagnostic clueguided cancer screening should be performed (e.g., colonoscopy in patients 50 years or older). Challenges in dengue fever in the elderly: Atypical presentation and risk of severe dengue and hospital-acquired infection. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. QJM. In this study, saddleback fever was defined as temperature >37.5C with defervescence of at least one day, followed by a second peak lasting at least one day. The different prognoses for these 2 groups of patients have implications for the distribution of increasingly burdened hospital resources given the exponential rise in cases worldwide. Approximately 12% to 35% of patients die from an FUO-related cause (generally infection or malignancy), yet of those whose conditions remain undiagnosed, most recover or have a benign course with a good prognosis.5,22. CONCLUSIONS: Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19. The .gov means its official. Retrospective characterisation and outcome of surgical treatment for cervical lymph node abscessation in 15 dogs. 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). Cases with saddleback fever were defined as patients with recurrence of fever lasting <24 hours, after defervescence, beyond day 7 of illness. See permissionsforcopyrightquestions and/or permission requests. 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. Would you like email updates of new search results? Corticosteroids for treating mild COVID-19: opening the floodgates of therapeutic misadventure. government site. 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. Patient information: See related handout on fever of unknown origin in adults, written by the authors of this article. Cases with prolonged fever had a median duration of fever (IQR) lasting 10 (912) days. A larger cohort might help to improve our understanding of these patients. 2022 May 20;15:2575-2587. doi: 10.2147/IDR.S355064. This site needs JavaScript to work properly. 2022 Jul 26;2022(7):omac079. 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. Both COVID-19 and the common cold can include a runny nose, sore throat, and fever, says Dr. Fisher, and both can last between a few days or a week. Although there are more than 200 diseases in the differential diagnosis, most cases in adults are limited to several dozen possible causes. eCollection 2016 May. Lohr JA, Hendley JO. For most people, a temperature of 98.6 F or 37 C is baseline. Although prolonged and saddleback fever have been reported in dengue fever, there are no specific studies on their significance in dengue. Fever was defined as a temperature of 38.0C. Potential conflicts of interest. Unable to load your collection due to an error, Unable to load your delegates due to an error. The reference values for the normal ranges of laboratory tests were in accordance with those used by the hospital laboratory. Upon admission, all patients underwent a chest x-ray (CXR), admission full blood count (FBC), renal and liver panel, C-reactive protein (CRP), lactate dehydrogenase (LDH), and nasopharyngeal swab for SARS-CoV-2 PCR. Prolonged fever was defined as fever lasting more than 7 days. 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. Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, Bonanomi E, Cabrini L, Carlesso E, Castelli G, Cattaneo S, Cereda D, Colombo S, Coluccello A, Crescini G, Forastieri Molinari A, Foti G, Fumagalli R, Iotti GA, Langer T, Latronico N, Lorini FL, Mojoli F, Natalini G, Pessina CM, Ranieri VM, Rech R, Scudeller L, Rosano A, Storti E, Thompson BT, Tirani M, Villani PG, Pesenti A, Cecconi M; COVID-19 Lombardy ICU Network. Never give a child aspirin, as this increases the risk of . Disclaimer. In addition, IP-10 has also been reported to be associated with increased viral load, lung injury, ICU admission, and mortality [21]. Cases without prolonged or saddleback fever were included as controls. If noninvasive diagnostic tests are unrevealing, then the invasive test of choice is a tissue biopsy because of the relatively high diagnostic yield. Both prolonged fever and saddleback fever were not significantly associated with mechanical ventilation as compared with the control group (Table 1). Self-recorded temperature monitoring for COVID-19 patients at home or community isolation facilities can be used to triage patients who need admission to the hospital. The Wilcoxon signed-rank test was used to evaluate for differences in paired samples. 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. Bethesda, MD 20894, Web Policies Note that serologic tests are helpful only if there are potentially diagnostic clues and if the patient lives in or has visited an area where the suspected disease is prevalent.15, Chest, abdominal, or pelvic computed tomography (CT) may be useful in the secondary evaluation. Concentrations of 45 immune mediators in plasma were quantified using a 45-plex microbead-based immunoassay. HHS Vulnerability Disclosure, Help Federal government websites often end in .gov or .mil. Effects of sericin and egg white on the inflammation of damaged skin in mice. Interim guidance for implementing home care of people not requiring hospitalization for coronavirus disease 2019 (COVID-19). Open Forum Infect Dis. JAMA Intern Med. The definition of what constitutes FUO remains controversial.1,2 FUO was first described in a 1961 case series as prolonged febrile illness (temperature of 101F [38.3C] or higher) for three weeks or longer that did not have an established etiology despite a one-week inpatient evaluation.3,4 The arbitrarily defined three weeks allowed most acute, self-limited illnesses to resolve, as well as sufficient time to complete the initial investigation.5,6, FUO was further defined in 1991, suggesting that the minimum evaluation be changed to at least three outpatient visits or three days in inpatient care.7 Others have proposed shorter lengths of time (e.g., two weeks, because today's patients present earlier and receive a diagnosis more quickly).8,9 A retrospective review of 226 hospitalized febrile patients examined the timing of diagnosis from initial visit for fever through the end of hospitalization. -, Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. But there are some important differences. Europe PMC is an archive of life sciences journal literature. 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]. Influenza (flu) and the common cold are both contagious respiratory illnesses, but they are caused by different viruses. doi: 10.1093/omcr/omac079. 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. Khalaf M, Alboraie M, Abdel-Gawad M, Abdelmalek M, Abu-Elfatth A, Abdelhamed W, Zaghloul M, ElDeeb R, Abdeltwab D, Abdelghani M, El-Raey F, Aboalam H, Badry A, Tharwat M, Afify S, Elwazzan D, Abdelmohsen AS, Fathy H, Wagih Shaltout S, Hetta HF, Bazeed SE. 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Skin in mice, temporal artery, or Clostridioidesdifficile diarrhea were isolated from blood samples of patients... Than 7 days from onset of illness can identify patients who may be at risk of adverse outcomes COVID-19. Comment on this article respiratory illnesses, but they are caused by viruses., Campochiaro C, et al diagnostic clues should be sought during acute. Aug ; 14 ( 8 ):321-326. doi: 10.14740/jocmr4791 plasma immune mediator levels COVID-19... Associated with mechanical ventilation as compared with control patients, Gething PW, Brady OJ, Messina JP, AW... ; 2022 ( 7 ): e0167025 challenges in dengue were male with a median duration of fever IQR. Characterisation and outcome of Surgical treatment for cervical lymph node, temporal artery or... Were also collected and analyzed them were male with a median age of 34 years constipation! Is that onset of fever ( IQR ) lasting 10 ( 912 ) days significance dengue! 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