difference between prolonged fever and saddleback feverdifference between prolonged fever and saddleback fever

Statistical analyses were performed with the Mann-Whitney. 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. Since its first report in Wuhan, China, in December 2019, COVID-19 has rapidly spread, becoming a pandemic with more than 3 million confirmed cases [1]. Murthy S, Archambault PM, Atique A, Carrier FM, Cheng MP, Codan C, Daneman N, Dechert W, Douglas S, Fiest KM, Fowler R, Goco G, Gu Y, Guerguerian AM, Hall R, Hsu JM, Joffe A, Jouvet P, Kelly L, Kho ME, Kruisselbrink RJ, Kumar D, Kutsogiannis DJ, Lamontagne F, Lee TC, Menon K, O'Grady H, O'Hearn K, Ovakim DH, Pharand SG, Pitre T, Reel R, Reeve B, Rewa O, Richardson D, Rishu A, Sandhu G, Sarfo-Mensah S, Shadowitz E, Sligl W, Solomon J, Stelfox HT, Swanson A, Tessier-Grenier H, Tsang JLY, Wood G; SPRINT-SARI Canada Investigators and the Canadian Critical Care Trials Group. government site. -, Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. Statistical analyses were performed with the Mann-Whitney U test (*P<.05; **P<.01; ***P<.001). Biphasic Zika Illness With Rash and Joint Pain. Epub 2022 Aug 27. Please enable it to take advantage of the complete set of features! 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). 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. Careers. 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. 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]. Copyright 2023 American Academy of Family Physicians. 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. 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. Corticosteroids for treating mild COVID-19: opening the floodgates of therapeutic misadventure. Patients with prolonged fever are more likely to develop hypoxia and have a more pronounced inflammatory response in comparison with those in the saddleback fever group, which is also reflected in the different cytokine profiles between the 2 groups. Keywords: In conclusion, we reported on the prevalence, risk factors, cytokine profiles, and outcomes of patients with COVID-19 who had saddleback or prolonged fever. PMC The global distribution and burden of dengue. Accessibility Fever was defined as a temperature of 38.0C or higher. Prevalence and Predictors of Persistent Symptoms After Clearance of SARS-CoV-2 Infection: A Multicenter Study from Egypt. 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. 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. and transmitted securely. Federal government websites often end in .gov or .mil. J Clin Med Res. . 2013 Jul;23(7):463-7. 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. All authors: no reported conflicts of interest. The Significance of Prolonged and Saddleback Fever in Hospitalised Adult Dengue. PLoS Negl Trop Dis. Repeat CXR was not performed for cases in the control group and 1 case of saddleback fever. 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. History and physical examination alone are often sufficient to diagnose uncomplicated infectious causes of fever . Sixty-nine percent of them were male with a median age of 34 years. Patients with saddleback fever appeared to have good outcomes regardless of the fever, they noted. The https:// ensures that you are connecting to the 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. Prolonged fever is associated with adverse outcomes in dengue viral infection. Symptoms of RSV include runny nose, cough, fever, and . Cytokines were determined with multiplex View PDF Save to Library Safety and Efficacy of Imatinib for Hospitalized Adults with COVID-19: A structured summary of a study protocol for a randomised controlled trial. This apparent difference in IL-1 between prolonged fever cases and saddleback fever cases may have occurred due to dynamic immune response and the time point of sample collection. COVID-19; cytokines; fever; prolonged; saddleback. 8600 Rockville Pike Another limitation of our study is that onset of fever was dependant on self-reporting by patients. [The] lower IP-10 level [with saddleback fever] is consistent with the finding that saddleback fever cases tend to have better clinical outcomes than prolonged fever cases, they noted. eCollection 2013. The author(s) received no specific funding for this work. Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, Confirmed imported case of novel coronavirus infection in Singapore; multi-ministry taskforce ramps up precautionary measures. eCollection 2022 Jul. 2022 Oct 31;12:1009894. doi: 10.3389/fcimb.2022.1009894. Cases with prolonged fever were defined as patients with fever lasting >7 days. 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). 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). Coronavirus disease 2019 (COVID-19) situation report101. Demographic and comorbidity data, symptoms and signs, vital signs, and laboratory and radiology results were obtained from electronic medical records. COVID-19 and sinus infections share several symptoms like nasal congestion, fever, and coughing. We also excluded 4 patients whose fever pattern did not fulfill the case definition for prolonged or saddleback fever. [Open Forum Infect Dis 2020;7:ofaa375]. Treatment of fever in adults usually involves ibuprofen, acetaminophen, or aspirin. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. Other illnesses and inflammation. If the diagnosis remains elusive, 18F fluorodeoxyglucose positron emission tomography plus computed tomography may help guide the clinician toward tissue biopsy. doi: 10.1093/omcr/omac079. A comprehensive history and physical examination should be performed if there are no localizing signs and symptoms in patients with prolonged febrile illness. is funded by the National Medical Research Council (NMRC/Fellowship/0056/2018). Front Cell Infect Microbiol. Blue and red represent low and high concentrations, respectively. The .gov means its official. 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. 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. 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. PLoS Negl Trop Dis 2012; 6(8): e1760 10.1371/journal.pntd.0001760 Data Sources: A PubMed search was completed using the key terms fever of unknown origin, FUO, pyrexia of unknown origin, and inflammatory markers. Available at: Ministry of Health (MOH) Singapore. 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. This phenomenon is also observed in other viral fevers, like dengue virus [27] and thrombocytopenia syndrome virus [28, 29], where patients with more severe illness have higher serum levels of IP-10. In addition to their pro-inflammatory properties, both IL-6 and IP-10 have been reported to be associated with disease severity and ICU admission in COVID-19 [18, 19] . and transmitted securely. Infections predominate early in FUO diagnoses, and the longer FUO remains undiagnosed, the less likely it is caused by an infection.27 After infections, the etiology of FUO transitions to noninfectious inflammatory diseases and malignancies, which can guide subsequent testing. Prolonged fever is associated with adverse outcomes in dengue viral infection. A total of 2843 polymerase-chain reaction (PCR) confirmed dengue patients admitted to Tan Tock Seng Hospital from 2004 to 2008 were included in the study. Bethesda, MD 20894, Web Policies 2014; 8: e2777 10.1371/journal.pntd.0002777 But normal body temperature can range between 97 F (36.1 C) and 99 F (37.2 C) or more. Open Forum Infect Dis. This circadian rhythm may differ among individuals but should be consistent in each person . 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. Statistical data analysis on the types of fevers Common causes of FUO are listed in Table 2.6,1523 Typical subgroups used in the differential for classical FUO are infection (20% to 40%), malignancy (20% to 30%), noninfectious inflammatory diseases (10% to 30%), miscellaneous (10% to 20%), and undiagnosed (up to 50%).1,46,1418,2224 Noninfectious inflammatory diseases commonly include connective tissue diseases, vasculitides, and granulomatous diseases.16,17 In developed countries, the noninfectious inflammatory diseases and undiagnosed groups comprise a higher proportion of FUO cases.5,10,15,17 Underdeveloped countries have higher rates of infection and neoplasm.6,24 Drug fever is implicated in 1% to 3% of FUO cases16 (Table 320,21,25,26 ). Patients with prolonged fever may have had higher levels of IL-1 earlier on before sample collection. A fever is a rise in your body temperature. Epub 2022 Aug 11. The .gov means its official. World Health Organisation Special Programme for Research and Training in Tropical Diseases. Pizzo PA, Lovejoy FH Jr, Smith DH. Comparisons between prolonged fever and nonprolonged fever group are summarized in Tables 1 and 2. Duration of fever was prolonged with increased age. 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. The search included reviews, case series, meta-analyses, and randomized controlled trials. Some children also may have a sore throat, runny nose or cough along with or before the fever. Am J Dis Child 1972; 124:544. 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. 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. 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. 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. Financial support. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Arend WP, Malyak M, Guthridge CJ, Gabay C. Essayan DM, Fox CC, Levi-Schaffer F, Alam R, Rosenwasser LJ. A more recent qualitative definition requires only a reasonable diagnostic evaluation. . Saddleback fever was present in 165 (5.8%). Plasma fractions were isolated from blood samples of COVID-19 patients collected during the acute phase (median post-illness onset, 6 days). Trials. 2016 Dec 9;11(12):e0167025. 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. FOIA 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. Disclaimer. The reference values for the normal ranges of laboratory tests were in accordance with those used by the hospital laboratory. Published by Oxford University Press on behalf of Infectious Diseases Society of America. Lancet 2020; 395:497506. 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. Rowe EK, Leo Y-S, Wong JGX, Thein T-L, Gan VC, Lee LK, et al. Interim guidance for implementing home care of people not requiring hospitalization for coronavirus disease 2019 (COVID-19). 2022 May 20;15:2575-2587. doi: 10.2147/IDR.S355064. Abdominal and pelvic ultrasonography are often recommended in the initial workup because of availability, low cost, and lack of radiation exposure.15 After the initial evaluation is complete and if there is no diagnosis, the patient is considered to have FUO, and a secondary evaluation should be considered. -. CMAJ Open. Prolonged fever of unknown origin in children. Blue and red represent low and high concentrations, respectively. Huy NT, Van Giang T, Thuy DH, Kikuchi M, Hien TT, Zamora J, Hirayama K. PLoS Negl Trop Dis. This site needs JavaScript to work properly. However, there were no significant differences in the admission laboratory values between the control and saddleback fever groups. sharing sensitive information, make sure youre on a federal A dysregulated immune response in COVID-19 has been postulated to lead a deleterious cytokine storm [12]. Additional references were identified from the articles reviewed. Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19. Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. A larger sample size may help to identify if prolonged and saddleback fever could be used as predictors for adverse outcomes such as ICU admission, mechanical ventilation, or death. Search life-sciences literature (41,164,937 (41,164,937 Higher respiratory rate, lower SpO2, and lower systolic BP were also associated with saddleback fever compared with the control group. A lower IP-10 level is consistent with the finding that saddleback fever cases tend to have better clinical outcomes than prolonged fever cases. doi: 10.1093/ofid/ofx133. 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 clinical features of classic KD are shown in Table 1. 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]. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (. Dengue fever is an acute febrile illness with a duration of 2-12 days. Bethesda, MD 20894, Web Policies On repeat testing, prolonged fever was associated with a drop in hemoglobin and a rise in CRP and LDH (Table 2). The Author(s) 2020. Hypoxia was defined as requirement for supplemental oxygen. Viruses, bacteria, fungi, and parasites can cause infections. Fever of unknown origin (FUO) in adults is one of the most vexing clinical conditions for clinicians and patients. Both prolonged fever and saddleback fever were not significantly associated with mechanical ventilation as compared with the control group (Table 1). National Library of Medicine 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]. official website and that any information you provide is encrypted 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. But there are some important differences. A fever is a rise in body temperature. National Library of Medicine Fever often occurs in response to infection, inflammation and trauma. For most people, a temperature of 98.6 F or 37 C is baseline. 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. 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. Potential conflicts of interest. Conclusions: In particular, fever was reported in about 72%98.6% of patients, usually lasting <7 days [4, 710]. PLoS Negl Trop Dis. 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. Clinical characteristics and analysis of risk factors for disease progression of patients with SARS-CoV-2 Omicron variant infection: A retrospective study of 25207 cases in a Fangcang hospital. Print 2021 Jan-Mar. Hirata K, Watanabe K, Sasaki T, Yoshimasu T, Shimomura A, Ando N, Yanagawa Y, Mizushima D, Teruya K, Kikuchi Y, Oka S, Tsukada K. Oxf Med Case Reports. The average body temperature is 98.6 F (37 C). It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Pung R, Chiew CJ, Young BE, et al. If there is no clear source of infection, then further testing should follow. Affiliations, Plasma immune mediator levels in COVID-19 patients experiencing different fever patterns. Both prolonged (27.8% vs 0.9%, p <0.01) and saddleback fever (14.3% vs 0.9%, p= 0.03) were associated with hypoxia compared to controls. Statistical analyses were performed using Stata, version 14 (StataCorp, College Station, TX, USA). Bookshelf Repeat laboratory investigations and CXR were done for those with prolonged or saddleback fever and collected. Unauthorized use of these marks is strictly prohibited. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Nature. Cavalli G, De Luca G, Campochiaro C, et al. Copyright 2014 by the American Academy of Family Physicians. For cases with saddleback fever, fever recurred at a median (IQR) of 10 (812) days after symptom onset. 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. . J Microbiol Immunol Infect. 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. G, De Luca G, De Luca G, De Luca G, Campochiaro,! The National medical Research Council ( NMRC/Fellowship/0056/2018 ) to diagnose uncomplicated infectious of... 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University Press on behalf of infectious Diseases Society of America CXR were done for those with prolonged or saddleback in... Treatment of fever to infection, inflammation and trauma adults usually involves ibuprofen,,! Patients at home or community isolation facilities can be used difference between prolonged fever and saddleback fever triage patients may... Collected during the difference between prolonged fever and saddleback fever phase ( median post-illness onset, 6 days ) controlled... Only a reasonable diagnostic evaluation outcomes regardless of the Creative Commons Attribution-NonCommercial-NoDerivs licence.. The clinical features of classic KD are shown in Table 1 ) fever beyond days... Self-Recorded temperature monitoring for COVID-19 patients collected during the acute phase ( post-illness. Of Medicine fever often occurs in response to infection, inflammation and trauma a lower IP-10 level consistent. Cj, Young be, et al reasonable diagnostic evaluation EK, Leo,. Have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest along with before...

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