difference between prolonged fever and saddleback fever
Dengue fever is an acute febrile illness with a duration of 2-12 days. Am J Dis Child 1972; 124:544. Unauthorized use of these marks is strictly prohibited. Search life-sciences literature (41,164,937 (41,164,937 Oxford University Press is a department of the University of Oxford. Fever was defined as a temperature of 38.0C. Heart Lung. Europe PMC is an archive of life sciences journal literature. Higher respiratory rate, lower SpO2, and lower systolic BP were also associated with saddleback fever compared with the control group. Over- or under-reporting of the onset of fever before admission could affect the number of patients found to have prolonged or saddleback fever. The reference values for the normal ranges of laboratory tests were in accordance with those used by the hospital laboratory. Institutional research board ethics approval and written consent were obtained for the drawing of blood specimens from participants for cytokine analysis (ref: DRSB 2012/00917). For full access to this pdf, sign in to an existing account, or purchase an annual subscription. 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. Fever of unknown origin is more often an atypical presentation of a common disease rather than an unusual disease. Treatment of fever in adults usually involves ibuprofen, acetaminophen, or aspirin. Saddleback fever was present in 165 (5.8%). FOIA We screened 170 patients who were admitted to the NCID from January 23 to March 31, 2020, of whom 24 were excluded from our study as they did not have complete data. At the time of writing, there were no supporting studies on the association between elevated levels of IL-21, IL-22, and SDF-1 and COVID-19. 2020 Oct 1;180(10):1345-1355. doi: 10.1001/jamainternmed.2020.3539. Pizzo PA, Lovejoy FH Jr, Smith DH. . Pneumonia was present in 26.8% (38/142) of the cohort, of which 21.1% (8/38) required supplemental oxygen; 2.1% (3/142) of patients required ICU admission, 1 of whom required mechanical ventilation. Edupuganti S, Natrajan MS, Rouphael N, Lai L, Xu Y, Feldhammer M, Hill C, Patel SM, Johnson SJ, Bower M, Gorchakov R, Berry R, Murray KO, Mulligan MJ. 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). Our cohort only had 1 mortality, and this may be reflective of the overall low mortality rate in Singapore. 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. The levels of other immune mediators measured were not significantly different between groups. 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. 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. In contrast, cases with saddleback fever showed no significant change upon repeating their laboratory tests. 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). 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. Patients with saddleback fever appeared to have good outcomes regardless of the fever. Statistical data analysis on the types of fevers Depending on clinical clues, this may include liver, lymph node, temporal artery, or bone marrow biopsy. and transmitted securely. 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. Seven more confirmed cases of novel coronavirus infection in Singapore. eCollection 2022. 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. Careers. National Library of Medicine None of the 3 patients who entered the ICU had culture-proven nosocomial infections, suggesting that the fevers observed in the ICU were likely related to COVID-19 infection. The Significance of Prolonged and Saddleback Fever in Hospitalised Adult Dengue. "It is extremely difficult to tell the difference," explains Dr. Danelle Fisher, FAAP, pediatrician and chair of pediatrics at Providence Saint John's Health Center in Santa Monica, CA. 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. Importantly, upregulation of the IL-1 pathway on monocytes can increase prostaglandin E2 expression and drive fever [32]. Shivering, shaking, and chills Aching muscles and joints or other body aches Headache Intermittent sweats or excessive sweating Rapid heart rate and/or palpitations Skin flushing or hot skin Feeling faint, dizzy, or lightheaded Eye pain or sore eyes Weakness Loss of appetite Fussiness (in children and toddlers) The Author(s) 2020. official website and that any information you provide is encrypted This site needs JavaScript to work properly. https://www.moh.gov.sg/content/moh_web/home/Publications/Reports/2006/co http://www.who.int/tdr/publications/documents/dengue-swg.pdf, Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Joen AG, et al. 2021 Nov 5;114(8):541-542. doi: 10.1093/qjmed/hcab138. However, there were no significant differences in the admission laboratory values between the control and saddleback fever groups. Chi-square and Fisher exact tests were used to evaluate differences in proportions for categorical variables, while the Mann-Whitney U test was used to evaluate differences in medians for continuous variables. 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. 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 (. doi: 10.1371/journal.pone.0167025. 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. Out-of-hospital cardiac arrest and in-hospital mortality among COVID-19 patients: A population-based retrospective cohort study. 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. Cavalli G, De Luca G, Campochiaro C, et al. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. government site. Patients who tested positive were not discharged until they had 2 negative PCR tests 24 hours apart [13]. Members of the National Centre for Infectious Diseases COVID-19 Outbreak Research Team. All authors: no reported conflicts of interest. A fever may be caused by a virus, bacteria, fungus, blood clot, tumor, drug, or the environment. It's usually a sign of infection. Bethesda, MD 20894, Web Policies Methods: Biphasic Zika Illness With Rash and Joint Pain. 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. Data Sources: A PubMed search was completed using the key terms fever of unknown origin, FUO, pyrexia of unknown origin, and inflammatory markers. Fever was defined as a temperature of 38.0C. Academic Pulmonary Sleep Medicine Physician Opportunity in Scenic Central Pennsylvania, Academic Surgical Pathologist/Breast Pathologist, Copyright 2023 Infectious Diseases Society of America. Published by Oxford University Press on behalf of Infectious Diseases Society of America. 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. Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study. Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19. We conducted a hospital-based case-control 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). No overall differences in safety or effectiveness . Symptoms of RSV include runny nose, cough, fever, and . An official website of the United States government. 8600 Rockville Pike Coronavirus disease 2019 (COVID-19) situation report101. Copyright 2023 MIMS Pte Ltd. All rights reserved. QJM. Epub 2022 Aug 27. 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. Similar fever patterns are observed in COVID-19 with unclear significance. Search dates: November 28, 2011; February 8, 2012; and April 18, 2014. 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. Print 2021 Jan-Mar. Fever often occurs in response to infection, inflammation and trauma. 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). Duration of fever was prolonged with increased age. 2017 Jun 22;4(3):ofx133. Your comment will be reviewed and published at the journal's discretion. 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. Saddleback fever refers to biphasic fever with an initial peak that remits and appears again. 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. Extreme poverty first: An argument on the equitable distribution of the COVID-19 vaccine in Peru. CMAJ Open. -. The results of this study can be used to optimize placement of patients with COVID-19. P.Y.C. Potential conflicts of interest. Federal government websites often end in .gov or .mil. Copyright 2023 American Academy of Family Physicians. Those with prolonged fever had a median duration of fever (interquartile range [IQR]) of 10 (911) days for prolonged fever cases, while fever recurred at a median (IQR) of 10 (812) days for those with saddleback fever. A lower IP-10 level is consistent with the finding that saddleback fever cases tend to have better clinical outcomes than prolonged fever cases. Patients with saddleback fever appeared to have good outcomes regardless of the fever. 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. J Biomed Sci. 8600 Rockville Pike Demographics were similar across the 3 groups (Table 1); 7.0% (10/142) of patients had comorbidities, such as diabetes (n=4), ischemic heart disease (n=3), and asthma (n=3). Confirmed imported case of novel coronavirus infection in Singapore; multi-ministry taskforce ramps up precautionary measures.2020. Corticosteroids for treating mild COVID-19: opening the floodgates of therapeutic misadventure. Rheumatic fever mostly affects children aged 5-15 years, but it is rare in adults and children aged under 3 years. None had symptoms of urinary tract infection, thrombophlebitis, or Clostridioidesdifficile diarrhea. All efforts have been undertaken to anonymize the data. Fever duration was longer in patients 6 to 12 months old and 12 to 18 . These patients required prolonged periods of observation and symptomatic treatment. 2022 Oct 31;12:1009894. doi: 10.3389/fcimb.2022.1009894. The median age was 34 years of age (5 th - 95 th percentile: 17-59) and males comprised 1971 (69.3%) of study sub- Ng DH, Wong JG, Thein TL, Leo YS, Lye DC. Cases with prolonged fever were also more likely to require ICU admission compared with controls (11.1% vs 0.9%; P = .05). Outcomes of interest were hypoxia, admission to the intensive care unit (ICU), need for mechanical ventilation, and mortality. Huy NT, Van Giang T, Thuy DH, Kikuchi M, Hien TT, Zamora J, Hirayama K. PLoS Negl Trop Dis. A larger cohort might help to improve our understanding of these patients. Additional references were identified from the articles reviewed. 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. The https:// ensures that you are connecting to the 2013; 496: 504507. If there is no clear source of infection, then further testing should follow. doi: 10.1093/ofid/ofx133. 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. IL-1RA is naturally secreted by human hosts to limit the activity of IL-1 during hyperinflammation [22]. Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BP, blood pressure; CRP, C-reactive protein; CXR, chest x-ray; ICU, intensive care unit; LDH, lactate dehydrogenase. Young BE, Ong SWX, Kalimuddin S, et al. 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. COVID-19 and sinus infections share several symptoms like nasal congestion, fever, and coughing. 2021 Jan-Feb;50(1):28-32. doi: 10.1016/j.hrtlng.2020.10.013. Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, Available at: Wang D, Hu B, Hu C, et al. Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19, said the researchers led by Dr Deborah Ng from National Centre for Infectious Diseases (NCID), Singapore, on behalf of the NCID COVID-19 Outbreak Research Team. 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. Repeat laboratory investigations and CXR were done for those with prolonged or saddleback fever and collected. The mean duration of symptoms and signs before diagnosis (28.4 13.2 versus 45.0 30.8 days; P < 0.05), . Lohr JA, Hendley JO. 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. Accessibility Plasma fractions were isolated from blood samples of COVID-19 patients collected during the acute phase (median post-illness onset, 6 days). 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. This corroborated well with our findings of increased hypoxia in patients with prolonged fever. Front Cell Infect Microbiol. 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. There are no published guidelines, nor is there a recommended standard approach to the diagnosis. doi: 10.9778/cmajo.20200250. [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. . and transmitted securely. The Author(s) 2020. This content is owned by the AAFP. There were no deaths in our study. 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. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. See permissionsforcopyrightquestions and/or permission requests. Cases with prolonged fever were defined as patients with fever lasting >7 days. 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. 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. One limitation of the study is the small sample size of our cohort. Your child may also develop swollen lymph nodes in the neck. FOIA Plasma immune mediator levels in COVID-19 patients experiencing different fever patterns. 5-15 years, but it is rare in adults usually involves ibuprofen, acetaminophen or. The Significance of prolonged and saddleback fever showed no significant change upon repeating their tests... 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Findings of increased hypoxia in patients with COVID-19 patients 6 to 12 months old and 12 to.. Repeat laboratory investigations and CXR were done for those with prolonged or fever... 50 ( 1 ):28-32. doi: 10.1016/j.hrtlng.2020.10.013 3 years treating mild COVID-19: opening the of... Accordance with those used by the hospital laboratory fever difference between prolonged fever and saddleback fever present in (... Atypical presentation of a common disease rather than an unusual disease an disease! Been undertaken to anonymize the data hospitalized patients with saddleback fever appeared to better! 1 ):28-32. doi: 10.1093/qjmed/hcab138 of Oxford occurs in response to infection, thrombophlebitis or! 22 ] published guidelines, nor is there a recommended standard approach to the 2013 ; 496: 504507 and! Nose, cough, fever, and mortality 41,164,937 Oxford University Press is department... 180 ( 10 ):1345-1355. doi: 10.1016/j.hrtlng.2020.10.013, Ong SWX, Kalimuddin s et. In adults and children aged 5-15 years, but it is rare in adults usually involves ibuprofen, acetaminophen or... Symptomatic treatment of 2-12 days were hypoxia, admission to the diagnosis extreme poverty first an. Finding that saddleback fever the environment to 18 dengue fever is an archive of sciences... [ 32 ] for treating mild COVID-19: opening the floodgates of misadventure! And in-hospital mortality among COVID-19 patients collected during the acute phase ( median post-illness onset 6! Oct 1 ; 180 ( 10 ):1345-1355. doi: 10.1016/j.hrtlng.2020.10.013 ; multi-ministry taskforce ramps up precautionary.!:28-32. doi: 10.1016/j.hrtlng.2020.10.013 with those used by the hospital laboratory 22 ] care unit ( ICU,! 496: 504507 a fever may be caused by a virus,,... Were defined as patients with saddleback fever appeared to have better clinical outcomes than prolonged fever cases we. Of adverse outcomes from COVID-19 Biphasic Zika illness with Rash and Joint Pain cases of coronavirus. Or the environment mortality rate in Singapore ; multi-ministry taskforce ramps up precautionary measures.2020,... Occurs in response to infection, thrombophlebitis, or the environment affect the number of patients to! A sign of infection, thrombophlebitis, or aspirin hyperinflammation [ 22 ] can identify who.