fever

Kikuchi-Fujimoto disease is a self-limited disease which is also known as histiocytic necrotizing lymphadenitis. The Kikuchi-Fujimoto disease is a rare cause of cervical lymphadenopathy, with or without systemic signs, such as fever, leukopenia, and skin rashes.

 We presented a case of Kikuchi-Fujimoto disease in a 29-year-old female mimicking sepsis after a COVID-19 infection. Clinical examination revealed stable vitals and multiple diffuse non-tender bilateral cervical and axillary lymph adenopathy with hepatosplenomegaly. The patient’s blood parameters showed leukopenia, raised erythrocyte sedimentation rate, lactate dehydrogenase, microcytic hypochromic anemia with normal renal and liver function tests. The patient was treated with broad spectrum intravenous antibiotics and subcutaneous neupogen with a clinical suspicion of sepsis. The patient then underwent a CT scan which validated the clinical findings. Although the fever subsided, a persistent cervical lymphadenopathy was observed and the biopsy confirmed it to be necrotising lymph adenitis secondary to Kikuchi-Fujimoto disease. This patient has been regularly monitored and has shown resolution of cervical lymphadenopathy.

Clinicians should suspect Kikuchi-Fujimoto disease when patients present with persistent cervical lymphadenopathy unresponsive to initial medical treatment. Lymph node biopsy should be undertaken to rule out Kikuchi-Fujimoto disease and prevent these patients from extensive diagnostic procedures and inappropriate treatment modalities.

Febrile neutropenia (FN) is one of the most important complications in pediatric oncology. The present study aimed to determine the predictive factors of fever duration in Iranian pediatric patients with FN.

This cross-sectional study was conducted on episodes of FN in children with cancer undergoing chemotherapy, admitted to the hospital with an oral temperature ≥ 38.3°C or at least two readings of oral temperature ≥ 38°C within one hour, and an absolute neutrophil count (ANC) ≤ 1500/µL at the time of admission. All children were treated according to our routine protocol for the management of FN. Potential predictive factors were recorded at the time of admission. The time of defervescence was considered the outcome variable. Ordinal regression analysis was used to determine the independent factors that could significantly predict the duration of fever in febrile neutropenic episodes.

One hundred and eighty FN episodes in children with cancer (53.3% boys, 46.7% girls, mean age 5.48 ± 3.44 years) were included in our study. Independent predictive factors were the severity of neutropenia (P = 0.01), patients’ general condition (P = 0.02), higher temperature ≥ 39°C (P = 0.006), higher serum C-reactive protein (CRP) > 90 (P = 0.04), positive central catheter culture (P = 0.00), and having at least one positive culture (P = 0.005).

We conclude that the severity of neutropenia, patients' poor general condition, higher temperature, higher serum CRP, and having at least one positive blood, urine, or central catheter culture are significant predictors of the duration of fever in FN episodes.

Fever and neutropenia are major causes of mortality in cancer patients. This study compares the effectiveness of cefepime monotherapy with a ceftriaxone–amikacin combination in treating these complications.

In a randomized clinical trial, 60 febrile neutropenic children with cancer at Shahid Motahari Hospital, Urmia, were assigned to receive either cefepime monotherapy or ceftriaxone–amikacin combination therapy. The hospital length of stay, time to defervescence, and frequency of therapy escalation were compared between the two groups.

The cefepime group had a shorter hospital stay, fewer febrile episodes, reduced antipyretic use, and less frequent antimicrobial escalation compared to the combination group. No significant differences were observed in laboratory results between admission and discharge in either group.

Cefepime monotherapy was significantly more effective than ceftriaxone–amikacin combination therapy in managing fever and neutropenia in pediatric cancer patients.

There is a paucity of quantitative studies on COVID-19 in children, and with the rising trend of infection in children, there is a need for more information in the clinical and paraclinical domains to be shared. The present research was designed to investigate the clinical and paraclinical manifestations of children with COVID-19 referred to Dr. Masih Daneshvari Hospital from September 2021 to September 2022 to maintain intuition into assessment and effective management of COVID-19 infection in children. In this cross-sectional study, 70 children (under 18 years old) with COVID-19 who met the study entry criteria were included. Demographic characteristics, including the age and gender of the patients, as well as the family history of COVID-19 exposure, were recorded for the patients. CT scan findings of the patients were documented according to a standard questionnaire. The study results were analyzed and examined using SPSS software to enhance the diagnosis. Among the 70 study subjects, 66 individuals (94.3%) tested positive for PCR-COVID, and four individuals tested negative for PCR-COVID. Only 38 cases (54.3%) reported common findings on CT scans. Fever, cough, and lethargy were the most common clinical findings in the study population. The presence of GGO on CT scans in children with COVID-19 should be regarded as an important indicator of the disease worsening. Among the clinical symptoms of chills, dyspnea, and myalgia had significant correlations with CT findings—particularly when two or all three symptoms were present. This allows clinicians to predict pulmonary involvement with reasonable accuracy and may help in deciding when to avoid unnecessary CT scans.

Exudative diarrhea is a significant global public health issue, particularly affecting children under the age of 5. Identifying the cause of diarrhea is crucial for epidemiological surveillance and, in some cases, for ensuring appropriate treatment for patients.

The aim of this study was to investigate the frequency of bacteria responsible for exudative diarrhea in samples from children under five years old in a tertiary hospital in Iran.

In this multicenter cross-sectional descriptive study, 104 children with exudative diarrhea who were referred to Mofid Children's Hospital in Tehran, as well as hospitals in Hamedan, Ardebil, and Bandar Abbas, from December 2020 to March 2022 were enrolled. DNA extraction was performed using a commercial kit, and the identification of various causative bacteria was conducted through conventional and real-time PCR. Descriptive and inferential statistics were analyzed using SPSS version 22 software.

Most of the children with exudative diarrhea were under 12 months old (31%) or between 12 and 24 months old (22%). Boys made up 66% of the participants. Additionally, 70% of the children had a fever, and 58% experienced vomiting. Furthermore, 56% of the patients were dehydrated. The most prevalent bacterial causes of exudative diarrhea were Shigella spp., followed by Salmonella spp., Campylobacter spp., Clostridium difficile, E. coli-Stx1 , and E. coli-Stx2 .

The findings indicated that * Shigella * spp. was the leading cause of diarrhea in children under five years old. The most common signs and symptoms associated with exudative diarrhea were fever and vomiting, which physicians should consider in their diagnostic and treatment processes.

This study aimed to investigate the clinical characteristics of children diagnosed with COVID-19 in Dr. Masih Daneshvari Hospital from September 2021 to September 2022 to provide insights into the diagnosis and effective management of COVID-19 infection in children. In this cross-sectional study, 70 children (under 18 years old) with COVID-19, meeting the study's inclusion criteria, were enrolled after obtaining informed written consent from their parents, and no charges were imposed on them. Demographic information, including age, gender, and family history of COVID-19 exposure, was recorded for the patients. Clinical manifestations and laboratory findings, including Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR), C - C-reactive protein (CRP), and Lactate Dehydrogenase (LDH), were documented according to standard questionnaires. Finally, the study results were analyzed using SPSS software to enhance the diagnosis and follow-up of children with COVID-19. Among the 70 study participants, 32 were female (45.7%), and 38 were male (54.3%). Regarding age distribution, 14 cases (20%) were less than six years old, 23 cases (32.9%) aged 6-12 years, and 33 cases (47.1%) aged 12-18 years. Among the participants, 66 (94.3%) tested positive for PCR-COVID, while 4 had negative PCR-COVID results. Common clinical findings in the study population included fever, cough, and lethargy. In symptomatic patients, laboratory findings are mainly present that can help identify individuals who are severely ill. Overall, COVID-19 disease in children has a lower prevalence and severity than that in adults, and the mortality rate is estimated to be very low.

Fever is a sign of illness in children, but when it cannot be controlled, it can become a serious concern.

This study examines mothers' awareness of their children's fever and how they respond to it.

This cross-sectional study was conducted at Bandar Abbas Children's Hospital in 2022. Mothers were randomly selected and completed a checklist covering their understanding of fever, how to measure it, the measurement tools used, their first action when their child has a fever, and the dose and type of antipyretic used.

Three hundred mothers of children were included in the study; 37% of the participants were illiterate or had less than a diploma, while 62% had a diploma or higher (P = 0.004). Sixteen percent did not know what temperature constitutes a fever, and 26% considered a temperature of 37°C or higher to be a fever. Approximately 18% of the participants reported a temperature of 37.5°C as a fever (P < 0.05). A total of 85% of mothers preferred to use acetaminophen, with a few preferring ibuprofen as a fever reducer. The majority of mothers administered acetaminophen every 6 hours, with only 8.35% giving it every 4 hours.

Most mothers in this study did not have accurate knowledge of how to treat and care for a child with a fever, especially those with lower education levels. We recommend that a comprehensive program be organized to increase mothers' awareness of managing children's fever.

Percutaneous nephrolithotomy (PCNL) is commonly used in the treatment of large renal stones. Postoperative infections are a common consequence of these procedures.

The purpose of this study is to evaluate the effects of antibiotic therapy before PCNL on the possibility of developing fever and common complications after the procedure.

We carried out a retrospective cross-sectional study involving 708 patients who had undergone PCNL at Razi Hospital in Rasht, covering the period from 2012 to 2022. Patients were allocated into two groups: Group 1 included 454 patients who had received antibiotic therapy, and group 2 included 254 patients who had not received pre-operative antibiotic therapy.

In group 1, there were 241 males (53.1%) and 213 females (46.9%), while in group 2, there were 138 males (54.3%) and 116 females (45.7%). In group 1, 82.7% of patients treated with antibiotics had a negative culture. The hospitalization time was 4.00 ± 1.75 days for group 1 and 2.26 ± 1.56 days for group 2. Fever was observed in 39 patients (11.2%) in group 1. Sepsis was seen in only one patient (0.3%) in group 1. There is a significant relationship between total hospitalization time (P = 0.000), hospitalization after the operation (P = 0.000), hypertension (P = 0.009), ischemic heart disease (P = 0.050), history of shock wave lithotripsy (P = 0.003), hydronephrosis (P = 0.000), age (P = 0.004), and hemoglobin levels (P = 0.000) with antibiotic therapy.

Surgeon overprescription of antibiotics may lead to resistance, complicating outcomes and extending hospital stays after PCNL. Some complications remain unaffected by antibiotic therapy due to surgical experience.

Increased body temperature (fever) is a common clinical indicator of disease and can lead to altered metabolism and subsequently threaten life. studies have shown antimicrobial, analgesic/antipyretic effect for some Eucalyptus and Mentha species. Therefore, in the present study we assessed the effect of the combination of mint (Mentha), eucalyptus, evening primrose, and basil on lowering body temperature.

This experimental study was performed on 30 rats in five groups. A hydroalcoholic extract was prepared from each plants using ethanol as solvent and concentrated with a rotary apparatus. Then the extracts were combined in equal proportions. To induce fever, the brewer's yeast fever induction method was used by intraperitoneal injection of a 20% aqueous suspension. The febrile rats were then divided into groups receiving different doses of the mixed extract (200, 500, 750 mg/kg); normal saline and paracetamol were used in control groups. Rectal temperature was measured with a digital thermometer before injection and 6, 8, 12, and 16 hours after extract injection. The analysis of variance with repeated measurements was used to evaluate the effect of hydroalcoholic plant extracts on fever changes.

The mean fever in the intervention groups with all effective doses decreased over the hours, and the mean fever with a dose of 750 mg decreased more than in the other groups (P-value < 0.05). We had the lowest fever at a dose of 750 mg and a time of 16 hours (P-value < 0.05).

The results show that the combined extract can reduce body temperature in rats, and by increasing the effective dose, the recovery rate and temperature reduction are faster and more effective.

Talaromyces marneffei is a pathogen that causes talaromycosis, a systemic fungal infection. Cases in which hepatic failure is the primary clinical presentation are exceedingly rare.

This report details the case of a 49-year-old male with no prior liver disease, presenting to the hospital with persistent symptoms, including a fever lasting over ten days, abdominal distension for five days, and jaundice for three days. The patient’s history included immune thrombocytopenia and prolonged glucocorticoid therapy. Physical examination revealed yellowing of the skin and sclera, abdominal distension, firmness of the abdominal wall, absence of abdominal tenderness, positive shifting dullness, and pitting edema in the lumbosacral region and bilateral lower extremities. An HIV antibody test was negative. The patient developed hepatic failure and received artificial liver support along with routine therapy. Despite these interventions, the patient was automatically discharged without improvement and subsequently passed away. Post-discharge, cultures from pleural and abdominal effusions identified Talaromyces marneffei.

Talaromyces marneffei infection should be considered in the differential diagnosis of immunocompromised patients, particularly those with no history of liver disease but with long-term glucocorticoid or immunosuppressant use who present with acute liver failure. Early and aggressive investigation for the causative pathogen is essential to minimize diagnostic and treatment delays. Given the prolonged incubation period of Talaromyces marneffei, metagenomic next-generation sequencing may offer a more rapid approach for etiological diagnosis.

This study explores the link between inflammatory markers and hospital outcomes in febrile neutropenic patients with solid cancers- a complication caused by systemic chemotherapy that can lead to hospitalization and requires timely diagnosis and treatment to reduce fatalities.

This study was conducted in 2017 at Vali-e-Asr Hospital in Birjand with 22 participants. Blood samples were collected to measure inflammatory indexes. The study documented various hospital outcomes, including duration of neutropenia and fever correction, length of hospital stays, ICU admission or mechanical ventilation, and mortality. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each marker.

According to the findings, there was no significant difference in the mean duration of neutropenia, the duration of fever, or the length of hospital stay comparing procalcitonin (PCT; P = 0.96, P = 0.36, P = 0.66, respectively), polymorphonuclears (PMNs; P = 0.11, P = 0.94, P = 0.52, respectively), and erythrocyte sedimentation rate (ESR; P = 0.41, P = 0.24, P = 0.17, respectively). Further, the performance metrics calculated for PCT, ESR, and PMNs were an accuracy of 50%, 50%, and 40.90%, sensitivity of 88.8%, 100%, and 88.8%, specificity of 23.07%, 15.38%, and 7.6%, PPV of 44.4%, 45%, and 40%, and NPV of 75%, 100%, and 50%, respectively.

Our findings suggested that there was no significant relationship between inflammatory factors and hospital outcomes. However, further research is needed to explore the prognostic value of these markers in a larger and more diverse patient population.

Childhood fever is very discomforting and most parents are usually anxious when children exhibit fever, leading to unnecessary visits and admissions into pediatric emergency centers. This study aimed to determine the effects of simulation-based education on parents’ knowledge, attitude, and management of fever in children. A non-randomized quasi-experimental study using convenient sampling was conducted to recruit parents of children aged 3 months to 8 years admitted to the Tamale Teaching Hospital in Tamale, Ghana. The study was conducted from July to September 2019. Eighty parents were equally assigned into an intervention group and a control group and respectively educated using simulation-based and routine education approaches on childhood fever. Data were collected using a four-part questionnaire and analyzed using descriptive statistics, Chi-square, independent samples t, and paired t tests as well as analysis of covariance. Except for the mean baseline knowledge (P< 0.0001), there were no significant differences between the two groups in mean pretest scores. The mean scores of fever knowledge, attitude, and management of parents in the simulation-based education group were 21.63 ± 2.40, 28.48 ± 6.03, and 25.15 ± 4.23 at baseline and increased to 26.38 ± 4.36, 28.48 ± 6.03, and 32.33 ± 5.18, respectively (P< 0.0001). All mean scores on the posttest were better than on the pretest in both groups.  However, at the posttest, mean scores for knowledge, attitude, and management were significantly higher in the simulation-based education than in the routine education group (P < 0.05). Compared with routine education, simulation-based education was more effective in improving parents’ knowledge, attitude, and management of fever. We therefore, recommend the use of similar simulation-based methods in educating parents regarding caring for acute fever in their children.

Febrile seizures are defined as seizures associated with a febrile illness that developed without central nervous system infection or acute electrolyte imbalance, intoxication, trauma, and metabolic disorder in children aged 1 month to 5 years without previous afebrile seizures. Various studies show a relationship between zinc levels and febrile seizures.

The purpose of this study was to examine the relationship between serum zinc levels and febrile seizures.

This prospective, cross-sectional, and descriptive study was conducted from 04/10/2021 to 04/02/2022. A total of 85 children aged 6 months to 5 years admitted to the pediatric emergency service of the Republic of Turkey Ministry of Health Cemil Ta¸scıo˘glu City Hospital were included in the study. The patients who met the inclusion criteria and whose consent was obtained were included in the study. Complex and febrile status patients were not included in the study due to the small number of patients. The cases included in the study were divided into 2 groups of patients and healthy controls. The patients with fever were divided into 2 groups, including those with and without febrile seizures. The levels of zinc and complete blood count parameters were measured in the blood samples taken from all the patients. IBM SPSS 22 package software was used for the statistical examination of the data.

When the cases included in this study were divided according to gender, 33 (38.8%) and 52 (61.2%) patients were female and male, respectively. The mean age of the cases was 29.2 ± 15.9 months (range: 6 - 60). Of the 85 participating cases, 30 patients had febrile seizures, 30 were only febrile patients, and 25 were healthy controls. When zinc levels were compared between the groups, the plasma zinc levels of the febrile seizures and febrile groups were observed to be lower than the healthy control group (P < 0.05).

In this study, the group consisting of patients with febrile seizures and the groups of patients who had a fever but did not have febrile seizures during the study had reduced serum zinc levels than the control group consisting of healthy patients without fever.

Transurethral ureterolithotripsy (TUL) is a common and highly efficient procedure for treating ureteral stones. The need for preoperative antibiotic prophylaxis to prevent post-TUL infections remains controversial.

This study aimed to investigate whether the removal of preoperative antibiotic prophylaxis affects the rate of postoperative complications in patients undergoing TUL.

A total of 62 patients (aged 15-65 years) undergoing TUL between November 2021 and March 2022 were included in this controlled clinical trial. Patients were divided into two groups by the available gradual and sequential sampling

33 had positive preoperative urine culture (UC), and 29 had negative preoperative UC. None of the patients in the two groups received preoperative antibiotic prophylaxis. Perioperative and postoperative outcomes, such as the operative time, stone-free rate, postoperative analgesic use, fever, urinary tract infection (UTI), and hospital stay, were reviewed in both groups.

Patients with positive UC were significantly older than those with negative UC (P=0.018), and had a higher BMI (P=0.016). No significant differences were observed between the two groups in most perioperative variables or postoperative outcomes (P>0.05). In addition, patients in the positive UC group had significantly more underlying diseases than the other group (P=0.022). Postoperative symptomatic UTI was found in neither of the two groups. Fever was reported in 3 (9.1%) and 1 (3.4%) patients in the positive and negative UC groups, respectively, with no statistically significant differences between the two groups (P=0.616). In the matched logistic regression model, the effect of preoperative UC on postoperative fever was not significant (P=0.40).

The results of our study showed that prophylactic antibiotics can be eliminated at the discretion of the surgeon in patients without symptomatic positive UC.