ABSTRACT
BACKGROUND: Zinc fever is well described in medical literature, particularly in workers after handling zinc-containing materials at high temperatures e.g., in the welding of hot-dip galvanized steel sheets. It is not known whether zinc fever also occurs at low temperatures. CASE PRESENTATION: We present the case of a 33-year-old Caucasian atopic painter and varnisher with work-related dyspnea, sweating, as well as multiple occurrences of fever. He was sent to Institute for Prevention and Occupational medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA) for the evaluation of isocyanate asthma, but an inhalative challenge with hexamethylene diisocyanate was negative. Since symptoms were closely related to the use of zinc coatings at room temperature without adequate protective measures, the diagnosis of zinc fever was made. After exposure cessation the worker immediately became symptom-free. The work as painter and varnisher may be associated with various exposures to hazardous substances. Besides solvents, epoxy compounds and isocyanates, which can cause obstructive respiratory diseases; additionally, zinc-containing agents should be considered as health hazards. CONCLUSIONS: This case demonstrates that zinc fever may occur also after application of zinc coatings by spray painting at low temperatures.
Subject(s)
Fever , Occupational Diseases , Occupational Exposure , Paint , Zinc , Humans , Male , Adult , Occupational Exposure/adverse effects , Zinc/adverse effects , Zinc/therapeutic use , Fever/etiology , Fever/chemically induced , Occupational Diseases/diagnosis , Paint/adverse effects , Dyspnea/etiology , SweatingSubject(s)
Fever , Platelet Aggregation Inhibitors , Prasugrel Hydrochloride , Humans , Prasugrel Hydrochloride/adverse effects , Prasugrel Hydrochloride/therapeutic use , Platelet Aggregation Inhibitors/adverse effects , Fever/chemically induced , Fever/drug therapy , Male , Middle Aged , Drug FeverABSTRACT
Patients infected with COVID-19 can develop coinfections or acute respiratory disorder that result in ventilation. Dexmedetomidine is a common medication used to sedate ventilated patients in the intensive care unit and for nonintubated patients prior to a surgical procedure. As a highly selective alpha-2 agonist, dexmedetomidine provides sedation while reducing the need for anxiolytics or opioids. However, previous case reports suggest dexmedetomidine can induce fever in a variety of conditions. The purpose of this case report is to describe a patient who acquired a fever of 42.6°C in the setting of COVID-19 after administration of dexmedetomidine.
Subject(s)
COVID-19 , Dexmedetomidine , Fever , Hypnotics and Sedatives , SARS-CoV-2 , Humans , Dexmedetomidine/adverse effects , COVID-19/complications , Fever/chemically induced , Hypnotics and Sedatives/adverse effects , Male , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/complications , Betacoronavirus , Middle Aged , Adrenergic alpha-2 Receptor Agonists/adverse effects , Drug FeverABSTRACT
OBJECTIVES: Although vaccines have promoted the socioeconomic normalization of COVID-19, adverse effects on work performance due to the post-vaccination side effects have been reported. Thus, we examined the relationship between the status of going to work the day following vaccination as a post-vaccination employment consideration and work performance among Japanese workers in the manufacturing industry. METHODS: Overall, 1273 employees who received the COVID-19 vaccine in a Japanese manufacturing district were surveyed using a self-administered web-based questionnaire that included fever, fatigue, workplace attendance the day after vaccination, work performance 1 week after vaccination, and demographic and occupational characteristics (age, gender, work style, and psychological distress [K6 scale]). The effects of fatigue and attendance on declining work performance were estimated using a linear mixed model, with individuals as random effects and the rest as fixed effects. RESULTS: After adjusting for demographic and occupational characteristics, the third-order interaction of fever, fatigue, and attendance on the day following vaccination was significant. The nonattendance group had a significantly higher work performance than the attendance group in those without fever and long-term fatigue (F1,1559 = 4.9, P = .026) and with fever and short-term fatigue (F1,1559 = 5.9, P = .015). Fever and workplace attendance the following day were not directly related to a decrease in work performance after vaccination. CONCLUSIONS: Our findings suggest that nonattendance at the workplace is associated with work performance due to the side effects after COVID-19 vaccination.
Subject(s)
COVID-19 Vaccines , COVID-19 , Fatigue , Manufacturing Industry , Work Performance , Humans , Male , Japan , Cross-Sectional Studies , Female , Adult , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Middle Aged , Surveys and Questionnaires , SARS-CoV-2 , Fever/chemically induced , East Asian PeopleABSTRACT
Neutropenic fever in adults undergoing chemotherapy for cancer treatment is a medical emergency and has been the focus of numerous studies. However, there is a paucity of data about non-chemotherapy induced neutropenic fever (non-CINF). We retrospectively reviewed 383 adults with neutropenic fever hospitalized at one academic medical center between October 2015 and September 2020 to characterize the frequency, causes, and outcomes of non-CINF. Twenty-six percent of cases of neutropenic fever were non-chemotherapy induced. Among these, the major causes of neutropenia were hematologic malignancy, infection, and rheumatologic disease, and the major causes of fever were infections. Patients with non-CINF had a higher 30-day mortality than those with chemotherapy induced neutropenic fever (25% vs 13%, Pâ =â .01). Non-CINF constitutedâ >â 25% of neutropenic fever events in hospitalized adults and was associated with a high mortality rate.
Subject(s)
Fever , Hospitalization , Neutropenia , Humans , Male , Female , Retrospective Studies , Middle Aged , Fever/chemically induced , Fever/etiology , Neutropenia/chemically induced , Neutropenia/epidemiology , Hospitalization/statistics & numerical data , Adult , Aged , Neoplasms/drug therapy , Antineoplastic Agents/adverse effects , Hematologic Neoplasms/drug therapyABSTRACT
Fever plays an indispensable role in host defense processes and is used as a rapid index of infection severity. Unfortunately, there are also substantial individual differences in fever reactions with biological sex, immunological history, and other demographic variables contributing to adverse outcomes of infection. The present series of studies were designed to test the hypothesis that a history of adolescent alcohol misuse may be a latent experiential variable that determines fever severity using polyinosinic:polycytidylic acid (poly I:C), a synthetic form of double-stranded RNA that mimics a viral challenge. Adult male and female Sprague Dawley rats were injected with 0 (saline) or 4 mg/kg poly I:C to first establish sex differences in fever sensitivity in Experiment 1 using implanted radiotelemetry devices for remote tracking. In Experiments 2 and 3, adolescent males and females were exposed to either water or ethanol (0 or 4 g/kg intragastrically, 3 days on, 2 days off, â¼P30-P50, 4 cycles/12 exposures total). After a period of abstinence, adult rats (â¼P80-96) were then challenged with saline or poly I:C, and fever induction and maintenance were examined across a prolonged time course of 8 h using implanted probes. In Experiments 4 and 5, adult male and female subjects with a prior history of adolescent water or adolescent intermittent ethanol (AIE) were given saline or poly I:C, with tissue collected for protein and gene expression analysis at 5 h post-injection. Initial sex differences in fever sensitivity were minimal in response to the 4 mg/kg dose of poly I:C in ethanol-naïve rats. AIE exposed males injected with poly I:C showed a sensitized fever response as well as enhanced TLR3, IκBα, and IL-1ß expression in the nucleus of the solitary tract. Other brain regions related to thermoregulation and peripheral organs such as spleen, liver, and blood showed generalized immune responses to poly I:C, with no differences evident between AIE and water-exposed males. In contrast, AIE did not affect responsiveness to poly I:C in females. Thus, the present findings suggest that adolescent binge drinking may produce sex-specific and long-lasting effects on fever reactivity to viral infection, with preliminary evidence suggesting that these effects may be due to centrally-mediated changes in fever regulation rather than peripheral immunological mechanisms.
Subject(s)
Ethanol , Fever , Poly I-C , Rats, Sprague-Dawley , Animals , Male , Female , Rats , Ethanol/administration & dosage , Ethanol/pharmacology , Fever/chemically inducedABSTRACT
ETHNOPHARMACOLOGICAL RELEVANCE: Syagrus coronata, a palm tree found in northeastern Brazil, popularly known as licuri, has socioeconomic importance for the production of vegetable oil rich in fatty acids with nutritional and pharmacological effects. Licuri oil is used in traditional medicine to treat inflammation, wound healing, mycosis, back discomfort, eye irritation, and other conditions. AIM OF THE STUDY: The study aimed to evaluate the antinociceptive, anti-inflammatory, and antipyretic effects of treatment with Syagrus coronata fixed oil (ScFO), as well as to determine the safety of use in mice. MATERIALS AND METHODS: Initially, the chemical characterization was performed by gas chromatography-mass spectrometry. Acute single-dose oral toxicity was evaluated in mice at a dose of 2000 mg/kg. Antinociceptive activity was evaluated through abdominal writhing, formalin, and tail dipping tests, and the anti-inflammatory potential was evaluated through the model of acute inflammation of ear edema, peritonitis, and fever at concentrations of 25, 50, and 100 mg/kg from ScFO. RESULTS: In the chemical analysis of ScFO, lauric (43.64%), caprylic (11.7%), and capric (7.2%) acids were detected as major. No mortality or behavioral abnormalities in the mice were evidenced over the 14 days of observation in the acute toxicity test. ScFO treatment decreased abdominal writhing by 27.07, 28.23, and 51.78% at 25, 50, and 100 mg/kg. ScFO demonstrated central and peripheral action in the formalin test, possibly via opioidergic and muscarinic systems. In the tail dipping test, ScFO showed action from the first hour after treatment at all concentrations. ScFO (100 mg/kg) reduced ear edema by 63.76% and leukocyte and neutrophil migration and IL-1ß and TNF-α production in the peritonitis test. CONCLUSION: Mice treated with ScFO had a reduction in fever after 60 min at all concentrations regardless of dose. Therefore, the fixed oil of S. coronata has the potential for the development of new pharmaceutical formulations for the treatment of pain, inflammation, and fever.
Subject(s)
Analgesics , Anti-Inflammatory Agents , Edema , Plant Oils , Animals , Analgesics/pharmacology , Analgesics/isolation & purification , Analgesics/toxicity , Mice , Anti-Inflammatory Agents/pharmacology , Anti-Inflammatory Agents/isolation & purification , Plant Oils/pharmacology , Male , Edema/drug therapy , Edema/chemically induced , Pain/drug therapy , Peritonitis/drug therapy , Antipyretics/pharmacology , Arecaceae/chemistry , Female , Inflammation/drug therapy , Inflammation/chemically induced , Fever/drug therapy , Fever/chemically induced , Administration, Oral , Disease Models, AnimalABSTRACT
INTRODUCTION: Febrile conditions often have an infectious etiology. However, there are also fevers associated with occupational exposures. A detailed occupational history can hold the key to the diagnosis. In the case of exposure to organic dusts, the development of hypersensitivity pneumonitis (HP) is possible. Thus, HP should be considered in the presence of interstitial lung disease of unclear etiology. Failure to recognize this can have dramatic consequences and, in extreme cases, lead to lung transplantation. Differentially, organic dust toxic syndrome (ODTS) must be considered. The syndrome of metal fume fever provoked by inhalation of inorganic substances is usually benign and self-limiting. The disease manifests with fever, cough, and flu-like sensations.
Subject(s)
Alveolitis, Extrinsic Allergic , Occupational Diseases , Occupational Exposure , Humans , Occupational Diseases/diagnosis , Occupational Diseases/etiology , Occupational Diseases/therapy , Diagnosis, Differential , Occupational Exposure/adverse effects , Alveolitis, Extrinsic Allergic/diagnosis , Alveolitis, Extrinsic Allergic/etiology , Alveolitis, Extrinsic Allergic/therapy , Dust , Fever of Unknown Origin/etiology , Fever of Unknown Origin/diagnosis , Fever/chemically induced , Fever/etiologyABSTRACT
INTRODUCTION: Hyperpyrexia, algesia and inflammation are pathological disorders which are treated with synthetic as well as herbal medications. AIMS: The basic aim of the present study is to evaluate the ethnopharmacological activities of phytoconstituents that are present in C. colocynthis (fruit extract) by using in vivo and in silico studies. METHODS: Thirty-six albino rats were used in our studies with an average weight between 150-170 g. Anti-inflammatory activity was investigated using carrageenan (an extract from a red seaweed) that induced edema in albino rat paws. However, in antipyretic and analgesic activity studies, yeast and acetic acid were used to cause pyrexia or algesia, respectively. Different doses of acetone fruit extract were used to treat inflammation, pyrexia and algesia. RESULTS: Our results showed that the maximum percentage inhibition of acetonic fruit extract in anti-inflammatory and analgesic activities was observed at 70% and 100%, respectively, with 400 mg/kg doses, and in pyretic activity the maximum inhibitory percentage was 86% with a 100 mg/kg dose. In in silico analysis, we have shown that bioactive compounds (α-spinasterol, ascorbic acid and chlorogenic acid) found in fruit extract have outstanding inhibition properties that involves proteins PTGS2, TLR2 and TRPV4. C. colocynthis fruit extract shows results that are statistically significant (p < 0.005) and comparable to a reference drug. Acetonic fruit extract of C. colocynthis can be used as a natural and safe remedy with no side effects. CONCLUSION: Both in vivo and in silico studies on chlorogenic acid, ascorbic acid and α-spinasterol have shown that these are inhibitory compounds that can be used for boosting the immune response.
Subject(s)
Antipyretics , Citrullus colocynthis , Rats , Animals , Antipyretics/pharmacology , Chlorogenic Acid/adverse effects , Plant Extracts/pharmacology , Anti-Inflammatory Agents/pharmacology , Analgesics/pharmacology , Fever/chemically induced , Inflammation/chemically induced , Saccharomyces cerevisiae , Ascorbic Acid/adverse effectsABSTRACT
BACKGROUND: Toxic Epidermal Necrolysis (TEN) is a rare, acute, and life-threatening mucocutaneous disease that occurs after the administration of certain drugs, resulting in extensive keratinocyte cell death, skin involvement at the dermal-epidermal junction, and extensive bullous skin eruptions and sloughing. Many published case reports have observed the presence of fever with a viral infection, drug, and/or genetic association as a possible trigger for TEN but associated with other comorbidities. Physicians still struggle to predict which individuals could be predisposed to TEN. The case report that we present had a history of multiple drug intake and fever due to dengue virus infection but was not associated with any other comorbidity. CASE PRESENTATION: We present an unusual case of a 32-year-old woman of Western Indian origin who had developed dengue infection and suffered toxic epidermal necrolysis following a five-day course of a third-generation cephalosporin antibiotic, cefixime and a three-day course of 2 analgesic drugs, paracetamol (acetaminophen), and nimesulide, with the adverse event occurring on the fifth day of the dengue infection. The offending drugs were stopped, and patient survived with supportive management and hydration. CONCLUSION: The presence of comorbidities may not always be the triggering factor for TEN, though it can affect patient outcomes. Rational drug use is always recommended for patient care. Further research is required to understand the pathomechanism behind the viral-drug-gene interaction.
Subject(s)
Dengue , Stevens-Johnson Syndrome , Female , Humans , Adult , Acetaminophen/adverse effects , Stevens-Johnson Syndrome/diagnosis , Stevens-Johnson Syndrome/etiology , Cefixime , Fever/chemically induced , Dengue/diagnosis , Dengue/drug therapy , Dengue/chemically inducedABSTRACT
OBJECTIVE: COVID-19 immunization was implemented with emergency-use authorization. We had concerns/lack of information on mRNA vaccine side effects in different inborn errors of immunity (IEI) types. METHODS: We enrolled 141 patients (IEIP) and 151 healthy controls(HC) who received SARS-CoV-2 vaccine/s(Sinovac and/or Pfizer-BioNTech(mRNA vaccine), one to five doses), questioned them for side-effects, evaluated in three groups according to the vaccine/s they received; only Sinovac, only Pfizer-BioNTech, and both vaccines. RESULTS: Arm pain, generalized weakness, myalgia, and fever were common side effects in IEI-P and HC groups. Generalized weakness/fatigue, fever, and palpitation were significantly frequent in IEI-P who experienced COVID-19 compared to those who did not (p = 0.021, p = 0.047, and p = 0.024, respectively). Severe symptoms after vaccination, new-onset splenomegaly and pancytopenia, urticaria, herpes simplex virus (HSV), and varicella zoster virus (VZV) reactivation were seen in four IEI-P (2.8%). CONCLUSION: IEI-P mRNA vaccination is relatively safe compared to the conventional vaccine. Individuals who experience uncommon side effects should undergo immunological screening.
Subject(s)
COVID-19 Vaccines , COVID-19 , Immune System Diseases , Humans , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Fever/chemically induced , mRNA Vaccines/adverse effects , SARS-CoV-2ABSTRACT
CONTEXT: Zi Xue Powder (ZXP) is a traditional formula for the treatment of fever. However, the potential mechanism of action of ZXP remains unknown. OBJECTIVE: This study elucidates the antipyretic characteristics of ZXP and the mechanism by which ZXP alleviates fever. MATERIALS AND METHODS: The key targets and underlying fever-reducing mechanisms of ZXP were predicted using network pharmacology and molecular docking. The targets of ZXP anti-fever active ingredient were obtained by searching TCMSP, STITCH and HERB. Moreover, male Sprague-Dawley rats were randomly divided into four groups: control, lipopolysaccharide (LPS), ZXP (0.54, 1.08, 2.16 g/kg), and positive control (acetaminophen, 0.045 g/kg); the fever model was established by intraperitoneal LPS injection. After the fever model was established at 0.5 h, the rats were administered treatment by gavage, and the anal temperature changes of each group were observed over 10 h after treatment. After 10 h, ELISA and Western blot analysis were used to further investigate the mechanism of ZXP. RESULTS: Network pharmacology analysis showed that MAPK was a crucial pathway through which ZXP suppresses fever. The results showed that ZXP (2.16 g/kg) decreased PGE2, CRH, TNF-a, IL-6, and IL-1ß levels while increasing AVP level compared to the LPS group. Furthermore, the intervention of ZXP inhibited the activation of MAPK pathway in LPS-induced fever rats. CONCLUSIONS: This study provides new insights into the mechanism by which ZXP reduces fever and provides important information and new research ideas for the discovery of antipyretic compounds from traditional Chinese medicine.
Subject(s)
Antipyretics , Drugs, Chinese Herbal , Rats , Male , Animals , Antipyretics/pharmacology , Antipyretics/therapeutic use , Rats, Sprague-Dawley , Powders/adverse effects , Molecular Docking Simulation , Lipopolysaccharides/toxicity , Network Pharmacology , Fever/drug therapy , Fever/chemically induced , Drugs, Chinese Herbal/adverse effectsABSTRACT
BACKGROUND An 82-year-old woman presented with acute pyrexial illness and mesenteric panniculitis and developed biochemical aseptic meningitis (cerebrospinal fluid pleocytosis with no identifiable pathogen). Investigation determined her illness was likely a delayed hypersensitivity reaction caused by sulfasalazine. Sulfasalazine-induced aseptic meningitis is a rare condition often diagnosed late in a patient's admission owing to initial non-specific illness symptomatology requiring the exclusion of more common "red flag" etiologies, such as infection and malignancy. CASE REPORT An 82-year-old woman with a history of recurrent urinary tract infections and seronegative arthritis presented with a 3-day history of fatigue, headache, dyspnea, and lassitude. On admission, she was treated as presumed sepsis of uncertain source owing to pyrexia and tachycardia. Brain computer tomography (CT) revealed no acute intracranial abnormality. Furthermore, CT of the chest, abdomen, and pelvis did not reveal any source of sepsis or features of malignancy. After excluding infective etiologies with serological and cerebrospinal fluid testing, sulfasalazine-induced aseptic meningitis (SIAM) was diagnosed. The patient was then commenced on intravenous steroids, resulting in immediate defervescence and symptom resolution. CONCLUSIONS SIAM remains a diagnostic challenge since patients present with non-specific signs and symptoms, such as pyrexia, headaches, and lassitude. These patients require a thorough investigative battery starting with anamnesis, physical examination, biochemical testing, and radiologic imaging. This case illustrates the need for a high suspicion index of drug-induced hypersensitivity reaction in a rheumatological patient with pyrexial illness where infective etiologies have been confidently excluded. Prompt initiation of intravenous steroids in SIAM provides a dramatic recovery and resolution of symptoms.
Subject(s)
Arthritis , Hypersensitivity, Delayed , Meningitis, Aseptic , Neoplasms , Panniculitis, Peritoneal , Sepsis , Female , Humans , Aged, 80 and over , Meningitis, Aseptic/chemically induced , Meningitis, Aseptic/diagnosis , Sulfasalazine/adverse effects , Panniculitis, Peritoneal/complications , Fever/chemically induced , Fever/complications , Sepsis/complications , Neoplasms/complications , Fatigue , Hypersensitivity, Delayed/complications , SteroidsABSTRACT
PURPOSE: The prompt initiation of a betalactam antibiotic in febrile neutropenic patients is considered standard of care, while the empiric use of vancomycin is recommended by guidelines in specific situations, with a low level of evidence. The objective of this study was to assess the utilization of vancomycin in the management of febrile neutropenia within four Brazilian medical centers that implemented more stringent criteria for its administration. METHODS: A comprehensive retrospective analysis was performed encompassing all instances of febrile neutropenia observed during the period from 2013 to 2019. The primary focus was to identify the reasons for initiating vancomycin therapy. RESULTS: A total of 536 consecutive episodes of febrile neutropenia were documented, involving 384 patients with a median age of 52 years (range 18-86). Chemotherapy preceded febrile neutropenia in 59.7% of cases, while 40.3% occurred after hematopoietic stem cell transplantation. The most prevalent underlying diseases were acute myeloid leukemia (26.5%) and non-Hodgkin's lymphoma (22%). According to international guidelines, vancomycin should have been initiated at the onset of fever in 145 episodes (27%); however, it was administered in only 27 cases (5.0%). Three episodes were associated with Staphylococcus aureus bacteremia, two of which were methicillin resistant. The 15-day and 30-day mortality rates were 5.0% and 9.9%, respectively. CONCLUSIONS: The results of this study underscore the notably low utilization rate of vancomycin in cases of febrile neutropenia, despite clear indications outlined in established guidelines. These findings emphasize the importance of carefully implementing guideline recommendations, considering local epidemiological factors, especially when the strength of recommendation is weak.
Subject(s)
Febrile Neutropenia , Vancomycin , Humans , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Vancomycin/therapeutic use , Vancomycin/adverse effects , Anti-Bacterial Agents , Retrospective Studies , Brazil , Fever/etiology , Fever/chemically induced , Febrile Neutropenia/drug therapy , Febrile Neutropenia/chemically inducedABSTRACT
RATIONALE: Calcium dobesilate, a vasoprotective and antioxidant agent, is gradually being used for the treatment of chronic kidney disease. Calcium dobesilate-induced hyperpyrexia is a rare clinical event, and few studies have reported it. PATIENT CONCERNS: The patient took calcium dobesilate, which caused high fever. After stopping calcium dobesilate, his body temperature returned to normal. DIAGNOSES: Based on the medical history, symptoms and signs, the patient was diagnosed with drug fever caused by calcium dobesilate. INTERVENTIONS: Calcium dobesilate was stopped, and supportive treatment was given at the same time. OUTCOMES: The present case was initially misdiagnosed as a fever caused by a bacterial infection, but treatment with the antibiotic moxifloxacin was ineffective. Based on the patient's medical history, laboratory and examination results, body temperature changes, and Naranjo Advanced Drug Response Scale, calcium dobesilate-induced hyperpyrexia was diagnosed. After discontinuation of calcium dobesilate, the patient's body temperature normalized, and no additional episode of fever was observed at follow-up. LESSON: Moreover, misdiagnosis and mistreatment of this condition can deteriorate the patient's condition. Herein, we report a case of calcium dobesilate-induced hyperpyrexia that occurred during the treatment of chronic renal insufficiency. Subsequently, a systematic analysis of the patient's diagnosis and treatment was reviewed. If unexplained high fever develops during the use of calcium dobesilate, calcium dobesilate-induced hyperpyrexia should be considered. Accordingly, calcium dobesilate should be discontinued.
Subject(s)
Calcium Dobesilate , Humans , Calcium Dobesilate/adverse effects , Hyperthermia/drug therapy , Fever/chemically induced , Fever/drug therapyABSTRACT
The four-component recombinant-DNA anti-meningococcus B vaccine (4CMenB) has been approved by the European Medicines Agency in 2013. In Italy, 4CMenB is recommended since 2017 for use in infants under one year of age. Due to the strong evidence of increased risk of fever after administration, surveillance of adverse events following immunization (AEFIs) is a priority for 4CMenB. This cross-sectional prospective study aims at investigating 4CMenB's safety profile. The study population is represented by infants under twelve months of age vaccinated with 4CMenB in selected ambulatories in Apulia, a region in South-Eastern Italy, from October 1st, 2020, to March 31st, 2023. Parents were provided with a post-vaccination diary covering up to seven days after immunization and were contacted one week after the vaccination day. Information about AEFIs was collected, and reactions were classified following World Health Organization guidelines. For serious AEFIs, causality assessment was carried out. AEFI risk determinants were investigated via logistic regression. A total of 4,773 diaries were completed, with 78.13 % of them (3,729/4,773) containing one or more AEFI reports. Systemic reactions such as malaise, drowsiness/insomnia and fatigue were the most common ones, followed by fever and local pain, tenderness, redness and swelling. Twenty-three cases of serious AEFIs were reported. Following causality assessment, 78.26 % of serious adverse events (18/23) were deemed to have a consistent causal association with the administration of 4CMenB (reporting rate: 0.38 %). Three infants were hospitalized following vaccination, but no cases of death or permanent/severe impairment were reported. Prophylactic paracetamol administration showed a significant protective effect against the risk of manifesting fever within the first 24 h after administration (OR: 0.75; p < 0.005). Our data confirms existing evidence regarding the safety of 4CMenB vaccination in babies under 2 years of age, but also highlight a significant risk of fever after vaccination. Prophylactic paracetamol administration could represent a protective factor against fever, especially during the first 24 h after vaccination.
Subject(s)
Meningococcal Infections , Meningococcal Vaccines , Neisseria meningitidis , Vaccines, DNA , Infant , Humans , Meningococcal Infections/prevention & control , Acetaminophen , Prospective Studies , Cross-Sectional Studies , Watchful Waiting , Meningococcal Vaccines/adverse effects , Immunization/adverse effects , Vaccination/adverse effects , Fever/chemically induced , Fever/epidemiology , Antibodies , Italy/epidemiologyABSTRACT
BACKGROUND: Acute upper respiratory infections (AURI) are widespread in adolescents. Infections are associated with inflammation which in turn is responsible for symptoms and fever occurrence. Ketoprofen lysine salt (KLS) has a potent anti-inflammatory activity associated with effective analgesic and antipyretic effects and has a valuable safety profile. In this regard, KLS could be advantageous in adolescents with AURI. METHODS: A group of primary-care pediatricians retrospectively collected data from adolescents with AURI treated with KLS for three days. Fever and symptom perception were assessed by a visual analog scale and were monitored daily for five days. Adolescents (or parents) sent their data to doctors using a phone application (WhatsApp; Meta Platforms, Inc., Menlo Park, CA, USA). RESULTS: This retrospective analysis included sixty-one adolescents (mean age 13.4 years, females and males). KLS treatment markedly and quickly reduced fever and symptoms severity. In addition, the treatment was very well tolerated by all adolescents. CONCLUSIONS: Adolescents present peculiar psychological characteristics that may determine some difficulties in prompt management of AURI treatment, while an adolescent with a respiratory infection requires a prompt and adequate cure. KLS, thanks to its pharmacologic profile, could be favorably used in this context. In addition, the treatment was safe, and the acceptability was high.
Subject(s)
Ketoprofen , Respiratory Tract Infections , Male , Female , Adolescent , Humans , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Retrospective Studies , Ketoprofen/pharmacology , Ketoprofen/therapeutic use , Fever/drug therapy , Fever/chemically induced , Respiratory Tract Infections/drug therapy , Sodium Chloride, DietaryABSTRACT
Objective: To assess the efficacy and safety of polymyxin B in neutropenic patients with hematologic disorders who had refractory gram-negative bacterial bloodstream infection. Methods: From August 2021 to July 2022, we retrospectively analyzed neutropenic patients with refractory gram-negative bacterial bloodstream infection who were treated with polymyxin B in the Department of Hematology of the First Affiliated Hospital of the Soochow University between August 2021 to July 2022. The cumulative response rate was then computed. Results: The study included 27 neutropenic patients with refractory gram-negative bacterial bloodstream infections. Polymyxin B therapy was effective in 22 of 27 patients. The median time between the onset of fever and the delivery of polymyxin B was 3 days [interquartile range (IQR) : 2-5]. The median duration of polymyxin B treatment was 7 days (IQR: 5-11). Polymyxin B therapy had a median antipyretic time of 37 h (IQR: 32-70). The incidence of acute renal dysfunction was 14.8% (four out of 27 cases), all classified as "injury" according to RIFLE criteria. The incidence of hyperpigmentation was 59.3%. Conclusion: Polymyxin B is a viable treatment option for granulocytopenia patients with refractory gram-negative bacterial bloodstream infections.
Subject(s)
Bacteremia , Gram-Negative Bacterial Infections , Sepsis , Humans , Polymyxin B/therapeutic use , Polymyxin B/adverse effects , Retrospective Studies , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/complications , Fever/chemically induced , Fever/drug therapy , Sepsis/drug therapy , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/complicationsABSTRACT
A woman in her 40s, with a known history of fibromyalgia, presented with high-grade fever and constitutional symptoms occurring 5 days following vaccination with Oxford-AstraZeneca COVID-19 vaccine (ChAdOx1). Her inflammatory markers and neutrophil count were found to be elevated and as such, she was started on antibiotics. Despite treatment, markers remained elevated and temperature spikes persisted for another 4 weeks before these symptoms subsided, and her blood tests normalised. All investigations taken in the interim were negative, with no source being identified for the fever. As a result, a positron emission tomography scan was performed to attempt to localise the source of these symptoms. This revealed low-to-moderate grade lymph node tracer uptake above and below the diaphragm most pervasive in the right axilla, with uptake in the right arm corresponding with the site of vaccination.