Marburg hemorrhagic fever in Durba and Watsa, Democratic Republic of the Congo: clinical documentation, features of illness, and treatment

The objective of the present study was to describe day of onset and duration of symptoms of Marburg hemorrhagic fever (MHF), to summarize the treatments applied, and to assess the quality of clinical documentation. Surveillance and clinical records of 77 patients with MHF cases were reviewed. Initial symptoms included fever, headache, general pain, nausea, vomiting, and anorexia (median day of onset, day 1-2), followed by hemorrhagic manifestations (day 5-8+), and terminal symptoms included confusion, agitation, coma, anuria, and shock. Treatment in isolation wards was acceptable, but the quality of clinical documentation was unsatisfactory. Improved clinical documentation is necessary for a basic evaluation of supportive treatment

Serum cholesterol levels in neutropenic patients with fever

Hypocholesterolemia, which often accompanies infectious diseases has been suggested to serve as a prognostic marker in hospitalized patients. Even though patients with chemotherapyinduced leukopenia are at high risk of infection and mortality, only limited information is available on serum cholesterol levels in these patients. We therefore measured serum cholesterol levels in 17 patients with hematological malignancies during chemotherapyinduced neutropenia and correlated it with clinical outcome. Patients with fever (>38.5 degreesC) showed a significant decrease in serum cholesterol levels within 24 hours. Eight days after onset of the fever nonsurvivors had significantly lower serum cholesterol levels (median 2.09 mmol/l, range 0.492.79, n=6) compared to survivors (median 3.23 mmol/l, range 1.684.86, n=11). Cholesterol levels in survivors returned to baseline levels at the time of discharge from the hospital. At the onset of fever, serum levels of inflammatory cytokines interleukin-6, tumor necrosis factor (TNF) and soluble TNF receptors p55 and p75 were elevated in all patients, but only TNF and TNF receptor p75 levels were significantly different in survivors and nonsurvivors. Our data suggest that a decrease in serum cholesterol levels is a prognostic marker in neutropenic patients with fever. Release of inflammatory cytokines may in part be responsible for hypocholesterolemia in these patients

Hay fever is associated with prevalence, age of onset and persistence of stuttering

Objectives: Atopic diseases and adverse childhood experiences are associated with neurodevelopmental disorders including developmental stuttering. This study examined the associations between these factors and lifetime prevalence, age of onset, and persistence of developmental stuttering. Methods: Data from 4874 participants (2264 men and 2610 women) from the PsyCoLaus study were used. Prevalence, age of onset, and persistence of stuttering were investigated through univariate, bivariate, and regression analyses. Results: Regression analyses indicated that hay fever, gender, familial aggregation, and fear of punishment by parents were associated with stuttering onset in childhood with odds ratios (OR) of 2–3. Hay fever was associated with an earlier onset of stuttering (difference of 1.5 years, p = .001). Moreover, early onset of stuttering (OR = 0.8, p = .009) and hay fever (OR = 9.2, p = .002) predicted whether stuttering persisted. Conclusions: This study suggests that immunological imbalances related to atopic diseases such as hay fever and adverse childhood experiences are also related to stuttering. The importance of this link is emphasized by the fact that hay fever is also associated with age of onset and persistence of stuttering

Fatal case of newborn Lassa fever virus infection mimicking late onset neonatal sepsis: a case report from northern Nigeria

BACKGROUND: Lassa fever is a zoonotic viral infection endemic to the West Africa countries. It is highly fatal during pregnancy and as such reports of neonatal onset Lassa fever infections are rare in scientific literature. We report a fatal case of Lassa fever in a 26-day-old neonate mimicking the diagnosis of late-onset neonatal sepsis. CASE PRESENTATION: The patient is a 26-day-old neonate who was admitted with a day history of fever, poor feeding, pre-auricular lymphadenopathy and sudden parental death. He was initially evaluated for late onset neonatal sepsis. He later developed abnormal bleeding and multiple convulsions while on admission, prompting the need to evaluate for Lassa fever using reverse transcription polymerase chain reaction (RT-PCR). He died 31 h into admission and RT-PCR result was positive for Lassa fever. CONCLUSIONS: Neonatal Lassa fever infection is highly fatal and can mimic neonatal sepsis. High index of suspicion is needed particularly for atypical presentations of neonatal sepsis in Lassa fever endemic areas

An unexpected cause for right loin pain

A 49-year-old woman presented with acute onset of persistent, severe right loin pain. This was associated with uncontrolled hypertension. There was no associated fever, haematuria or dysuria. There was no history of trauma. At 17 years of age, she underwent a left nephrectomy for an atrophic kidneypeer-reviewe

Eczema in early childhood increases the risk of allergic multimorbidity

Background: Eczema in early childhood is associated with the development of subsequent allergic diseases, including food allergy (FA), asthma and hay fever. However, eczema has a heterogenous presentation regarding onset age and persistence, which may lead to different allergic outcomes during childhood/adolescence. Recently, sub-phenotypes of eczema have been suggested as predictors of allergic multimorbidity. Thus, we aimed to identify associations of eczema phenotypes with FA, asthma and hay fever during childhood/adolescence. Additionally, we described the trajectories of eczema, asthma and hay fever stratified by FA presence. Methods: TRACKER (Trajectories of Allergy in Children in Real Life Databases) is a population-based cohort study of 6852 children/adolescents from the Lifelines cohort. We investigated the associations of seven eczema phenotypes, based on onset age and persistence, with FA, asthma and hay fever using logistic regression, adjusted for appropriate covariates. Disease trajectories were determined by calculating prevalence at different ages. Results: Participants who suffered from eczema throughout childhood showed higher risks of developing FA, hay fever and asthma. “Very early onset—persistent” eczema showed the strongest associations with FA, asthma and hay fever. The prevalence of eczema, asthma and hay fever at all ages was significantly higher in participants with FA, compared to those without. Conclusion: One of the largest cohort studies on this topic to date shows that (very) early onset and persistent eczema increases the risk of allergic multimorbidity. Identification of infants at risk for developing (very) early onset eczema is of utmost importance to prevent allergic multimorbidity.</p

Reimann's "Habitual Hyperthermia" Responding to Hormone Therapy.

A 25-year-old woman presented with fever of unknown origin, exhibiting malaise and low-grade fevers in evenings. These fevers exhibited a pattern of starting mid-menstrual cycle with resolution around the onset of menses, matching a pattern of "habitual hyperthermia" reported by H. Reimann in the 1930s. Extensive workup was unremarkable, and the fevers improved on oral synthetic estrogen and progesterone therapy

An outbreak of sheep-associated malignant catarrhal fever in sows

his paper describes a case of malignant catarrhal fever in a sow herd in Belgium caused by infection with ovine herpesvirus-2 (OHV-2). The 11 affected sows had high fever and 10 of them died within 3 days after the onset of clinical disease. The most prominent macroscopic lesion was a hemorrhagic to pseudo-membranous gastritis. Histopathology revealed severe infiltration and necrosis of the gastric mucosa. Neither antimicrobial treatment nor injection with anti-inflammatory drugs ameliorated the severity of the disease. As the sows and sheep were housed in the same building with the possibility of having direct nose-to-nose contact, and as PCR testing showed that the virus found in the sows was identical to that found in the sheep, it is very likely that the infection was transmitted from the subclinically infected sheep to the sows. The present case showed that OHV-2 infection should be included in the differential diagnosis when facing problems of fever followed by death, especially when pigs are housed in close contact with sheep