Comparative study of serum ferritin levels and hepatic transaminases between uncomplicated paediatric dengue inpatients and other febrile illnesses in Kanchipuram, India

Background: Fever is the most common complaint with bringing children for hospital consultation. Dengue is a cause of public health concern with case fatality rate of 1%. Ferritin is an acute-phase reactant which is produced in response to infection and inflammation. Liver enzymes are also considered as markers of febrile illness. Aim of this study was to assess serum ferritin levels, aspartate-aminotransferase (AST) and alanine-aminotransferase (ALT) levels in pediatric inpatients with febrile illness, to correlate it with patient’s Dengue profile and to analyse these parameters with sub-group analysis of dengue and OFI.Methods: Among 120 children admitted for fever of more than 3 days duration were included in the study. 58 were Dengue-NS1 positive and the remaining 62 were considered to be OFI. Serum ferritin levels, AST and ALT were the investigative parameters measured at the time of admission for the study and treated as per WHO Dengue Guidelines. Data was coded and entered in Microsoft Excel 2013. Data was analysed using SPSS v16. p value of <0.05 was considered statistically significant.Results: Ferritin levels were higher in Dengue-IgM positive subgroup than in OFI subgroup (U= 173, Z score -6.09, p<0.00001). AST levels are higher in Dengue-NS1 positive subgroup than in OFI subgroup (U= 103, Z score -8.08, p<0.00001). AST levels were also higher in Dengue-IgM positive subgroup than in OFI subgroup (U= 377.5, Z score -4.86, p<0.00001). ALT levels are higher in Dengue-NS1 positive subgroup than in OFI subgroup (U=76, Z score -8.95, p<0.00001) as well as in Dengue-IgM positive subgroup than in OFI subgroup (U= 417, Z score -4.4, p<0.00001).Conclusions: Hyperferritinemia and elevation of hepatic-transaminases is seen in dengue. Although elevated in other febrile illnesses, it is elevated more so in dengue. This can be a predictor of severity of dengue fever, but needs to be confirmed in larger studies.

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Iron deficiency anemia as a risk factor for simple febrile seizures in pediatric patients

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192126 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1414 ◽

Cited By ~ 1

Author(s):

Bharath Kumar T. ◽

Kanimozhi Thandapani ◽

Vinod Babu S.

Keyword(s):

Risk Factor ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Ferritin ◽

Febrile Seizure ◽

Hematological Parameters ◽

Significant Risk ◽

Febrile Illness ◽

Deficiency Anemia ◽

P Value

Background: Febrile seizure (FS) is the most common cause of seizure in children, occurring between 6-60 months. It coincides with peak age of incidence for Iron deficiency anemia (IDA). Iron is required for optimal growth and development and its deficiency is associated with numerous problems including persistent cognitive and motor delays. The objective was to study the role of IDA as a risk factor for simple febrile seizure and its recurrenceMethods: A case control study was conducted among 90 febrile children - 45 cases with simple febrile seizure and 45 cases with febrile illness, between the age group of six months to five years of age at Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, between September 2013 and June 2015. The hematological parameters like Hemoglobin, Serum ferritin and RDW were compared between the two groups with respect to fever and different temperature intervals, recurrence of FS.Results: Hb and Serum Ferritin levels were found to be significantly associated with simple febrile seizure, with p value of <0.002 and 0.001 respectively. Similar association was found at different temperature intervals. However, there was no association of hematological parameters with FS recurrence.Conclusions: IDA is a significant risk factor for FS in children while same may not have any effect on the recurrence of FS.

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Hyperferritinemia as independent risk factor and biomarker in COVID-19 to predict severity and mortality.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.08.6178 ◽

2021 ◽

Vol 28 (08) ◽

pp. 1183-1189

Author(s):

Shah Taj Khan ◽

◽

Saiqa Zahoor ◽

Hamzullah Khan ◽

Khalid Khan ◽

...

Keyword(s):

Risk Factor ◽

Serum Ferritin ◽

Age Groups ◽

Case Fatality ◽

Binary Logistic Regression ◽

Female Gender ◽

Male Gender ◽

P Value ◽

Binary Logistic Regression Analysis ◽

Gender Groups

Objectives: To determine the role of deranged serum ferritin levels as independent pathogenic risk factor to predict the progression towards a worse clinical outcome in COVID-19. Study Design: Descriptive Cross Section Study. Setting: Hayatabad Medical Complex Peshawar. Period: 1 March to 10 July 2020. Material & Methods: A total of 267 patients were enrolled from COVID-19 isolation units, Hayatabad Medical Complex Peshawar Descriptive statistics were used for numerical variables. Binary logistic regression analysis was used to predict the worst outcome in patients with deranged levels of ferritin. Correlation statistic were used to quantify the correlation of ferritin with mortality and severity of the disease. Kaplan Meir test was used for survival analysis to compare the mortality rate in gender groups in COVID-19 patients with deranged ferritin levels. Results: The mean age of the patients was 53+14years. The median value of the Serum ferritin levels of Covid-19 patients was 978 ug/L the ferritin distribution in gender groups was not normally distributed (Shapiro Wilk test, p-value 0.001). 215/267(80.5%) cases reported >400 ug/Lof serum ferritin. There was a statistically significant uphill positive correlation of serum ferritin levels with an increase in age (rs-0.213, p-0.001) and with disease outcome in terms of mortality (rs-0.29, p-0.05). The probability case fatality in patients with deranged serum ferritin levels was 1.8 times more as compared to patients without hyperferritinemia (p-0.05, OR 1.8). The surviving capability in female gender with deranged ferritin levels in extreme of age was 65% as compared to 20% in male gender. Conclusion: More than 80% of the COVID-19 patients had abnormally higher readings of serum ferritin. The deranged ferritin levels had a statistically significant correlation with an increase in age of patient and with worst outcome in terms of death. Female gender more protective with higher chances of survival with deranged serum ferritin levels in all age groups compared to male gender.

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ASSESSMENT OF KNOWLEDGE, ATTITUDES AND PRACTICE TOWARD DENGUE FEVER AMONG UNIVERSITY STUDENTS IN MALAYSIA

Global Journal of Public Health Medicine ◽

10.37557/gjphm.v3i1.76 ◽

2021 ◽

Vol 3 (1) ◽

pp. 289-300

Keyword(s):

University Students ◽

Dengue Fever ◽

Dengue Infection ◽

Febrile Illness ◽

Simple Random Sampling ◽

Health Concern ◽

P Value ◽

Cross Sectional ◽

Level Of Knowledge ◽

Dengue Prevention

Introduction: Dengue fever is an acute febrile illness with a significant public health concern in tropical and subtropical countries. Population knowledge and practice play an essential role in the transmission and prevention of the disease. This study aims to evaluate the level of knowledge, attitudes, and practice regarding dengue fever among Malaysian university students. Methods: A cross-sectional descriptive study was conducted in twenty-five randomly selected universities across Malaysia. A total of 1520 respondents were approached by simple random sampling method. A previously validated and published questionnaire was used with little modification. The associations between the level of knowledge, Attitudes, and practice with different risk factors were calculated statistically and the significant association was considered with a p-value <0.05. Results: The data were analysed and showed that most of the students (56.3%, 46.2%, and 43.3%) has a moderate level of knowledge, attitude, and practice respectively toward dengue infection among the respondents. The result shows a significant association between the level of practice and knowledge (p-value <0.001) as well as between the level of practice and attitudes (p-value <0.001). Conclusion: The significant association between the practice and knowledge along with attitudes indicates the more knowledge and attitudes lead to better practice. This study highlighted the important role of university students in dengue prevention-based programs. They should be exposed more to improve and transfer their knowledge and attitude to other community population to reduce the incidence of dengue not only in Malaysia but globally.

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Impact of obesity on outcome of severe bacterial infections

PLoS ONE ◽

10.1371/journal.pone.0251887 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251887

Author(s):

Åsa Alsiö ◽

Salmir Nasic ◽

Lars Ljungström ◽

Gunnar Jacobsson

Keyword(s):

Observational Study ◽

Bacterial Infections ◽

Negative Impact ◽

Survival Rates ◽

Case Fatality ◽

Life Time ◽

Population Based ◽

Continuous Variable ◽

Health Concern ◽

P Value

Introduction Obesity is a rapidly growing global health concern with considerable negative impact on life-time expectancy. It has yet not been clarified if and how obesity impacts outcomes of severe bacterial infections. The aim of this study was to determine how body mass index impacts outcome of severe bacterial infections in a well-defined population-based cohort. Methods This study is based on a cohort of 2196 patients included in a Swedish prospective, population-based, consecutive observational study of the incidence of community-onset severe sepsis and septic shock in adults. All patients with weight and height documented in the medical records on admission were included. Results The case fatality rate (CFR) was negatively correlating with increasing BMI. Outcomes included 28-day CFR (p-value = 0.002), hospital CFR (p-value = 0.039) and 1-year CFR (p-value<0.001). When BMI was applied as continuous variable in a multiple logistic regression together with other possible covariates, we still could discern that BMI was associated with decreasing 28-day CFR (OR = 0.93, 95% CI 0.88–0.98, p-value = 0.009) and 1-year CFR (OR = 0.94, 95% CI 0.91–0.97, p-value<0.001). Conclusion The hypothesis and paradox of obesity being associated with higher survival rates in severe bacterial infections was confirmed in this prospective, population-based observational study.

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Trends in Acute Undifferentiated Febrile Illness in Patients Seeking Treatment from a Tertiary Care Hospital of Central Kerala

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/236 ◽

2021 ◽

Vol 8 (18) ◽

pp. 1230-1235

Author(s):

Reshmi Ramachandran ◽

Jeena Ramesh ◽

Bindhu Vasudevan

Keyword(s):

Public Health ◽

Disease Incidence ◽

Tertiary Care ◽

Age Groups ◽

Case Fatality ◽

Febrile Illness ◽

Sampling Technique ◽

P Value ◽

Care Hospital ◽

Age Group

BACKGROUND Acute undifferentiated febrile illness (AUFI / AFI) is one of the most common reasons for people seeking medical care globally. Investigation into the aetiology and trends in AUFI cases are valuable public health data source. Absence of such evidence-based data may result in unintended public health consequences. Present study was undertaken to address the gap in period specific trends in AUFI cases reported from the region. METHODS A record based descriptive study was done in patients treated with AUFI from January 1st, 2015 to December 31st , 2019 in Government Medical College, Ernakulam. Universal sampling technique was adopted, and the data was entered in Microsoft Excel and analysed using Epi-Info software. Line diagram was constructed to obtain the trends in AUFI cases over the five-year period. Chisquare test was applied to find out the association between age group (paediatric and others) and causative agents of AUFI. RESULTS A total of 7998 AUFI cases were included in this study. Highest number of AUFI cases (1986) was reported in the year 2017. Under five age group was the most common, 1564 (19.6 %). Majority of the AUFI were reported among males, 4947 (61.9 %). Undetermined fever was found to be the most common AUFI, 2188 (27.4 %). Dengue fever, 1993 (24.9 %) was the most diagnosed AUFI. Viral aetiology was found to be the most common, 3895 (48.7 %) in both paediatric and other age groups. No statistically significant association was found between (P-value = 0.22) age group and organisms causing AUFI. There were 121 (1.5 %) deaths reported among the AUFI cases during the five-year period. It was seen that the case fatality due to AUFI was highest (2.41 %) in the year 2019. CONCLUSIONS A lack of consistent pattern in the aetiology of AUFI cases reported over the fiveyear study period, calls for persistent vigil by the public health surveillance system in the region, to identify any impending infectious disease outbreak at the earliest. As this study is based on hospital-based surveillance record it can underestimate the disease incidence. KEYWORDS Acute Undifferentiated Febrile Illness (AUFI), Trends, Dengue, Acute Febrile Illness

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Serum Ferritin Status of Patients with Type 2 DM Attending OPD of BIRDEM General Hospital

Anwer Khan Modern Medical College Journal ◽

10.3329/akmmcj.v11i1.45660 ◽

2020 ◽

Vol 11 (1) ◽

pp. 7-10

Author(s):

Khadiza Begum ◽

Fahmida Islam ◽

Farjana Aktar ◽

Murshida Aziz ◽

Tohfa E Ayub Tahiya

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Serum Ferritin ◽

Study Groups ◽

Acute Phase Reactant ◽

The Body ◽

Iron Stores ◽

Normal Healthy Individual ◽

Diabetes Patients

Background: In recent times much is talked about of serum ferritin, an acute phase reactant a marker of iron stores in the body and its association with diabetes mellitus. Studies implicate that increased body iron stores and subclinical hemochromatosis has been associated with the development of glucose intolerance, type 2 diabetes and its micro as well as macrovascular complications. Material & Methods: This study was carried out to examine and to observe for any relationship between serum ferritin with Type 2 diabetes mellitus. Our study populations were included 163. Among them 81 type 2 diabetes patients as a case (M=49,F=32, mean 44.68 age in years)and 82 normal healthy individual as a control ( M=35, F=47 , mean 34.71 in years). Results: Majority were healthy outpatients who had come for regular checkup and were matched with controls. Serum ferritin and FBS were estimated and other investigations. Results showed that although Serum ferritin was in the normal range value it was increased in type 2 diabetes patients than in controls and was statistically significant, we did get a positive correlation with duration of diabetes. It can be concluded that there were positive associations between serum ferritin and FBG, age, sex among study groups. Conclusion: In conclusion our study shows that there is significant correlation between increased serum ferritin in diabetes compared to individuals with normal blood sugars in this part and hyper ferritinemia may be one of the causes for development of insulin resistance before overt diabetes. Anwer Khan Modern Medical College Journal Vol. 11, No. 1: Jan 2020, P 7-10

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Managing Febrile Illness in Malaria-endemic Areas: Developing Novel Diagnostics Using Host Immunological Signatures as Surrogate Markers of Infection

Current Immunology Reviews ◽

10.2174/1573395515666191025104514 ◽

2019 ◽

Vol 15 (2) ◽

pp. 202-206 ◽

Cited By ~ 2

Author(s):

Olaitan O. Omitola ◽

Hammed O. Mogaji ◽

Andrew W. Taylor-Robinson

Keyword(s):

Clinical Symptoms ◽

Transcriptional Profiling ◽

Febrile Illness ◽

Molecular Techniques ◽

Health Concern ◽

Illness Management ◽

Presumptive Treatment ◽

Disease Diagnostics ◽

Proteomics Technology ◽

Tools And Methods

Recent research has highlighted the growing public health concern arising from mismanagement of malarial and non-malarial febrile illnesses that present with similar clinical symptoms. A retrospective examination of patient records suggests that a syndrome-based diagnosis results in over-diagnosis of malaria. Consequently, interventions to mitigate the frequency of presumptive treatment of fever in malaria-endemic settings have been sought, especially for resourcelimited areas. Guidelines that promote the use of microbiological tests and modern diagnostic kits have demonstrated laudable progress in the ongoing challenge of febrile illness management. However, this has brought attention to other factors like the complication of mixed infections. These issues, which remain significant limitations to current tools and methods in the accurate diagnosis and subsequent therapy of febrile illnesses, call for innovative diagnostic interventions. Advancements in biomedical research over the last decade have led to the introduction of state-of-the-art molecular techniques of omics origin that provide the possibility of diverse applications in disease diagnostics. Here, we present notable challenges in febrile illness management, describe currently available tools and methods for diagnosis, and discuss the opportunities for future progress, including harnessing cuttingedge transcriptional profiling and proteomics technology to detect host immunological signatures during infection.

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Population-Predicted MHC Class II Epitope Presentation of SARS-CoV-2 Structural Proteins Correlates to the Case Fatality Rates of COVID-19 in Different Countries

International Journal of Molecular Sciences ◽

10.3390/ijms22052630 ◽

2021 ◽

Vol 22 (5) ◽

pp. 2630

Author(s):

Chunguang Liang ◽

Elena Bencurova ◽

Eric Psota ◽

Priya Neurgaonkar ◽

Martina Prelog ◽

...

Keyword(s):

Mhc Class Ii ◽

Case Fatality Rate ◽

Case Fatality ◽

Class Ii ◽

Viral Envelope ◽

Structural Proteins ◽

P Value ◽

Fatality Rate ◽

Different Populations ◽

Infection Spread

We observed substantial differences in predicted Major Histocompatibility Complex II (MHCII) epitope presentation of SARS-CoV-2 proteins for different populations but only minor differences in predicted MHCI epitope presentation. A comparison of this predicted epitope MHC-coverage revealed for the early phase of infection spread (till day 15 after reaching 128 observed infection cases) highly significant negative correlations with the case fatality rate. Specifically, this was observed in different populations for MHC class II presentation of the viral spike protein (p-value: 0.0733 for linear regression), the envelope protein (p-value: 0.023), and the membrane protein (p-value: 0.00053), indicating that the high case fatality rates of COVID-19 observed in some countries seem to be related with poor MHC class II presentation and hence weak adaptive immune response against these viral envelope proteins. Our results highlight the general importance of the SARS-CoV-2 structural proteins in immunological control in early infection spread looking at a global census in various countries and taking case fatality rate into account. Other factors such as health system and control measures become more important after the early spread. Our study should encourage further studies on MHCII alleles as potential risk factors in COVID-19 including assessment of local populations and specific allele distributions.

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Active Circulation of Madariaga Virus, a Member of the Eastern Equine Encephalitis Virus Complex, in Northeast Brazil

Pathogens ◽

10.3390/pathogens10080983 ◽

2021 ◽

Vol 10 (8) ◽

pp. 983

Author(s):

Laura H. V. G. Gil ◽

Tereza Magalhaes ◽

Beatriz S. A. S. Santos ◽

Livia V. Oliveira ◽

Edmilson F. Oliveira-Filho ◽

...

Keyword(s):

Phylogenetic Analyses ◽

Case Fatality ◽

Febrile Illness ◽

Encephalitis Virus ◽

Northeast Brazil ◽

Eastern Equine Encephalitis Virus ◽

Eastern Equine Encephalitis ◽

Vaccination Programs ◽

Transmission Cycle ◽

Equine Encephalitis Virus

Madariaga virus (MADV) is a member of the eastern equine encephalitis virus (EEEV) complex that circulates in Central and South America. It is a zoonotic, mosquito-borne pathogen, belonging to the family Togaviridae. Disturbances in the natural transmission cycle of this virus result in outbreaks in equines and humans, leading to high case fatality in the former and acute febrile illness or neurological disease in the latter. Although a considerable amount of knowledge exists on the eco-epidemiology of North American EEEV strains, little is known about MADV. In Brazil, the most recent isolations of MADV occurred in 2009 in the States of Paraíba and Ceará, northeast Brazil. Because of that, health authorities have recommended vaccination of animals in these regions. However, in 2019 an equine encephalitis outbreak was reported in a municipality in Ceará. Here, we present the isolation of MADV from two horses that died in this outbreak. The full-length genome of these viruses was sequenced, and phylogenetic analyses performed. Pathological findings from postmortem examination are also discussed. We conclude that MADV is actively circulating in northeast Brazil despite vaccination programs, and call attention to this arbovirus that likely represents an emerging pathogen in Latin America.

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Abstract 132: Methylprednisolone Pulse Therapy for Kawasaki Disease with Symptomatic Myocarditis

Circulation ◽

10.1161/circ.131.suppl_2.132 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

yeo hyang kim ◽

Chae Ok Shin ◽

Myung Chul Hyun ◽

Dong Seok Lee

Keyword(s):

Kawasaki Disease ◽

Systolic Function ◽

Systemic Vasculitis ◽

Cervical Lymphadenopathy ◽

Febrile Illness ◽

Pulse Therapy ◽

Left Ventricular ◽

Acute Stage ◽

Z Score ◽

Intravenous Methylprednisolone

Purpose: Kawasaki disease (KD) is an acute febrile illness of infants and young children that is characterized by a systemic vasculitis, especially involving the coronary arteries. Although, sometimes, subclinical myocarditis is combined in KD, symptomatic myocarditis is extremely uncommon. We report a 7 year old boy who developed hypotension and decreased left ventricular systolic function (EF 40%) in the acute phase of KD. Case: A 7 year old boy (height 115 cm, body weight 20 kg) was admitted because of 2 days of persistent fever and left cervical lymphadenopathy (white blood cell count 17,870 /mm 3 , C reactive protein 23.6 mg/dL). Conjunctiva injection and lip redness developed on the 4th day of illness, and hypotension and tachycardia (SBP 59/DBP 29 mmHg, HR 153/bpm) were combined. The echocardiography revealed a decreased ejection fraction (EF) (40%) without chamber dilatation and normal coronary artery size (LM 1.9mm, z score=-1.3, RCA 2.3mm, z score=0.4). The level of N terminal pro BNP was 28,000 pg/mL. With a diagnosis of KD with myocarditis, he was initially treated with inotropics and intravenous immunoglobulin (2 g/kg). Without clinical improvement in spite of initial treatment, A change of coronary arterial size (LM 2.9mm, z score=1.2, RCA 3.1mm, z score=2.3) was developed and decreased LV systolic function (EF 45%) and fever were persisted. Then, he was given 3 daily pulses of intravenous methylprednisolone followed by tapering doses of oral prednisolone. He showed prompt clinical recovery after pulse therapy of intravenous methylprednisolone (SBP 95/DBP 49 mmHg, HR 98/bpm). Although EF was improved (59%), coronary arterial dilatation was progressed (LM 3.4mm, z score=2.4 RCA 5.5mm, z score=7.9). Conclusions: The present case serves to highlight the fact that methylprednisolone should be considered as the priority in children with KD who have symptomatic myocarditis during the acute stage.

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