Statistical analyses were performed with the Mann-Whitney. eCollection 2022. Cytokine and chemokine concentrations from an additional 23 healthy controls who did not have COVID-19 were also analyzed for baseline comparison. A, Heatmap showing the relative concentration of cytokines across patients with different fever patterns. Cases who were already on supplemental oxygen or were already in the ICU at the time of satisfying criteria for prolonged or saddleback fever were excluded from the analysis. Because there are no guidelines to the approach of the febrile patient, most evaluation recommendations are based on expert opinion.17 On initial presentation, most clinicians perform a history and physical examination in pursuit of an infection. as they fulfilled overlapping criteria for prolonged and saddleback fever. 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. 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 and SD but not DSS. The search included reviews, case series, meta-analyses, and randomized controlled trials. Outcomes of interest were hypoxia, admission to the intensive care unit (ICU), need for mechanical ventilation, and mortality. Seven more confirmed cases of novel coronavirus infection in Singapore.2020. P.Y.C. Our cohort only had 1 mortality, and this may be reflective of the overall low mortality rate in Singapore. "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. Hospitalized COVID-19 patients with prolonged fever showed more pronounced inflammatory response and were more likely to require ICU admission than cases with saddleback fever or with fever lasting Recommendations of the Scientific Working Group on Dengue. Fever was defined as a temperature of 38.0C or higher. Although there are more than 200 diseases in the differential diagnosis, most cases in adults are limited to several dozen possible causes. In hypoxic conditions, it can trigger the expression of chemokines that attract neutrophils and monocytes to the ischemic tissue [31]. An official website of the United States government. 2013; 496: 504507. All authors: no reported conflicts of interest. 2020 Oct 28;21(1):897. doi: 10.1186/s13063-020-04819-9. Khalaf M, Alboraie M, Abdel-Gawad M, Abdelmalek M, Abu-Elfatth A, Abdelhamed W, Zaghloul M, ElDeeb R, Abdeltwab D, Abdelghani M, El-Raey F, Aboalam H, Badry A, Tharwat M, Afify S, Elwazzan D, Abdelmohsen AS, Fathy H, Wagih Shaltout S, Hetta HF, Bazeed SE. There were no significant changes in laboratory findings when repeated at the point of fever, except for a rise in platelet and lymphocyte counts (Table 2). 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. Chan SY, Tsai YF, Yen MY, Yu WR, Hung CC, Kuo TL, Chen CC, Yen YF, Huang SH, Huang TC, Huang SJ. Pizzo PA, Lovejoy FH Jr, Smith DH. 2014; 8: e2777 10.1371/journal.pntd.0002777 CONCLUSIONS: Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19. 7 days, a Singapore study reveals. National Library of Medicine This corroborated well with our findings of increased hypoxia in patients with prolonged fever. [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. Interim guidance for implementing home care of people not requiring hospitalization for coronavirus disease 2019 (COVID-19). Influenza (flu) and the common cold are both contagious respiratory illnesses, but they are caused by different viruses. JAMA 2020; 323(11):10619. The site is secure. FOIA Out-of-hospital cardiac arrest and in-hospital mortality among COVID-19 patients: A population-based retrospective cohort study. 2021 Mar 8;9(1):E181-E188. Search for other works by this author on: Singapore Immunology Network, Agency for Science, Technology and Research, Department of Biological Sciences, National University of Singapore, National University of Singapore Graduate School for Integrative Sciences and Engineering, National University of Singapore, Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, National Centre for Infectious Diseases COVID-19 Outbreak Research Team. doi: 10.1093/omcr/omac079. The Significance of Prolonged and Saddleback Fever in Hospitalised Adult Dengue. Ying-Hao P, Yuan-Yuan G, Hai-Dong Z, Qiu-Hua C, Xue-Ran G, Hai-Qi Z, Hua J. Although prolonged and saddleback fever have been reported in dengue fever, there are no specific studies on their significance in dengue. 2016 Dec 9;11(12):e0167025. Statistical analyses were performed with the Mann-Whitney U test (*P<.05; **P<.01; ***P<.001). eCollection 2022 Jul. A fever may be caused by a virus, bacteria, fungus, blood clot, tumor, drug, or the environment. Plasma fractions, MeSH Coronavirus disease 2019 (COVID-19) situation report101. Cases without prolonged or saddleback fever were included as controls. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. 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Emadi A, Chua JV, Talwani R, Bentzen SM, Baddley J. . Cytokines were determined with multiplex View PDF Save to Library doi: 10.1093/ofid/ofx133. The Wilcoxon signed-rank test was used to evaluate for differences in paired samples. CMAJ Open. Coronavirus disease 2019 (COVID-19) situation report101.2020. 2022 Dec;55(6 Pt 1):1044-1051. doi: 10.1016/j.jmii.2022.07.009. Concentrations of 45 immune mediators in plasma were quantified using a 45-plex microbead-based immunoassay. Effects of sericin and egg white on the inflammation of damaged skin in mice. Federal government websites often end in .gov or .mil. Pediatrics 1975; 55:468. Patients with prolonged fever had higher induced protein10 and lower interleukin-1 levels compared with those with saddleback fever at the early acute phase of disease. We conducted a hospital-based casecontrol 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). In particular, fever was reported in about 72%98.6% of patients, usually lasting <7 days [4, 710]. For cases with prolonged fever, investigations were repeated beyond day 7 of illness, and for cases with saddleback fever, investigations were repeated at point of fever recurrence. Fever often occurs in response to infection, inflammation and trauma. Please check for further notifications by email. . Laboratory Results for Prolonged and Saddleback Fever. Treatment. Patients with prolonged fever may have had higher levels of IL-1 earlier on before sample collection. Patients with saddleback fever appeared to have good outcomes regardless of the fever. 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. and transmitted securely. While both prolonged and saddleback fever showed an association with hypoxia, only prolonged fever was associated with ICU admission. ELIZABETH C. HERSCH, COL, MC, USA, AND C. ROBERT, OH, LTC, MC, USA. The Author(s) 2020. Potential conflicts of interest. 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. HHS Vulnerability Disclosure, Help Both COVID-19 and the common cold can include a runny nose, sore throat, and fever, says Dr. Fisher, and both can last between a few days or a week. 2022 May 20;15:2575-2587. doi: 10.2147/IDR.S355064. This phenomenon is also observed in other viral fevers, like dengue virus [27] and thrombocytopenia syndrome virus [28, 29], where patients with more severe illness have higher serum levels of IP-10. Patients were categorized as having prolonged fever (lasting >7 days), saddleback fever (defined as recurrent fever which lasts for <24 hours, after defervescence beyond day 7 of illness), or controls if their fever was 7 days.