About all

Critical fever: The request could not be satisfied

Содержание

Fever or Chills, Age 12 and Older

Overview

Fever is the body’s normal and healthy reaction to infection and other illnesses, both minor and serious. It helps the body fight infection. Fever is a symptom, not a disease. In most cases, having a fever means you have a minor illness. When you have a fever, your other symptoms will help you determine how serious your illness is.

Temperatures in this topic are oral temperatures. Oral temperatures are usually taken in older children and adults.

Normal body temperature

Most people have an average body temperature of about 37°C (98.6°F), measured orally (a thermometer is placed under the tongue). Your temperature may be as low as 36. 3°C (97.4°F) in the morning or as high as 37.6°C (99.6°F) in the late afternoon. Your temperature may go up when you exercise, wear too many clothes, take a hot bath, or are exposed to hot weather.

Fever temperatures

A fever is a high body temperature. A temperature of up to 38.9°C (102°F) can be helpful because it helps the body fight infection. Most healthy children and adults can tolerate a fever as high as 39.4°C (103°F) to 40°C (104°F) for short periods of time without problems. Children tend to have higher fevers than adults.

The degree of fever may not show how serious the illness is. With a minor illness, such as a cold, you may have a temperature, while a very serious infection may cause little or no fever. It is important to look for and evaluate other symptoms along with the fever.

If you are not able to measure your temperature with a thermometer, you need to look for other symptoms of illness. A fever without other symptoms that lasts 3 to 4 days, comes and goes, and gradually reduces over time is usually not a cause for concern. When you have a fever, you may feel tired, lack energy, and not eat as much as usual. High fevers are not comfortable, but they rarely cause serious problems.

Oral temperature taken after smoking or drinking a hot fluid may give you a false high temperature reading. After drinking or eating cold foods or fluids, an oral temperature may be falsely low.

Causes of fever

Viral infections, such as colds and influenza (flu), and bacterial infections, such as a urinary tract infection or pneumonia, often cause a fever.

Travel outside your native country can expose you to other diseases. Fevers that begin after travel in other countries need to be evaluated by your doctor.

Fever and respiratory symptoms are hard to evaluate during the flu season. A fever of 38.9°C (102°F) or higher for 3 to 4 days is common with the flu. For more information, see the topic Respiratory Problems, Age 12 and Older.

Recurrent fevers are those that occur 3 or more times within 6 months and are at least 7 days apart. Each new viral infection may cause a fever. It may seem that a fever is ongoing, but if 48 hours pass between fevers, then the fever is recurring. If you have frequent or recurrent fevers, it may be a symptom of a more serious problem. Talk to your doctor about your fevers.

Treating a fever

In most cases, the illness that caused the fever will clear up in a few days. You usually can treat the fever at home if you are in good health and do not have any medical problems or significant symptoms with the fever. Make sure that you are taking enough foods and fluids and urinating in normal amounts.

Low body temperature

If a low body temperature is your only symptom, it is not something to worry about. If a low body temperature occurs with other symptoms, such as chills, shaking, breathing problems, or confusion, then this may be a sign of more serious illness.

Low body temperature may occur from cold exposure, shock, alcohol or drug use, or certain metabolic disorders, such as diabetes or hypothyroidism. A low body temperature may also be present with an infection, particularly in newborns, older adults, or people who are frail. An overwhelming infection, such as sepsis, may also cause an abnormally low body temperature.

Home Treatment

It’s easy to become dehydrated when you have a fever.

In the early stages, you may be able to correct mild to moderate dehydration with home treatment measures. It is important to control fluid losses and replace lost fluids.

Adults and children age 12 and older

If you become mildly to moderately dehydrated:

  • Stop your activity and rest.
  • Drink a rehydration drink, water, juice, or sports drink to replace fluids and minerals. Drink 2 L (2 qt) of cool liquids over the next 2 to 4 hours. You should drink at least 10 glasses of liquid a day to replace lost fluids. You can make an inexpensive rehydration drink at home. But do not give this homemade drink to children younger than 12. Measure all ingredients precisely. Small variations can make the drink less effective or even harmful. Mix the following:
    • 1 L (1 quart ) purified water
    • 2. 5 mL (½ teaspoon) salt
    • 30 mL (6 teaspoons) sugar

Rest and take it easy for 24 hours, and continue to drink a lot of fluids. Although you will probably start feeling better within just a few hours, it may take as long as a day and a half to completely replace the fluid that you lost.

Many people find that taking a lukewarm [ 27°C (80°F) to 32°C (90°F)] shower or bath makes them feel better when they have a fever. Do not try to take a shower if you are dizzy or unsteady on your feet. Increase the water temperature if you start to shiver. Shivering is a sign that your body is trying to raise its temperature.Do not use rubbing alcohol, ice, or cold water to cool your body.

Dress lightly when you have a fever. This will help your body cool down. Wear light pyjamas or a light undershirt. Do not wear very warm clothing or use heavy bed covers. Keep room temperature at 21°C (70°F) or lower.

If you are not able to measure your temperature, you need to look for other symptoms of illness every hour while you have a fever and follow home treatment measures.

Medicine you can buy without a prescription

Try a non-prescription medicine to help treat your fever or pain:

Talk to your child’s doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

Safety tips

Be sure to follow these safety tips when you use a non-prescription medicine:

  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not take more than the recommended dose.
  • Do not take a medicine if you have had an allergic reaction to it in the past.
  • If you have been told to avoid a medicine, call your doctor before you take it.
  • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.
  • Do not give aspirin to anyone younger than 18 unless your doctor tells you to.
  • Do not give your child naproxen (such as Aleve) to children younger than age 12 unless your child’s doctor tells you to.

Be sure to check your temperature every 2 to 4 hours to make sure home treatment is working.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • Level of consciousness changes.
  • You have signs of dehydration and you are unable to drink enough to replace lost fluids. Signs of dehydration include being thirstier than usual and having darker urine than usual.
  • Other symptoms develop, such as pain in one area of the body, shortness of breath, or urinary symptoms.
  • Symptoms become more severe or frequent.

Causes and consequences of fever complicating critical surgical illness


Background:

Fever may have malign consequences in the postoperative period. This study was performed to determine the causes and consequences of fever in critically ill surgical patients. The specific hypothesis tested is that postoperative fever is associated with adverse clinical outcomes, including increased organ dysfunction and risk of death.


Methods:

Inception-cohort study of critically ill surgical patients who manifested a core temperature of >/=38. 2 degrees C for the first time. The episode of fever was monitored until resolution, which was defined as a core temperature of <38.2 degrees C for at least 72 consecutive h. Demographic data collected included age, gender, admission diagnosis, admission status (elective/emergency), severity of illness (APACHE III), the systemic inflammatory response syndrome (SIRS) score, the cumulative multiple organ dysfunction score, cause of fever (infectious/non-infectious), ICU and hospital length of stay, and mortality. The day of onset of fever in the ICU, peak temperature, ICU day of peak temperature, and duration of fever episode were recorded. All diagnostic and therapeutic interventions were recorded, including the type and duration of antibiotic therapy. Univariate results of possible significance (alpha < 0.15) were tested in logistic regression models for independence of effect upon mortality after auto-correlation was excluded by matrix correlations and the Durbin-Watson statistic. Cases where both non-infectious and infectious causes of fever were present were analyzed as part of the infectious group, whereas the cumulative MOD score was dichotomized (< 5, >/=5 points) at a value known to be associated with increased mortality.


Results:

Among 2,419 screened patients, 626 patients (26%) developed fever. Febrile patients were older, sicker, more likely to have undergone emergency surgery, more likely to develop organ dysfunction, and more likely to die (all, p < 0.0001). The mean day of onset of fever was day 1 and the mean peak temperature for the episode was 39.1 +/- 0.1 degrees C. For most patients, it was their only episode of fever, with a mean of 1.4 +/- 0.1 episodes/patient. Forty-six percent of febrile patients were found to have an infectious cause of fever. Nearly all patients had SIRS, and nearly all developed organ dysfunction to some degree. By logistic regression, the presence of SIRS (as opposed to fever in isolation), emergency status, higher APACHE III score and the peak temperature were associated with increased mortality, with peak temperature being the most powerful predictor in the model (OR 2.20, 95% Cl 1.57-3.19). Gender had no bearing on outcome, and there was a trend toward a protective effect from an infectious etiology of fever.


Conclusions:

Postoperative fever is deleterious to critically ill patients. The magnitude of fever is a determinant of mortality, whereas an infectious etiology of fever may not be. The impacts of nosocomial infection and suppression of fever on critically surgical patients deserve further study.

It’s Getting Hot in Here: The Conundrum of Fever in the ICU

The following was originally posted by PW blogger Kelly Cawcutt, MD, to the University of Nebraska Medical Center Division of Infectious Diseases blog.


 

Fever has plagued mankind through the ages although was not until the 1600s when Thomas Sydenham reportedly first recognized that fever was an innate response” to get rid of the injurious agents causing the disease”.

In the intensive care unit, fever is one of the most common abnormal signs documented and frequently results in changes in clinical management of the patient, yet we continue to lack adequate evidence regarding the definitions of fever, the incidence, the impact of fever on mortality and whether or not we should treat fever (and if we should, in who).

With this in mind, clinicians need to review fever and the continual evolution of literature regarding this, particularly as it is very likely that temperature management will continue to garner attention regarding how temperature impacts sepsis management and outcomes.

Definition and Pathophysiology

Normothermia: Defined as a normal body temperature of approximately 37. 0 C although there is noted variation that is normal of+/- 0.5C throughout the day.

  • Fever: There has been a range of temperatures defined as fever in the literature, however a core body temperature of > 38.3 C has been accepted as fever among the critically ill. However, it should be noted that lower temperatures may represent fever in the immunocompromised.
  • High Fever: Generally this is defined as a persistent body temperature greater than 39-40 C, although here again there has been some variations in the literature.
  •  Prolonged Fever: If the duration of fever is >5 days, it is often considered a prolonged fever.
  • Hyperthermia: An elevated body temperature, often >41 C,  that may be indistinguishable from “fever” clinically, but is due to lack of change in the hypothalamic “setpoint” (See below for further detail).

Pathophysiology

Fever and hyperthermia are notably different mechanisms of alterations in body temperature, although initially these may be difficult to differentiate during a patient evaluation. Thermoregulation is controlled by the hypothalamus, and in fever from infectious and noninfectious causes, the “set point” of temperature by the hypothalamus is increased thereby “allowing” fever. This however is not the case in hyperthermia syndromes. In hyperthermia, there is no change in the hypothalamic “set point” and body temperature is dysregulated resulting in decreased ability for natural heat dissipation.

Measurement of Fever

With the definition of fever behind us, we can focus on how exactly we detect fever. The gold standard for measuring temperature is through a pulmonary artery catheter. However, in the absence of this, we resort to alternative measurements such as thermistors on bladder catheters, esophageal probes or rectal probes. Alternative options also include tympanic membrane or temporal artery thermometers. Of these, rectal, esophageal, bladder and tympanic membrane (not infrared) may be the closest to core body temperature. Axillary, oral and skin temperatures are available but may be impractical and/or less reliable.

Incidence of Fever

Body temperature measurements are ubiquitous in the hospital and intensive care units. Fever is also incredibly common with reports of approximately 25 to greater than 80% of ICU admissions having at least one fever during their ICU stay, and of this approximately 50% are ultimately attributed to infection.

Causes of Fever: Infectious vs Noninfectious vs Hyperthermia
There are many potential causes of fever in the ICU. When evaluating patients, history can be critical to determining if there is a risk for a hyperthermia syndrome such as heat stroke, malignant hyperthermia, neuroleptic malignant syndrome or serotonin syndrome or endocrine diseases causing hyperthermia such as drug intoxication and withdrawal,thyrotoxicosis, adrenal crisis and pheochromocytoma.

Infectious causes a fever are incredibly diverse and may be secondary to a variety of pathogens including bacteria, viruses, protozoa and fungi. Further, some of these fevers will be driven by infections that were present are incubating on arrival to the ICU and others will develop during the ICU stay as a nosocomial infection.

Finally, there are also many noninfectious causes of fever among critically ill. These can include post-operative fevers, drug reactions, thrombosis and emboli or infarct, hemorrhage, pancreatitis, transfusion reactions, pancreatitis or acalculus cholecystitis and occult malignancy among many other potentials.

Given the robust array of potential causes of fever or hypothermia in the critically ill population, providers need to be very thoughtful and thorough when obtaining the initial history, past medical history, review of systems, medications, social and exposures/travel history combined with a thorough examination of the patient to search for potential clues for the cause of fever. Guidelines call for thoughtful evaluation and not to proceed with a reflex fever evaluation.

Managing Fever

Finding fevers, or other abnormal temperatures, among critically ill patient’s is clearly common and impacts clinical decision making however we still lack evidence on whether or not we should intervene on all fevers. The difficulty remains the complex balance between risks and benefits that fever portends to the patient.

The risks and benefit of fever are complex at best. There is always concern for patient discomfort with fever the combined with increased metabolic and oxygen demands raising increased risk of brain damage and multi organ failure. On the other hand, fever is a normal and adaptive response to infection that prompts further evaluation and management from clinicians. Further, this normal febrile response to infection may improve host immune responses, impede bacterial growth, enhance both antimicrobial concentrations and efficacy.

There is ongoing discrepancies in the literature regarding whether or not fever carries increased mortality or not and these variations may be due to timing of fever, severity of fever and underlying comorbidities at the time of fever. In a 2017 meta-analysis, Rombus et al aimed to assess the association between body temperature and mortality among patients with sepsis(10). In this particular study, fever(greater than 38 C) was associated with decreased mortality while hypothermia (<36 C) had a higher associated mortality compared to normothermia. This is concordant with a 2017 study in Critical Care Medicine regarding the predictive value of fever in the emergency department for patients, which demonstrated an inverse relationship between decreased mortality and shorter hospital length of stay associated with higher temperatures on presentation. However, patients with high and prolonged fever have been shown to have higher mortality in some studies.

Treatment of fever in patients with neurologic injury, myocardial ischemia and arguably in severe hypoxia, may improve outcomes, but this does not necessarily translate to all critically ill populations. In addition, hyperthermia syndromes do require emergent therapy which may include stopping the offending agent, antidote and supportive cares including physical cooling. In hyperthermia, antipyretics are not routinely recommended as they are not usually effective in states without an elevated hypothalamic setpoint.

Use of Antipyretics or cooling therapies

Finding fever is one thing and deciding to treat it in order to decrease it is another. This area remains one of “hot” debate including whether fever is simply a marker for poorer outcomes or whether active treatment of abnormal body temperature can improve outcomes.

Given the frequency of acetaminophen administration among critically ill patients with fever, a randomized controlled trial assessed treatment versus placebo and did not find a significant difference in the number of ICU free days or 90 day mortality(12). Systematic reviewed meta-analysis of antipyretic therapy among critically ill septic patients also did not demonstrate a significant improvement in 28 day or hospital mortality(6). However, on the contrary, there has been associations of fever with increased mortality prompting further observational study on the association of body temperature and antipyretics treatments with mortality(13). In this study it was noted that in patients without sepsis, high fever (>39.5) was associated with mortality and antipyretics among septic patients increased mortality, raising question into the potential different impacts fever and antipyretics may have depending on whether the patient has sepsis(13). A recent systematic review and meta-analysis of antipyretic use in critically ill adults with sepsis did not find a significant improvement in either 28-day or hospital mortality(6).

Physical cooling therapies are also utilized in both fever and hyperthermia. There is a vast array of technology from the simplicity of ice packs and stands to advanced cooling blankets to intravascular cooling devices. It is unknown if there is a significant difference with these varying methods for cooling patient’s and despite the increased speed and stability of intravascular cooling, we lack substantial evidence to state that this is provides significant improvement in patient outcome(4, 5). All cooling methods carry some risk however the intravascular devices are by nature invasive in carry the risk of central line placement with them(4).

Summary

What to do with abnormal body temperatures, particularly fever, remain an area where we need more research to guide our clinical practice. For now, abnormal temperatures should be evaluated for the underlying etiology and then the art of medicine kicks in – which temperature is right for your patient? Hot, cold or somewhere in between? The many risks and benefits will need to be weighed for each individual patient – unless you have high fever with a hyperthermia syndrome, neurologic injury, myocardial ischemia or severe hypoxia – in these settings, normothermia may prevent further organ damage.

When is a fever dangerous for my baby, toddler, or older child? • KidMedVA

Multiple factors determine whether a fever may indicate a serious illness for your child:

  1. Behavior change
  2. Age
  3. Temperature
  4. Symptoms
  5. Fever duration

Among those variables, the degree of fever is the least critical. The best way to determine whether your child’s fever reflects a serious illness is through symptoms and behavior changes. If your child continues to eat, drink, and play normally, there’s less cause for concern.
However, significant behavior changes may indicate serious illness, even with a “low-grade” fever that falls below the medical threshold of 100.4° F (rectal). A temperature of 100.4° F is cause for concern only when your child is under 3 months of age. In infancy, a child’s immune system is unprepared to fight an infection, and you should see a physician if your young infant has a fever.
A healthcare provider should also be consulted if your child has a fever for more than three days, or if your child appears ill even when the fever is reduced with medication. Other reasons for seeking medical attention for fever include fussiness, lethargy, refusing to drink fluids, persistent vomiting, or difficulty breathing.
Fevers are not inherently dangerous and are self-limiting. Reaching a body temperature that causes brain injury (around 108° F) requires extreme environmental temperatures, like those of a closed car on a hot day. (Those dangerous temperatures have also been seen with rare adverse reactions to anesthesia.) For fevers caused by illness in children, the fever itself will never be high enough to cause brain injury, despite a common myth to the contrary.

Fevers by the numbers

While “normal” body temperature is 98.6° F (37° C), a child’s temperature can vary slightly from that standard. A normal temperature range is between 97.5° F (36.4° C) and 99.5° F (37.5° C). It also fluctuates throughout the day, with highest temperature between late afternoon and early evening, and lowest between midnight and the early morning.
Except for children under 3 months, deciding whether to visit the doctor should consider your child’s behavior as much as the thermometer’s reading. Even high fevers are common and not necessarily indicative of dangerous illness. For the most part, there is no direct correlation between the degree of fever and the severity of an illness.
What constitutes a fever also depends on how a child’s temperature is taken. Typically, rectal thermometers offer the most accurate temperature readings for infants and young toddlers; oral thermometers provide greatest accuracy for older children. (Most children can manage an oral thermometer at 4 years of age.)

Thermometer type Fever threshold
Axillary (armpit) 99.0° F (37.2° C)
Ear* 100.4° F (38° C)
Oral 100.0° F (37.8° C)
Pacifier* 100.0° F (37.8° C)
Rectal 100.4° F (38° C)
Temporal artery* 100.4° F (38° C)

*Ear, pacifier, and temporal artery thermometers are not as reliable as digital multiuse thermometers, in part because ambient temperatures affect their readings.

What is a fever?

A fever is the body’s natural response to illness—not an illness itself. For most children, a fever is a sign that their body is responding effectively to an infection. Fevers impede bacteria and viruses’ ability to replicate, and stimulate white blood cells to respond.
When viruses or bacteria invade your body, white blood cells release proteins called pyrogens. Pyrogens flow through the bloodstream to the hypothalamus, the region of the brain that controls body temperature. There, they bind to receptors that cause the hypothalamus to raise internal body temperature, resulting in a fever.
As the body’s immune response overwhelms the virus, white blood cells release fewer pyrogens, and body temperature gradually declines. Importantly, this process is self-limiting—an immune response will not trigger a fever sufficient to cause brain injury. In short, a fever is protective and a good sign that the immune system is trying to fight the infection.
There is little to no scientific evidence to support the widely held belief that teething causes significant fever. Temperatures above 102° F (38.9° C) should never be attributed to teething alone.

What to do when your child has a fever

Caring for your child during a fever is less about managing the fever and more about your child’s comfort. If your child is comfortable, fever-reducing medications are unnecessary. While they temporarily reduce a fever, they do not enhance the body’s ability to defeat the underlying illness. Only when an infection has been eliminated will body temperature return to normal.
Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are among the most common fever-reducing medicines. Dosing should be based on body weight. (KidMed maintains a free online dosing chart for acetaminophen and ibuprofen.) If your child is under 3 months of age, consult with your physician first before giving any fever-reducing medicines.  Avoid giving aspirin to any child under age 18. Aspirin can cause a dangerous condition known as Reye’s syndrome.
Other common at-home treatments, like cool baths or applying rubbing alcohol to the skin, are not recommended. Simply cooling the surface of the skin will not bring down your child’s body temperature. Tepid water baths of 85–90° F (29.4–32.2° C) may help bring down body temperature, but usually by only one or two degrees.
Piles of blankets to keep a child warm during feverish chills can negatively affect the body’s natural efforts to regulate temperature. Bundling infants less than 3 months old can actually increase body temperature. Light clothing and blankets are sufficient.
Keeping your child hydrated is critical during a fever or other illness. Bland foods and fluids are best. If your child has not wet a diaper or urinated in eight hours, has dry lips, and produces no tears when crying, this is a sign of dehydration and reason to seek medical attention.

What are febrile seizures?

While scary for parents, febrile seizures are rarely dangerous to children. These seizures are induced by a rapid rise in body temperature—not an exceptionally high body temperature. Most febrile seizures occur when a fever begins and, as such, there is no warning.
Febrile seizure affect 2–4% of all children under the age of 5, with children most susceptible at age 2. The vast majority are brief, lasting a matter of seconds or a few minutes. A child having a febrile seizure may present with classic jerking movements, or may simply appear to pass out.
If your child has a febrile seizure, slowly lower them onto their side. Do not put anything in their mouth or hold them during the seizure. The greatest risk from febrile seizures is the potential to fall or choke on food, saliva, or another object.
Seek immediate medical attention following a febrile seizure. It is unnecessary to call 911 unless a seizure continues beyond 15 minutes, or if the child does not recover quickly following a short seizure. Even febrile seizures lasting more than 15 minutes typically have good outcomes. Hospitalization is necessary only for children under 2 months of age, those with a potentially serious illness, or those with prolonged seizures.
Simple febrile seizures lasting less than 30 minutes do not increase the risk for unrelated epileptic seizures and do not cause brain damage or developmental delay. They are more common in children who have a family history of febrile seizures. Children who have had one febrile seizure are more likely to have another.
Your pediatrician and the pediatric urgent care professionals at KidMed are always available to help determine the cause of your child’s fever. Be wary of online information unless the source is trusted, like the American Academy of Pediatrics’ healthychildren.org.
 

Oops! We could not locate your form.

Temperature control in critically ill patients with fever: A meta-analysis of randomized controlled trials

Highlights

Fever control does not impact mortality or other important clinical outcomes.

Treatment of fever in critically ill patients should be individualized, weighing potential harms and benefits.

Antipyretics effectively reduce temperature in febrile non-neurocritical ill patients with suspected or confirmed infection.

Abstract

Purpose

Fever is frequently encountered in ICU. It is unclear if targeted temperature control is beneficial in critically ill patients with suspected or confirmed infection. We conducted a systemic review and meta-analysis to answer this question.

Methods

We systematically reviewed major databases before January 2020 to identify randomized controlled trials (RCTs) that compared antipyretic with placebo for temperature control in non-neurocritical ill adult patients with suspected or confirmed infection. Outcomes of interest were 28-day mortality, temperature level, hospital mortality, length of stay, shock reversal, and patient comfort.

Result

13 RCTs enrolling 1963 patients were included. No difference in 28-day mortality between antipyretic compared with placebo (risk ratio [RR] 1.03; 95% CI 0.79–1.35). Lower temperature levels were achieved in the antipyretic group (MD [mean difference] -0.41; 95% CI -0.66 to −0.16). Antipyretic use did not affect the risk of hospital mortality (RR 0.97; 95% CI 0.73–1.30), ICU length of stay (MD -0.07; 95% CI -0.70 to 0.56), or shock reversal (RR 1.11; 95% CI 0.76–1.62).

Conclusion

Antipyretic therapy effectively reduces temperature in non-neurocritical ill patients but does not reduce mortality or impact other outcomes.

Keywords

Critical illness

Fever

Non-steroidal anti-inflammatory drugs

Acetaminophen

Physical cooling

Sepsis

Mortality

Recommended articlesCiting articles (0)

View full text

© 2020 Elsevier Inc. All rights reserved.

Recommended articles

Citing articles

How Fever in Early Pregnancy Might Cause Heart, Facial Birth Defects

DURHAM, N.C. — Researchers have known for decades that fevers in the first trimester of pregnancy increase risk for some heart defects and facial deformities such as cleft lip or palate. Exactly how this happens is unclear. Scientists have debated whether a virus or other infection source causes the defects, or if fever alone is the underlying problem.

Duke researchers now have evidence to suggest the fever itself, not its root source, could interfere with the development of the heart and jaw during the first three to eight weeks of pregnancy. Their findings, demonstrated in animal embryos, will be published Oct. 10 in the journal Science Signaling. The results provide new leads as scientists continue investigating heart defects, which affect 1 percent of live births in the U.S., and cleft lip or palate, affecting about 4,000 infants per year. 

The animal models suggest a portion of congenital birth defects in humans might be prevented if fevers are treated through means including the judicious use of acetaminophen during the first trimester, said senior author Eric Benner, M.D., Ph.D., a neonatologist and assistant professor of pediatrics at Duke.

“My hope is that right now, as women are planning to become pregnant and their doctors advise them to start taking prenatal vitamins and folic acid, their doctor also informs them if they get a fever, they should not hesitate to call and consider taking a fever reducer, specifically acetaminophen (Tylenol), which has been studied extensively and determined to be safe during the first trimester,” Benner said. “While doctors advise most women to avoid any drug during pregnancy, there may be benefits to taking acetaminophen to reduce fever. Women should discuss all risks and benefits with their doctors.”

Benner cautions that nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin also reduce fevers, but one should not use aspirin, naproxen or ibuprofen during pregnancy. There is also ongoing debate over whether sustained use of acetaminophen is safe during pregnancy to manage ongoing conditions such as arthritis, Benner said.

“However, its judicious use for an acute problem such as fever is considered safe. These findings suggest we can reduce the risk of birth defects that otherwise could lead to serious health complications requiring surgery,” he said.

To observe how fever impacts a developing fetus, the researchers studied zebrafish and chicken embryos. Among their discoveries, the scientists found that neural crest cells — cells that are critical building blocks for the heart, face and jaw — contain temperature-sensitive properties.

“We found that these neural crest cells contain temperature-sensitive ion channels that typically are found in your sensory neurons,” Benner said. “They’re the channels that, when you stick your hand in a hot cup of water, tell your body the temperature has changed.”

The Duke researchers engineered a noninvasive magnet-based technology to create fever-like conditions in two specific temperature-sensitive ion channels called TRPV1 and TRPV4 in the neural crest cells involved in developing the heart and face. When those neural crest cells were subjected to conditions mimicking a transient fever, the embryos developed craniofacial irregularities and heart defects, including double outlet right ventricle, Tetralogy of Fallot and other outflow obstructions.

The type of defect depends on whether the fever occurs during heart development or head and face development in the embryo. What researchers still do not know is whether or how the severity or duration of a fever impacts development, Benner said.

“We have known since the early 1980s that fevers are associated with birth defects, but how that was happening has been a complete mystery,” Benner said. It is challenging to gather data from mothers on the circumstances, severity or duration of a fever from many months before, he said.

“I hope moving forward, we can educate more women about fever as a risk factor for birth defects and let them know they shouldn’t just tough it out if they develop a fever,” Benner said. “They should ask their doctor before getting pregnant whether they may benefit from taking a fever-reducer such as acetaminophen in the event they develop a fever.”

Obstetricians at Duke Health say fevers are common during pregnancy and measures such as getting the flu vaccine and thorough hand washing can lessen a woman’s chances of getting sick with a fever.

“If a pregnant woman has questions about what medicines she can take during pregnancy or her symptoms are not getting better, she should call her prenatal care provider or planned delivery hospital with questions,” said maternal-fetal medicine specialist Geeta K. Swamy, M.D., who was not involved in the study.

In addition to Benner, study authors include Mary R. Hutson, Anna L. Keyte, Eric Gibbs, Zachary A. Kupchinsky, Ioannis Argyridis, Kyle N. Erwin, Kelly Pegram, Margaret Kneifel, Paul B. Rosenberg, Pavle Matak, Luke Xie, Jörg Grandl, Erica E. Davis, Nicholas Katsanis of Duke, and Miriam Hernández-Morales and Chunlei Liu of the University of California, Berkeley.

The research was supported by the Jean and George Brumley Jr. Neonatal Perinatal Research Institute, the Zeist Foundation, the Hartwell Foundation, the Mandel Foundation, the Duke Health Scholars Award, the American Heart Association (16GRNT30980012), and the National Institutes of Health (NIMH R01MH096979, NHLBI R21HL122759, and NIBIB P41EB015897), including grants specifically from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD043494, T32HD043728), and the National Institute of Biomedical Imaging and Bioengineering (T32EB001040).

Disclosures: Co-senior authors Benner and Liu have filed a patent application relating to the use of FeRIC technology for cell modulation and treatments.

Multisystem Inflammatory Syndrome in Children (MIS-C)

What causes MIS-C in children?

The cause of MIS-C is not yet fully understood — it’s a question that’s being actively investigated, here at Boston Children’s and elsewhere.

Some researchers suspect that MIS-C is caused by a delayed immune response to the coronavirus that somehow goes into overdrive, causing inflammation that damages organs. It’s also possible that the antibodies children make to the virus, or some of their immune cells, are creating the illness. Since only a small number of children develop MIS-C, it is possible that there are genetic factors that make some children susceptible.

It is important to remember that overall, children fare very well with COVID-19 as compared to adults. Only a small number of children seem to develop signs and symptoms of MIS-C, and most have recovered quickly.

How is MIS-C diagnosed?

Currently, MIS-C is diagnosed based on symptoms (persistent fever and dysfunction of one or more organs, such as the heart or gastrointestinal system), together with laboratory tests to look for signs of inflammation in the body.

Children should also have a positive test for COVID-19. Testing is also done to rule out other possible causes of the symptoms, such as other infections.

Once MIS-C is diagnosed, children will need to be followed over time with laboratory tests to assess inflammation, blood clotting, liver function, heart function, and other aspects of their illness. Children should also have echocardiograms to evaluate their heart and coronary arteries, and some children with heart problems may also require additional testing such as cardiac MRI, Holter monitors, or exercise testing.

How is MIS-C treated?

Children diagnosed with MIS-C need close observation. All need to be admitted to the hospital, and some may need intensive care. Pediatric specialists in rheumatology, critical care, and cardiology can anticipate and address different aspects of the illness.

Treatments include IV immunoglobulin (used to treat Kawasaki disease), and anti-inflammatory drugs (corticosteroids, and drugs blocking IL-1 or IL-6). Other treatments may be used depending on the results of laboratory tests. Children are also treated with low-dose aspirin to decrease the risk of blood clots.

Children need to be followed after discharge from the hospital, with repeat echocardiograms to monitor their heart and coronary arteries, even if they didn’t have serious problems in the hospital. Children who are fully recovered at six months no longer need close follow-up.

Should children who have had MIS-C receive COVID-19 vaccination?

This question is actively being studied. While we wait for answers, we recommend talking with your medical providers to decide if and when to vaccinate your child, per recommendations of the U.S. Centers for Disease Control and Prevention (CDC). The latest guidance from the CDC can be found on its website.

90,000 Specialized scientific and practical publications for veterinarians and students of veterinary universities.

Toggler


Journal issues by year

Journal contacts

vetpeterburg

Subscribe to news

You can subscribe to our newsletter.
To do this, you need to fill out the form, indicating your postal e-mail.
Distribution is carried out no more than 5-6 times a year.
The administration of the site never, under any circumstances, discloses or transfers to other persons data about the users of the site.

Purchase the paper version

To purchase a paper version of the magazine, you need to place an order and pay for it online.
Delivery is carried out by Russian Post.
The cost of a copy of the magazine is indicated including delivery.
For questions about mailing to other countries, please contact the Deputy Editor-in-Chief: [email protected]

Pre-order

Delivery for clinics

For veterinary clinics in St. Petersburg and Len. area.
Delivery is made by courier to the address of the clinic in the amount of one copy.
To arrange delivery, you must fill out the form.The delivery is subscribed to once and is valid until a representative of your organization submits a request to cancel the delivery.

Arrange delivery

90,000 Six myths (and also quite true things) about hay fever

  • Claudia Hammond
  • BBC Future

Photo Credit, Getty Images

When blooming season comes, from hay fever (pollinosis ) suffers from 10 to 30% of the world’s population.Should we put our hopes on heavy rain? Will it get easier when evening comes down? The BBC Future columnist has tried to separate myth from truth.

Runs out of the nose, watery eyes, sore throat. At the most inopportune moment, the nose itches, and we sneeze, sneeze, sneeze …

The flowering season has come again. Let’s try to figure out what can help us, and what is better not to pin hopes on.

1. Does hay fever have anything to do with hay?

At the beginning of the 19th century, it was believed that the whole problem was in the grass freshly cut in the hay.Hence the name.

Then a British physician named James Bostock, who suffered from the same symptoms every summer, correctly noted that hay had nothing to do with it.

He felt better when he left for the sea. But Bostock came to the erroneous conclusion that the disease was exacerbated by the heat of summer days. He even called her “summer cold”.

The link to pollen was established in 1859 by British scientist Charles Blackley, who is said to have started sneezing after sniffing a bunch of bluegrass flowers.

He not only managed to establish that the cause is in the pollen, but also that the cause of the symptoms is most likely the pollen of plants and trees, which is more easily transported through the air.

But he was only partially right. The role of the immune system in allergic reactions was not yet understood, and Blakely decided that the cause of the unpleasant symptoms was the toxic substances contained in the pollen.

Today we know that when some people are “attacked” by a certain type of pollen, their immune system overreacts to it, perceiving the pollen as a virus.Our bodies respond to this with the familiar symptoms of hay fever.

VERDICT: This is true

Photo author, Getty Images

Caption,

About 30% of all people suffer from hay fever when the flowering season begins

2. Does hay fever go away with age?

We can assume that hay fever comes to us in childhood, and as we age, it goes away. And the good news is that, indeed, about half of people find their symptoms improve as they get older.And in 20% they disappear altogether.

A Swedish study found that hay fever is more likely to disappear in people over the age of 50. Others, however, have symptoms again and again during the flowering season.

A happens and vice versa. There are people who never experienced hay fever symptoms as children, but first experienced them when they were in their 30s or 40s.

VERDICT: If you’re lucky, it might be true

3.Do your hay fever symptoms get better after rain (because the pollen is nailed down by the water)?

Some allergy sufferers look forward to rain, hoping that the pollen in humid conditions will not be able to travel through the air (and get into the eyes and nose).

Indeed, a little rain, as well as moderate rain will help. A downpour can have the opposite effect.

When scientists analyzed data from the health insurance system in South Korea and compared it with daily weather conditions, it turned out that the number of visits to doctors in clinics of patients with allergic rhinitis after heavy rains or typhoons increased.

The researchers call 10 cm of precipitation the critical point. After American scientists analyzed and compared meteorological data and data on pollen levels over 14 years, it turned out that the pollen content in the air dropped after rain, which brought less than 10 cm of precipitation, but increased when precipitation exceeded this figure.

The rainstorm seems to increase the amount of pollen in the air, especially if heavy rain is accompanied by wind.

VERDICT: Depends on rainfall

Photo author, Getty Images

Photo caption,

Is there really less pollen in the air after a rainstorm? It turns out that the lighter the rain, the better…

4. Does hay fever feel worst during the day?

If you suffer from hay fever, you have already heard this advice more than once: stay behind closed doors as long as possible during the day, but in the evening you can take the risk of going for a walk.

Yes, it might help, but unfortunately it’s not that simple. It all depends on what kind of pollen you are allergic to.

During a Polish study with the charming name “Pollen Nightmare”, scientists set up pollen traps on the roof of a house.Day and night, the concentration of the five most common species was measured.

The level of pollen concentration of wormwood was indeed lower at night, but ragweed – higher, while the level of concentration of pollen of various grasses and alder did not differ almost during the day.

During the day, the air temperature rises, warm air saturated with pollen rises, but at night the pollen falls again, and its content increases above the ground. So some allergy sufferers may feel even worse at night.

The concentration of pollen depends on how easily it travels through the air, how far it can travel, and the time of day when certain plants release their pollen.

Wormwood pollen is not very scattered, its level is low at night. But ragweed pollen can be transported far enough.

So the answer to the above question depends on where you live, which plants are common in the area and which ones cause you an allergic reaction.

VERDICT: Not at all necessary

5. Will antihistamines make you sleepy?

Antihistamines relieve some of the symptoms of hay fever by blocking the action of histamine produced by the body when it thinks it is being attacked by proteins in the pollen.

Indeed, sleepiness was one of the side effects of first generation antihistamines.

And if at night people suffering from allergic rhinitis were even glad of additional sleepiness, then during the day such a state is completely inappropriate.

But, since the 1980s, new generations of antihistamines have appeared on the market. They do not give drowsiness, do not have a cardiotoxic effect.

VERDICT: This rarely happens with modern drugs of the new generation

Photo author, Getty Images

Caption,

For a long time it was believed that honey relieves the symptoms of hay fever

6. Does honey help relieve the symptoms of hay fever?

A spoonful of honey has long been recommended for allergy sufferers, but does it work?

There has been very little research on this topic.One of them, small in scale, was conducted in the United States. People were given one of three things: either pasteurized honey, raw honey, or honey-flavored syrup.

Participants in the study did not know what they were getting They took one tablespoon daily, along with their usual hay fever remedies. None of them had any evidence of any type of honey influencing their symptoms.

Another small study from Finland found that regular consumption of honey gave almost nothing, but honey with the addition of birch pollen seemed to help.

The authors, however, warn that their work is an experimental, pilot study, its results should not be taken as a recommendation.

VERDICT: Honey is delicious, of course, but there is currently no evidence that it helps with allergic rhinitis

Read the original of this article in English at BBC Future .

Beware of hemorrhagic fever!

Hemorrhagic fever in most cases combines a characteristic course with a sequential change of periods: incubation (usually 1-3 weeks), initial (2-7 days), peak (1-2 weeks) and convalescence (several weeks).

The initial period is manifested by general intoxication symptoms, usually very intense. Fever in severe cases can reach critical numbers, intoxication can contribute to a disorder of consciousness, delirium, hallucinations. Against the background of general intoxication, already in the initial period, toxic hemorrhage (capillary toxicosis) is noted: the face and neck, the conjunctiva of patients are usually hyperemic, the sclera are injected, elements of a hemorrhagic rash on the mucous membrane of the soft palate can be detected, endothelial symptoms (“tourniquet” and “pinch”) are positive …There are toxic violations of the heart rhythm (tachycardia, turning into bradycardia), a decrease in blood pressure. During this period, a general blood test shows leukopenia (lasts 3-4 days) and increasing thrombocytopenia.

Fever usually lasts 8-9 days, after which a decrease in body temperature occurs within 2-3 days, however, after its normalization, the patient’s condition does not improve, vomiting may occur, and renal syndrome progresses. Improvement of the condition and regression of clinical symptoms occurs 4-5 days after the fever subsides.The disease enters the convalescence phase. At this time, polyuria is characteristic – an increased formation of urine. In adults with polyuria, instead of the daily norm of 1000-1500 ml, over 1800-2000 ml, sometimes more than 3 liters of urine, are excreted from the body.

Complications of hemorrhagic fever

Hemorrhagic fevers can contribute to the development of severe, life-threatening conditions: infectious-toxic shock, acute renal failure, coma.

Treatment of hemorrhagic fever

Patients with any hemorrhagic fever should be hospitalized. Prescribed bed rest, a semi-liquid high-calorie, easily digestible diet, maximally saturated with vitamins (especially C and B) – vegetable decoctions, fruit and berry juices, rosehip infusion, fruit drinks). In addition, vitamin therapy is prescribed. Discharge from the hospital is made after complete clinical recovery. Upon discharge, the patients are observed for some time on an outpatient basis.

90,000 The Ministry of Health said that pregnant women with covid may suddenly develop a critical condition – Society

MOSCOW, July 6. / TASS /. The sudden development of a critical condition is possible in pregnant women with coronavirus infection against the background of a stable course of the disease, follows from the methodological recommendations of the Ministry of Health of the Russian Federation on the organization of medical care for pregnant women and newborns with COVID-19.

“Pregnant women with COVID-19 may suddenly develop a critical condition against the background of a stable course of the disease.A 2021 systematic review of 10,000 pregnant women and 128,176 non-pregnant women reported increased mortality among pregnant women relative to non-pregnant patients, “the document says.

It is also noted that, in general, in pregnant women, the clinical characteristics of COVID-19 are similar to the general population, often asymptomatic is observed. According to foreign studies, the most common clinical signs of the disease in pregnant women were fever, cough, and myalgia (muscle pain).

Pregnant women with somatic diseases

Pregnant women with chronic diseases of the lungs, cardiovascular system, diabetes mellitus and obesity are included in the high-risk groups for severe COVID-19, follows from the guidelines of the Ministry of Health of the Russian Federation.

“The group with the highest risk of developing severe forms of COVID-19 is made up of pregnant women with somatic diseases: chronic lung diseases, including moderate and severe bronchial asthma, diseases of the cardiovascular system, arterial hypertension, diabetes mellitus, cancer, obesity ; chronic kidney disease, liver disease, “the document says.

It is also noted that a systematic review, which included 100 thousand pregnant women, showed the possibility of vertical transmission of coronavirus from mother to child in 5.3% of women and the frequency of births positive for COVID-19 newborns in 8% of observations. “The frequency of excretion of SARS CoV 2 from the placenta was recorded in 12% of cases, from the umbilical cord – in 6%, from amniotic fluid – in 5.6%, from breast milk – in 5.0%,” the recommendations said.

“Among perinatal outcomes, fetal distress syndrome (26.5-30%), low birth weight (25%), newborn asphyxia (1.4%) are most often recorded.Hospitalization of newborns in the intensive care unit is required in 43% of cases, and the perinatal mortality rate is 0.35-2.2% “, – follows from the document of the Ministry of Health of the Russian Federation.

Earlier, the ministry released the fourth version of the guidelines “Organization of medical care for pregnant women, women in labor, women in childbirth and newborns with a new coronavirus infection COVID-19.” In particular, the document added information on the specific prevention of COVID-19 using vaccination based on the available data on its effect on the reproductive system, as well as the chapter “Planning a pregnancy in the context of COVID-19”, which includes the main aspects of disease prevention.Recommendations have already been sent to the regions of Russia for use in work.

90,000 Stages, symptoms and treatment of withdrawal symptoms

How long does alcohol withdrawal syndrome (hangover) last?

Symptoms can be divided into three stages:
1. Anxiety, insomnia, nausea, abdominal pain, occur 8 hours after the last alcohol consumption.
2. High blood pressure, fever, rapid heart rate and memory problems begin within 24 to 72 hours.
3. Hallucinations, fever, seizures and nervousness may begin 72 hours after the last drink.
All symptoms last no more than 5-7 days.

According to population studies, about 87% of Russians over 18 have tried alcohol at least once in their life. Unlike many other addictive substances, alcohol is legal for people over the age of 18 and can be easily purchased.
Many people consume alcohol on a regular basis without any consequences.Even the Mayo Clinic publishes that moderate alcohol consumption “has a positive effect on health” (no more than one standard drink a day for a woman and two for a man). Alcoholism experts at the National Institute on Alcohol Abuse and Alcoholism in America consider the use of more than four drinks for a woman or five drinks for a man for several hours or more than seven drinks a week for a woman and 14 drinks a week for a man.

Statistics on alcohol abuse and its consequences.

• About 14.4 million people in Russia suffer from alcoholism.
• One in three admissions to the emergency department are due to alcohol.
• The cause of death from 2006-2010 for one in ten working-age adults aged 20-64 is alcohol abuse.
After drinking an alcoholic beverage in a person, the level of dopamine in the brain rises and it causes false-pleasant feelings. In a state of intoxication, a person’s mood rises, self-confidence and the illusion of easy overcoming of difficulties appear.Only very soon alcoholic “joys” dissipate and leave unpleasant sensations.
After repeated consumption of alcohol, the level of dopamine will increase, and the person will feel better for a short period of time, but at this time the level of dopamine substances is inhibited or stopped altogether.

After prolonged use of alcohol, alcoholism develops. The human body is constantly striving for drinking for no reason. When the effects of intoxication weaken, the person begins to suffer from withdrawal symptoms (hangovers), which manifest themselves from mild to life-threatening.

How long does it take to get out of the binge?

Specialists divide withdrawal symptoms into several stages:
• Stage 1 (mild): anxiety, insomnia, nausea, vomiting, abdominal pain, loss of appetite, fatigue, tremors, depression, blurred memory, mood swings, heart palpitations.
• Stage 2 (medium): high blood pressure, body temperature, irregular heart rate, dizziness, sweating, irritability, depression.
• Stage 3 (severe): hallucinations, fever, convulsions, agitation, psychosis.

The withdrawal of alcohol from the body is individual, it is influenced by several factors, such as the duration of drinking, the amount drunk each time, medical history, the presence of a mental disorder, addiction, childhood trauma, stress. The use of different drugs in combination with alcohol affects the syndrome and increases the side effects. The greater the alcohol dependence, the more severe withdrawal symptoms a person will experience. Hence, not everyone can go through every stage of cancellation.
The most critical stage of withdrawal symptoms is “alcoholic delirium” (or “delirium tremens”). High probability of death without treatment. It occurs in 3-5% of people who have consumed alcohol.
If delirium tremens develops, the patient needs urgent hospitalization. The person should be closely monitored by medical professionals who will monitor vital signs and monitor treatment.
Toxins, toxic substances that have accumulated for a long time in the patient’s body, destroy almost all vital organs.Sudden cessation of alcohol use can be life threatening. Caring for a patient in this condition requires intensive medical supervision.

When to start treatment and get out of binge?

There is no specific time for the withdrawal of alcohol, but there are general patterns:
• Approximately 8 hours after the first drink, the withdrawal symptoms of the first stage may begin.
• Stage 2 and 3 symptoms may appear after 24-72 hours.
• 5-7 days later, symptoms may begin to decrease.
• After a week, some side effects, especially psychological ones, usually persist and may continue for several more weeks without treatment.
The first step during detoxification is to control physical symptoms and achieve stability. For therapy, medications are used to treat symptoms of nausea, dehydration, convulsions, and insomnia. During alcohol detoxification, benzodiazepines may be used to reduce the activity that the central nervous system experiences as it tries to restore its natural order.At the same time, healthcare providers must monitor blood pressure, pulse, respiration, and body temperature. Steps must be taken to keep them at a safe level. Alcohol consumption can be slowly reduced according to a schedule drawn up by specialists and monitored by them. This is necessary in order to avoid death. Some sufferers may be malnourished. Eating a healthy diet and getting good regular sleep improves alcohol withdrawal symptoms and helps the body recover faster.

Treatment of withdrawal symptoms in alcoholism.

When physical symptoms are under control, mental health professionals can help reduce the emotional side effects of withdrawal.
Anxiety, depression, and potential suicidal thoughts can be controlled with medication, therapy sessions, and counseling. Relapse prevention is an important goal of any alcohol treatment clinic, and group and individual therapy can offer ongoing support in and out of the clinic.
There are three main drugs used in alcohol treatment centers: disulfiram, naltrexone and acamprosate. These medications relieve withdrawal symptoms and discourage alcohol use. Naltrexone blocks opioid receptors in the brain, thereby reducing alcohol cravings. Acamprosate works on long-term withdrawal symptoms. Disulfiram is averse to alcohol. A fourth drug, topiramate, can also be used in the treatment of alcohol addiction.
Treatment for addiction should not be done without professional help, as symptoms can be unpredictable.Even after physical symptoms are under control, emotional support cannot be left without proper control and treatment.
A medical detoxification program can provide the most complete and supportive environment at all stages of withdrawal symptoms and their treatment.

Scientists have identified biomarkers of “mouse fever” in humans – Gazeta.Ru

Russian scientists from Kazan Federal University (KFU), together with foreign colleagues, have identified the mechanisms of development and biomarkers of two different viral diseases (hemorrhagic fever with renal syndrome (HFRS) and pulmonary hantavirus syndrome (HLS), transmitted to humans from rodents.This will help improve methods of treating diseases. The research was supported by the grant of the Russian Science Foundation (RSF), the results of work were published in the journal Frontiers in Immunology.

Hantavirus infections are dangerous infectious diseases caused by hantavirus, which is found in the urine and feces of rodents. Usually, a person becomes infected by inhaling air containing viral particles. Hemorrhagic (acute) fever with renal syndrome (HFRS), also called “mouse fever”, occurs in the countries of the Old World.The virus infects the blood vessels, so the patient develops hemorrhages on the skin, resembling a rash. Without treatment, kidney damage, acute vascular insufficiency, pulmonary edema, focal pneumonia, and other complications may develop. On average, up to 10 cases of this disease are registered in Russia per 100 thousand of the population, and the mortality rate from it can reach 12%. Natural foci of mouse fever are Bashkiria, Tatarstan, Udmurtia and the Far East.

In Tatarstan, there is a mild form of “mouse fever” – epidemic nephropathy (EN).At the same time, a person does not suffer from pronounced symptoms, the disease leads to death much less often (up to 0.5%).

Hantavirus pulmonary syndrome (HPS) occurs only in the Americas and manifests itself as progressive pulmonary and cardiopulmonary insufficiency. This disease is more acute than “mouse fever”: mortality from it reaches 60%.
A person who has contracted a hantavirus infection must be urgently hospitalized in an infectious diseases hospital, where doctors will monitor kidney function, and in case of acute renal failure, hemodialysis – blood purification.Hantavirus infections are not transmitted from person to person; there is no need to isolate the patient.

The mechanisms of development of mild forms of “mouse fever” and pulmonary syndrome are not fully understood. Understanding these mechanisms is at the heart of vaccine development.

“It is important to understand how the infection proceeds in the body. When we compare two, on the one hand, similar, and on the other hand, different pathogens, we can find out what they have in common and what distinguishes one disease from another.The answer to these two questions allows us to better understand exactly how and why the body is sick, which means that we can improve the methods of diagnosing and treating the disease, ”said co-author of the study, head of the RSF grant, chief researcher of Kazan Federal University Albert Rizvanov.

Scientists have tested a large number of cytokines (molecules that regulate the immune response in response to infection) in the blood serum of patients with mild mouse fever and pulmonary syndrome. It turned out that in patients with hantavirus pulmonary syndrome, the concentration of a large amount of cytokines in the blood serum was increased.The scientists found changes in the concentration of 40 infection-fighting cytokines. In the body of a patient with a mild form of “mouse fever”, the number of such cytokines reaches only 21. Moreover, cytokines in pulmonary syndrome have a large inflammatory effect: they are more conducive to inflammation.

“The inflammatory response itself is beneficial. But if the body reacts too violently, it becomes a problem. So, in the case of hantavirus infection, the virus itself does not kill cells. But an excessive inflammatory response leads to undesirable side effects, – commented Albert Rizvanov.

Researchers have identified biomarkers that differentiate between mild mouse fever and Hantavirus Pulmonary Syndrome. These biomarkers include a strong inflammatory response (cytokine IL-18) in HLS and activation of the T-helper immune response in mouse fever.

“It is very important to understand which biomarker or set of biomarkers is specific for a particular disease, otherwise, if the temperature rises, it is impossible to tell whether you have the flu or sore throat. The biomarkers that we have identified allow us to tell how severe the disease is.In addition, biomarkers, like a microscope, allow you to look into the molecular and cellular world of an organism and understand how exactly pathogens interact with the body.