Fever & Hiccup: Causes & Reasons

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Possible Causes for Fever & Hiccup

Subphrenic Abscess

Presents with cough, increased respiratory rate with shallow respiration, diminished or absent breath sounds, hiccups, dullness in percussion, tenderness over the 8th–11th
[en.wikipedia. org]

CASE REPORT A 22-month-old boy with no significant medical history was well until 8 days before admission, when he presented with fever to 104°F.
[pediatrics.aappublications.org]

There are many complications of abscess including sepsis, pyrexia of unknown origin, abdominal pain, hiccups and chest pain but subphrenic abscess complicating pericarditis
[pjmhsonline.com]

Liver Abscess

Results: A 84 year-old man with a refractory anemia with excess of blasts (13% in marrow) was admitted for high fever, hiccups and moderate pain at the right upper abdominal
[aspergillus.org.uk]

He visited the emergency outpatient department for fever and general malaise that had been ongoing for 2 weeks.
[ncbi. nlm.nih.gov]

Nausea Malaise Cough and/or hiccups due to irritation of the diaphragm Jaundice sometimes Some patients may present with no abdominal pain.
[healthhype.com]

Marburg Virus Disease

Symptoms significantly associated with being a MVD case included hiccups, anorexia, fatigue, vomiting, sore throat, and difficulty swallowing.
[ncbi.nlm.nih.gov]

Three days prior to hospitalization, the first symptoms (fever, chills) occurred, followed by rapid clinical deterioration.
[cdc.gov]

Conjunctivitis, hiccups, and jaundice had high specificity (≥90%) but poor sensitivity. Conversely, fever and asthenia had high sensitivity but poor specificity.
[doi.org]

Mallory-Weiss Syndrome

Discussion Only 2 cases of hiccup-associated Mallory-Weiss tears have been reported previously: one was an infant with postprandial hiccups just before hematemesis.
[amjmed.com]

The most common symptoms of chikungunya virus infection are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash.
[gastrointestinalatlas.com]

[…] is perforated through all layers, which basically leads to mediastinitis, which is potentially lethal, and manifests with very severe substernal pain initially and then fever
[prep4usmle.com]

Pericarditis

It is difficult to exactly measure the span of CEP spread since the symptoms are not clear in most cases; however, some of the symptoms are chest pain, lightheadedness, hiccups
[news-medical.net]

The pain is typically relieved by leaning forwards The differentials for this type of pain are basically pleurisy and pericarditis Fever – a low grade fever may be present
[almostadoctor. co.uk]

In cases where symptoms are present, they may include: chest pain light-headedness cough shortness of breath hiccups Possible causes of chronic effusive pericarditis include
[hse.ie]

Pleurisy

[…] oedema (inc acute), Pulmonary alveolar haemorrhage#, Bronchospasm, Chronic obstructive pulmonary disease*, Hypoxaemia*, Respiratory tract congestion*, Hypoxia, Pleurisy*, Hiccups
[mymemory.translated.net]

The onset of pleurisy was accompanied by acute fever.
[ncbi.nlm.nih.gov]

Two weeks previously, he had a 1-day viral syndrome, with fatigue, headache, rhinorrhea, and fever.
[journal.chestnet.org]

Hodgkin Lymphoma

We describe the case of a 59-year-old Caucasian male who presented to the outpatient clinic with intractable hiccups, upper abdominal pain, repeated bouts of vomiting, and
[ncbi. nlm.nih.gov]

Night sweats Intermittent fever in about 35% of cases Infrequently, Pel-Ebstein fever (high fever for 1-2 wk followed by an afebrile period of 1-2 wk) A large mediastinal
[learningradiology.com]

A 30-year-old lady presented with fever, dry cough and weight loss for the preceding five months.
[ncbi.nlm.nih.gov]

Peritonitis

In patients with subdiaphragmatic abscesses, irritation of contiguous structures may produce shoulder pain, chest pain, cough, shortness of breath, hiccup, and pulmonary findings
[infectiousdiseaseadvisor.com]

Fever is common, but presentation can be marked by altered mental status or abdominal pain in those with cirrhosis.
[visualdx. com]

Signs of SBP may include fever, malaise, encephalopathy, worsening hepatic failure, and unexplained clinical deterioration.
[merckmanuals.com]

Yellow Fever

In the most severe form (called malignant yellow fever), delirium, intractable hiccups, seizures, coma, and multiple organ failure may occur terminally.
[msdmanuals.com]

It includes: Viral hemorrhagic fevers Viral hepatitis Malaria Lassa fever Ebola virus Typhoid fever Dengue fever Disseminated Intravascular Coagulation Louse-borne relapsing
[ncbi.nlm.nih.gov]

There could be constant hiccuping so that relatively lucid moments provided no comfort.
[bobarnebeck.com]

Perforated Peptic Ulcer

[…] acid reflux are: heartburn – a burning sensation in the middle of your chest an unpleasant sour taste in your mouth, caused by stomach acid You may also have: a cough or hiccups
[nhs. uk]

There were also four significantly different variables between them: fever, hemoglobin value, site of perforation and operative method.
[ncbi.nlm.nih.gov]

On admission, no fever was noted, the abdomen was flat and extremely hard, tenderness was noted, and peritoneal rebound was absent.
[ncbi.nlm.nih.gov]

Myocardial Infarction

Hiccups, a benign and self-limited condition, can become persistent or intractable with overlooked underlying etiology.
[ncbi.nlm.nih.gov]

We report the case of 56 year old male, who presented with high grade fever and leukocytosis.
[ncbi.nlm.nih.gov]

Patients with fever, and significant risk factors for endocarditis, who develop ACS, need a prompt diagnostic work up, including trans-esophageal echocardiography.
[ncbi.nlm.nih.gov]

Pneumonia

Samples were collected from two secondary cases and two close contacts with fever.
[ncbi.nlm.nih.gov]

Or, they may vomit, have a fever and cough, or appear restless, sick, or tired and without energy.
[lung.org]

Chest radiograph improvement and symptom improvement, including fever and respiratory symptoms, was observed after 2 week of oral prednisolone treatment.
[ncbi.nlm.nih.gov]

Herpes Zoster

Symptoms include fever, severe headache, sensitivity to light, and achy muscles.
[verywell.com]

In addition, shingles may cause headache, fatigue, fever, and a general achy feeling. Individuals experiencing the aforementioned symptoms should seek medical attention.
[illinoisderm.com]

In addition, certain percentage of affected population may also experience fever along with general weakness.
[symptoma.com]

Bacterial Pneumonia

Fever reducers : Doctors also suggest fever reducers in case of high fever. These include medications such as aspirin, ibuprofen and acetaminophen.
[md-health.com]

Patients who develop a high, persistent fever should seek medical care immediately.
[livestrong.com]

Patients with bacterial pneumonia can develop shaking chills followed by a high fever.
[livestrong.com]

Viral Hepatitis

Abstract A typhoid patient presenting with fever and jaundice is reported. Investigations revealed that the patient had both typhoid fever and acute viral hepatitis A.
[ncbi.nlm.nih.gov]

We are reporting an unusual combination of Typhoid fever and viral hepatitis in a G6PD deficient individual.
[ncbi.nlm.nih.gov]

” (dengue, hantavirus, yellow fever).
[ncbi.nlm.nih.gov]

Acute Mediastinitis

A 24-year-old woman was admitted to our hospital for complaints of chest pain and fever and was subsequently diagnosed as having an anterior mediastinal tumor.
[ncbi.nlm.nih.gov]

However, the development of anorexia and fevers in our patient made this diagnosis less likely.
[journals.lww.com]

Early signs and symptoms include fever, severe pain and swelling, and redness at the wound site.
[roderic.uv.es]

Fitz-Hugh-Curtis Syndrome

Other symptoms might include: Fever Chills Night sweat Nausea and vomiting Hiccups Headaches A general feeling of poor health (malaise) The symptoms of PID — pain in the
[webmd.com]

She noticed a low-grade fever (a temperature of 37.5°C per mouth was noted on admission).
[amjmed.com]

[…] may have moved to the right shoulder and inside of right arm Increasing pain with coughing, sneezing, or movement Nausea Vomiting Chills and fever Night sweats Headaches Hiccupping
[verywell.com]

Perforated Viscus

A 40-year-old man presented to the emergency room with fever and right upper quadrant abdominal pain. The fever had been on/off for a period of 1 month.
[ncbi.nlm.nih.gov]

Furthermore, viscus perforation may be a consequence of inflammatory illnesses of the intestine such as typhoid fever.
[ic.steadyhealth.com]

Typhoid fever and certain infections and illnesses affecting the organs of the abdomen, can cause a perforated abdominal viscus.
[buzzle.com]

Gastritis

His gastritis prohibited food-intake and the hiccup accelerated. From Wikipedia This example is from Wikipedia and may be reused under a CC BY-SA license.
[dictionary.cambridge.org]

[…] three separate occasions in 2012 and 2013, three ill, indigenous, black African female infants aged 4, 6 and 7 months, were brought to hospital with symptoms ranging from fever
[ncbi. nlm.nih.gov]

The most common symptoms of gastritis include: Belching and hiccups Belly or abdominal bleeding Blood in your vomit or stool (a sign that your stomach lining may be bleeding
[umiamihealth.org]

Trichinellosis

The symptoms of the disease vary widely depending on the infection load, stage of infection and host immunity and include nausea, vomiting, abdominal pain, fever, facial edema
[ncbi.nlm.nih.gov]

Diagnosing trichinella can be problematic because fever and myalgia are nonspecific, and diagnosis may be delayed.
[ncbi.nlm.nih.gov]

In milder cases, the presentation may be asymptomatic or consist of few constitutional symptoms – myalgia, low-grade fever, and gastrointestinal discomfort.
[symptoma. com]

Herpes Simplex Esophagitis

He remained free of hiccups during the remaining hospital stay and follow up.
[ncbi.nlm.nih.gov]

Weight loss, esophageal inflammation, fever and joint pain may be symptoms as well.
[wisegeekhealth.com]

Other symptoms can include food impaction, hiccups, weight loss, fever, and on rare occasions upper gastrointestinal bleeding as noted in the image above and tracheoesophageal
[en.wikipedia.org]

Bronchogenic Carcinoma

A 14-year-old Korean boy was admitted with cough, hemoptysis, and fever. A chest X-ray showed a solitary pulmonary mass and pneumonitis.
[ncbi.nlm.nih.gov]

In addition to hemoptysis, other symptoms include a high fever, cough, and chest pain. Publication Review By: Stanley J. Swierzewski, III, M.D.
[healthcommunities.com]

He later developed pneumonia In alcoholics, aspiration pneumonia is common–bacteria enter the lung via aspiration of gastric contents. and fever.
[peir.path.uab.edu]

Intraperitoneal Abscess in the Right Lower Quadrant

[…] diverse and include: abdominal pain, often poorly localized nausea, vomiting paralytic ileus Subphrenic abscesses can cause: shoulder pain (referred diaphragmatic pain, C3,4) hiccup
[sharinginhealth.ca]

[…] cell crisis and malignancies can present with fever and diffuse abdominal pain.
[antimicrobe.org]

Subphrenic abscesses may cause chest symptoms such as nonproductive cough, chest pain, dyspnea, hiccups, and shoulder pain.
[merckmanuals.com]

Acute Myocardial Infarction

Abstract Thrombotic microangiopathy (TMA) is a rare but lethal multisystem disease characterized by peripheral thrombocytopenia, microangiopathic hemolytic anemia, fever,
[ncbi.nlm.nih.gov]

Pericarditis pain is distinguishable from infarct pain because of its pleuritic nature, radiation to the left trapezius ridge, and the associated low-grade fever and pericardial
[brown.edu]

Signs Cardiovascular examination findings can vary enormously: Low-grade fever, pale and cool, clammy skin.
[patient.info]

Acute Gastritis

The most common symptoms of gastritis include: Belching and hiccups Belly or abdominal bleeding Blood in your vomit or stool (a sign that your stomach lining may be bleeding
[umiamihealth. org]

—In the milder forms, where there is no fever, the diagnosis is readily made by the local symptoms, but where the disease commences with a chill followed by more or less fever
[henriettes-herb.com]

His gastritis prohibited food-intake and the hiccup accelerated. From Wikipedia This example is from Wikipedia and may be reused under a CC BY-SA license.
[dictionary.cambridge.org]

Peritoneal Abscess

Subphrenic abscesses may cause chest symptoms such as nonproductive cough, chest pain, dyspnea, hiccups, and shoulder pain.
[merckmanuals.com]

With a subphrenic collection, there may be shoulder tip pain, hiccups and unexplained pulmonary symptoms (pleural effusion, basal atelectasis).
[surgwiki. com]

Shoulder tip pain and hiccups may derive from a sub-phrenic abscess. Diarrhoea and urinary frequency may result from pelvic abscess.
[ptolemy.ca]

Alcoholic Gastritis

Hiccups: This is a non-specific symptom, meaning that hiccups by themselves do not mean much.
[therecoveryvillage.com]

</p> <h4>Rheumatic fever</h4> <p>Although rare, rheumatic fever can also develop as a complication of strep throat.
[aboutkidshealth.ca]

The most frequent symptoms of gastritis include: Heartburn Indigestion Upper abdominal pain Loss of appetite Dark stools Hiccups Nausea Diarrhea Vomiting Unexplained weight
[alcoholmastery.com]

Acute Kidney Injury

Effects may include a metallic taste in the mouth, prolonged nausea and vomiting, incessant hiccuping, itching all over the body, fluid retention, unintended weight loss and
[livestrong. com]

Two common eponymous syndromes associated with cholangitis are: Charcots Triad: Jaundice, Fever, and RUQ Pain Reynold’s Pentad: Jaundice, Fever, and RUQ Pain, Hypotension,
[teachmesurgery.com]

[…] or slow sluggish movements Flank pain (between the ribs and hips) Hand tremor Heart murmur High blood pressure Nausea or vomiting, may last for days Nosebleeds Persistent hiccups
[medlineplus.gov]

Mediastinal Disease

[…] worse at night · Relieved by antacids · Nausea after eating Less common symptoms are: · Bringing food back up (regurgitation) · Cough or wheezing · Difficulty swallowing · Hiccups
[intranet.tdmu.edu.ua]

Abstract Tuberculosis is a frequent cause of prolonged fever. Mediastinal lymph node enlargement is an uncommon feature of intrathoracic tuberculosis in adults.
[ncbi.nlm.nih.gov]

Night sweats Intermittent fever in about 35% of cases Infrequently, Pel-Ebstein fever (high fever for 1-2 wk followed by an afebrile period of 1-2 wk) A large mediastinal
[learningradiology.com]

Phlegmonous Esophagitis

It is not usual for people who suffer from phlegmonous gastritis to also experience certain other symptoms such as hiccups, chills and sometimes even fever.
[ic.steadyhealth.com]

[…] unexplained fever.
[books.google.com]

[…] obstruction) Incompetent Lower esophageal sphincter Irritant effects of gastric juices (refluxate) Clinical features: Heartburn most common presenting feature Hoarseness, cough, hiccup
[slideshare. net]

Hiccups and psychosis: two atypical presentations of COVID-19 | International Journal of Emergency Medicine

• Case report
• Open Access
• Published: 20 January 2021

• Teresa Alvarez-Cisneros 
  ORCID: orcid.org/0000-0002-0448-5856¹,
• Aldo Lara-Reyes² &
• Stephanie Sansón-Tinoco² 

International Journal of Emergency Medicine
volume 14, Article number: 8 (2021)
Cite this article

• 18k Accesses

• 13 Citations

• 5 Altmetric

• Metrics details

Abstract

The WHO defines a possible case of COVID-19 as a person experiencing fever, cough, shortness of breath, and neurological signs including anosmia, ageusia, or dysgeusia. However, experiences from hospitals all over the world have shown that presentations vary widely. Some atypical presentations include cardiac, gastrointestinal, neurological, and cutaneous and while some are driven by the inflammatory response, others are a consequence of the hypercoagulable state. In our emergency department in a private hospital in Mexico City, we received two patients with very different symptoms on the same shift. Two previously healthy men in their 40s presented to the ER with very atypical manifestations of COVID-19. Neither of them complained of fever, cough, or shortness of breath. The first referred a 3-day history of hiccups that had not resolved with metoclopramide. The second presented with an acute episode of altered mental status. While the first case revealed lung involvement of the disease, the second case had a clean chest CT scan. These cases are relevant as manifestations of COVID-19 vary widely, especially in previously healthy young adults.

Introduction and background

Fever, cough, shortness of breath, anosmia, ageusia, or dysgeusia are the most common symptoms of COVID-19. However, a wide variety of atypical presentations have also been described [1]. Some uncommon presentations are related to the hypercoagulable state, while others are a result of the inflammatory response. These manifestations can occur almost at any organ level. For example, cardiac manifestations include acute MI, myocarditis, arrhythmias, and pericarditis. Atypical heart manifestations are more common in individuals with previous heart conditions, but it seems that the high systemic inflammation and the angiotensin-converting enzyme 2 (ACE2) tropism are involved in this relationship and may cause manifestations in previously healthy individuals [2]. ACE 2 is also expressed in the gastrointestinal tract and up to 48% of patients present with gastrointestinal manifestations. They range from liver abnormalities such as mild to moderate liver injury with aminotransferase elevations and albumin decline, also diarrhea, nausea, and vomiting. Similar to the gastrointestinal tract, the nervous system also expresses ACE 2; thus, neuropsychiatric symptoms of COVID-19 occur in up to 36% of patients and are more frequent among those with severe disease [3]. The spectrum of neurological manifestations includes not only cerebrovascular disease and skeletal muscle injury, but also meningoencephalitis, encephalomyelitis, Guillain Barre, and perfusion abnormalities [4,5,6]. Psychiatric manifestations are wide and could be divided into those driven by the infection itself and those driven by stress and isolation related to the pandemic. Delirium has been suggested as the most common neuropsychiatric manifestation [7], but they also include psychosis, dementia-like symptoms, and affective disorders [8].

Considering these diverse presentations, it is relevant for the emergency department physicians to consider COVID-19 in unexplained manifestations of inflammatory disease or arterial and venous thrombosis at any organ level.

Case 1

A 48-year-old man presented to the gastroenterologist with an episode of hiccups lasting at least 96 h. His past medical history only revealed an L5 surgical repair in 2005, and he denied allergies or recent travel. Aside from the hiccups, the patient recalled no other symptoms and denied abdominal pain, nausea, vomiting, diarrhea, chest pain, cough, dyspnea, or fever. He was started on ambulatory treatment with metoclopramide 10 mg every 8 h; however, the symptoms did not resolve.

He presented to the ER approximately 5 h later with the same complaint. His vitals showed a heart rate of 82 beats/min, respiratory rate 20 respirations/min, blood pressure 133/88 mmHg, oxygen saturation 93%, and temperature 36.7 °C. On the physical exam, the patient was alert and oriented with a normal affect and normal gait. The exam revealed no dermatological lesions and benign head, ear, nose, and throat exam. His chest showed a normal diameter. However, lung auscultation revealed the presence of crackles left lung base. The remainder exam was normal.

Initially, he was treated with IV metoclopramide, omeprazole 40 mg, ondansetron 8 mg, and oral frappe magaldrate/dimeticone (80/10 mg) without symptom improvement. Laboratory analysis revealed hyperglycemia (182 mg/dl), thrombocytopenia (81,000/mcl), leucopenia (4,000/mcl), and lymphopenia (700/mcl absolute count). The remaining results were normal (hemoglobin 16.2 g/l, hematocrit 48.3%, BUN 19.2, urea 41.1, serum creatinine 1.1 mg/dl, sodium 136.8 mEq/L, potassium 3.56 mEq/L). A chest X-ray (Fig. 1) revealed bilateral infiltrates. The thoracic CT scan revealed multiple zones of diffuse alveolar infiltrate across all segments of both lungs (Fig. 2).

Fig. 1

Chest X-ray showing multiple ground-glass bilateral infiltrates

Full size image

Fig. 2

Chest CT scan showing multiple bilateral and peripheral ground-glass and consolidative pulmonary opacities

Full size image

SARS-CoV-2 PCR results were positive. The patient refused admission and was lost to follow-up.

Case 2

A 43-year-old man was brought to the emergency department by his mother for altered mental status. She reported her son’s symptoms had started 3 days after his father was diagnosed with COVID-19. The patient presented with tachylalia, disorganized ideas, restlessness, delusions of grandeur, emotional lability, hetero-aggression, and aggression towards his mother. His mother revealed a past history of hetero-aggressive episodes which usually resolved during 48 h. Episodes did not affect social or professional functioning and were never medically evaluated.

Aside from his psychiatric symptoms, his vitals were normal, and his physical exam did not reveal any significant findings. Neurology and psychiatry were consulted, and due to known exposure, SARS-CoV-2 PCR was ordered.

While results were pending, we documented hypokalemia K 3.3, elevation of hepatic enzymes (aspartate aminotransferase 53 U/L, alanine aminotransferase 69 U/L), indirect hyperbilirubinemia (total bilirubin 2.07 mg/dl, indirect bilirubin 1.73 mg/dl, direct bilirubin 0.34 mg/dl), and elevated ferritin levels (595 ng/mL). The rest were within normal limits: C-reactive protein 1.8 mg/dL, erythrocyte sedimentation rate 10 mm/h, procalcitonin 0.05 ng/mL, and fibrinogen 297 g/L.

A contrast brain MRI (Fig. 3) and a thoracic CT (Fig. 4) were obtained to investigate for possible COVID-19-related changes such as encephalitis, stroke, or pulmonary changes. However, there were no significant findings.

Fig. 3

Brain MRI showing no signs of stroke or encephalitis

Full size image

Fig. 4

Chest CT scan not showing any infiltrates, consolidation images, or other signs of pneumonia; a nonsignificant single pleural nodule was identified

Full size image

A spinal tap and cytological testing yielded the following: transparent, with 0 leucocytes, 0 erythrocytes, and 0 crenocytes. Glucose 65.6 mg/dL, proteins 17.5 mg/dL, the Gram stain did not report any organisms, bacterial antigens were negative, and viral PCR did not detect any pathogen. Chinese ink was negative.

The PCR for SARS-CoV-2 was positive, and the patient was diagnosed with manic psychosis and COVID-19. Due to isolation precautions of the hospital, family members decided to take the patient home in a voluntary discharge. He will receive follow-up care by the neurologist and infectious disease specialist. The patient consented to the publishing of his experience.

Discussion

Case 1

Singultus or hiccups are caused by involuntary, myoclonic, and repetitive contractions of the diaphragm and intercostal muscles [9]. These coordinated contractions cause a rapid intake of air interrupted by closure of the glottis that results in the characteristic sound [10]. Singultus can be classified based on their duration. If the event lasts less than 48 h, it is called acute, persistent if last more than 48 h, and intractable if the attack lasts more than 30 days [9,10,11].

Although hiccups lasting > 48 h are rare, the workup should try to identify organic pathology. The main causes of prolonged hiccups can be divided in three groups: structural, infectious, and inflammatory disorders that impact either the central nervous system or the phrenic nerves or their branches [11, 12]. Searching for the cause of hiccups can be challenging due to the long course of nerves along the reflex pathway.

In this case, our patient had received pharmacological treatment for gastroesophageal causes of singultus with no improvement. The only remarkable finding during examination was crackles on lung auscultation. Similar to the case previously reported by Prince et al., where a 62-year-old woman presented with a 4-day history of hiccups, our patient had a chest X-ray and a CT scan showing ground-glass and consolidative pulmonary opacities compatible with SARS-CoV-2 pneumonia [13]. Thus, the most likely cause of the patient’s symptoms was phrenic nerve inflammation secondary to COVID-19 pneumonia.

Case 2

The second patient presented with no other symptom apart from an acute episode of psychosis, and we suspect this is a neuropsychiatric symptom of the disease. Several other cases have been reported; however, it is not clear how many of the others had lung involvement [7, 8, 14, 15]. Similar to the patient presented here, the three cases reported by Ferrando et al. did not show any respiratory tract involvement but did have elevated acute phase reactants and a positive SARS-CoV-2 PCR [14]. This differs from other patients experiencing psychotic symptoms because of fear for the disease but have been tested negative [15]. Even if Ferrando et al. suspect that the cytokine storm is involved in the pathophysiology behind these symptoms and this would explain this patient elevated ferritin and liver enzymes as well as the clear spinal tap, an EEG and the CSF SARS-CoV-2 PCR would be needed in order to rule out encephalitis [16] even if most patients with neurological symptoms with COVID-19 have been shown to have undetectable or very low levels of SARS-CoV-2 RNA in cerebrospinal fluid [17]. Another useful diagnostic test could have been oligoclonal band testing in serum and CSF, to identify whether the infection was primarily encephalitis or a result of systemic infection [18]. This could be useful to identify the presence of an escape syndrome variant, which is typically a phenomenon seen in patients with human immunodeficiency virus. The patients described by Ferrando et al. and this patient all presented with no other sign of organ involvement, and all four patients had no relevant past medical history. Escape syndrome described in HIV refers to patients with low plasmatic viral load but high CSF viral load and is the result of a well-controlled disease where virus migrate to the CSF and the patient develops new neuropsychiatric conditions [19]. Perhaps these cases represent viral escape when the patient’s immunological response is adequate. Further studies are needed in order to explain clearly the physiopathology of SARS-CoV-2. SARS-CoV-2 neuropsychiatric manifestations are uncommon, but should remain in an emergency physician’s differential especially if patients have been in close contact with the disease.

Conclusions

We present two atypical cases of COVID-19. While most atypical manifestations have been described among children, older adults, and patients with multiple comorbidities, these cases include two young previously healthy men. To our knowledge, this is the second case of hiccups and COVID-19 reported in the literature and the fourth case of a psychotic episode as the only manifestation of the condition. While the patient presenting with hiccups has the expected physiopathology of SARS-CoV-2, it remains unclear if the psychosis presented in the second case is a result of encephalitis or cytokine storm. These two cases highlight the diversity of presentations of the condition and add to the growing knowledge bank about this virus.

Availability of data and materials

Please contact the author for data requests.

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Authors and Affiliations

1. Instituto Nacional de Geriatría Anillo Periferico, 2767 San Jerónimo, 10200, Mexico City, Mexico

   Teresa Alvarez-Cisneros

2. Medica Sur, Puente de Piedra 150 Toriello Guerra, 14050, Mexico City, Mexico

   Aldo Lara-Reyes & Stephanie Sansón-Tinoco

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1. Teresa Alvarez-Cisneros

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Teresa Alvarez-Cisneros and Aldo Lara received the patients and coordinated the clinical cases. They also drafted the manuscript. Stephanie Sanson-Tinoco helped with the analysis of case 2. All authors read and approved the final manuscript.

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Teresa Alvarez-Cisneros.

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Situation on hemorrhagic fever with renal syndrome in the Kursk region

Situation on hemorrhagic fever with renal syndrome in the Kursk region Over the past 5 years, 53 cases of this disease have been registered.

In the current year, there has been some increase in the incidence of HFRS.

For 9 months of 2012, 17 laboratory-confirmed cases were registered in the region, including 2 cases registered in June, 3 cases in July, 4 cases in August, 4 cases in September of the current year. Cases were registered in Ponyrovsky, Dmitrievsky, Solntsevsky, Konyshevsky, Belovsky (2 cases), Glushkovsky (2 cases), Korenevsky (3 cases), Rylsky (3 cases), Pristensky (2 cases) districts and the city of Kursk.

In the territories of Sudzhansky, Belovsky, Glushkovsky, Korenevsky, Rylsky districts of the Kursk region, natural foci of HFRS have formed, and cases of human disease and positive results of small mammals are recorded here every year.

In order to constantly monitor the circulation of the HFRS pathogen in the environment, from 102 to 994 mouse-like rodents are examined annually in the Kursk region on the basis of Rospotrebnadzor institutions, the proportion of positive findings is up to 5%.

Specialists of the Rospotrebnadzor Administration control the implementation of deratization measures at objects of high epidemiological significance (food, children’s, medical, trade facilities, etc. ), as well as in HFRS outbreaks. The heads of administrations and municipalities are given recommendations on carrying out deratization work on the territory of settlements.

HFRS is an acute viral natural focal disease characterized by selective damage to blood vessels and proceeding with fever, intoxication and kidney damage. In the Russian Federation, HFRS is one of the first places in the incidence of people among natural focal infectious diseases.

The source of infection is various types of wild mouse-like rodents. Infection of people with HFRS occurs as a result of direct contact of people with infected wild small mammals, and more often indirectly, through environmental objects contaminated with secretions of these animals. Cases of infection with HFRS from a sick person are unknown.

The incidence has a clear seasonality: the largest number of cases of the disease is recorded from May to October-December with a maximum rise in June-September, due to an increase in the number of rodents, frequent visits to the forest, fishing trips, agricultural work, etc. , as well as in November-December, which is associated with the migration of rodents to residential premises.

Most often rural residents get sick. The incidence of urban residents is associated with their stay in the suburban area (visiting the forest, resting in holiday camps and sanatoriums located near the forest).

Immunity after an illness is quite stable. Recurrences are rare.

The disease is characterized by a cyclic course and a variety of clinical variants. From the moment of infection to the appearance of the first signs of the disease, 7-10 days pass (up to a maximum of 40 days). The onset of the disease is similar to a common acute respiratory infection – fever, headache, muscle pain, general weakness, loss of appetite, sometimes nausea and vomiting. Some patients have catarrhal phenomena (nasal congestion, dry cough, hyperemia of the pharynx), short-term deterioration of vision (fog in the eyes). On the 4-5th day of the disease, pain in the lower back and abdomen joins the listed symptoms, sometimes a rash appears on the skin. Kidney function is disturbed, thirst, dry mouth, hiccups are disturbing. Bleeding occurs – kidney, stomach, nose, etc.

In case of any manifestations of the disease, it is necessary to contact the polyclinic at the place of residence as soon as possible. Hospitalization in this disease is mandatory, regardless of the severity of the disease, since the possibility of developing severe complications is not excluded in any course of the disease.

Specific (vaccine, specific immunoglobulin) prophylaxis not developed. Preventive measures in natural foci of HFRS are reduced to the destruction of rodents and to the protection of people from contact with rodents or objects contaminated with their secretions.

In order to prevent HFRS disease in humans, it is recommended to carry out the following preventive measures:

1. Destruction of rodents in houses, livestock facilities, epidemiological facilities (food, children’s, medical institutions, etc.), in places of mass recreation and stay of the population.

2. Regular cleaning of territories from debris and dead wood, sanitary cleaning.

3. Ensuring the rodent-proofness of residential, industrial and storage premises by carrying out engineering and technical, repair and construction activities.

4. Carrying out barrier derat control during the period of rodent migration to the premises in the autumn months.

5. Use of respiratory protective equipment when participating in haymaking, feeding livestock with hay.

6. Thoroughly wash fruits and vegetables before eating, especially if they have been stored for some time.

To breathe or not to breathe. The rarest unpleasant symptom of COVID-19 is described

https://ria.ru/20220114/ikota-1767739885.html

To breathe or not to breathe. The rarest unpleasant symptom of COVID-19 is described

To breathe or not to breathe. The rarest unpleasant symptom of COVID-19 is described The rarest unpleasant symptom of COVID-19 is described

As the COVID-19 pandemic develops, articles about atypical manifestations of the disease are published in scientific journals. One of them is hiccups, which does not stop for several… RIA Novosti, 05/23/2022

science

mexico

turkey

health

biology

coronavirus covid-19

hepatitis c

pcr test

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/html/head/meta[@name=’og:description’]/@content

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MOSCOW, January 14 – RIA Novosti, Tatyana Pichugina. As the COVID-19 Pandemic Evolvesin scientific journals publish articles about atypical manifestations of the disease. One of them is hiccups, which does not stop for several days. How it is connected with a viral infection – in the material of RIA Novosti. Hiccups brought to the hospital A 62-year-old man was admitted to the Cook County clinic in the United States with complaints of hiccups lasting four days. In addition, in recent months he has lost a lot of weight. There were no cold symptoms, except for a slightly elevated temperature. Doctors took a chest X-ray to check for a tumor, but instead found ground-glass opacities in the lungs, a typical sign of viral pneumonia. Studies have shown that the patient has COVID-19. He was quickly cured. Doctors described this case in an article and emphasized the importance of such a symptom of coronavirus infection as hiccups. In November 2020, scientists from Cairo University in Egypt reported on a 48-year-old man who was admitted to the hospital with hiccups, fever and sore throat. He’s been sick for a week now. According to CT of the lungs and PCR tests, he was diagnosed with COVID-19. To therapy added drugs that relieve hiccups. Ten days later, the patient was discharged. Pneumonia really occasionally manifests itself in the form of hiccups, which disappears after a course of treatment, doctors from Turkey write. They observed two men who went to the doctors because of the constant hiccups. One was diagnosed with covid, and the other recently recovered, but the consequences made themselves felt in such an unusual way. Another story from Mexico. A 48-year-old man came to the hospital with hiccups that did not stop 96 hours. There were no other painful symptoms, so he was treated as an outpatient, but the reaction did not go away. Then he was examined in more detail and found pneumonia on CT, the smear was positive. “With unexplained manifestations of inflammatory diseases, arterial and venous thrombosis, it is important to keep in mind COVID-19,” the authors conclude. In Search of CausesHiccups are respiratory failure due to simultaneous contraction of the diaphragm and intercostal muscles. The person takes a sharp breath, but the glottis closes, the air slips through the folds with a characteristic “hic” sound. Such a reaction is considered physiologically normal in response to stomach irritation, bloating and overeating. Hiccups come and go spontaneously. If it lasts two days or more, this is already a pathology. A person suffers, his body is exhausted. “The third day went like hiccups, I want to sleep, but I can’t,” says one of the Pikabu network users. To find out the cause of the violation, he went to the doctor. Hepatitis C was discovered. As the authors of the review “Hiccups: Mystery, Nature, Treatment” write, the brain processes that are responsible for the appearance of an unpleasant reflex are poorly understood. It is known that molecules of dopamine, gamma-aminobutyric acid are involved in this, so drugs blocking them sometimes work. But in general, there is no special treatment. Neither adults nor children are spared from hiccups – even the fetus inside the womb. Scientists know more than a hundred causes: chemical irritants, drugs, inflammation, infections, tumors, injuries, heart problems, alcoholism. In some cases, drugs are needed, someone is helped by acupuncture, holding the breath and other folk remedies, for example, inducing a gag reflex, as well as sugar, lemon. American scientists estimate that almost four thousand people go to US hospitals a year due to hiccups. Sometimes attacks last more than a month. Record set by Iowa farmer who hiccupped 69years and 9 months: from 1922 to 1990. The cause was a cerebral hemorrhage after the man raised the pig. Mexico

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mexico, turkey, health, biology, coronavirus covid-19, hepatitis c, PCR test

Science, Mexico, Turkey, Health, biology, Coronavirus COVID-19, Hepatitis C, PCR test gin. As the COVID-19 pandemic evolves, scientific journals publish articles about unusual manifestations of the disease. One of them is hiccups, which does not stop for several days. How this is connected with a viral infection – in the material RIA Novosti.

Hiccups brought to the hospital

A 62-year-old man was admitted to a hospital in Cook County, USA, complaining of hiccups lasting four days. In addition, in recent months he has lost a lot of weight. There were no cold symptoms, except for a slightly elevated temperature. Doctors took a chest x-ray to check for a tumor, but instead found ground-glass opacities in the lungs, a typical sign of viral pneumonia.

Studies have shown that the patient has COVID-19. He was quickly cured. The doctors described this case in an article and emphasized the importance of such a symptom of a coronavirus infection as hiccups.

In November 2020, scientists from Cairo University in Egypt reported on a 48-year-old man who was admitted to the hospital with hiccups, fever and sore throat. He’s been sick for a week now. According to CT of the lungs and PCR tests, he was diagnosed with COVID-19. To therapy added drugs that relieve hiccups. The patient was discharged ten days later.

Pneumonia really occasionally manifests itself in the form of hiccups, which disappears after a course of treatment, doctors from Turkey write. They observed two men who went to the doctors because of the constant hiccups. One was diagnosed with covid, and the other recently recovered, but the consequences made themselves felt in such an unusual way.

Another story from Mexico. A 48-year-old man came to the hospital with hiccups that did not stop for 96 hours. There were no other painful symptoms, so he was treated as an outpatient, but the reaction did not go away. Then he was examined in more detail and found pneumonia on CT, the smear was positive. “For unexplained manifestations of inflammatory diseases, arterial and venous thrombosis, it is important to keep in mind COVID-19,” the authors of the work conclude.

Hiccups turned out to be a symptom of a fatal disease

October 19, 2021, 01:35

In search of causes

Hiccups are respiratory disorders due to simultaneous contraction of the diaphragm and intercostal muscles. The person takes a sharp breath, but the glottis closes, the air slips through the folds with a characteristic “hic” sound. Such a reaction is considered physiologically normal in response to stomach irritation, bloating and overeating.

Hiccups come on and go spontaneously. If it lasts two days or more, this is already a pathology. A person suffers, his body is exhausted. “The third day went like hiccups, I want to sleep, but I can’t,” says one of the Pikabu network users. To find out the cause of the violation, he went to the doctor. Found hepatitis C.

© Depositphotos.com / rob3000Hiccups

© Depositphotos.com / rob3000

As the authors of the review “Hiccups: Mystery, Nature, Cure” write, the brain processes that are responsible for the emergence of an unpleasant reflex are poorly understood. It is known that molecules of dopamine, gamma-aminobutyric acid are involved in this, so drugs blocking them sometimes work. But in general, there is no special treatment.

Neither adults nor children are exempt from hiccups, not even the fetus inside the womb. Scientists know more than a hundred causes: chemical irritants, drugs, inflammation, infections, tumors, injuries, heart problems, alcoholism.