Search

A 72-year-old man presented to our hospital with a fever. Chest computed tomography showed typical coronavirus disease 2019 (COVID-19) pneumonia. The fever normalized after a few days, and the pneumonia was alleviated. However, the intermittent fever subsequently re-occurred and persisted for over a month. Various tests, including blood tests, culture tests, and image evaluations, were performed. However, the conclusion was that long COVID was the cause of the intermittent fever as an exclusion diagnosis. Many patients suffer from persistent symptoms of COVID-19, but the symptoms and their durations vary. Here we report a case of prolonged fever after COVID-19 pneumonia.

Background Malaria-associated secondary hemophagocytic lymphohistiocytosis (HLH) is rare. Moreover, the literature on malaria-associated HLH is sparse, and there are no similar cases reported in China. Case summary We report the case of a 29-year-old woman with unexplained intermittent fever who was admitted to our hospital due to an unclear diagnosis. The patient concealed her history of travel to Nigeria before onset. We made a diagnosis of malaria-associated secondary HLH. The treatment strategy for this patient included treatment of the inciting factor (artemether for 9 d followed by artemisinin for 5 d), the use of immunosuppressants (steroids, intravenous immunoglobulin) and supportive care. The patient was discharged in normal physical condition after 25 d of intensive care. No relapses were documented on follow-up at six months and 1 year. Conclusion Early diagnosis of the primary disease along with timely intervention and a multidisciplinary approach can help patients achieve a satisfactory outcome.

Aconitum heterophyllum Wall ex. Royle is considered an important medicinal plant in traditional system of medicine as the tuberous roots are used for curing different ailments. But over grazing, prolong seed dormancy and many other reasons have led to the exploitation of this plant, so conservation through various modes is the need of the hour. Aims: The present review aims for accounting extensive information on different methods of propagation, traditional uses and pharmacological activities of Aconitum heterophyllum. Review Methods: A literature search was done on Aconitum heterophyllum using relevant Ayurvedic and contemporary texts. Different scientific databases such as Pubmed, Scopus, EBSCO, Google Scholar Information were used to collect all information regarding propagation and pharmacology of this plant. Results: Available data has reported that this endangered plant can be propagated through various methods such as raising propagules from seeds and daughter tubers, and other plant tissue culture techniques. Plant has reported to have 0.79% of total alkaloids in roots, out of which Atisine (0.4%), Heteratisine (0.3%), histisine, heterophyllisine, heterophylline, heterophyllidine are some major alkaloids. It also possesses important pharmacological activities like anti-bacterial activity, anti-diarrhoeal activity, enzyme-inhibition activity, anti-inflammatory activity, hepato-protective activity and anti-spasmodic activity. Conclusion: The results of this review clearly suggests about the valuable traditional use of Aconitum heterophyllum in curing various ailments like diarrhoea, dysentery, bilious complaints, intermittent fever and diseases of children. Further research: Different traditional uses mentioned in Āyurveda texts need further validation through different experimental and clinical studies which is a recommendation of this review.

Prolonged and unexplained fevers in young adults are uncommon, especially when access to diagnostic tests is simplified. Therefore, the definition of unexplained fever depends on the volume of tests performed. However, low-grade fever has not been a priority in research. Management of low-grade fever [eg, an oral temperature of ≥37.8°C (100°F) and

CASE REPORT A 1-year-old, neutered male German Shepherd was presented with a 5-month history of episodic lethargy, intermittent fever, weight loss and a hunched posture. The dog was diagnosed with presumptive microsporidian meningoencephalitis based on cytological findings on cerebrospinal fluid analysis and a positive PCR test. The dog initially responded favourably to a 4-week course of trimethoprim-sulfadiazine, pyrimethamine and fenbendazole, and remained well for 12 weeks following cessation of treatment. Disease then recurred, and despite an initial positive response to treatment, he deteriorated and was euthanased 11 weeks later, 7.5 months after definitive diagnosis and 13 months after clinical signs were first reported. CONCLUSION To the authors knowledge, this is the first case of canine microsporidiosis in Australia.

Background Liver infarction is a rare necrotic lesion due to the dual blood supply consisting of the hepatic artery and portal vein. The absence of specific clinical manifestations and imaging appearances usually leads to misdiagnosis and poor prognosis. Thus, the precise diagnosis of liver infarction always requires imaging studies, serum studies, and possible liver biopsy. Case summary We report a case of 31-year-old man who developed a huge liver infarction. Persistent right upper abdominal pain and intermittent fever were the main symptoms in this patient. Computed tomography revealed a huge irregular lesion with a maximum diameter of 12.7 cm in the right lobe of the liver. Three-dimensional reconstruction was performed and no significant interruption of the main hepatic vessels was observed. The lesion was initially considered to be a malignant tumor with internal bleeding. Laparoscopic right hepatectomy was performed, and pathology indicated a rare liver infarction. The patient recovered well and was discharged on postoperative day 21. No fever or abnormal liver function were reported in the subsequent 6 mo. Conclusion In patients with a huge liver infarction, early surgical intervention may be beneficial.

Case Presentation A 51-year-old woman with no comorbidities presented with a 3-month history of cough with mucopurulent expectoration and intermittent fever. Over the past 1 month, she complained of streaky hemoptysis and gave history of expectorating "whitish pellets" in the sputum on two occasions. She had developed progressive breathlessness for a week prior to presentation to our hospital. There was no history of chest pain or loss of weight or appetite. She was a nonsmoker and did not consume alcohol. She had received multiple courses of antibiotics at another center with no relief of symptoms.

Background Pasteurella aerogenes is a gram-negative coccobacilli commensal in animals, rarely describe in human infection. We describe the first case of infective endocarditis caused by Pasteurella aerogenes, a rare pathogen in human infections that usually results from domestic animal bites. Case presentation This is a case of a 21-year old Taiwanese man who initially presented headache and intermittent fever without any specific neurologic sign. Investigations revealed a diagnosis of infective endocarditis with mitral valve involvement and blood culture growing P. aerogenes. He recovered well after surgical intervention with the completion of antibiotic therapy. Conclusion P. aerogenes cause human infection, mostly soft tissue infection by exposure to domestic animals and pets. Our case highlights that endocarditis should be considered in bacteremia with this pathogen.

Bronchial mucoepidermoid carcinoma is a rare disease in the field of thoracic surgery, and it is even more rarer in children. A 10-year Chinese child whose chief complaint was intermittent fever and cough for one year was referred to our hospital. Based on the imaging, pathology and immunohistochemistry findings, the patient was diagnosed with right inferior lobar bronchial mucoepidermoid carcinoma; and was treated with video-assisted thoracoscopic (VATS) right inferior lobe resection and had a good prognosis. Key Words: Mucoepidermoid carcinoma, Child, Lobe resection, VATS.

Background: The presence of retained foreign bodies in the spinal canal has been reported in the literature. They are attributed to retained pieces of medical equipment after surgery, or, following trauma, to residual bullets, glass fragments, or knife blades. Although some retained materials do not cause any neurological deficits in the short run, others may become symptomatic months later. Case Description: A 2-year-old male presented with a history of intermittent fever and mild lower extremity weakness. Notably, the original infectious workup was negative. However, a noncontrast CT scan later documented a needle-shaped foreign body in the spinal canal at the T10 level. During the T10 laminectomy, a needle (i.e. from a medical syringe) was removed, the patient remained neurologically intact. The foreign body turned out to be a medical syringe needle tip. Conclusion: A 2-year-old male presented with fevers and mild lower extremity weakness attributed to an intraspinal needle tip found utilizing CT at the T10 level. T10 laminectomy allowed for removal of a small needle tip. This shows the importance of removing retained spinal foreign bodies to avoid further/future neurological injury, and/or the potential risks/complications of foreign body migration/sequestration.

We herein report a case of large-vessel vasculitis in a 57-year-old woman who developed an intermittent fever and weight loss. While contrast-enhanced computed tomography was noncontributory, positron emission tomography-computed tomography (PET-CT) revealed the diffuse, intense uptake of fluorodeoxyglucose (FDG) in the aorta and its branches. Although she had no signs of relapse after successful oral corticosteroid therapy, PET-CT at 30 months revealed a persistent FDG uptake in the large vessels, which warranted regular follow-up imaging for vascular complications. In cases with an intense FDG uptake at the diagnosis, PET-CT follow-up after clinical remission may help predict the risk of relapse and vascular complications.

A hepatic abscess caused by a swallowed foreign body is a rare and challenging diagnosis. Most patients have nonspecific symptoms, and more than 90% of patients do not remember having swallowed it, which occurred accidentally. In this setting, fish bones, chicken bones, and toothpicks are the most found foreign bodies. We reported the case of a 54-year-old male patient admitted with abdominal pain and intermittent fever. He was diagnosed with liver abscess and treated successfully with antibiotics and a laparoscopic procedure; a rosemary twig was found during the abscess drainage procedure. Furthermore, a literature review of 22 cases of laparoscopic treated liver abscesses associated with a foreign body was made.

Human brucellosis, one of the most common zoonoses worldwide, rarely occurs in Japan, and only a few chronic cases have been reported. We herein report the case of a 39-year-old Japanese woman with chronic human brucellosis, considered a Brucella canis infection, that persisted for 19 years. Her medical history and fever pattern suggested chronic brucellosis, and the diagnosis was made based on the results of a serum tube agglutination test (SAT). After undergoing combination therapy with streptomycin and doxycycline, she achieved symptomatic relief and showed negative SAT results. Even in non-endemic areas, chronic brucellosis is an important differential diagnosis in patients with long-term persistent fatigue or a fever.

A 60-year-old male presented with complaints of dyspnea, intermittent fever, and 40 pounds of weight loss over the previous 9 months and was admitted for acute hypoxemic respiratory failure. Labs demonstrated elevated inflammatory markers, mild anemia, and thrombocytopenia. Fluorodeoxyglucose-positron emission tomography scan demonstrated diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding abnormality on CT images. Excisional lung biopsy demonstrated intravascular large B-cell lymphoma (IV-LBCL). Presentation, imaging findings, and diagnosis of IV-LBCL will be discussed, as well as differential considerations for pulmonary involvement by IV-LBCL. Keywords: Lymphoma, Intravascular large B-cell lymphoma, FDG-PET, CT, Pulmonary uptake

International audience; Endemic malaria, which claimed 229 million new cases and 409,000 deaths in 2019 mainly in Africa, was eradicated from Europe by the mid-20th century. Historical descriptions of intermittent tertian and quartan fever reported in texts of Hippocrates in Greece and Celsus in Italy suggest malaria. A few paleomicrobiology investigations have confirmed the presence of malarial parasite Plasmodium falciparum in 1st, 2nd, and 5th century infected individuals in diverse regions of Italy, and Plasmodium sp. later in Bavaria. The causative Plasmodium pathogens, discovered in the 19th century in Algeria, were controversially used as therapeutic agents in the European pharmacopeia more than two centuries after effective quinine-based treatments had been introduced in Europe. How Europe managed to eradicate malaria and what the history of malaria was in Europe are of medical interest, and this review traces research pathways for a renewed understanding of malaria eradication in Europe through combined historical and paleomicrobiological investigations.

A 36-year-old man (previously fit and healthy) presented to the Emergency Department with an 18-day history of progressively worsening pain around his forehead. This was associated with a centrally located and confined erythematous, tender forehead swelling, an intermittent fever and left- sided rhinorrhea.

Background Intermittent fever along with increased inflammatory markers (CRP and ESR) most commonly is the sign of an infectious disease. Nevertheless, without an adequate response to antibiotic treatment, it should raise concern of other conditions, including several rheumatic, like Kawasaki disease, periodic fever syndromes and systemic form of juvenile idiopathic arthritis (JIA), even when no clear arthritis is present. Case Presentation We present a case of a 7-year- old girl with a 14-month history of intermittent fever with increased inflammatory markers, along with unspecific symptoms such as hepatomegaly, polymorphous rash and migratory arthralgia. An extensive diagnostic workup excluded infectious aetiology, genetic testing did not detect pathogenic mutations. Despite the treatment with intravenous imunoglobulines and low dose glucocorticoids (GCs), the fever did not subside. Finally, extensive laboratory workup revealed increased proinflammatory cytokines IL-6 and TNF- alpha along with chronic anaemia and thrombocytosis. The systemic subtype of JIA was considered, and treatment with pulse (30mg/kg), continued with high (2mg/kg) doses of GCs was initiated with an instant resolution of symptoms. Nevertheless, after the weaning of GCs, the new exacerbation was observed and therefore tocilizumab, humanized monoclonal antibody against IL-6 receptor, was initiated. Conclusion Systemic form of juvenile idiopathic arthritis is a heterogeneous disease dominated musculoskeletal and systemic symptoms. While the former ones are a result of similar pathophysiologiocal mechanisms as other forms of JIA, activation of the nonspecific immune response is responsible for the sytemic ones, similar to other autoinflammatory diseases. Therefore, it is possible that in some cases of systemic form of JIA, systemic inflammation is present without the musculoskeletal symptoms. With the existing classification criteria of the International League against rheumatism (ILAR) it can be difficult to diagnose and initiate appropriate therapy. Consequently it can mislead to recognize a serious complication – macrophage activation the syndrome. The recognition of the unique nature of systemic JIA in comparison to other types of JIA as well as an increased understanding of its pathogenesis, provides a better outcome and prognosis for children who often go undiagnosed with a debilitating chronic condition.

A 50-year-old female patient presented to the emergency room with intermittent fever and bilateral upper/lower limb weakness for 2 weeks and intermittent abdominal pain for 1 week. On general examination there were features of hypotension, tachypnoea and pallor. On nervous system examination there

A 56-year-old female patient presented with a productive cough and intermittent fever for 3 weeks. On further questioning, she reported a nasal drip. She is a non-smoker. Prior to face-to-face assessment, she was screened for potential contact with coronavirus 19 (COVID-19). Of note, the patient reported symptoms consistent with COVID-19 but did not qualify for testing at that time. During the first face-to-face consultation, she was diagnosed with presumed viral illness and rhinitis. She was advised on self-care strategies and started on a steroid nasal spray. The patient subsequently presented a further eight times over the next month. This was mostly telephone encounters due to the initiation of ‘lockdown’ and restrictions on face-to-face contact. The symptoms were not progressive. The fever settled and the cough became dry. Throughout, there was persistent rhinorrhoea, worse at night, forcing the patient to sleep upright. Examination was limited, given the nature of encounters, and only basic ear, nose, and throat (ENT) examination was carried out (limited intranasal examination). Bloods and chest X-ray were …

Prolonged fever is a particular challenge. A 47-year-old man with 5-year intermittent fever and remarkable splenomegaly was diagnosed as chronic melioidosis after splenectomy. The case would help clinicians to raise awareness and include chronic melioidosis in the differential diagnosis for patients with the travel history in melioidosis endemic regions.

Rationale: Myelodysplastic syndrome (MDS) can be complicated with Crohn disease (CD). Irritable bowel disease (IBD) associated with MDS has already been reported in the past; however, hematopoietic stem cell transplantation (HSCT) is rarely performed. Herein, we report a case of CD with MDS for HSCT. Patient concerns: A 41-year-old man was hospitalized due to abdominal pain and intermittent fever for 40 days. Two years later, he was readmitted due to abdominal pain and diarrhea with fever for 10 days. Diagnosis: Symptoms, laboratory examinations, and imaging findings of the patient were indicative of CD complicated with MDS. Interventions: An allogeneic HSCT was performed. Outcomes: He died of severe lung infection 125 days post-transplantation. Lessons: The number of cases of CD combined with MDS remains insufficient, and no consensus opinions are available to date. Hence, HSCT is a very potential treatment method. Additional experiences are needed to determine its effectiveness.

We report a case of a 30-year-old man who was treated as recurrent right inguinal abscess following a 2-month history of right inguinal swelling and intermittent fever with no respiratory symptoms. Resection of his right inguinal lymph node and the histopathological analysis revealed the diagnosis of Langerhans cell histiocytosis. In addition, the CT of the thorax showed presence of bilateral cystic lung changes consistent with pulmonary Langerhans cell histiocytosis.

The adaptive and therapeutic nature of fever has been recognized for centuries and both local and systemic thermotherapy are now used to enhance the effectiveness of both chemotherapy and radiation therapy for cancer. We propose that the success of antiseptic, antibiotic, antipyretic and antimalarial strategies and medications over the past century and a half may have had the unintended effect of releasing precancerous growths and neoplastic foci from the inhibitory effects of intermittent fever. This may be a previously unrecognized factor in the overall rise in cancer rates in the late 19th and early 20th centuries.

The present ethnobotanical investigation was carried out from December, 2016 to February, 2017 to identify the medicinal plants used by local people residing in and around Marandahalli village, Dharmapuri District regularly. A total of 58 medicinal plants were identified on basis of available first hand information from local people inhabiting in the study area, from literature survey and internet. Out of 58 medicinal plants documented in the study area, only 27 plants have been used by them for the treatment of various diseases like fever, intermittent fever, cough, asthma, jaundice, gastric problems, urinary disorders, dry skin disease,psoriasis, skin allergies, leucoderma, burning skin, liver disorders, snake bite, memory power, ulcer, diabetes,stomach aches etc., The plants were also to be used in different forms such as juice, decoction, powder and past. Authentication is needed to validate the usage.

A 25-year-old female presented, reporting back pain and intermittent fever for 3 months. At the time, she was at the end of the third trimester of pregnancy; therefore, an imaging examination could not be carried out., Can you diagnose this case of puerpera with back pain and intermittent fever? http://ow.ly/AC0U30k2OkF

Odontogenic infections are associated with a variety of microorganisms. Antibiotics are commonly used for the management of various dental infections and have a proven role in decreasing morbidity and mortality caused by infectious diseases. The frequent and over usage of antibiotics has been associated with a number of consequences such as the selection of drug resistant strains, and the formation of antibiomas. Antibiomas are characterized by the formation of a localized pathology surrounded by thick fibrous tissues in response to long term antibiotics use. An established antibioma is characterized by a tough fibrous swelling accompanied by painful or painless swelling, intermittent fever and constitutional symptoms. In this article, we are reporting the case of a facial antibioma formed due to prolonged use of antibiotics prescribed for a residual periapical infection following endodontic treatment. In addition, the association of using antibiotics in this context is discussed.

Microscopic examination is still a gold standard for malaria diagnostic tests. Immunochromatographic (IC) technique can be usedas an alternative examination. The aim is to compare the identification value of immunochromatographic method diagnostic test tomicroscopic examination of malaria in laboratory examination. Cross sectional diagnostic study approach was applied to those withsymptoms of: (1) fever (temperature > 38°C) or intermittent fever lasting for two days or more (2) cephalgia/myalgia, 604 sampleswere taken consecutively in January to July 2005 from primary health centres of Sukaraja and Keruak, as well as Clinic Nugraha atLombok Timur district , province of Nusa Tenggara Barat . From these samples, there were 37 samples with P.vivax, 45 samples with P.falciparum, 5 samples with mixed infection and 517 samples without Plasmodium sp. From IC examination, results were reserved for 36samples with P. vivax, 69 samples with P. falciparum, 5 samples with mixed infection and 503 samples without Plasmodium sp. Diagnostictest data analysis showed that the immunochromatographic test revealed 100% sensitivity, 96.7% specificity, 83.2% positive predictivevalue and 100% negative predictive value. It can be concluded that malaria IC test is reliable to be used as a routine malaria test.

Background and study aim: Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes.The aim of this study is to study the clinical presentations and outcomes of malarial infected cases attending Almaza Military Fever Hospital in Cairo. Patients and Methods: Fifty patients with malarial infection were selected from those admitted to Almaza Military Fever Hospital. The following investigations were done for all cases; (CBC), liver and renal function tests, serological tests (rapid diagnostic test for serum malarial antigens & microscopic examination of peripheral blood film) and abdominal US. Results: The majority of cases (76%) was already diagnosed and was coming from Peace Keeping Mission Forces in Africa. Congo was the most malaria-infected place (36%), then Ivory Coast (26%). Most of cases (80%) had intermittent fever. Six patients (12%) were admitted at ICU. The thick film method was the most sensitive diagnostic test (98%). P. falciparum was the commonest species among cases (80%) then P. ovale (20%). The best response in studied cases was poly-therapy (84%) while mono-therapy was effective in only 5 patients (10%), (82%) of cases were cured, one patient died and one patient had a relapse while 2 patient (4%) had recurred. Conclusion: Thick film is the most sensitive and informative test among diagnostic test modalities. Combined therapy (polytherapy) is preferable than monotherapy.

Cystic duct (CD) variation is challenging for surgeons performing biliary surgery. The misunderstanding of CD variants can lead to iatrogenic bile duct injuries (BDIs). We describe a 65-year-old man who presented with a 10-day history of abdominal pain and intermittent fever. He was admitted with the diagnosis of acute cholecystitis and underwent laparoscopic cholecystectomy during hospitalization. Intraoperatively, we found that the CD drained into the right hepatic duct rather than directly through the common bile duct, which is a very rare anatomic variation. This unusual case emphasizes the importance of recognizing this CD variation to avoid iatrogenic BDIs. This is particularly valuable for less experienced surgeons.

A Man with Dyspnea and Abnormalities on Chest Imaging A 20-year-old man with a history of electronic-cigarette use presented to the hospital because of a history of dyspnea, intermittent fever, joi...