Volume Article Contents Abstract. Davis , Timothy M. Oxford Academic. Google Scholar. Ashley E. Elizabeth A. Keng E. Revision received:. Cite Cite Timothy M. Select Format Select format. Permissions Icon Permissions. Abstract We investigated pulse-temperature relationships in 66 children with enteric fever group 1 and in 76 with other infections group 2.
Issue Section:. Download all slides. First of all… no flogging. Equally important is focusing on esoteric information without distinguishing between it and what is clinically useful. I have not come across any specific numbers on occurrence of the finding and, as such, I would let its absence steer you away from the diagnosis in the right clinical setting.
I will see if I can find any data about the specific rates of occurrence. Thank you! However, it is based on normal heart rate of that patient that may vary from beats per minute. No exact and useful definition exists and the underlying mechanisms are unknown. Despite this, the term is often used in the literature and in clinical practice both as a clinical sign for an individual patient and as a characteristic feature of certain specific diseases.
In particular, the classic signs of relative bradycardia and absolute eosinopenia may not be useful to differentiate enteric fever from dengue fever S3 and S4 Tables. Therefore, even with these predictors, considering other tropical febrile illness is required in an actual clinical setting. Furthermore, even without these predictors, it is important to obtain cultures because cultures can provide substantial information for not only patients with suspected enteric fever but also for all febrile patients.
There are several limitations in this study. First, the cases included predominantly adults and Asian patients, and our controls included only one patient with rickettsiosis, while enteric fever has been historically confused with rickettsiosis. These might limit the application of these results to other populations. However, in our controls, the composition of travel-related febrile diseases was fairly similar to that of a previous study in returned travellers using the GeoSentinel Surveillance Network database between and [ 32 ].
Therefore, we believe our results represent the actual clinical setting of febrile returned travellers to non-tropical or subtropical areas, and our results are acceptable in such situations. By varying the population and geographical areas, further studies might reveal the effectiveness of these classic signs in predicting enteric fever in different settings. Second, the incubation period was not considered for each infectious disease, in either cases or controls.
In clinical practice, additional information on the estimated incubation period could be useful in predicting diagnosis among afebrile returned travellers from tropics or subtropics [ 33 ]. Third, haematocrit remained an independent predictor for the diagnosis of enteric fever, even in the multivariate logistic regression analysis; however, this may be because the model was not adjusted for hypovolemic status.
The median haematocrit for each disease in the controls was higher than that for enteric fever Finally, the highest risk factor for enteric fever in this study was return from travel to South Asia. However, it is also necessary to consider that the usefulness of such epidemiological information is limited when an outbreak of enteric fever occurs in areas outside of South Asia.
The present study provides evidence of a diagnostic tool for enteric fever that utilises the presence of classic signs. Hence, among febrile returned travellers to non-endemic areas, the classic signs of relative bradycardia and eosinopenia should be re-evaluated for predicting a diagnosis of enteric fever prior to obtaining blood cultures.
We thank the staff at NIID for conducting the microbiological tests, particularly for diagnosing dengue fever and leptospirosis. Some of the patients with enteric fever included in the present study were also described in our previously published case series [35]. Conceptualization: TM S. Formal analysis: TM S. Funding acquisition: Y.
Investigation: TM. Methodology: TM S. Kutsuna Y. Kato MK. Project administration: Y. Resources: TM S. Kato Y. Kanagawa NO. Supervision: Y. Validation: TM S. Visualization: TM. Writing — original draft: TM. Kanagawa MK. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background The lack of characteristic clinical findings and accurate diagnostic tools has made the diagnosis of enteric fever difficult.
Methods This matched case-control study used data from to for culture-proven enteric fever patients as cases. Results Data from patients 40 cases and controls were analysed. Conclusions The classic signs of relative bradycardia and eosinopenia were not specific for enteric fever; however both met the criteria for being diagnostic predictors for enteric fever.
Introduction Enteric fever typhoid and paratyphoid fever is a systemic infection caused by human-specific food- and water-borne pathogens, such as Salmonella enterica subspecies enterica serovar Typhi or Paratyphi A, B, or C.
Study population Cases. Download: PPT. Fig 1. Flow diagram of selection criteria for cases enteric fever and controls non-enteric fever. Measurements and definitions Baseline characteristics were collected at the time of diagnosis of each infection, including age, sex, race, travel destination, and laboratory findings eosinophil counts, etc. Results Baseline and clinical characteristics Cases.
Table 1. Table 2. Table 3. Logistic regression analysis of variables in the prediction of enteric fever diagnosis. Subgroup analyses The proportion of relative bradycardia and absolute eosinopenia differed according to the diseases among controls.
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