Fever without apparent source on clinical examination

PURPOSE OF REVIEW: Routine immunization of children with the heptavalent pneumococcal conjugate (PCV7) vaccine and rapid tests for identification of viruses since the last review in 2002 make this review timely and relevant. RECENT FINDINGS: Since the introduction of the PCV7 vaccine, the incidence of true bacteremia has decreased to 1% and has impacted the epidemiology of fever in the under-3-year-old population, making urinary tract infection the most common cause. Polymerase chain reaction testing for viruses helps in early diagnosis and serves to decrease the unnecessary use of antibiotics. Serious infections are dependent not only on the virulence of the agent, but also on host susceptibility, which has been getting more attention recently. Kawasaki disease in the very young infant is also discussed and awareness is increasing among physicians. SUMMARY: The decrease in the rate of bacteremia since the PCV7 vaccine was introduced means that the management guidelines for fever in the under-3-year-old population need to be reviewed. In addition, better markers are required to predict serious bacterial infection in this population. Further research into the understanding of the host immune response is also needed.     

Sonographic features of umbilical catheter-related complications

Pediatric Radiology - Umbilical catheters are commonly used in the neonatal period for blood sampling or for administering medication or parenteral nutrition. The position of the catheter is...     

High Rates of Diabetes Mellitus,Pre-diabetes and Obesity Among Somali Immigrants and Refugees in Minnesota: A Retrospective Chart Review

We examined the prevalence of cardiovascular risk factors among Somali refugees at a midwestern hospital in the U.S. This was a retrospective cohort study of 1007 adult Somali patients and an age and frequency-matched cohort of non-Somali patients actively empanelled to a large, academic primary care practice network in the Midwest United States between January 1, 2011 and December 31, 2012. Cardiovascular risk factors were obtained by chart review and compared between the two cohorts using a Chi squared test. Median age was 35 years (Q1, Q3; 27, 50). The prevalence of diabetes was significantly higher among Somali versus non-Somali patients (12.1 vs 5.3 %; p = 0.0001), as was prediabetes (21.3 vs 17.2 %; p < 0.02) and obesity (34.6 vs 32.1 %; p = 0.047). After adjusting for age, sex, body mass index, education and employment, among the Somali patients, the odds ratio (95 % confidence interval) for diabetes was 2.78 (1.76–4.40) and 1.57 (1.16–2.13) for pre-diabetes. There was a significantly higher prevalence of diabetes, pre-diabetes and obesity among Somali patients compared with non-Somali patients. Further research into the specific causes of these disparities and development of targeted effective and sustainable interventions to address them is needed.     

High incidence of subacute sclerosing panencephalitis in south India

During 1983-7 a clinical diagnosis of subacute sclerosing panencephalitis (SSPE) was confirmed by the detection of measles virus haemagglutination inhibiting antibody in the cerebrospinal fluid (CSF) in 81 subjects resident in Tamilnadu. The antibody titre (reciprocol of the end-point dilution) in the CSF ranged from 2 to 32 and in the sera from 8 to 2048. The CSF:serum ratios of titres were 1:4-1:64 in 80 cases and 1:128 in one case. The median age at onset of SSPE was 10 years and 97% of cases were diagnosed at stage 2 and beyond. Based on the geographic distribution of 72 cases in an estimated population of 8.4 million, the annual incidence of SSPE was calculated to be 2.14 per million population, or 4.3 cases per million children below 20 years. Assuming that only 10% of all cases would have reached the level of laboratory diagnosis, the incidence may be as high as 21 cases per million population.