Journal of Yeungnam Medical Science

Original articles

Treatment decision for cancer patients with fever during the coronavirus disease 2019 (COVID-19) pandemic: In Hee Lee, Sung Ae Koh, Soo Jung Lee, Sun Ah Lee, Yoon Young Cho, Ji Yeon Lee, Jin Young Kim; Yeungnam Univ J Med. 2021;38(4):344-349. Published online August 23, 2021; DOI: https://doi.org/10.12701/yujm.2021.01144

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Abstract PDF: Background
Cancer patients have been disproportionally affected by the coronavirus disease 2019 (COVID-19) pandemic, with high rates of severe outcomes and mortality. Fever is the most common symptom in COVID-19 patients. During the COVID-19 pandemic, physicians may have difficulty in determining the cause of fever (COVID-19, another infection, or cancer fever) in cancer patients. Furthermore, there are no specific guidelines for managing cancer patients with fever during the COVID-19 pandemic. Thus, this study evaluated the clinical characteristics and outcomes of cancer patients with fever during the COVID-19 pandemic.
Methods
This study retrospectively reviewed the medical records of 328 cancer patients with COVID-19 symptoms (fever) admitted to five hospitals in Daegu, Korea from January to October 2020. We obtained data on demographics, clinical manifestations, laboratory test results, chest computed tomography images, cancer history, cancer treatment, and outcomes of all enrolled patients from electronic medical records.
Results
The most common COVID-19-like symptoms were fever (n=256, 78%). Among 256 patients with fever, only three (1.2%) were diagnosed with COVID-19. Most patients (253, 98.8%) with fever were not diagnosed with COVID-19. The most common solid malignancies were lung cancer (65, 19.8%) and hepatobiliary cancer (61, 18.6%). Twenty patients with fever experienced a delay in receiving cancer treatment. Eighteen patients discontinued active cancer treatment because of fever. Major events during the treatment delay period included death (2.7%), cancer progression (1.5%), and major organ dysfunction (2.7%).
Conclusion
Considering that only 0.9% of patients tested for COVID-19 were positive, screening for COVID-19 in cancer patients with fever should be based on the physician’s clinical decision, and patients might not be routinely tested.

Predictive value of C-reactive protein for the diagnosis of meningitis in febrile infants under 3 months of age in the emergency department: Tae Gyoung Lee, Seung Taek Yu, Cheol Hwan So; Yeungnam Univ J Med. 2020;37(2):106-111. Published online January 8, 2020; DOI: https://doi.org/10.12701/yujm.2019.00402

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Background
Fever is a common cause of pediatric consultation in the emergency department. However, identifying the source of infection in many febrile infants is challenging because of insufficient presentation of signs and symptoms. Meningitis is a critical cause of fever in infants, and its diagnosis is confirmed invasively by lumbar puncture. This study aimed to evaluate potential laboratory markers for meningitis in febrile infants.
Methods
We retrospectively analyzed infants aged <3 months who visited the emergency department of our hospital between May 2012 and May 2017 because of fever of unknown etiology. Clinical information and laboratory data were evaluated. Receiver operating characteristic (ROC) curves were constructed.
Results
In total, 145 febrile infants aged <3 months who underwent lumbar punctures were evaluated retrospectively. The mean C-reactive protein (CRP) level was significantly higher in the meningitis group than in the non-meningitis group, whereas the mean white blood cell count or absolute neutrophil count (ANC) did not significantly differ between groups. The area under the ROC curve (AUC) for CRP was 0.779 (95% confidence interval [CI], 0.701–0.858). The AUC for the leukocyte count was 0.455 (95% CI, 0.360–0.550) and that for ANC was 0.453 (95% CI, 0.359–0.547). The CRP cut-off value of 10 mg/L was optimal for identifying possible meningitis.
Conclusion
CRP has an intrinsic predictive value for meningitis in febrile infants aged <3 months. Despite its invasiveness, a lumbar puncture may be recommended to diagnose meningitis in young, febrile infants with a CRP level >10 mg/L.

Citations

Citations to this article as recorded by

Fever without a source under 3 months of age: any predictive factors of Serious Bacterial Infection?
Rita Calejo Pereira Machado Ribeiro, Joana Raquel Pinto de Carvalho Queiros, Ana Ines Rodrigues Paiva Ferreira, Ines Isabel Aires Martins, Fabio David Monteiro Barroso
Pediatric Oncall.2024;[Epub] CrossRef
Immunologic biomarkers for bacterial meningitis
Mina Yekani, Mohammad Yousef Memar
Clinica Chimica Acta.2023; 548: 117470. CrossRef
Febrile infants: written guidelines to reduce non-essential hospitalizations
Ji Yoon Oh, Soo-Young Lee
World Journal of Pediatrics.2021; 17(5): 555. CrossRef

Original Article

Diagnostic Values of Abdominal Ultrasonograpy in Patients with Fever and Abdominal Symptoms.: Mi Kyung Lee, Chang Sung Im, Sun Mi Ahn, Chang Hi Kim, Dong Jin Lee, Joong Hyuck Kwan, Yong Hoon Park; Yeungnam Univ J Med. 1995;12(2):191-202. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.191

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Abstract PDF: PURPOSE: Acute febrile illness in children frequently accompanies with abdominal symptoms such as vomiting, diarrhea, and abdominal pain, even if its etiology is not occured from the gastrointestinal tract. If the etiology of fever was unknown and the fever was accompanied with abdominal symptoms, we should be concerned about whether the etiology of fever was originated from the gastrointestinal tract or interpretated from the abnormality in the gastrointestinal tract. This study was performed to evaluate the diagnostic value of abdominal ultrasonography in patients with fever and abdominal symptoms. METHODS: We reviewed retrospectively the medical records of abdominal ultrasonographic (US) findings of 60 cases of acute febrile illness with abdominal symptoms at department of Pediatrics, Ulsan Dongang General RESULTS: (100%), splenomegaly in 4 cases (66.7%), ileocecitis in 1 case (16.7%), enlarged mesenteric lymph nodes and splenomegaly in 4 cases (66.7%), enlarged mesenteric lymph nodes, splenomegaly and ileocecitis in 1 cases (16.7%). 6) The enlarged mesenteric lymph nodes and the abnormalities around the appendix were seen in 7 cases (11.7%), which were confirmed as appendicitis all. 7) The thickening of wall in urinary bladder was seen in 2 cases (3.3%) of acute cystitis and acute hemorrhagic cystitis. 8) The subtle thickening of wall in colon was seen in 1 cases (1.7%) of shigellosis. CONCLUSIONS: The enlarged mesenteric lymph nodes, splenomegaly and ileocolitis on the abdominal ultrasonography in patients with fever and abdominal symptoms aree suggestive findings of typhoid fever. The enlarged mesenteric lymph nodes and the abnormalities around the appendix on abdominal ultrasonography make the rapid diagnosis of acute appendicitis and its complications, when physical examination is difficult in small children and diagnosis of their illnesses is obscure in patients with fever and abdominal pain.

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