The immune and lymphatic systems, infection and sepsis
Peate Ian, Dutton Helen in Acute Nursing Care, 2020
There are many causes of fever: Infection, e.g., bacterial, viral, fungal or protozoan.Autoimmune diseases such as lupus erythaematous.Inflammatory bowel disease.The breakdown of red blood cells, or haemolysis, from surgery can induce a temperature postoperatively.Myocardial infarction.Crush syndrome as a result of rhabdomyolysis.Drugs can also cause a ‘drug fever’, either as a direct consequence of the drug or as an adverse reaction to the drug (e.g., allergic reaction to antibiotics). Discontinuation of some drugs, for example heroin withdrawal, can induce a fever.
Cephalosporins
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
Maculopapular rashes occurring after several days of therapy are the most frequently reported hypersensitivity reaction with cephalosporins, occurring in a few percentage of patients. Serious reactions, such as IgE-mediated bronchospasm, urticaria, and anaphylaxis, are very uncommon. Patients who are allergic to penicillins develop cross-hypersensitivity with first-generation cephalosporins at a frequency of <5-10%, and very rarely to never with higher-generation drugs. The likelihood of cross-reactivity appears to be related to the presence or absence of side chains. If it is absolutely necessary to use a cephalosporin in an older patient with a past history of a severe type 1 hypersensitivity reaction to penicillins, desensitization is prudent (23). Drug fever is a clinically perplexing complication that occurs with longer courses of therapy.
Clinical Approach to Fever in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Drug fevers are common in the CCU setting due to the multiplicity of medications. Physicians should always be suspicious of the possibility of drug fever when other diagnostic possibilities have been exhausted. Drug fever may occur in individuals who have just recently been started on the sensitizing medication but more commonly in those who have been on a sensitizing medication for a long period of time, without previous problems. Patients with drug fever do not necessarily have multiple allergies to medications and are not usually atopic. However, the likelihood of drug fever is more likely in patients who are atopic and have multiple drug allergies (Table 2.6).
Phase I study of glypican-3-derived peptide vaccine therapy for patients with refractory pediatric solid tumors
Published in OncoImmunology, 2018
Nobuhiro Tsuchiya, Ako Hosono, Toshiaki Yoshikawa, Kayoko Shoda, Kazuto Nosaka, Manami Shimomura, Junichi Hara, Chika Nitani, Atsushi Manabe, Hiroki Yoshihara, Yosuke Hosoya, Hide Kaneda, Yoshiaki Kinoshita, Kenichi Kohashi, Kenichi Yoshimura, Norihiro Fujinami, Keigo Saito, Shoichi Mizuno, Tetsuya Nakatsura
The adverse events observed in this trial are listed in Table 3. No dose-limiting toxicity (DLT) or dose-specific adverse events were observed. Grade 3 or 4 adverse events correlated with receipt of GPC3-peptide vaccine therapy were not observed in any patients during the follow-up period. Almost all of the adverse events were judged as grade 1, except for three grade 2 adverse events (cases 6 and 7: drug fever; case 6: upper respiratory infection). Although grade 3 adverse events (case 7: drug fever; case 10: epilepsy and depressed level of consciousness; case 15: fever, spasticity, and increased aspartate aminotransferase levels) were observed, the effect and safety evaluation committee, including the external members, judged these events unrelated to the treatment, but rather to disease progression. Thirteen patients experienced grade 1 or 2 transient immune-related events, including local skin reactions at the injection site, drug fever, and flushing. These results suggested that the GPC3-peptide vaccine therapy was well tolerated.
Colony stimulating factors for prophylaxis of chemotherapy-induced neutropenia in children
Published in Expert Review of Clinical Pharmacology, 2022
Based on national trends in US from 2007 to 2014, fever occurs in about one-third of neutropenic episodes in children with cancer or hematopoietic cell transplantations with range of 10 to 60% [7]. Approximate rate of fever occurrence was 0.76 episodes per every 30 days of neutropenia. Rate of hospitalizations for febrile neutropenia in pediatric cancer patients ranged from 13 to 18 per 100,000 population and the incidence increased over time. For these patients, the median length of stay was 4 to 5 days and overall mortality rate was 0.75%. Comorbidities that were most frequently associated with mortality were sepsis, pneumonia, meningitis, and mycosis. Other noninfectious causes of fever in pediatric cancer patients were drug fever, cancer-related fever, deep vein thrombosis (DVT), pulmonary emboli (PE), transfusion reaction, and dysautonomia [7].
Current antimicrobial management of community-acquired pneumonia in HIV-infected children
Published in Expert Opinion on Pharmacotherapy, 2019
Serious adverse events related to cotrimoxazole include rash (Stevens Johnson syndrome and erythema multiforme), drug fever, haematological abnormalities (neutropaenia, anaemia, thrombocytopaenia), renal dysfunction (interstitial nephritis), electrolyte disorders and liver toxicity. Induction of tolerance to TMP/SMX using a graded challenge approach has been used following a hypersensitivity reaction [86]. Discontinuation of cotrimoxazole and use of alternative second-line treatment for PCP should be instituted for severe adverse events. Alternative treatment options include pentamidine, atovaquone, dapsone plus trimethoprim, and primaquine plus clindamycin but there is limited data in children [8]. Dosing information is provided in Table 2.
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