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Hausmann J, Dedeoglu F, Broderick L. Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis Syndrome and Syndrome of Unexplained Recurrent Fevers in Children and Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1676-1687. [PMID: 36958521 DOI: 10.1016/j.jaip.2023.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
Children and adults with autoinflammatory disorders, who often experience recurrent fevers, rashes, cold-induced symptoms, conjunctivitis, lymphadenopathy, recurrent infections, aphthous stomatitis, and abnormal blood cell counts, may present to the allergist/immunologist because the symptoms mimic allergies and disorders of immunity. In recent years, there has been increased recognition of non-monogenic autoinflammatory disorders, including periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome and syndrome of undifferentiated recurrent fevers. For many clinical practitioners, the natural history, diagnostic criteria, differential diagnoses, and preferred therapies remain challenging because of the presumed rarity of patients and the evolving field of autoinflammation. Here, we aim to provide a practical framework for the clinical allergist/immunologist to evaluate and treat this patient population.
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Affiliation(s)
- Jonathan Hausmann
- Department of Medicine, Harvard Medical School, Boston, Mass; Program in Rheumatology, Division of Immunology, Boston Children's Hospital, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Fatma Dedeoglu
- Department of Medicine, Harvard Medical School, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Lori Broderick
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California-San Diego, La Jolla, Calif; Rady Children's Foundation, Rady Children's Hospital, San Diego, Calif.
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Patel J, Boyer N, Mensah K, Haider S, Gibson O, Martin D, Walter E. Critical illness aspects of heatstroke: A hot topic. J Intensive Care Soc 2023; 24:206-214. [PMID: 37260431 PMCID: PMC10227888 DOI: 10.1177/17511437221148922] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Heatstroke represents the most severe end of the heat illness spectrum, and is increasingly seen in those undergoing exercise or exertion ('exertional heatstroke') and those exposed to high ambient temperatures, for example in heatwaves ('classical heatstroke'). Both forms may be associated with significant thermal injury, leading to organ dysfunction and the need for admission to an intensive care unit. The process may be exacerbated by translocation of bacteria or endotoxin through an intestinal wall rendered more permeable by the hyperthermia. This narrative review highlights the importance of early diagnosis, rapid cooling and effective management of complications. It discusses the incidence, clinical features and treatment of heatstroke, and discusses the possible role of intestinal permeability and advances in follow-up and recovery of this condition. Optimum treatment involves an integrated input from prehospital, emergency department and critical care teams, along with follow-up by rehabilitation teams and, if appropriate, sports or clinical physiologists.
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Affiliation(s)
- Jesal Patel
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
| | - Naomi Boyer
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
| | - Kwabena Mensah
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
| | - Syeda Haider
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
| | - Oliver Gibson
- Division of Sport, Health and Exercise
Sciences, Brunel University, London, UK
| | - Daniel Martin
- Department of Intensive Care, Derriford
Hospital, Plymouth, UK
- Peninsula Medical School, University of
Plymouth, UK
| | - Edward Walter
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
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Out-of-hospital cardiac arrest complicated by hyperthermia. Resusc Plus 2022; 12:100333. [DOI: 10.1016/j.resplu.2022.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
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Rodrigues G, de Andrade PV, Dos Santos JM, do Amaral JLG, da Silva HCA. Impact of a digital manual for guidance on malignant hyperthermia: patient education. Orphanet J Rare Dis 2022; 17:265. [PMID: 35841058 PMCID: PMC9288001 DOI: 10.1186/s13023-022-02435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background Malignant hyperthermia (MH) is a rare, hereditary disease with a hypermetabolic response to volatile anesthetics/succinylcholine. Susceptible patients face difficulties due to a lack of knowledge about MH. As informational materials could increase knowledge and adherence to prevention/therapy, digital information about rare diseases validated for patients is needed. Our objective was to evaluate the following: (1) the impact of digital manuals on the knowledge/quality of life of MH patients and (2) access to MH services. Materials and methods Fifty MH-susceptible patients filled out a virtual questionnaire twice (demographic/economic/clinical data, MH knowledge and impact on daily life, and SF-36 quality of life). Test groups 1 (n = 17) and 2 (n = 16) were evaluated 30 and 180 days after receiving a digital manual, and the control group (n = 17; without manual) was evaluated after 180 days. We collected the MH service data about the number of contacts. Results Twenty-four (48%) patients reported problems in personal/professional life, sports, clinical/surgical/dental treatments, and military service, in addition to concerns about emergency care and complaints of sequelae. The percentage of correct answers in the second MH knowledge questionnaire increased for test group 2 (62% vs. 74.1%; unpaired t test, p < 0.01), was significantly greater in test groups 1 (68.1%) and 2 (74.1%) than in the control group (56.5%; Kruskal–Wallis, p < 0.05), and correlated with more time studying the manual and reports of MH-related problems (multiple regression, p < 0.05). Conclusions The digital manual improved patients’ MH knowledge. Online contacts with the MH service increased, allowing greater information dissemination. As informational materials could increase knowledge/adherence to prevention/therapy, digital information about MH validated for patients should be implemented.
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Affiliation(s)
- Gislene Rodrigues
- Brazilian Malignant Hyperthermia Unit - Discipline of Anaesthesiology, Pain and Intensive Care, Federal University of São Paulo, Rua Pedro de Toledo, 781, 04039-032, São Paulo, Brazil
| | - Pamela Vieira de Andrade
- Brazilian Malignant Hyperthermia Unit - Discipline of Anaesthesiology, Pain and Intensive Care, Federal University of São Paulo, Rua Pedro de Toledo, 781, 04039-032, São Paulo, Brazil
| | - Joilson Moura Dos Santos
- Brazilian Malignant Hyperthermia Unit - Discipline of Anaesthesiology, Pain and Intensive Care, Federal University of São Paulo, Rua Pedro de Toledo, 781, 04039-032, São Paulo, Brazil
| | - José Luiz Gomes do Amaral
- Brazilian Malignant Hyperthermia Unit - Discipline of Anaesthesiology, Pain and Intensive Care, Federal University of São Paulo, Rua Pedro de Toledo, 781, 04039-032, São Paulo, Brazil
| | - Helga Cristina Almeida da Silva
- Brazilian Malignant Hyperthermia Unit - Discipline of Anaesthesiology, Pain and Intensive Care, Federal University of São Paulo, Rua Pedro de Toledo, 781, 04039-032, São Paulo, Brazil.
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Maddock K, Connor K. Drug Fever: A Patient Case Scenario and Review of the Evidence. AACN Adv Crit Care 2021; 31:233-238. [PMID: 32866251 DOI: 10.4037/aacnacc2020311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Kevin Maddock
- Kevin Maddock is Pharmacy Resident, Mercy Hospital, Buffalo, New York
| | - Kathryn Connor
- Kathryn Connor is Associate Professor of Pharmacy Practice and Administration, St John Fisher College, 3690 East Avenue, Rochester, NY 14618
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Multiple myeloma cells are exceptionally sensitive to heat shock, which overwhelms their proteostasis network and induces apoptosis. Proc Natl Acad Sci U S A 2020; 117:21588-21597. [PMID: 32817432 DOI: 10.1073/pnas.2001323117] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Proteasome inhibitors, such as bortezomib (BTZ), are highly effective and widely used treatments for multiple myeloma. One proposed reason for myeloma cells' exceptional sensitivity to proteasome inhibition is that they produce and continually degrade unusually large amounts of abnormal immunoglobulins. We, therefore, hypothesized that, heat shock may also be especially toxic to myeloma cells by causing protein unfolding, increasing further the substrate load on proteasomes, and, thus, putting further stress on their capacity for protein homeostasis. After a shift from 37 to 43 °C, all four myeloma lines studied underwent extensive apoptosis in 4 h, unlike 13 nonmyeloma cell lines, even though the myeloma cells induced heat-shock proteins and increased protein degradation similar to other cells. Furthermore, two myeloma lines resistant to proteasome inhibitors were also more resistant to 43 °C. Shifting myeloma cells to 43, 41, or 39 °C (which was not cytotoxic) dramatically increased their killing by proteasome inhibitors and inhibitors of ubiquitination or p97/VCP. Combining increased temperature with BTZ increased the accumulation of misfolded proteins and substrate load on the 26S proteasome. The apoptosis seen at 43 °C and at 39 °C with BTZ was mediated by caspase-9 and was linked to an accumulation of the proapoptotic Bcl-2-family member Noxa. Thus, myeloma cells are exceptionally sensitive to increased temperatures, which greatly increase substrate load on the ubiquitin-proteasome system and eventually activate the intrinsic apoptotic pathway. Consequently, for myeloma, mild hyperthermia may be a beneficial approach to enhance the therapeutic efficacy of proteasome inhibitors.
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Walter E, Gibson OR. The efficacy of steroids in reducing morbidity and mortality from extreme hyperthermia and heatstroke-A systematic review. Pharmacol Res Perspect 2020; 8:e00626. [PMID: 32666709 PMCID: PMC7360483 DOI: 10.1002/prp2.626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/09/2022] Open
Abstract
Severe hyperthermia from classical or exertional heatstroke, or from drug ingestion or other noninfective pyrogens, is associated with a high mortality and morbidity. A systemic pro-inflammatory response occurs during heatstroke, characterized by elevated cytokines with endotoxemia from elevated lipopolysaccharide (LPS) levels. Corticosteroids reduce LPS and cytokine levels, suggesting that they may improve outcome. A systematic review searching Embase, MEDLINE, and PubMed from the earliest date available until September 2019 was conducted, according to the PRISMA guidelines, with five papers identified. In four studies, systemic steroids administered before or at the onset of heat stress improved mortality or reduced organ dysfunction. Survival time was greatest when steroid administration preceded heat stress. In one study, a nonsignificant increase in mortality was seen. A dose response was observed, with higher doses extending survival time. Animal studies suggest that steroids improve mortality and/or organ dysfunction after an episode of heat stress or extreme hyperthermia.
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Affiliation(s)
- Edward Walter
- Intensive Care UnitRoyal Surrey County HospitalGuildfordUK
| | - Oliver R. Gibson
- Division of Sport, Health and Exercise SciencesCentre for Human Performance, Exercise and Rehabilitation (CHPER)Brunel University LondonUxbridgeUK
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Bongers KS, Salahudeen MS, Peterson GM. Drug-associated non-pyrogenic hyperthermia: a narrative review. Eur J Clin Pharmacol 2019; 76:9-16. [PMID: 31642960 DOI: 10.1007/s00228-019-02763-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/12/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Hyperthermia occurs when heat accumulation surpasses the body's ability for heat dissipation. Many drugs may affect thermoregulation. This narrative review aimed to provide an overview of the current literature concerning reports of drug-associated non-pyrogenic hyperthermia. METHODS A comprehensive search was performed across 5 databases covering the period of inception to March 2019, for publications that reported hyperthermia associated with drug use. Studies that reported potential drug association with hyperthermia due to altered thermoregulatory mechanisms were included. Case reports of less than 3 cases were excluded, as well as hyperthermia due to other causes, such as hypersensitivity, malignant hyperthermia and neuroleptic malignant syndrome. The primary outcomes of interest were hospitalisation and mortality. RESULTS The literature search initially identified a total of 2609 records. Based on full-text analysis, 11 articles met the inclusion criteria, of which there were 5 case-control studies, 2 case series and 4 retrospective analyses. Studies reported heat-related hospitalisations or emergency department presentations associated with the use of psychotropics (antipsychotics, antidepressants and anxiolytics), anticholinergics, antihistamines, diuretics, cardiovascular agents, non-steroidal anti-inflammatory drugs and anticoagulants. Psychotropic drugs were reported to be associated with increased heat-related mortality, other than through neuroleptic malignant syndrome, but findings varied among the studies. CONCLUSION Given the relative lack of publications, more research is necessary to study specific effects of drugs on body temperature and the likelihood of inducing non-pyrogenic hyperthermia. In particular, psychotropics, anticholinergics, diuretics and cardiovascular agents are of interest for future studies.
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Affiliation(s)
- Koen Sebastiaan Bongers
- Discipline of Pharmacy, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia.,Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mohammed S Salahudeen
- Discipline of Pharmacy, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia
| | - Gregory M Peterson
- Discipline of Pharmacy, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia. .,Faculty of Health, University of Canberra, Canberra, ACT, Australia.
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Oliver CF, Palamar JJ, Salomone A, Simmons SJ, Philogene-Khalid HL, Stokes-McCloskey N, Rawls SM. Synthetic cathinone adulteration of illegal drugs. Psychopharmacology (Berl) 2019; 236:869-879. [PMID: 30338489 PMCID: PMC6472990 DOI: 10.1007/s00213-018-5066-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/03/2018] [Indexed: 01/28/2023]
Abstract
RATIONALE Current prevalence estimates of synthetic cathinone ("bath salt") use may be underestimates given that traditional metrics (e.g., surveys, urinalysis) often fail to capture the emergent issue of synthetic cathinone adulteration of more common illegal drugs, such as ecstasy (3,4-methylenedioxymethamphetamine). OBJECTIVES This review examines the evolution of synthetic cathinones and prevalence of use over the past decade in the United States. We also review methods of self-report and biological testing of these compounds as well as adverse outcomes associated with adulterated drug use. RESULTS Synthetic cathinone use emerged in the United States by 2009 with use associated with tens of thousands of poisonings. Reported poisonings and self-reported use have substantially decreased over the past five years. However, our review suggests that current estimates of use are underestimates due to underreporting stemming primarily from unknown or unintentional use of adulterated formulations of relatively popular illegal drugs, such as ecstasy. CONCLUSIONS While intentional synthetic cathinone use has decreased in recent years, evidence suggests that prevalence of use is underestimated. Testing of drugs and/or biological specimens can improve the accuracy of synthetic cathinone use estimates. Furthermore, we advocate that researchers and clinicians should become better aware that exposure to these potent compounds (e.g., as adulterants) often occurs unknowingly or unintentionally. To improve our understanding of synthetic cathinone adulteration, research utilizing a combinatorial approach (survey and biological testing) will help more accurately estimate the prevalence and impact of this public health issue.
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Affiliation(s)
- Chicora F Oliver
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, 882A, Philadelphia, PA, 19140, USA.
| | - Joseph J Palamar
- Department of Population Health, 180 Madison Avenue Room 1752, New York, NY, 10016, USA
| | - Alberto Salomone
- Centro Regionale Antidoping "A. Bertinaria", Regione Gonzole 10/1, 10043, Orbassano, Torino, Italy
| | - Steven J Simmons
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, 882A, Philadelphia, PA, 19140, USA
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, 19104, USA
| | - Helene L Philogene-Khalid
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, 882A, Philadelphia, PA, 19140, USA
- Department of Psychiatry, 100 E. Lehigh Ave, Philadelphia, PA, 19125, USA
| | - Nick Stokes-McCloskey
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, 882A, Philadelphia, PA, 19140, USA
| | - Scott M Rawls
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, 882A, Philadelphia, PA, 19140, USA
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Dean-Paccagnella R, Creed M, Kakollu M, Gopala Pillai SK. Hyperthermia and Rigidity Following Overdose of an Unknown Drug; A Case Report and Literature Review. Bull Emerg Trauma 2018; 6:249-252. [PMID: 30090822 PMCID: PMC6078474 DOI: 10.29252/beat-060311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Drug induced hyperthermia is a rare presentation which can rapidly lead to gross metabolic abnormality and death. These presentations are further complicated by the wide range of potentially causative agents. We present a case of rigidity and hyperthermia, following overdose of an initially unknown substance leading to challenging management decisions in the Emergency Department. This case was later identified as Serotonin Syndrome. The patient presented with trismus which was managed with rapid sequence induction of anaesthesia to allow airway protection. On extubation a significant degree of laryngeal oedema complicated weaning, a possible complication of Serotonin Syndrome not previously described in the literature. We discuss the pathophysiology of Serotonin Syndrome, important differentials and practical considerations in managing hypertonicity of unknown origin in a young person.
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Affiliation(s)
| | - Matthew Creed
- Specialist Registrar in Anaesthetics, Morriston Hospital, Swansea, UK
| | - Mahendra Kakollu
- Specialist Registrar in Emergency Medicine, Morriston Hospital, Swansea, UK
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Gollapudy S, Cronin DC, Pagel PS, Boettcher BT. Serotonin Syndrome Resulting From Acute Decompensation of Nonalcoholic Steatohepatitis Cirrhosis in a Patient Chronically Treated With Citalopram and Tramadol. J Cardiothorac Vasc Anesth 2016; 31:1385-1388. [PMID: 27838198 DOI: 10.1053/j.jvca.2016.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Suneeta Gollapudy
- Departments of Anesthesiology, Medical College of Wisconsin, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - David C Cronin
- Departments of Surgery, Medical College of Wisconsin, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Departments of Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Brent T Boettcher
- Departments of Anesthesiology, Medical College of Wisconsin, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Walter EJ, Hanna-Jumma S, Carraretto M, Forni L. The pathophysiological basis and consequences of fever. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:200. [PMID: 27411542 PMCID: PMC4944485 DOI: 10.1186/s13054-016-1375-5] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There are numerous causes of a raised core temperature. A fever occurring in sepsis may be associated with a survival benefit. However, this is not the case for non-infective triggers. Where heat generation exceeds heat loss and the core temperature rises above that set by the hypothalamus, a combination of cellular, local, organ-specific, and systemic effects occurs and puts the individual at risk of both short-term and long-term dysfunction which, if severe or sustained, may lead to death. This narrative review is part of a series that will outline the pathophysiology of pyrogenic and non-pyrogenic fever, concentrating primarily on the pathophysiology of non-septic causes.
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Affiliation(s)
- Edward James Walter
- Department of Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK.
| | - Sameer Hanna-Jumma
- Department of Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK
| | - Mike Carraretto
- Department of Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK
| | - Lui Forni
- Department of Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK
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Belete M, Bigham C. Beta-lactam-induced pyrexia. J Intensive Care Soc 2016; 17:84. [PMID: 28979464 PMCID: PMC5606370 DOI: 10.1177/1751143715594628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Affiliation(s)
- Martha Belete
- Intensive Care Department, Derriford Hospital, Plymouth, UK
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