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647. Diagnoses Associated with Temperature ≥104°F in Adults

BACKGROUND: Temperature ≥104°F (T ≥ 104) is uncommon in adults. The diagnoses and clinical characteristics were reviewed for patients with T ≥ 104. METHODS: Infectious disease physicians reviewed charts of patients with T ≥ 104 seen at the Washington DC Veterans Affairs Medical Center from 2009 to 2...

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Autores principales: Chi, Sharon, Simon, Gary, Weintrob, Amy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811085/
http://dx.doi.org/10.1093/ofid/ofz360.715
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author Chi, Sharon
Simon, Gary
Weintrob, Amy
author_facet Chi, Sharon
Simon, Gary
Weintrob, Amy
author_sort Chi, Sharon
collection PubMed
description BACKGROUND: Temperature ≥104°F (T ≥ 104) is uncommon in adults. The diagnoses and clinical characteristics were reviewed for patients with T ≥ 104. METHODS: Infectious disease physicians reviewed charts of patients with T ≥ 104 seen at the Washington DC Veterans Affairs Medical Center from 2009 to 2018. The following was collected: demographics, past medical history, medications, WBC, maximum temperature, time to defervescence, etiology of T ≥ 104, and death. RESULTS: Less than 0.01% of all patient encounters were associated with T ≥ 104. Of the 60 most recent patients with T ≥ 104 (from 2014 to 2018), the median age was 63.5 years (range 23–97), 65% were African American, 88% were male. 82% of those with T ≥ 104 were hospitalized; 76% of those had the T ≥ 104 on or within 72 hours of admission. 25% of the 60 patients had underlying cancer, 10% HIV, 30% DM, 13% CKD, and 13% were on steroids/immunosuppressants/biologics. The median peak temperature was 104.3°F (interquartile range 104.0 – 104.7); maximum was 106.8°F. 82% had T ≥ 104 for only 1 day and the median time to defervescence was 2 days. There were 55 diagnoses amongst 48 patients; 12 had no identifiable etiology of T ≥ 104. Of the identifiable diagnoses, there were 45 (81.8%) infections, 4 (7.3%) metastatic malignancies (1 Hodgkin’s lymphoma, 1 small cell carcinoma, 1 squamous cell carcinoma, 1 unknown primary), 2 (3.6%) intracranial bleeds, 2 (3.6%) GI bleeds, 1 (1.8%) mixed collagen vascular disease, and 1 (1.8%) neuroleptic malignant syndrome. The most common infections were 15 cases of pneumonia including 2 Legionella, 8 complicated UTI/pyelonephritis, 3 primary bacteremia, 2 West Nile virus, 2 influenza, and 2 cholangitis with bacteremia. The median WBC of infectious diagnoses (9.8) was significantly higher than noninfectious diagnoses (5.8, P = 0.006, T-test). Of the 60 patients, 20% died within 30 days of T ≥ 104 including 2 patients who died of sepsis. 67% of those who died were receiving hospice care. CONCLUSION: T ≥ 104 is rare in adults and is usually associated with bacterial infections such as pneumonia (including Legionella), complicated UTIs/pyelonephritis, and primary bacteremia but may also be seen with viral infections such as West Nile virus and influenza. Mortality is high. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68110852019-10-28 647. Diagnoses Associated with Temperature ≥104°F in Adults Chi, Sharon Simon, Gary Weintrob, Amy Open Forum Infect Dis Abstracts BACKGROUND: Temperature ≥104°F (T ≥ 104) is uncommon in adults. The diagnoses and clinical characteristics were reviewed for patients with T ≥ 104. METHODS: Infectious disease physicians reviewed charts of patients with T ≥ 104 seen at the Washington DC Veterans Affairs Medical Center from 2009 to 2018. The following was collected: demographics, past medical history, medications, WBC, maximum temperature, time to defervescence, etiology of T ≥ 104, and death. RESULTS: Less than 0.01% of all patient encounters were associated with T ≥ 104. Of the 60 most recent patients with T ≥ 104 (from 2014 to 2018), the median age was 63.5 years (range 23–97), 65% were African American, 88% were male. 82% of those with T ≥ 104 were hospitalized; 76% of those had the T ≥ 104 on or within 72 hours of admission. 25% of the 60 patients had underlying cancer, 10% HIV, 30% DM, 13% CKD, and 13% were on steroids/immunosuppressants/biologics. The median peak temperature was 104.3°F (interquartile range 104.0 – 104.7); maximum was 106.8°F. 82% had T ≥ 104 for only 1 day and the median time to defervescence was 2 days. There were 55 diagnoses amongst 48 patients; 12 had no identifiable etiology of T ≥ 104. Of the identifiable diagnoses, there were 45 (81.8%) infections, 4 (7.3%) metastatic malignancies (1 Hodgkin’s lymphoma, 1 small cell carcinoma, 1 squamous cell carcinoma, 1 unknown primary), 2 (3.6%) intracranial bleeds, 2 (3.6%) GI bleeds, 1 (1.8%) mixed collagen vascular disease, and 1 (1.8%) neuroleptic malignant syndrome. The most common infections were 15 cases of pneumonia including 2 Legionella, 8 complicated UTI/pyelonephritis, 3 primary bacteremia, 2 West Nile virus, 2 influenza, and 2 cholangitis with bacteremia. The median WBC of infectious diagnoses (9.8) was significantly higher than noninfectious diagnoses (5.8, P = 0.006, T-test). Of the 60 patients, 20% died within 30 days of T ≥ 104 including 2 patients who died of sepsis. 67% of those who died were receiving hospice care. CONCLUSION: T ≥ 104 is rare in adults and is usually associated with bacterial infections such as pneumonia (including Legionella), complicated UTIs/pyelonephritis, and primary bacteremia but may also be seen with viral infections such as West Nile virus and influenza. Mortality is high. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6811085/ http://dx.doi.org/10.1093/ofid/ofz360.715 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Chi, Sharon
Simon, Gary
Weintrob, Amy
647. Diagnoses Associated with Temperature ≥104°F in Adults
title 647. Diagnoses Associated with Temperature ≥104°F in Adults
title_full 647. Diagnoses Associated with Temperature ≥104°F in Adults
title_fullStr 647. Diagnoses Associated with Temperature ≥104°F in Adults
title_full_unstemmed 647. Diagnoses Associated with Temperature ≥104°F in Adults
title_short 647. Diagnoses Associated with Temperature ≥104°F in Adults
title_sort 647. diagnoses associated with temperature ≥104°f in adults
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811085/
http://dx.doi.org/10.1093/ofid/ofz360.715
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