The management of prolonged fever in low-socioeconomic-status areas by primary care providers such as general practitioners is challenging. Given the endemic nature of many infectious diseases, physicians typically start empirical antibiotic therapy following a limited diagnostic workup including serologic examinations. Herein, we report the case of a young male patient with prolonged fever and arthralgia initially diagnosed with and treated for brucellosis but with a confirmed diagnosis of systemic lupus erythematosus on follow-up. This unique case shows that close follow-up is the best practice for managing prolonged fever in cases with non-specific laboratory findings.

Citations

• Association of HMGB1, IL-1β, IL-8, IL-10, and MCP-1 with the Development of Systemic Inflammatory Response Syndrome in Pediatric Patients with Recently Diagnosed Acute Lymphoblastic Leukemia
  Carmen Maldonado-Bernal, Horacio Márquez-González, Erandi Pérez-Figueroa, Rocío Nieto-Meneses, Víctor Olivar-López, Aurora Medina-Sanson, Elva Jiménez-Hernández
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Infectious diseases imported from other countries have increased. Feco-oral route is the most common mode of transmission for both typhoid fever and hepatitis A, and thus infection by these agents have an association with poor sanitation. A 30-year-old male was visited to the hospital because of high fever after traveling in Thailand. The level of hepatic transaminases were mildly elevated and viral serological marker for hepatitis was negative. The blood culture was reported positive for Salmonella typhi. After a few days, the level of hepatic transaminases rapidly increased and viral serological marker for hepatitis became positive with anti-hepatitis A viral IgM at follow-up. Therefore we report a case of co-infection of S. typhi and viral hepatitis A after traveling abroad.

A 59 year old woman visited the hospital complaining of sore throat, chill, myalgia and whole body skin rash. There was abnormal finding of fever, sinus tachycardia, increased lactic dehydrogenase and elongation prothrombin time. We started treatment with acetaminophen and fluid because she had not specific history of visiting to the mountain or field, etc. After treatment increased aspartate aminotransferase/alanine aminotransferase and thrombocytopenia appeared without symptomatic improvement so that we investigated tsutsugamushi antibodies and diagnosed her condition as Tsutsugamushi disease with polyuria. But the clinical manifestation in our case showed atypical symptom which had polyuria. There is no report on that in Korea and over the world therefore the author et al. report of case of Tsutsugamushi disease with polyuria, atypical symptom.

Background
: In the Republic of Korea, there had been no reports about indigenous malaria cases since 1984 until a vivax malaria case was detected in 1993. Thereafter vivax malaria has been a reemerging disease in Korea, the number of cases of malaria increasing recently and the prevalent area being more wider. We suggested that we should take malaria into consideration as the differential diagnosis whenever we meet the febrile patients. We analyzed the cases of malaria who were treated in Myoungji hospital located in Goyang-Si during 4years.

Methods : We retrospectively analyzed data of 79 confirmed cases of malaria treated in the Myoungji hospital from January 1, 1998 to December 31, 2001. All of the patients had no histories of traveling abroad, drug abuse or blood transfusion. The clinical manifestation, hematologic abnormalities and prognosis of patients were reviewed.

Results : Seventy-nine cases of malaria were diagnosed as vivax malaria by blood smears. Vivax malaria was developed in Goyang-Si from May through November. Common symptoms were fever (100%), chilling (84.8%), headache (64.6%) and myalgia (55.7%). Splenomegaly was detected in 77.2% of cases by sonography. In 1998, Tertian fever pattern was most frequent. Since 1999, irregular and atypical fever patterns, such as almost-daily high fever or the every fourth or fifth-day fever, were increased in numbers. Laboratory findings included thrombocytopenia (92.4%), anemia (29.1%), leukopenia (25.3%) and leukocytosys (5.1%).

Conclusion : Cases of indigenous malaria have been progressively increasing in the Republic of Korea. Therefore early diagnosis, treatment and prevention of malaria are very important. Fortunately, patients were well responsed to treatment.

Background
: Although adult immunization is as important as childhood immunization, is being inadequately performed. However, previous studies concerning adult immunization could not be sufficiently evaluated because studies were restricted to the residents in rural area or those who have visited a doctor.

Methods : We conducted a study by telephone interview which included 201 households(375 adult family members)selected by systematic sampling from the yellow pages of Kangnam-gu and Sungbuk-gu districts of Seoul. The types of immunization covered in this study were immunizations against hepatitis B, influenza, pneumococcus, and hemorrhagic fever with renal syndrome(HFRS). Immunization status of all adult household members, cognition of the need for immunization and of interviewees were surveyed. Sex, age, area of residency, education, medical history of study subjects were considered as factors related to the cognition of the need for immunization and immunization performance.

Results : The cognition rates of immunization were as follows : hepatitis B 85.1%, influenza 45.8%, pneumonia 38.3%, and HFRS 33.8%. In the people over 65 years old, the cognition rate against influenza and pneumococcus were 6.25%, 6.25% respectively and for those who have chronic disease. 80.0%, 20.0%, respectively. The cognition rates of immunization was significantly higher among those subjects who were young, well educated, and those residing in Kangnam-gu district.
The immunization performance rate of hepatitis B was 62.5%, influenza 5.6%, pneumonia 0.8%, and HFRS 1.1%. 75.8% of subjects vaccinated against hepatitis B had received at least three times. The immunization performance rate of influenza and pneumococcus by the immunization indication are as follows : 8.0%, 0.0%, respectively in the subjects over 65 years old, and 11.1%, 0.0% respectively in the people who have chronic diseases. The immunization performance rate of hepatitis B was higher among young, well educated subjects living in Kangnam-gu district. But age, education, area of residency played no apparent role in the case of other types of immunization.
The immunization performance rate of those who felt the need for immunization as significantly higher than that of those who did not. To assess the factors which relate to the correct cognition for immunization necessity, we used a multiple logistic regression test. For all types of immunization surveyed, sex(females) and age(young) seemed to be significantly related to the correct necessity cognition. Medical history of chronic disease was also related to the correct necessity cognition for immunization against hepatitis B and influenza.

Conclusion : This study reveals that among living in urban area the immunization performance rate and the correct cognition rate concerning the necessity for adult immunization was generally very low. Therefore, an active publicity and public education will be needed to increase the level of correct necessity cognition for immunization in which the disease status, sex, and age of vaccinee are considered. And more active effort to increase the cognition for immunization necessity performance is required.

Background
: Family physicians in their on primary practice frequently encounters patients with fever, which is one of the common symptoms. Fever is an important symptom and can occur in mild disease, common cold, influenza, acute pharyngotonsillitis or can originate from a particular severe disease, such as bacterial endocarditis, malignant lymphoma and SLE, which need more aggressive management. Therefore, we studied patients who were admitted with short-term fever or long-term fever to find out their causes of febrile diseases and to compare the differences with previous other studies.

Methods : 601 patients with fever above 37.2 degree centigrade or those who were transferred from other hospitals due to long-term fever were enrolled from Jan. 1991 to Jun. 1997. Patients' medical records were reviewed and classified according to disease, sex, age. Srandardization of Petersdorf's rule for F.U.O. was used.

Results : 601 patients were randomly selected among which 301 were males and 300 females. Males were 147 and females 147 young adult patients as compared to 154 males and 153 females were elderly patients. According to disease category, the number of infections, connective tissue diseases, neoplastic diseases and other diseases were 442(73.5%), 14(2.3%), 87(14.5%) and 21(3.5%), respectively. The number of diseases of undetermined case was 37(6.2%). The most frequent disease was pneumonia with 103(31.1%). UTI and tuberculosis were the 2nd and 3rd most common diseases. The total number of F.U.O. patients was 82(13.6%). According to the disease categories there were 29(35.4%) in infections, 2(2.4%) in connective tissue diseases, 12(14.6%) in neoplasms, 2(2.4%) in others and 37(45.2%) in unknown origin. The most common disease in the classification of sex and age of F.U.O. was infections and tubrculosis.

Conclusion : In the clinical study of febrile patients admitted from Jan. 1991 to Jun. 1997 through medical record review, the disease category in the order of frequency was infection, neoplasm, connective tissue disease and the distribution of F.U.O was same result. In comparison with other study, the order of connective tissue disease and neoplasm was different in other hospital study but same result was taken in comparison with Petersdorf's study.