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It is clear that, had the physician in the ED known about the elevated white blood cell count in addition to the fever, elevated pulse and respiratory rate, he or she would have recognized that Rory had SIRS.
Relevant pediatric-specific literature In a recent case series of 13 pediatric patients with cholecystitis or biliary tract disease, no patient had the classic presentation of fever, elevated leukocyte count and an acute abdomen.
The rapid growth of the tumor, along with the continuous high fever, elevated leukocyte count, and elevated CRP, in the absence of infection, suggested that the mass was a G-CSF producing pancreatic cancer.
In a recent case series of 13 pediatric patients with cholecystitis or biliary tract disease, no patient had the classic presentation of fever, elevated leukocyte count and an acute abdomen.
18 The Minor criteria are arthralgias, fever, elevated acute-phase reactants, and first degree heart block.
These diseases share many features including recurrent bouts of fever, elevated acute phase proteins, fatigue and hearing loss.
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We know that fever elevates both heart and respiratory rates, 16 17 which is why we excluded patients with fever from the study.
This may manifest clinically as persistent fevers, elevated white cell count, and development of a palpable scrotal abnormality.
In contrast, in Junju blood smears were done only on children with an objective fever (axillary temp≥37.5°C) and children with subjective fever without elevated temperature were followed 6 12 hours later, and the temperature measurement repeated.
In dengue fever, which has similar clinical manifestations as chikungunya fever, only elevated CXCL8, IL-6, IL-10, and TNF-α concentrations have been shown consistently (7, 8 ), although CXCL10 expression has not been studied.
Other physical examination findings included fever and elevated blood pressure.
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