PubMed was searched from 1935 to December 2017 with a variety of search phrases among article titles. The references of the identified manuscripts were then manually searched. The inclusion criteria were as follows: (1) the paper presented data on measured normal body temperature of healthy human subjects ages 18 and older, (2) a prospective design was used, and (3) the paper was written in or translated into the English language. Thirty-six articles met the inclusion criteria. This comprised 9227 measurement sites from 7636 subjects. The calculated ranges (mean ± 2 standard deviations) were 36.32–37.76 (rectal), 35.76–37.52 (tympanic), 35.61–37.61 (urine), 35.73–37.41 (oral), and 35.01–36.93 (axillary). Older adults (age ≥60) had lower temperature than younger adults (age <60) by 0.23°C, on average. There was only insignificant gender difference. Compared with the currently established reference point for normothermia of 36.8°C, our means are slightly lower but the difference likely has no physiological importance. We conclude that the most important patient factors remain site of measurement and patient’s age.
Most of the cases of Klebsiella pneumoniae liver abscess reported early on were from Asia, predominantly Taiwan, with a significant number of patients being middle aged diabetic men, and developing metastatic complications, especially endophthalmitis. The entity is now being increasingly recognized in the United States. In this article, the authors review those reported cases, and also the literature regarding the pathophysiology of this intriguing syndrome.
Background
Critically ill patients with coronavirus disease‐2019 (COVID‐19) are at the theoretical risk of invasive pulmonary aspergillosis (IPA) due to known risk factors.
Patients/Methods
We aimed to describe the clinical features of COVID‐19‐associated pulmonary aspergillosis at a single centre in New York City. We performed a retrospective chart review of all patients with COVID‐19 with Aspergillus isolated from respiratory cultures.
Results
A total of seven patients with COVID‐19 who had one or more positive respiratory cultures for Aspergillus fumigatus were identified, all of whom were mechanically ventilated in the ICU. Four patients were classified as putative IPA. The median age was 79 years, and all patients were male. The patients had been mechanically ventilated for a mean of 6.8 days (range: 1‐14 days) before Aspergillus isolation. Serum galactomannan level was positive for only one patient. The majority of our cases received much higher doses of glucocorticoids than the dosage with a proven mortality benefit. All four patients died.
Conclusions
Vigilance for secondary fungal infections will be needed to reduce adverse outcomes in critically ill patients with COVID‐19.
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