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Is thermal scanner losing its bite in mass screening of fever due to SARS?

Severe acute respiratory syndrome (SARS) is a highly infectious disease caused by a coronavirus. Screening to detect a potential SARS infected person plays an important role in preventing the spread of SARS. The use of infrared thermal imaging cameras has been proposed as a noninvasive, speedy, cost effective and fairly accurate means for mass blind screening of potential SARS infected persons. Infrared thermography provides a digital image showing temperature patterns. This has been previously utilized in the detection of inflammation and nerve dysfunctions. It is believed that IR cameras can potentially be used to detect subjects with fever, the cardinal symptom of SARS, and avian influenza. The accuracy of the infrared system can, however, be affected by human, environmental, and equipment variables. It is also limited by the fact that the thermal imager measures the skin temperature and not the core body temperature. As known, the body determines a temperature as its so-called "set point" at any one time during the body temperature regulation. Fever happens if the hypothalamus detects pyrogens and then raises the set point. The time course of a typical fever can be divided into three stages. When the fever initiates, the body attempts to raise its temperature but vasoconstriction occurs to prevent heat loss through the skin. With this reason, some individuals at this stage of fever (at the rising slope and immediately after fever begins or falling slope after the fever breaks) will not be detected by the scanner if it is not designed to detect subject at the plateau of the fever (with her/his high core temperature) in particular. This paper aims to study the effectiveness of infrared systems for its application in mass blind screening to detect subjects with elevated body temperature. For this application, it is critical for thermal imagers to be able to identify febrile from normal subjects accurately. Minimizing the number of false positive and false negative cases, improves the efficiency of the screening stations. False negative results should be avoided at all costs, as letting a SARS infected person through the screening process may result in potentially catastrophic results. Various statistical methods such as linear regression, Receiver Operating Characteristics analysis, and neural networks based classification were used to analyze the temperature data collected from various sites on the face on both the frontal and side profiles. Two important conclusions were drawn from the analysis: the best region on the face to obtain temperature readings and the optimal preset threshold temperature for the thermal imager. To conclude, the current research application will remain an interest and useful for reference by both local and overseas manufacturers of thermal scanners, users, and various government and private establishments. As elevation of body temperature is a common presenting symptom for many illnesses including infectious diseases, thermal imagers are useful tools for mass screening of body temperature not only for SARS but also during other public health crisis where widespread transmission of infection is a concern.

Body Temperature↗

Automatic control of human thermal comfort by a liquid-cooled garment.

Astronauts utilize water cooling in a liquid-cooled garment to maintain thermal comfort during extravehicular activities (EVA's). In the Apollo and Skylab Programs, manual control of the cooling water was a necessary operation to ensure proper control of body heat storage for the EVA crewman. The development of an automatic thermal control system would be a valuable asset to the conduct of EVA, relieving the crewman of a task that can interfere with his EVA objectives. An analytical model of human thermoregulation was used to develop the equations governing the operation of such an automatic controller. A series of tests verified the feasibility of a controller utilizing only a measurement of the difference in coolant temperature into and out of the astronaut's liquid-cooled garment and an estimate of environmental heat loss to maintain the proper crewman thermal balance. Three test subjects performed over a wide range of metabolic rates, and the crewman heat balance was maintained well within allowable medical limits. This study demonstrates the use of a mathematical model to generate previously unknown physiological relationships between human thermal comfort and liquid cooled garment performance. In so doing, it quantitates physiological parameters that are difficult to relate directly by experiment. Index terms: body temperature regulation, space suit cooling, temperature control, human thermoregulation.

Aerospace Medicine↗

Peptide neurohormones: their role in thermoregulation and fever.

The neural elements of the rostral diencephalon in the mammal have been implicated in the regulation of body temperature. Moreover, it may be the neural elements within this region of the brain which activate the febrile mechanisms in response to pyrogen. Is it possible that the neuropeptides located within this area of the brain serve as neurochemical intermediaries involved in temperature regulation, fever, and (or) antipyresis? Central administration of several neuropeptides can elicit marked changes in the core temperature of an animal. Although most of these purative neuroregulators exert only a very minor influence on thermoregulation, a small number of the neuropeptides have been shown to have a profound effect on the system controlling this basic vegetative function. One of these peptides, arginine vasopressin (AVP) may play a role as an endogenous antipyretic. The neuroanatomical localization of this peptide, as well as its axonal projections, are consistent with such a role for this neurohypophyseal peptide in the mediation of antipyresis. In addition, current evidence suggests that AVP does function as a neurotransmitter. Examination of the febrile response to pyrogen in both the periparturient animal and the neonate indicates that an elevation in plasma levels of AVP is closely correlated with the diminution in the febrile response. Also, when AVP is perfused into punctate regions of the brain, a pyrogen-induced fever may be markedly suppressed AVP appears to act primarily within the septal area, 2- to 3-mm rostral to the anterior commissure. During the development of fever, the release of AVP is altered within these same loci. As body temperature decreases during the febrile state, there is a concomitant increase in the amount of AVP released into the extracellular fluid of these septal sites. Very recent findings suggest that AVP may have additional central neurochemical functions. For example, this peptide may be involved in the etiology of some forms of convulsive disorders. The precise manner in which body temperature is regulated by the central nervous system normally and during fever is not well understood.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenocorticotropic Hormone↗

Nocturnal hypometabolism as an overwintering strategy of red deer (Cervus elaphus).

Herbivores of temperate and arctic zones are confronted during winter with harsh climatic conditions and nutritional shortness. It is still not fully understood how large ungulates cope with this twofold challenge. We found that red deer, similar to many other northern ungulates, show large seasonal fluctuations of metabolic rate, as indicated by heart rate, with a 60% reduction at the winter nadir compared with the summer peak. A previously unknown mechanism of energy conservation, i.e., nocturnal hypometabolism associated with peripheral cooling, contributed significantly to lower energy expenditure during winter. Predominantly during late winter night and early morning hours, subcutaneous temperature could decrease substantially. Importantly, during these episodes of peripheral cooling, heart rate was not maintained at a constant level, as to be expected from classical models of thermoregulation in the thermoneutral zone, but continuously decreased with subcutaneous temperature, both during locomotor activity and at rest. This indicates that the circadian minimum of basal metabolic rate and of the set-point of body temperature regulation varied and dropped to particularly low levels during late winter. Our results suggest, together with accumulating evidence from other species, that reducing endogenous heat production is not restricted to hibernators and daily heterotherms but is a common and well-regulated physiological response of endothermic organisms to energetically challenging situations. Whether the temperature of all tissues is affected, or the body shell only, may simply be a result of the duration and degree of hypometabolism and its interaction with body size-dependent heat loss.

Acclimatization↗

Characteristics of body heat balance of paraplegics during exercise in a hot environment.

The purpose of this investigation was to clarify the characteristics of body temperature regulation in paraplegics due to spinal cord injury (SCI) during an arm cranking exercise in a hot environment. Twelve paraplegics with lesions located between Th3 and L1,2 and seven able-bodied subjects (AB) participated in this study. The subjects were exposed to a hot (33 degrees C) or a moderate temperature (25 degrees C) environment for one hour and during the last 10 min of the exposure, the subjects performed arm cranking exercises at an exercise intensity of 40 W. The skin temperatures at the chest, the upper arm, the thigh and the calf, the tympanic membrane temperature (Tty), and the skin blood flow of the thigh (SBFT) were continuously monitored during the experiment. Although no systematical variation was found in the Tty at 25 degrees C, the Tty at 33 degrees C in paraplegics during exercise was significantly greater than that at rest (P < 0.01), which indicated a pronounced heat stress for paraplegics at 33 degrees C. SBFT of paraplegics with high lesions of the SCI remained unchanged during the experiment at 25 degrees C and 33 degrees C, while paraplegics with low lesions in this study showed consecutive increases in SBFT during exercise in both environmental conditions similar to AB. The increased core temperature in paraplegics with high lesions was considered to be due to a lack of sweat response and vasomotor activity in the paralyzed area. On the basis of the findings in this study, it can be suggested that high core temperature without any increment of SBFT may be characterized as body heat balance of paraplegics with high lesions during exercise in a hot environment.

Adult↗

Influence of heat stress on exercise-induced changes in regional blood flow in sheep.

Radioactive microspheres were used to measure cardiac output and blood flow to most major tissues in sheep at rest and during treadmill exercise (3- to 6-fold increase in metabolic rate for 30 min) in thermoneutral (TN) [dry bulb temperature (Tdb) = 16 degrees C, wet bulb temperature (Twb) = 12 degrees C] and mildly hot (MH) (Tdb = 40 degrees C, Twb = 23 degrees C) environments. During exercise, rectal temperature increased more under MH than under TN conditions; exercise-induced changes in the major central cardiovascular parameters were unaffected by MH. Exercise in TN caused mild hypocapnia, and in MH, severe respiratory alkalosis. Skin blood flow in the torso decreased during exercise in TN and MH. Extremity skin blood flow was increased by heat but not exercise. Exercise-induced increases in flows to respiratory muscles and upper respiratory tract tissues were greatly enhanced in MH. Exercise caused large increases in blood flow to fore- and hindlimb muscles, which were less in MH than in TN. Effects of MH on exercise-induced changes in flow to these and other tissues (e.g., abdominal viscera and adipose tissue) are discussed in terms of the conflicting requirements of energy expenditure and body temperature regulation during exercise in sheep and other species, particularly humans.

Adipose Tissue↗

Regulation of daily rhythm of body temperature by neurotensin receptor in rats.

It is proposed that neurotensin receptor mediated signal transduction may play an important role in the thermoregulatory control in the brain. In this study, a significant increase in body core temperature was observed with SR 48692, a neurotensin receptor antagonist, after treatment of rats at light phase when the temperature is regulated low. On the other hand, SR 48692 delayed the physiological decline of body core temperature at dark phase when the temperature is highly regulated. We also found slight daily rhythmicity, though not significant, in neurotensin/neuromedin N precursor protein mRNA levels in the medial preoptic nucleus using in situ hybridization technique. Our results support the hypothesis that endogenous neurotensin receptor agonists play a physiological role in the central modulation of body core temperature in rats.

Animals↗

Thermal regulation in the heat during exercise after caffeine and ephedrine ingestion.

BACKGROUND: Ingesting a combination of caffeine and ephedrine (C+E) has been shown to raise metabolic heat production and body temperature. This side effect of C+E ingestion may be positive during a cold stress scenario, however, during heat stress it could prove to be detrimental. Thus, the purpose of this study was to clarify the effect of C+E ingestion on body temperature regulation during moderate exercise in a hot dry environment. METHODS: Ten, healthy, non heat acclimated, males exercised at 50% VO2peak in a 40 degrees C and 30% RH environment until rectal temperature reached 39.3 degrees C; heart rate (HR) remained at 95% of peak value or greater for 3 min, dizziness or nausea precluded further exercise, or 3 h had elapsed. They did this four times at weekly intervals: familiarization (Fam), control (Cont), placebo, and C+E (5 mg . kg(-1) caffeine + 1 mg . kg(-1) ephedrine) trials. The Fam and Cont treatments were done first and sequentially while the placebo and C+E treatments were balanced and double-blind. Tolerance times, mean skin temperature (Tsk), rectal temperature (Tre), Vo2, Vco2, VE, sweat rate (SR), HR, and sensation of thermal comfort were measured. RESULTS: Tolerance times (mean+/-SD in minutes) were similar for the placebo (120.0+/-28.4) and C+E (121.3+/-33.9) trials and both times were significantly longer than Cont (106.6+/-24.0) trial. C+E did not affect Tsk, initial TrC, delta Tre, SR or the sensation of thermal comfort. VO2 and VF, were significantly increased by C+E. HR was elevated by C+E compared with the other trials, but only during the initial 20 min of exercise. CONCLUSION: Although the metabolic rate was slightly increased with C+E treatment, it was sufficiently offset by increased heat loss mechanisms so that internal body temperature was not increased during moderate exercise in a hot, dry environment.

Adult↗

Rise in plasma alpha-amino nitrogen concentration in rats eviscerated after colure regulation.

Rats were exposed to 4 or 25 degrees C for 6, 12, and 24 h or for longer periods up to 2 wk, then eviscerated. The hourly changes in plasma alpha-amino nitrogen were followed for 4 h after operation, which because of functional removal of the liver allows amino acids released from the extrahepatic tissues to accumulate in the blood. Although cold exposure of tissues to accumulate in the blood. Although cold exposure of 24-h-fasted rats for 6 h before eviscerated resulted in an increased rate of rise of plasma alpha-amino nitrogen postoperatively, the rise was not significantly greater than warm controls until after 12 h of exposure. Thereafter, similar results were obtained whether cold was 12, 24, or 48 h or 14 days duration. Fasting in the cold produced an immediate sharp rise after evisceration so that the concentration was 2 times the control value in 2 h. By contrast, animals allowed to eat adlibitum showed the rise after evisceration but it was progressively smaller in amount as the exposure extended beyond the 1st day. After 5 days there were no longer significant differences from control values. The reduction in rate of rise in plasma alpha-amino nitrogen coincided with cold-induced increases in food intake. The findings support the view that protein metabolism of muscle, the predominant extrahepatic tissue, may participate in thermogenesis when other sources of energy in the body have been depleted.

Amino Acids↗

[Effect of activation and blockade of central P2X receptors on body temperature].

The aim of the present study was to elucidate the role of extracellular ATP acting on specific P2X receptors in the central mechanisms of thermoregulation. Using immunohistochemistry methods, it was found that the brainstem structures involved in the body temperature regulation contain a large number of nerve cells which possess P2X receptors for ATP. Experiments with intracerebroventricular application of a stable ATP analogue and P2X receptor antagonists to conscious rats showed that both activation and blockade of central P2X receptors resulted in marked changes in body temperature. Analysis of the effects of these agents suggests that ATP by acting on P2X receptors performs an important function in the mechanisms of transmission of afferent information coming from peripheral thermoreceptors to the brainstem thermoregulatory centres responsible for heat loss, and during pyrogen-induced fever can be involved in the action of the endogenous antipyretic system.

Adenosine Triphosphate↗

Mechanism of cocaine-induced hyperthermia in humans.

BACKGROUND: The lethal effects of cocaine are unique among those of other illicit drugs because cocaine has the propensity to cause hyperthermia. The traditional view is that cocaine causes a hypermetabolic state with increased heat production. However, because cocaine-induced hyperthermia occurs primarily in hot weather, it is hypothesized that cocaine also impairs thermoregulatory adjustments that mediate heat dissipation. OBJECTIVE: To test the effects of cocaine on body temperature regulation in humans. DESIGN: Randomized, double-blind, placebo-controlled crossover trial. SETTING: A cardiovascular physiology laboratory in Dallas, Texas. PARTICIPANTS: 7 healthy, cocaine-naive volunteers. INTERVENTION: Progressive passive heat stress, during which each participant received intranasal cocaine (2 mg/kg of body weight) or placebo (lidocaine, 2 mg/kg). MEASUREMENTS: Esophageal temperature, skin blood flow, sweat rate, and perceived thermal sensation. RESULTS: Three major new findings were noted. First, cocaine substantially augmented the progressive increase in esophageal temperature during heat stress (P < 0.001). Second, this augmentation was explained by a rightward shift in the esophageal temperature threshold for the onset of both cutaneous vasodilation (37.37 +/- 0.09 degrees C for cocaine vs. 37.06 +/- 0.07 degrees C for lidocaine; P = 0.01) and sweating (37.38 +/- 0.09 degrees C for cocaine vs. 37.07 +/- 0.06 degrees C for lidocaine; P = 0.002). Third, cocaine paradoxically impaired the perception of heating by attenuating the progressive increase in thermal discomfort associated with heat stress. CONCLUSIONS: In humans, impaired heat dissipation is a major mechanism by which cocaine elevates body temperature. When healthy, cocaine-naive persons are subjected to passive heating, pretreatment with even a small dose of intranasal cocaine impairs sweating and cutaneous vasodilation (the major autonomic adjustments to thermal stress) and heat perception (the key trigger for behavioral adjustments).

Adult↗