Transcript 3. Fever

TASHKENT MEDICAL ACADEMY
Infectious and children infectious
diseases department
Theme: Early and Comparative
diagnosis of diseases with the
syndrome of fever
Lecturer:
What is fever ?
 FEVER is a Diagnostic Clue
 It is an essential host defense mechanism
 Associated with or without localizing signs
 It can be due to Infection, inflammation or neoplasm
Fever - Magnitude
 Below 97 degree F – Hypothermia
 98.4 degree F - Normal
 98 to 102 degree F – INFECTIONS
 106 degree and above – Non- infectious fever (Hyperpyrexia)
Fever- Patterns
o Intermittent type – temp return to normal once during most days
o Remittent type – temp do not return to normal each day
o Sustained/Continuous – temp do not vary more than 1 degree F /day
o Relapsing - recurrent over days to weeks
Fever - types
Classical PUO
1. FEVER – MORE THAN 101 F
2. MORE THAN 3 WEEKS
3. CAUSE NOT DIAGNOSED AFTER ONE WEEK OF
INTENSIVE HOSP INVESTIGN
TYPES OF PUO
 ACUTE,
 NOSOCOMIAL,
 HIV ASSOCIATED
 NEUTROPENIC PUO
PUO – causes
 INFECTIONS – 30%
 MALIGNANCY –20%
 CONNECTIVE TISSUE D- 15 %
 OTHERS – 20 %
 UNDIAGNOSED – 15 %
FEVER - Common Clues
 RESPIRATORY SYMPTOMS – URTI ,LRTI,TB,
 URINARY SYMPTOMS – UTI,APN,CYSTITIS
 ABDOMINAL SYMPTOMS – ABSCESS,ACUTE ABDOMEN
 ARTHRITIS SYMPTOMS –RA,SLE,AS
 TRAVEL HISTORY
 DIETARY HISTORY
 OCCUPATIONAL HISTORY
TRAVEL History
MALARIA – ENDEMIC AREAS
DENGUE FEVER - Eg )SINGAPORE
VIRAL FEVERS
TYPHOID
TUBERCULOSIS
SCHISTOSOMIASIS
Dietary & Occupational History
 BIRDS – PSITTACOSIS
 ANIMALS CONTACT- TOXOPLASMOSIS (CAT),
BRUCELLOSIS,LEPTOSPIROSIS (RAT)
 UNCOOKED MEAT/SEA FOOD/ -
HEPATITIS –A & E,SALMONELLA
 UNPASTEURIZED MILK – SALMONELLA,TB,BRUCELLOSIS
Drug fever
 All drugs can produce Drug INDUCED fever except DIGOXIN
 Bradycardia, hypotension, Skin rash, pruritus +,
 Eosinophilia
 eg) pencillin, sulpha, ATT
THERE IS NO SUBSTITUTE
FOR OBSERVING THE PATIENT,
TALKING TO HIM AND
THINKING ABOUT HIM.
FEVER & MYALGIA
VIRAL FEVERS – LEUCO & THROMBO CYTOPENIA
INFLUENZA – URTI SYMPTOMS
POLYMYOSITIS – PROXIMAL M WEAKNESS, MUSCLE
PAIN & TENDERNESS, CPK HIGH
MENINGOCOCCAL INFECTION -Rash
SEPSIS
Fever & Night Sweats
 TUBERCULOSIS
 LYMPHOMA
 ABSCESS
 BRUCELLOSIS
 INFECTIVE ENDOCARDITIS
 ALCOHOL WITHDRAWAL SYNDROME
FEVER – Brady, Tachycardia
 RELATIVE BRADYCARDIA
 RELATIVE TACHYCARDIA
TYPHOID FEVER
MALARIA
MENINGITIS
LEPTOSPIROSIS
VIRAL
DRUG FEVER
TOXINS
Fever & Eyes
EYE PAIN – TEMPORAL ARTERITIS
WATERY EYES- PAN
DRY EYES – SLE,RA
SC HGE –SBE
CONJUNCTIVITIS – TB,SLE
CONJUNCTIVAL SUFFUSION- LEPTOSPIROSIS
UVEITIS- TB,SLE,SARCOIDOSIS
FEVER WITH JAUNDICE
LEPTOSPIROSIS – RENAL FAILURE +
HEPATITIS- DRUGS (ATT) ,VIRAL
ALCOHOLIC HEPATITIS
CIRRHOSIS OF LIVER
HEPATOMA
VIRAL FEVERS
MALARIA
GENERALIZED LYMPHADENOPATHY
 LEUKEMIA – ALL , CLL
 LYMPHOMA – MEDIASTINAL INVOLVEMENT
 HIV INFECTION – ORAL CANDIDIASIS,THIN BUILT,
 TOXOPLASMOSIS- WITH LIVER,SPLEEN
 DISSEMINATED TUBERCULOSIS – WITH LIVER ,SPLEEN
 BRUCELLOSIS- WITH LIVER,SPLEEN
EPI TROCHLEAR LYMPH NODES
MILIARY TB
LYMPHOMA
HIV INFECTION
SYPHILIS
FEVER WITH HEPATOSPLENOMEGALY
MALARIA
TYPHOID
LYMPHOMA
LEUKEMIA
DISSEMINATED TB
INFECTIVE ENDOCARDITIS
BRUCELLOSIS
KALA AZAR
FEVER WITH MENTAL CONFUSION
MENINGITIS
MENINGISM- TYPHOID
HIV
BRUCELLOSIS
CNS NEOPLASMS
LOCAL TENDERNESS
TONGUE- RELAPSING FEVER
TRAPEZIUS – SUB DIAPHRAGMATIC ABSCESS
STERNAL – METASTASIS, PRE –LEUKEMIA
SPINAL – BRUCELLOSIS,TYPHOID,SBE,OM
THIGH- POLYMYOSITIS,BRUCELLOSIS
CALF – POLYMYOSITIS, RMSF
FEVER - ARDS
 SARS INFECTION
 CEREBRAL MALARIA (P FALCIPARUM )
 HANTA VIRUS INFECTION
 SEPSIS
HIGH ESR
TB
TEMPORAL ARTERITIS
CARCINOMA
LYMPHOMAS
ABSCESS
MYELOPROLIFERATIVE DISORDER
FEVER & LOW PLATELETS
DENGUE FEVER
VIRAL FEVERS
LEUKEMIA
LYMPHOMA
MYELOPROLIFERATIVE DISORDER
DRUG FEVER
SLE
HIV INFECTION
CHEST X-RAY DIAGNOSIS
 TB- ANY FORM
 LYMPHOMAS- MEDIASTINAL INVOLVEMENT
 SARCOIDOSIS – BHL
 PNEUMONIAS
 AUTOIMMUNE DISEASES
DIAGNOSTIC TESTS
 ANA,ANTI DS DNA – SLE
 BONE SCAN- OSTEOMYELITIS,METASTASIS
 ECHO HEART – ATRIAL MYXOMA,IE,PCITIS
 SMEAR TEST + VE – MALARIA,
 ELISA IGM AB - LEPTOSPIRA
 VIRAL CULTURE + IN EBV,CMV INFECTIONS
 BLOOD CULTURE + IN IE,SEPSIS,
 AGGLUTININ TEST + IN SALMONELLA , BRUCELLOSIS
ULTRA SOUND
HEPATOMA
ABSCESS
HYPERNEPHROMA (PHYSICIAN S TUMOUR)
LYMPHOMA
PELVIC TUMORS
THANK YOU
 ALL WE KNOW IS STILL INFINITELY
LESS THAN ALL THAT REMAINS UNKNOWN
-WILLIAM HARVEY -