fever– a clinical approach
DESCRIPTION
Fever– A Clinical approach. Dr Sabir. Definition. an oral temperature exceeding 37.2 ° C in the early morning and 37.7°C in the late afternoon or evening (Rectal temperatures are higher by approximately 0.6°C ). Diurnal variation. - PowerPoint PPT PresentationTRANSCRIPT
Fever– A Clinical approachDr Sabir
Definitionan oral temperature exceeding 37.2°C in the early
morning and 37.7°C in the late afternoon or evening
(Rectal temperatures are higher by approximately 0.6°C )
Diurnal variationthe mean diurnal temperature oscillation is
approximately 0.5°C, with women generally having slightly higher normal temperatures than men. Temperature is lowest in the early morning and highest in the late afternoon or early evening
The diurnal rhythm is usually preserved with a fever
What is fever ?
FEVER is a Diagnostic ClueIt is an essential host defense mechanismAssociated with or without localizing signs It can be due to Infection, inflammation or neoplasm
HyperthermiaHyperthermia—not mediated by cytokines—occurs
when body metabolic heat production or environmental heat load exceeds normal heat loss capacity or when there is impaired heat loss; heat stroke is an example. Body temperature may rise to levels (> 41.1 °C) capable of producing irreversible protein denaturation and resultant brain damage; no diurnal variation is observed.
Antipyretics are effective in treating fever but are unlikely to affect hyperthermia.
Neuroleptic malignant syndrome is a rare and potentially lethal idiosyncratic reaction to major tranquilizers( haloperidol, fluphenazine)
Treatment: dantrolene ± bromocriptine or levodopa Serotonin syndrome: occurs within hours of ingestion of
agents that increase levels of serotonin in the CNS, including serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, pethidine, dextromethorphan, bromocriptine, tramadol, and lithium.
Treatment: central serotonin receptor antagonist—cyproheptadine or chlorpromazine ± a benzodiazepine.
Fever- Patternso 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 PUO1. FEVER – more than 38.3º C2. At least 3 wk3. Cause not diagnosed after 3 OP visits or 3 days of
hospitalization.
TYPES OF PUO: ACUTE, NOSOCOMIAL, HIV ASSOCIATED NEUTROPENIC PUO
PUO – causes
INFECTIONS – 40%MALIGNANCY –30%CONNECTIVE TISSUE D- 20 %UNDIAGNOSED – 10 %
DDxInfection: amoebic liver abscess, brucellosis, TB,
Typhoid, IE….etcMalignancy: soild tumors (pancreas, lung, sarcoma,
colon…etc)Systemic dis: SLE, Reiter’s, granulomatous
hepatitis…etcMiscellaneous: drug fever, factitious fever,
hyperthyroidism, Behcet’s dis, FMF…etc
Drug feverAny drug may be responsibleExamples: nitrofurantoin, phenytoin, hydralazine,
methyldopa, quinidine, quinine, procainamideVery rarely caused by: digoxin, aminoglycosidesPeripheral eosinophilia is a clue but present only in
25%
FEVER WITH HEPATOSPLENOMEGALY MALARIATYPHOID LYMPHOMALEUKEMIADISSEMINATED TBINFECTIVE ENDOCARDITISBRUCELLOSISKALA AZAR
HIGH ESR TBTEMPORAL ARTERITISCARCINOMALYMPHOMASABSCESSMYELOPROLIFERATIVE DISORDER
FEVER & LOW PLATELETS
VIRAL FEVERSLEUKEMIALYMPHOMAMYELOPROLIFERATIVE DISORDERDRUG FEVERSLEHIV INFECTION
DIAGNOSTIC TESTS
ANA,ANTI- Ds DNA – SLEBONE SCAN- OSTEOMYELITIS, METASTASISECHO HEART – ATRIAL MYXOMA, IESMEAR TEST + VE – MALARIA,VIRAL CULTURE + IN EBV, CMV INFECTIONSBLOOD CULTURE + IN IE, SEPSISAGGLUTININ TEST + IN SALMONELLA , BRUCELLOSIS