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TASHKENT MEDICAL ACADEMY Infectious and children infectious diseases department

Theme: Early and Comparative diagnosis of diseases with the syndrome of fever. TASHKENT MEDICAL ACADEMY Infectious and children infectious diseases department. Lecturer:. What is fever ?. FEVER is a Diagnostic Clue It is an essential host defense mechanism

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TASHKENT MEDICAL ACADEMY Infectious and children infectious diseases department

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  1. Theme:Early and Comparative diagnosis of diseases with the syndrome of fever TASHKENT MEDICAL ACADEMY Infectious and children infectious diseases department Lecturer:

  2. 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 toInfection, inflammation or neoplasm

  3. 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)

  4. Fever- Patterns • Intermittent type – temp return to normal once during most days • Remittent type – temp do not return to normal each day • Sustained/Continuous– temp do not vary more than 1 degree F /day • Relapsing - recurrent over days to weeks

  5. Fever - types

  6. Classical PUO • FEVER – MORE THAN 101 F • MORE THAN 3 WEEKS • CAUSE NOT DIAGNOSED AFTER ONE WEEK OF INTENSIVE HOSP INVESTIGN TYPES OF PUO • ACUTE, • NOSOCOMIAL, • HIV ASSOCIATED • NEUTROPENIC PUO

  7. PUO – causes • INFECTIONS – 30% • MALIGNANCY –20% • CONNECTIVE TISSUE D- 15 % • OTHERS – 20 % • UNDIAGNOSED – 15 %

  8. 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

  9. TRAVEL History • MALARIA – ENDEMIC AREAS • DENGUE FEVER - Eg )SINGAPORE • VIRAL FEVERS • TYPHOID • TUBERCULOSIS • SCHISTOSOMIASIS

  10. 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

  11. Drug fever • All drugs can produce Drug INDUCED fever except DIGOXIN • Bradycardia, hypotension, Skin rash, pruritus +, • Eosinophilia • eg) pencillin, sulpha, ATT

  12. THERE IS NO SUBSTITUTE FOR OBSERVING THE PATIENT, TALKING TO HIM AND THINKING ABOUT HIM.

  13. FEVER & MYALGIA • VIRAL FEVERS – LEUCO & THROMBO CYTOPENIA • INFLUENZA – URTI SYMPTOMS • POLYMYOSITIS – PROXIMAL M WEAKNESS, MUSCLE PAIN & TENDERNESS, CPK HIGH • MENINGOCOCCAL INFECTION -Rash • SEPSIS

  14. Fever & Night Sweats • TUBERCULOSIS • LYMPHOMA • ABSCESS • BRUCELLOSIS • INFECTIVE ENDOCARDITIS • ALCOHOL WITHDRAWAL SYNDROME

  15. FEVER – Brady, Tachycardia • RELATIVE BRADYCARDIA • TYPHOID FEVER • MALARIA • MENINGITIS • LEPTOSPIROSIS • VIRAL • DRUG FEVER • RELATIVE TACHYCARDIA • TOXINS

  16. 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

  17. FEVER WITH JAUNDICE • LEPTOSPIROSIS – RENAL FAILURE + • HEPATITIS- DRUGS (ATT) ,VIRAL • ALCOHOLIC HEPATITIS • CIRRHOSIS OF LIVER • HEPATOMA • VIRAL FEVERS • MALARIA

  18. 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

  19. EPI TROCHLEAR LYMPH NODES • MILIARY TB • LYMPHOMA • HIV INFECTION • SYPHILIS

  20. FEVER WITH HEPATOSPLENOMEGALY • MALARIA • TYPHOID • LYMPHOMA • LEUKEMIA • DISSEMINATED TB • INFECTIVE ENDOCARDITIS • BRUCELLOSIS • KALA AZAR

  21. FEVER WITH MENTAL CONFUSION • MENINGITIS • MENINGISM- TYPHOID • HIV • BRUCELLOSIS • CNS NEOPLASMS

  22. LOCAL TENDERNESS • TONGUE- RELAPSING FEVER • TRAPEZIUS– SUB DIAPHRAGMATIC ABSCESS • STERNAL – METASTASIS, PRE –LEUKEMIA • SPINAL – BRUCELLOSIS,TYPHOID,SBE,OM • THIGH- POLYMYOSITIS,BRUCELLOSIS • CALF – POLYMYOSITIS, RMSF

  23. FEVER - ARDS • SARS INFECTION • CEREBRAL MALARIA (P FALCIPARUM ) • HANTA VIRUS INFECTION • SEPSIS

  24. HIGH ESR • TB • TEMPORAL ARTERITIS • CARCINOMA • LYMPHOMAS • ABSCESS • MYELOPROLIFERATIVE DISORDER

  25. FEVER & LOW PLATELETS • DENGUE FEVER • VIRAL FEVERS • LEUKEMIA • LYMPHOMA • MYELOPROLIFERATIVE DISORDER • DRUG FEVER • SLE • HIV INFECTION

  26. CHEST X-RAY DIAGNOSIS • TB- ANY FORM • LYMPHOMAS- MEDIASTINAL INVOLVEMENT • SARCOIDOSIS – BHL • PNEUMONIAS • AUTOIMMUNE DISEASES

  27. 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

  28. ULTRA SOUND • HEPATOMA • ABSCESS • HYPERNEPHROMA (PHYSICIAN S TUMOUR) • LYMPHOMA • PELVIC TUMORS

  29. THANK YOU • ALL WE KNOW IS STILL INFINITELY LESS THAN ALL THAT REMAINS UNKNOWN -WILLIAM HARVEY -

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