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Fever– A Clinical approach

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.

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Fever– A Clinical approach

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  1. Fever– A Clinical approach Dr Sabir

  2. 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 )

  3. Diurnal variation • the 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

  4. 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

  5. Hyperthermia • Hyperthermia—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.

  6. 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.

  7. 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

  8. Fever - types

  9. Classical PUO • FEVER – more than 38.3º C • At least 3 wk • Cause not diagnosed after 3 OP visits or 3 days of hospitalization. TYPES OF PUO: • ACUTE, • NOSOCOMIAL, • HIV ASSOCIATED • NEUTROPENIC PUO

  10. PUO – causes • INFECTIONS – 40% • MALIGNANCY –30% • CONNECTIVE TISSUE D- 20 % • UNDIAGNOSED – 10 %

  11. DDx • Infection: amoebic liver abscess, brucellosis, TB, Typhoid, IE….etc • Malignancy: soild tumors (pancreas, lung, sarcoma, colon…etc) • Systemic dis: SLE, Reiter’s, granulomatous hepatitis…etc • Miscellaneous: drug fever, factitious fever, hyperthyroidism, Behcet’s dis, FMF…etc

  12. Drug fever • Any drug may be responsible • Examples: nitrofurantoin, phenytoin, hydralazine, methyldopa, quinidine, quinine, procainamide • Very rarely caused by: digoxin, aminoglycosides • Peripheral eosinophilia is a clue but present only in 25%

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

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

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

  16. DIAGNOSTIC TESTS • ANA,ANTI- Ds DNA – SLE • BONE SCAN- OSTEOMYELITIS, METASTASIS • ECHO HEART – ATRIAL MYXOMA, IE • SMEAR TEST + VE – MALARIA, • VIRAL CULTURE + IN EBV, CMV INFECTIONS • BLOOD CULTURE + IN IE, SEPSIS • AGGLUTININ TEST + IN SALMONELLA , BRUCELLOSIS

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