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fever a clinical approach

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Notes

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Slide 1 :

Fever– A Clinical approach Dr. R.KANNAN , M D (GENERAL MEDICINE) ASSISTANT PROFESSOR OF MEDICINE SAVEETHA MEDICAL COLLEGE & HOSPITALS SAVEETHA UNIVERSITY THANDALAM,KANCHIPURAM,INDIA & CONSULTANT PHYSICIAN HANDE HOSPITALS ,CHENNAI,INDIA On 25th June 2008 EMAIL endork@yahoo.com

Slide 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 to Infection, inflammation or neoplasm

Slide 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)

Slide 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

Slide 5 :

Fever - types

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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

Slide 7 :

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

Slide 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

Slide 9 :

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

Slide 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

Slide 11 :

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

Slide 12 :

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

Slide 13 :

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

Slide 14 :

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

Slide 15 :

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

Slide 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

Slide 17 :

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

Slide 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

Slide 19 :

EPI TROCHLEAR LYMPH NODES MILIARY TB LYMPHOMA HIV INFECTION SYPHILIS

Slide 20 :

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

Slide 21 :

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

Slide 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

Slide 23 :

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

Slide 24 :

HIGH ESR TB TEMPORAL ARTERITIS CARCINOMA LYMPHOMAS ABSCESS MYELOPROLIFERATIVE DISORDER

Slide 25 :

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

Slide 26 :

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

Slide 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

Slide 28 :

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

Slide 29 :

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

	endork 1 Years ago. Category: Internal Medicine

Tags:	Internal Medicine

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