Differential Diagnosis &Management of common Febrile illness Dr.Praful Chhasatia,md
Fever• Since antiquity, Fever has been recognized as cardinal manifestation of disease.• Given importance over other symptoms and demands high therapeutic expectation.• Persistent and relapsing fevers are amongst the most difficult diagnostic challenges in medicine
Definition of Fever• A state of elevated core temperature, which is often, but not necessarily, part of defensive response of body to invasion of live or pathogenic matter.• Pyrogen endogenous,or exogenous,iduced.
Definition of Hyperthermia• Unregulated rise in body temp.• Uncontrolled heat production, inadequate heat dissipation, defective thermoregulation• Not pyrogen related.• No response to antipyratics.
Normal Temperature• 37°C(98.6°F) is defined as normal• There are various differences among workers• Diurnal variation exist .• Morning Temp.< Evening Temp.• Female have higher Temp. ,and rises further during menstruation• Hyperpyrexia > 105°F
Investigations specific & advanced• Serology:Widal,NS1antigen,IgM,IgG for Lepto,Hunta,TB,Virus,HIV• Sputum:AFB,Gram st.,C&S,Cytology• Culturs:Blood,urine,pus,aspirates,stool• CT Scan: Abdoman,Brain,Chest+HRCT,Sinus• MRI:Spine.Joints,Brain• Acute phase reactant: CRP,ProCalcitonin
CBC• Hb: down,up,• RBC:down,Sickle,MP,Fragments• WBC:N,H,D• Platelet:N,H,D,ask for manual count,look for other cause• ESR:non specific• PS: MP,Parasites,Leucamia,TTP,ITP,RBC morphology,Platelet,Thin and Thick(3) smear• Auto Cell counter
Urine• Proteins:Infection,renal,pregnancy• Acetone:DM,dehydration,poor nutrition• Sugar:DM,IV fluid,renal• Pus cells:infection,renal• Organism:bacteria,fungus
Dengue-What not to do• Do not give Aspirin or Brufen for treatment of fever.• Avoid giving intravenous therapy before there is evidence of haemorrhage and bleeding.• Avoid giving blood transfusion unless indicated, reduction in haematocrit or severe bleeding.• Avoid giving steroids. They do not show any benefit.• Do not use antibiotics• Do not change the speed of fluid rapidly, i.e. avoid rapidly increasing or rapidly slowing the speed of fluids.• Insertion of nasogastric tube to determine concealed bleeding or to stop bleeding (by cold lavage) is not recommended since it is hazardous
P.F.Malaria• Uncomplicated:treat• Complicated:Reference• Tratment:ACT(Artemisinin derivative combined with long acting antimalarial)(Amodiaquinine,Lumefantrine, Mafloquine,Sulfadixine-pyrimethamine)• Artemisinin alone? No• Pregnancy:ACT in 2nd & 3rd trimester,Quinine in 1st• Mixed Infection: treat like pf• Clinical Malaria: RDT,PS negative but strong clinical presentation• Vaccine
Complicated PF• If not detected early and treated ,in severe pF malaria,sevre meifestations can develop in 12-24 hr,and lead to death• Platelet factor responsible for immunity storm• P.Knowelsi : Thailand , in Monkey
Complicated PF Severe manifestations• Impaired conciousness/coma• Convulsions• Renal failure• Jaundice• Anaemia:rapid lowerin of Hb <5 g/dl• ARDS• Hypoglycemia• Metabolic Acidosis(clinical?)• Shock• DIC /bleeding• Haemoglobinuria• Hypothermia• Heavy parasitemia• Pregnancy