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introduction TO <br />FEVER <br />& <br />fuo<br /><ul><li>MUKESH SHANKER
Kmcmanipal</li></li></ul><li>Regulation Of Body Temperature<br />Centre of Control : Hypothalamus<br />Signals From:<br />...
Temperature Of Blood. </li></ul>THE BALANCE OF BODY HEAT<br />
Normal Body Temperature<br />36.8 ± 0.4°C Or 98.2 ± 0.7°F <br />So, Normal Oral temp.=<br />36.4 to 37.2°C OR <br />97.5 t...
Different Places to Record Temp.<br />ORAL : Usually done in conscious patient.<br />     Thermometer kept under the tongu...
AXILLARY : Should be avoided.<br />              Can be done in<br />children under 5yrs.<br />TYMPANIC : Measures radiant...
THERMOMETER :<br />
FEVER :<br />A.M. Temperature of ><br />Or<br />P.M. Temperature of ><br />37.2°C  Or >98.9°F<br />Or<br />37.7°C  Or >99....
PATHOGENESIS<br />EXOGENOUS PYROGENS<br />Microbial Products<br />Microorganisms<br />Microbial toxins<br />Act on Macroph...
    THERMOREGULATORY SET POINT<br /> HEAT CONSERVATION<br /> HEAT PRODUCTION<br /><ul><li>Vasoconstriction
Blood flows away from periphery.
“CHILLS.”
“SHIVERING”
Non Shivering Mech.
Behavioral Adjustment</li></ul>CORE BODY TEMP. REACHES THE <br />NEW SET POINT<br />FEVER<br />
Concentration of Pyrogens<br />Antipyretics<br />  HYPOTHALAMUS RESET TO NORMAL<br /><ul><li>Vasodilatation
Sweating
Behavioral Change</li></ul>  BODY TEMPERATURE DROPS<br />TO NORMAL<br />
PATTERNS OF FEVER<br />
 SOME OTHER PATTERNS<br />
 GRADING OF TEMPERATURE<br />Hypothermia = <35°C Or 95°F<br />Subnormal Temp. = 35°C – 36.6°C<br />FEVER<br />Low Grade = ...
HYPERTHERMIA:<br /><ul><li>Increase in body temperature
No change in hypothalamic thermoregulatory set point</li></li></ul><li>FEVER OF UNKNOWN ORIGIN<br />Or<br />PYREXIA OF unk...
Definition :<br />Petersdorf & Beeson :<br />Temperature of >38.3°C on several occasions.<br />Duration of fever of >3 wee...
New Criteria & Classification :<br />1. CLASSICAL FUO :<br />Temperature of >38.3°C on several occasions.<br />Duration of...
2. NOSOCOMIAL FUO :<br />Temperature of >38.3°C on several occasions in a Hospitalized patient. <br />Duration of fever of...
    4. NEUTROPENIC FUO :<br />Temperature of >38.3°C on several occasions.<br />Neutrophil count  is <500/mcl<br />Duratio...
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Introduction To Fever & Fuo

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This presentation covers fever, its pathogenesis, different types of fever. Also covers fuo, its classification and causes.

Published in: Health & Medicine

Introduction To Fever & Fuo

  1. 1. introduction TO <br />FEVER <br />& <br />fuo<br /><ul><li>MUKESH SHANKER
  2. 2. Kmcmanipal</li></li></ul><li>Regulation Of Body Temperature<br />Centre of Control : Hypothalamus<br />Signals From:<br /><ul><li>Peripheral Nerves.
  3. 3. Temperature Of Blood. </li></ul>THE BALANCE OF BODY HEAT<br />
  4. 4. Normal Body Temperature<br />36.8 ± 0.4°C Or 98.2 ± 0.7°F <br />So, Normal Oral temp.=<br />36.4 to 37.2°C OR <br />97.5 to 99°F<br />CircadianRhythm= 0.5°C<br />Minimum Temp at 6 A.M.<br />Maximum Temp at evening. [ 4-6 P.M. ]<br />
  5. 5. Different Places to Record Temp.<br />ORAL : Usually done in conscious patient.<br /> Thermometer kept under the tongue.<br /> Slightly lower than actual core temperature.<br />RECTAL : Done in children, elderly,<br />unconscious patient.<br /> Gives the core body temperature.<br />
  6. 6. AXILLARY : Should be avoided.<br /> Can be done in<br />children under 5yrs.<br />TYMPANIC : Measures radiant heat from<br />tympanic mem & nearby.<br /> Accurate but difficult.<br />RECTAL TEMP = 0.4 + ORAL TEMP.<br /> = 0.8 + TYMPANIC TEMP.<br />
  7. 7. THERMOMETER :<br />
  8. 8.
  9. 9. FEVER :<br />A.M. Temperature of ><br />Or<br />P.M. Temperature of ><br />37.2°C Or >98.9°F<br />Or<br />37.7°C Or >99.9°F<br />WITH<br />INCREASE IN HYPOTHALAMIC SET POINT.<br />
  10. 10. PATHOGENESIS<br />EXOGENOUS PYROGENS<br />Microbial Products<br />Microorganisms<br />Microbial toxins<br />Act on Macrophages & other cells<br /> ENDOGENOUS PYROGENS<br />Peripheral Manifestations<br />HYPOTHALAMIC ENDOTHELIUM<br />PGE2<br />THERMOREGULATORY<br />SET POINT<br />cAMP<br />
  11. 11. THERMOREGULATORY SET POINT<br /> HEAT CONSERVATION<br /> HEAT PRODUCTION<br /><ul><li>Vasoconstriction
  12. 12. Blood flows away from periphery.
  13. 13. “CHILLS.”
  14. 14. “SHIVERING”
  15. 15. Non Shivering Mech.
  16. 16. Behavioral Adjustment</li></ul>CORE BODY TEMP. REACHES THE <br />NEW SET POINT<br />FEVER<br />
  17. 17. Concentration of Pyrogens<br />Antipyretics<br /> HYPOTHALAMUS RESET TO NORMAL<br /><ul><li>Vasodilatation
  18. 18. Sweating
  19. 19. Behavioral Change</li></ul> BODY TEMPERATURE DROPS<br />TO NORMAL<br />
  20. 20. PATTERNS OF FEVER<br />
  21. 21. SOME OTHER PATTERNS<br />
  22. 22. GRADING OF TEMPERATURE<br />Hypothermia = <35°C Or 95°F<br />Subnormal Temp. = 35°C – 36.6°C<br />FEVER<br />Low Grade = Only evening rises.<br />Mild = 37.2 – 37.8°C [99 – 100°F]<br />Moderate = 37.8 – 39.4°C [100 – 103°F]<br />High Grade = > 39.4°C [>103°F]<br />Hyperpyrexia = > 41.5°C [>106. 7°F]<br />
  23. 23. HYPERTHERMIA:<br /><ul><li>Increase in body temperature
  24. 24. No change in hypothalamic thermoregulatory set point</li></li></ul><li>FEVER OF UNKNOWN ORIGIN<br />Or<br />PYREXIA OF unknown ORIGIN<br />
  25. 25. Definition :<br />Petersdorf & Beeson :<br />Temperature of >38.3°C on several occasions.<br />Duration of fever of >3 weeks. &<br />Failure to reach a diagnosis despite one week of inpatient investigation<br />
  26. 26. New Criteria & Classification :<br />1. CLASSICAL FUO :<br />Temperature of >38.3°C on several occasions.<br />Duration of fever of >3 weeks. &<br />Failure to reach a diagnosis despite 3 OPD visits,<br /> Or 3days in the hospital without elucidation of a cause,<br /> Or one week of intelligent & invasive ambulatory investigation.<br />
  27. 27. 2. NOSOCOMIAL FUO :<br />Temperature of >38.3°C on several occasions in a Hospitalized patient. <br />Duration of fever of >3 weeks &<br /> 3 days of investigation including at least 2 days’ incubation of cultures<br />3. HIV Associated FUO :<br />Temperature of >38.3°C on several occasions in a Hospitalized patient. <br />Duration of fever of >4 weeks &<br /> 3 days of investigation including at least 2 days’ incubation of cultures<br />
  28. 28. 4. NEUTROPENIC FUO :<br />Temperature of >38.3°C on several occasions.<br />Neutrophil count is <500/mcl<br />Duration of fever of >3 weeks &<br />3 days of investigation including at least 2 days’ incubation of cultures.<br />
  29. 29. CAUSES OF FUO:<br />
  30. 30.
  31. 31. CAUSES OF FUO:<br />
  32. 32. Infectious Cause:<br />BACTERIAL :<br />Extra pulmonary TB,<br /> Abscess.<br />IE, Osteomyelitis, HACEK .<br />Sinusitis & dental inf.<br />FUNGAL:<br />Histoplasmosis, Cryptococcus Neoformans.<br />VIRAL:<br />EBV, CMV, HIV, Dengue, Hepatitis.<br />PARASITIC: Amoebiasis, Malaria.<br />
  33. 33. Neoplastic:<br /><ul><li>Incidence of FUO due to neoplasm has decreased.
  34. 34. Commonest is Colon CA – in aged.
  35. 35. Others – Hodgkin's, Pancreatic CA.</li></ul>IN ELDERLY:<br /><ul><li>Giant cell arteritis.
  36. 36. TB
  37. 37. CA Colon.</li></li></ul><li>Non Infectious Inflammatory Disease:<br />Rheumatological disease :<br />SLE, Stills Disease.<br />Vasculitic disease :<br />Giant cell arteritis, Connective tissue disorder.<br />Granulomatous disease :<br />Sarcoidosis, Crohn’s.<br />
  38. 38. Miscellaneous Disease:<br />Drug Fever :<br />Antimicrobial – B lactam<br />CVS Drugs – Quinidine<br />Antineoplastic drugs.<br />Pulmonary Embolism :<br />Hereditary Periodic Fever Syndrome.<br />Factitious Fever.<br />Thermoregulatory Disturbances :<br />Habitual Hyperthermia:<br />
  39. 39. Thank YOU….<br />

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