This document discusses fever and rash, including definitions, diagnostic approaches, and specific conditions that can present with fever and rash. It defines fever and discusses methods of taking temperature. It describes patterns of fever such as continuous, remittent, and intermittent fever. It then discusses specific conditions that can present with fever and a rash, categorizing them based on the type of rash: centrally distributed maculopapular eruptions (such as measles, rubella, epidemic typhus), nodular eruptions (such as erythema nodosum), and purpuric eruptions (such as meningococcal disease). It emphasizes taking a thorough history, physical exam, and conducting appropriate laboratory
Rodenticide Poisoning + Rat Killer paste poisoning managementVasif Mayan
Rodenticide paste poisoning
Case Study
Clinical features
Management
Investigations
Treatment guidelines
pathogenesis
N acetyl cysteine
Coumarins
other rodenticides
Contains 17 clinical situations of prolonged fever and discussion of various differential diagnosis based on them. Also gives the key points in the diagnosis of a prototype diagnosis and the usefulness of a relevant investigation modality in identifying these conditions. This power point presentaion is based on the chapter in Harrison's Text Book on Internal Medicine chapter on Fever of Unknown Origin
Rodenticide Poisoning + Rat Killer paste poisoning managementVasif Mayan
Rodenticide paste poisoning
Case Study
Clinical features
Management
Investigations
Treatment guidelines
pathogenesis
N acetyl cysteine
Coumarins
other rodenticides
Contains 17 clinical situations of prolonged fever and discussion of various differential diagnosis based on them. Also gives the key points in the diagnosis of a prototype diagnosis and the usefulness of a relevant investigation modality in identifying these conditions. This power point presentaion is based on the chapter in Harrison's Text Book on Internal Medicine chapter on Fever of Unknown Origin
fever of unknown origin is defined as
1) Fever >38.3*C (101*F) on atleast 2 occasions
2) illness duration more than 3 weeks
3) No known immunocompromised state
4) Uncertain diagnosis despite one week of inpatient evaluation
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
Fever and Hyperthermia and Pyrexia of unknown origin by Dr Mohammad Hussien for Medical Student .
Ass.Lecturer of Hepatogastroentrology at Kafrelsheikh University.
fever of unknown origin is defined as
1) Fever >38.3*C (101*F) on atleast 2 occasions
2) illness duration more than 3 weeks
3) No known immunocompromised state
4) Uncertain diagnosis despite one week of inpatient evaluation
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
Fever and Hyperthermia and Pyrexia of unknown origin by Dr Mohammad Hussien for Medical Student .
Ass.Lecturer of Hepatogastroentrology at Kafrelsheikh University.
This presentation focuses on the entity known as pyrexia of unknown origin / fever of unknown origin. It demonstrates both common and rare causes, and the epidemiological trend, its clinical presentation, management and prognosis.
The syndrome of pyrexia of unknown origin (PUO) was first defined in 1961 but remains a clinical challenge for many physicians. Different subgroups with PUO have been suggested, each requiring different investigative strategies: classical, nosocomial, neutropenic, and HIV-related. This could be expanded to include the elderly as a fifth group. The causes are broadly divided into four groups: infective, inflammatory, neoplastic, and miscellaneous. Increasing early use of positron emission tomography–computed tomography (PET-CT) and the development of new molecular and serological tests for infection have improved diagnostic capability, but up to 50% of patients still have no cause found despite adequate investigations. Reassuringly, the cohort of undiagnosed patients has a good prognosis. In this article we review the possible aetiologies of
The definition of pyrexia of unknown origin (PUO) dates back to 1961; it was described as a persistent fever above 38.3°C (100°F) that evades diagnosis for at least 3 weeks, including 1 week of investigation in hospital. PUO and present a systematic clinical approach to the investigation and management of patients, recommending potential second-line investigations when the etiology is unclear
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. FEVER
Definition :
Fever is an elevation of body
temperature above the normal
physiological variation as a result of the
change in the thermoregulatory center,
located in the hypothalamus
At oral site fever is defined as temp:-.
• Am >98.9 F
• Pm > 99.9 F
5. Site of measuring Tempreature
• Oral cavity-sub lingual
• Axilla
• Rectum .
• Tympanic Membrane based thermometer.
• Rectal temp is 1 .F higher then then Oral which is 1.F higher then Temp
recorded in Axilla
• Rectal temp mos accurate for core body temp.
6. VARIATION
Hypothermia = rectal temperature <35 °C (<95 °F).
Body temperature °F (oral site)
Normal
Febrile
98.6–99.9
>100
Mild/low grade fever 100.5–102.2
Moderate grade fever 102.2–104.0
High grade fever 104.1–106.0
Hyperpyrexia >106.0
7. VARIOUS RELATIONSHIPS
Every one degree rise of core body temp above 100.F – Pulse >10 , RR by
4
Fever increases o2 demand
• This law when not followed in respect of pulse, for some diseases , called
RELATIVE BRAYCARDIA (Faget sign), reported in typhoid fever, typhus,
leptospirosis, malaria etc.
9. Remittent Fever
• The temperature fluctuation exceeds 0.6°C (1°F), but without touching the
baseline eg:- Brucellosis , Typhoid fever , Infective Endocarditis .
10. Intermittent Fever
• The elevated temperature touches the
baseline in between
diurnal variation is extremely large 3-4 .F
associated with septicemia .
11. Relapsing Fevers
Febrile episodes are separated by normal temperature for more than one
day, various types described
a. Tertian fever---, e.g. Plasmodium vivax, ovale, falciparum.
b. Quartan fever -----, e.g. Plasmodium malariae.
c. Pel-Ebstein -----e.g. Hodgkins and other lymphomas.
d. Saddle back fever/Bi-Phasic fever:----e.g. Dengue fever.
ef)cyclic neutropenia ---- every 21 days
12.
13. Drug induced fever
• It begins 1–3 weeks after the start
• persists 2–3 days after withdrawal
• Rash, arthralgia, Hypotension
• Relative bradycardia
• CBC –Eosinophilia
• Any drug but most notorious are
Sulphonamide Procainamide Penicillins Propylthiouracil Iodides Methyldopa
Anti-TB drugs Anticonvulsants
14. Hyperpyrexia
• core body temperature, above 41°C (106°F)
• Medical emergency,
• Causes
• 1. Severe infection & septicemia
2 CNS haemorrages eg Pontine haemorrhage
• 3. Rheumatic fever
• 4. Meningococcal meningitis
• 5. Cerebral malaria.
• Treatment emergency: physical cooling
• later treat the cause
15. APPROACH TO THE PATIENT
Fever
• Documentation & Same site.
• Chronology with other symp? , Age , Duration, Events before fever ?
Exposure, immune status , underlying Renal or Liver conditions?
• LABORATORY TESTS
• The workup must include
CBC and PS
• Urine Analysis, naked eye and laboratory
• CXR
• C-reactive protein (CRP) level and the ESR
• Further -- case by case basis.
• Fever must be relived by anti-pyretics,as no evidence has been found that
its reduction hampers disease recovery in any way.
16. Nacked Eye Urine Examination
Turbid urine– sign of UTI and infection
Reddish/pink Urine – s/o Gross Hematurea ? renal./urethral
stones,? Cystitis / Ca bladder
Cola coloured Urine(dark/brown urine) –Choluria is a common
symptom of liver diseases, when serum bilirubin is higher than 1.5
mg/dL.
Black coloured – Black water fever , P. Falcifarum inf not
adequately treated ? Black water fever sudden and severe
intravascular haemolysis leading to haemoglobinaemia and
haemoglobinuria and clinically manifested by anaemia, passage of
dark urine and often oliguric renal failure
Black Water Urine
choluria
17. TPR RECORDS FROM WARDS FOR TEMP, PULSE CHARTING
• We keep on sos
19. Pyrexia /Fever of Unknown Origin
• FUO is defined as follows:
•
1. Fever ≥38.3°C (≥101°F) on at least two occasions
•
2. Illness duration of ≥3 weeks
•
3. No known immunocompromised state
•
4. Diagnosis that remains uncertain after a thorough history-taking,
physical examination, and the following obligatory investigations
20. Obligatory Investigations for workup
• HIV serology , CBC with PS, ESR, CRP, electrolytes, creatinine, total
protein, alkaline phosphatase(ALP), alanine aminotransferase(ALT/SGPT),
aspartate aminotransferase(AST/SGOT), lactate dehydrogenase, creatine
kinase,
ferritin, antinuclear antibodies, and rheumatoid factor; protein
electrophoresis; urinalysis; blood cultures (n = 3); urine culture; chest
x-ray; abdominal ultrasonography; and tuberculin skin test (TST) or
interferon γ release assay (IGRA
• For Indian scenarios , three blood smears for malarial parasites,
urine microscopy, typhi dot also recommended
•
21. Differential diagnosis of PUO
• DIFFERENTIAL DIAGNOSIS
•
The differential diagnosis for FUO is extensive. It is important
to remember that FUO is far more often caused by an atypical
presentation of a rather common disease than by a very rare disease.
22. DIAGNOSTIC APPROCH AND INITIAL
WORKUP
•
Fever Documentation
• ‘Detailed History and Physical Examination
•
24. • If the patient is not in multi-organ system failure,
previous antibiotics/drugs should be stopped, the patient
observed for at least 72 hours, at which point multiple blood
(and fluid, if indicated) cultures should be taken.
• A second tier of
investigations, depending on the constellation of symptoms like CSF
Examination, bone
marrow aspiration with a biopsy and routine, mycobacterial and
fungal cultures and specific radiological investigations like CT, MRI is
undertaken
• PUO if further categorized as :- 1)Classic 2)Nocosomial and with
Neutropenia
25. Classical PUO
• The three major
categories
include
infections,
neoplasms and
non-infectious
inflammatory
diseases
(collagen
vascular
diseases and
sarcoidosis).
Other
minor category
include drug
fever.
26. • In a large series of classic FUO from
Eastern India, infections were the most dominant cause seen in
53% (half of these were tuberculosis), neoplasms in 17% and
collagen vascular diseases in 11%.
27. Infectious Causes
The most common infectious causes of FUO include the following:
• Tuberculosis (TB)
• Subacute bacterial endocarditis (SBE), Discitis
• Enteric (typhoid) fever, Malaria, Extrapulmonary TB
• Less-common infectious causes of FUO include the following:
• HIV infection
Abdominopelvic abscesses
Epstein-Barr virus (EBV) infection
Cytomegalovirus (CMV) infection
Toxoplasmosis
28. Non-infective causes of pyrexia of unknown origin
• common noninfectious inflammatory causes of FUO include the following:
•
Giant cell (temporal) arteritis
Systemic lupus erythematosus (SLE)
Periarteritis nodosa/microscopic polyangiitis (PAN/MPA)
Rheumatoid arthritis (RA)
•
Antiphospholipid syndrome (APS)
Gout
Pseudogout
Behçet disease
Sarcoidosis
Felty syndrome
Takayasu arteritis
29. • Malignant and Neoplastic Causes of FUO
•
Malignant and neoplastic causes of FUO are as follows:
•
Most common: Lymphoma, renal cell carcinoma
•
Less common: Myeloproliferative disorder, acute myelogenous leukemia
Multiple myeloma, breast/liver/pancreatic/colon cancer, atrial myxoma, metastases to
brain/liver
30. Nosocomial PUO
• In Nosocomial origin fever when uncertain diagnosis despite 1 week of
inpatient evaluation.
• About 50% of nosocomial
fever is due to infections. Non-infectious causes include drug fever,
deep venous thrombosis, cholecystitis, pancreatitis and
pulmonary embolism .
32. HIV associated FUO
• In India, tuberculosis
accounts for about 70% of cases of prolonged fever, followed
by disseminated cryptococcosis (10%), Pneumocystis jiroveci
pneumonia (7%), community acquired pneumonia (2%) and
liver abscess (2%).
• In the initial 6 months after the start of ART,
immune reconstitution inflammatory syndrome (IRIS), drug
fever are common whereas after 6 months, causes
of prolonged fever include various forms of tuberculosis,
neoplasms and non-infectious inflammatory diseases similar
to a classic FUO.
34. Miscellaneous Causes of FUO
•
Most common: Cirrhosis (due to portal endotoxins), drug fever
•
Less common: Thyroiditis, Crohn disease
•
Least common: Pulmonary emboli, hypothalamic syndrome, familial periodic fever
syndromes, cyclic neutropenia,
factitious fever (especially in those experienced with the healthcare field)
35. • World Wide - Increasing early use
of positron emission tomography–
computed tomography (PET-CT)
and the development of new
molecular and serological tests for
infection have improved diagnostic
capability, but up to 50% of patients
still have no cause found despite
adequate investigations.
Reassuringly, the cohort of
undiagnosed patients has a good
prognosis.
36. Neutropenic Fever
• Causes of Neutropenia are divided as
• Decreased production – These conditions are either a) Drug Induced
b)Infections and others .
• At least 50% of
neutropaenic patients who become febrile have an established
or occult infection
37. • Drug fever with the drugs may be presented with neutropenia like, drug
induced fever with Alkylating agents , Antimetabolites eg MTX , Non
Cytotoxic agents like antibiotics Chloroquin , Penicilline , Sulphonamides ,
anticonvulsant like carbamazepine , antipsycotics like clozapine , and
many others .
• some infections like Tuberculosis , Typhoid fever, Brucellosis , Tularemia ,
Measels , Infectious Mononucleosis , Malaria , Viral Hepatitis,
Leishmaniasis and AIDS may present with neutropenic puicture.
• Conditions with Increase peripheral pooling may present with Transient
Neutropenuia e.g. Overwhelming Bacterial Infections
• Conditions with inc destructions like Autoimmune Disorders ,
Rheumatoid arthritis , Lupus erythrematosis , Feltys syndrome may also
present eith febrile illness with neutropenia
40. Fever and Rash
• Fever with rash is a common presentation of many infectious and non
infectious diseases that range from benign to life threatening.
44. CENTRALLY DISTRIBUTED
MACULOPAPULAR
ERUPTIONS
• Diseases with fever and rash may be classified by type of eruption:
centrally distributed maculopapular & peripheral
• Centrally distributed rashes, in which lesions are primarily truncal,
are the most common type of eruption.
45. Measels
• The rash of rubeola (measles)
starts at the hairline 4th days into the
illness and moves down the
body, typically sparing the palms and
soles . MaculoPapular Rash
Causative agent is Measels Virus or
ParaMyxoVirus
• Mgt- Symptomatic & supportive
• Complication– Associated Pneumonia,
encephlitis and Subacute sclerosing
panencephalitis (late n rare)
46. Rubella German Measels
• Causative Agent- Rubella Virus
• Ip- 18 days
• Pink maculopapular , develops on forehead spread
to extremities , fades by third day . Forchheimer
sign small red papule on area of soft palate in 20%
of cases
• Mgt- supportive and symptomatic
47.
48. Epidemic typhus
• Epidemic typhus is due
to Rickettsia prowazekii spread
by body lice,
• no vaccine is commercially
available
• Treatment – Tab Doxy 100 mg Bd
x 14 days
51. Dengue
Fever
• Diffuse flushing
• Maculopapular rash
begins on trunk and
spread to extremities
and face , petechial
on extremities ,
pruritic during
recovery
• t/t- Supportive with
Carefull attention to
fluid management
53. Typhoid
Fever
Rose spots on chest and
abdomen on 1st week ,
small pale red macule
blanchable . Last 2-3
days
54. Bacterial
endocarditis
• Rash – Janeway
lesions – Painless
erythematous macules
usually on palms or
soles
• Osler Nodes –
Tender pink nodules on
finger or toe pads
• Petechial rash on
skin mucosa
• Splinter hemorrhage
on Nails
55. Chikungunya
fever
• Vector – Aedes aegypti ,
Aedes albopictus .
• IP- 2-4 days
• Rash Transient between 1-
4 days , Maculopapular
mostly on face , trunk ,
extremities
56. Erythema
marginatum
(Rheumatic
fever )
• Cause– Gp A
streptococcous , in patient
with Rheumatic fever
• Rash- Erythematous
annular papule and plaque
over trunk and proximal
extremities . Evolving and
resolving within hours.
(evanescent rash )
64. Herpes Zoster
• Herpes zoster is viral infection that occurs
with reactivation of the varicella-
zoster virus. It is usually a painful but self-
limited dermatomal vasicular rash
• Reactivation of varicella-zoster virus (VZV)
that has remained dormant within dorsal
root ganglia
65.
66.
67. Drug Indused
Rash
• Mild , mostly disappear with 2-3 days
and rarely upto 14 days , when
offending drug is withdrawn
• In CBC – Eosinophilia may be present
• Macular eruptions ,a/w itching ,
arthralgia , mild fever
• Some drugs are more notorious :
68.
69.
70.
71. SJS is defined as skin involvement of < 10%, TEN is defined as skin
involvement of > 30%, and SJS/TEN overlap as 10-30% skin
involvement.
72. Ebola
• Hemorragic Viral fever
• Virus appeared in South sudan
Ebola is a nonspecific maculopapular rash that appears
between day four and six of disease. ,
• Dark-red pinpoint papules arise on the face, arms, legs,
buttocks, and around the hair roots with subsequent
spread to the rest of the body.
• Ebola treatment is largely supportive and symptoimatic,
VACCINE is available
73. Waterhouse-Friderichsen syndrome
• meningococcal septicemia but may
complicate sepsis caused by other
organisms
• Waterhouse-Friderichsen
syndrome is characterized by the
abrupt onset of fever, petechiae,
arthralgia, weakness, and
myalgias,
• Acute adrenal insufficiency due to
adrenal gland hemorrhage
74. CLINICAL SCENARIOS
• A RECENTLY DIAGNOSED PLHA BY
ROUTINE INCIDENTAL EXAMINATION
,AFEBRILE ERLIER HAS BEEN
STARTED ART , AFTER `12 DAYS HE
PRESENTEED AGAIN WITH C/O
INTERMITTENT FEVER , ALL
DIAGNOISTIC TEST HAS FOUND TO
BE NEGATIVE . WHAT IS MOST
PROBABLE CAUSE OF FEVER ?
• OPTION ?????
• ??1) IMMUNE RECONSTITUTION
SYNDEOME
• ??2) DRUG FEVER
•
75. • ANS- DRUG FEVER, DUE TO ONE OF ART COMPONENT IS ,MOST
LIKEKY AS IT APPERED BEFORE < 6 WEEK OF STARTING OF ART
AND ALL DIAGNOSTIC TESTS WERE NEGATIVE
76. Clinical scenario 2
• A 60ye old female with a H/o CAD and on regular medications ,
presented with she h/o mild intermittent fever since 15 days Gross
ascites, on ascitic fluid exam cell count 384/Cum, 92% lymphocytes
and 8% PMN were found , further ESR was 42 mm in 1 hr. SAAG
ratio of ascitic fluid was 1 . On P/e JVP was not raised chest was
clear. BP was 100/60 and pulse 80/min . s.Amlyase was normal and
s.create was 0.7, her Mantoux was negative , what is most
probable cause of her recently developed ascitis>?
• Option 1 CHF
• 2 abdominal Koch
• 3 CRF
77. • Ans- Here SAAG Ratio 1 indiacate
infective causes , in that
mononuclear cells being 90 %
with abundant cellularity and 42
esr indicate toward chronic
indolent infection , all most
consistence with Abdominal Koch
• Q2 – For confirmation what further
workup as tier 3 investigation
should be done ?
78. • Ans – USG W/A and CECT Abdomen for evidence of
enlargement of Mesenteric nodes is most likely step
forward .
79. Take home message
• Fever is commonly encountered in OPD and IPD patients ,
• Red flag sign which should alert clinician
• Fever with Hypotension , Visual disturbences, Severe Headache, Neck
rigidity, H/o Significant weight loss, Aneamia , Cr. Jaundice , Anuira/Oligurea,
Toxic look, S/o Multi-Organ Involvement , Unintentional weight loss, seizures,
dark coloured urine , h/o drenching night sweats , new cardiac murmer,
splinter hemorrhage
• Fever with Hemoptysis or ahematoemesis
• These are associated with disease with severe outcomes and should not be
taken casualy