This document discusses fever of unknown origin (FUO). It begins by classifying FUO into categories like classical FUO and nosocomial FUO. It then discusses the epidemiology and common etiologies of FUO, which include infections, collagen vascular diseases, and malignancies. The diagnostic approach involves a thorough history, repeated physical exams, and diagnostic testing like blood tests, imaging, and biopsies. Empirical therapeutic drug trials can help diagnose certain conditions but have limitations. The prognosis depends on the underlying cause, with poorer outcomes seen in elderly patients or those with neoplasms or diagnostic delays.
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
1. Fever of unknown origin (FUO) is defined as a fever over 38.3°C for more than 3 weeks without a diagnosis after 1 week of investigation.
2. There are four main classifications of FUO: classic FUO, nosocomial FUO, neutropenic FUO, and HIV-associated FUO.
3. Infections, neoplasms, and noninfectious inflammatory diseases are the most common causes of classic FUO in adults, with tuberculosis, typhoid fever, and malaria among the leading infectious causes.
Approach to a patient with fever of unknown origin sunil kumar daha
Please find the power point on Approach to a patient with fever of unknown origin . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This document discusses vasculitis, which is inflammation of blood vessels. It defines vasculitis and describes the different types including large vessel, medium vessel, and small vessel vasculitis. Specific conditions are discussed such as giant cell arteritis, granulomatosis with polyangiitis, Churg-Strauss syndrome, Behcet's disease, thromboangiitis obliterans, and infectious vasculitis. The pathology, clinical features, morphology, and treatment of some of these conditions are summarized. Images are also included showing histological features.
Atypical pneumonia is caused by certain bacteria including Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, and Legionella pneumophila. It tends to cause milder symptoms than typical pneumonia and does not usually require hospitalization. Different antibiotics are required to treat atypical versus typical pneumonia. Common symptoms include a persistent cough, headache, and low-grade fever.
This document discusses pyrexia of unknown origin (PUO). It begins by defining PUO according to old and new definitions. It then expands the new definition to include categories like nosocomial PUO, neutropenic PUO, and HIV-associated PUO. The document goes on to discuss the causes of PUO in different regions and time periods, with infectious diseases like tuberculosis being very common. It also outlines the evaluation and diagnostic approach for PUO, including relevant laboratory tests, physical exam findings, and potential etiologies.
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
1. Fever of unknown origin (FUO) is defined as a fever over 38.3°C for more than 3 weeks without a diagnosis after 1 week of investigation.
2. There are four main classifications of FUO: classic FUO, nosocomial FUO, neutropenic FUO, and HIV-associated FUO.
3. Infections, neoplasms, and noninfectious inflammatory diseases are the most common causes of classic FUO in adults, with tuberculosis, typhoid fever, and malaria among the leading infectious causes.
Approach to a patient with fever of unknown origin sunil kumar daha
Please find the power point on Approach to a patient with fever of unknown origin . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This document discusses vasculitis, which is inflammation of blood vessels. It defines vasculitis and describes the different types including large vessel, medium vessel, and small vessel vasculitis. Specific conditions are discussed such as giant cell arteritis, granulomatosis with polyangiitis, Churg-Strauss syndrome, Behcet's disease, thromboangiitis obliterans, and infectious vasculitis. The pathology, clinical features, morphology, and treatment of some of these conditions are summarized. Images are also included showing histological features.
Atypical pneumonia is caused by certain bacteria including Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, and Legionella pneumophila. It tends to cause milder symptoms than typical pneumonia and does not usually require hospitalization. Different antibiotics are required to treat atypical versus typical pneumonia. Common symptoms include a persistent cough, headache, and low-grade fever.
This document discusses pyrexia of unknown origin (PUO). It begins by defining PUO according to old and new definitions. It then expands the new definition to include categories like nosocomial PUO, neutropenic PUO, and HIV-associated PUO. The document goes on to discuss the causes of PUO in different regions and time periods, with infectious diseases like tuberculosis being very common. It also outlines the evaluation and diagnostic approach for PUO, including relevant laboratory tests, physical exam findings, and potential etiologies.
This document discusses pyrexia of unknown origin (PUO), also known as fever of unknown origin (FUO). It provides definitions of PUO, outlines the normal human body temperature, and categorizes different types of PUO including classical, nosocomial, neutropenic, HIV-associated, and transplant-associated PUO. It also discusses common causes of PUO including infections, malignancies, and collagen vascular diseases. The document emphasizes the importance of a thorough history and physical examination to identify potential etiologies and key physical signs.
The document provides details on evaluating a patient presenting with fever. It includes sections on taking a thorough history with perspectives on biomedical factors, the patient's experience, and contextual background. A review of systems explores all major organ systems for localizing symptoms. The physical exam findings note vital signs and examination of different body systems. Analyzing symptoms like fever patterns, associated issues, and past medical history are essential for determining the underlying cause.
This document discusses reactive arthritis, beginning with the case of a 36-year-old man who was admitted to the hospital with acute arthritis in both knees after experiencing diarrhea. Reactive arthritis is defined as an infectious-induced systemic illness characterized by aseptic joint inflammation in a genetically predisposed individual following a distant bacterial infection. It commonly follows infections from bacteria like Salmonella, Shigella, Campylobacter, Yersinia, and Chlamydia. The presentation, epidemiology, pathogenesis, clinical manifestations, diagnostic criteria, treatment, and prognosis of reactive arthritis are described in detail.
The document provides guidance on how to take a history and examine a patient presenting with edema. It discusses evaluating the appearance, onset, first site of appearance and associated symptoms to determine if the edema is localized or generalized. Examination of the patient should include assessing nutrition status, pallor, icterus, cyanosis, lymphadenopathy and vital signs. Demonstrating edema clinically involves applying pressure over bony prominences and looking for pitting. Specific examinations are described for cardiac, renal and ascites-related edema.
Rheumatic fever is caused by an autoimmune response following a Group A streptococcal throat infection. It can affect the heart, joints, brain and skin. Heart involvement occurs in 50% of cases and can lead to permanent valve damage over years. Diagnosis is based on Jones criteria of evidence of prior streptococcal infection and major/minor clinical manifestations. Treatment involves bed rest, antibiotics, anti-inflammatories and secondary prophylaxis with antibiotics to prevent recurrence. Recurrence risks are higher if the initial attack involved heart inflammation. Long term follow up is needed due to risk of developing chronic rheumatic heart disease.
This document discusses vasculitis, which is an inflammatory destruction of blood vessels. It can affect all ages but some types are restricted to certain groups. It has both genetic and environmental components. Symptoms vary depending on the size of vessels involved and can include fatigue, rashes, nerve problems, and organ damage. Diagnosis involves clinical features, lab tests, and sometimes biopsies. Treatment is usually with steroids and other immunosuppressants to induce and maintain remission. Complications can be serious if not treated properly.
Dermatomyositis is a chronic inflammatory disorder of the skin and muscles that is characterized by an autoimmune pathogenesis. It commonly presents with characteristic rashes like Gottron's papules and heliotrope rash as well as proximal muscle weakness. Dermatomyositis can also involve internal organs like the lungs, esophagus and heart. Diagnosis involves assessing clinical features, muscle enzymes, electromyography, muscle/skin biopsies and identifying myositis-specific antibodies. Prognosis depends on the severity and organ involvement, with risks of residual weakness, contractures and death from respiratory or cardiac complications.
This document discusses fever with rash and provides details on various conditions that can cause fever and rash. It describes the causes of fever as being pyrogens produced during infection or inflammation. Rash is described as being caused by infectious organisms multiplying in the skin, toxins acting on skin, autoimmune destruction, or vasculature involvement. Several conditions are then discussed in detail, including their causative agents, hosts, modes of transmission, symptoms, rashes, complications, diagnoses, and treatments. These conditions include measles, rubella, erythema infectiosum, roseola, infectious mononucleosis, primary HIV infection, and epidemic typhus.
This document provides an approach to evaluating a case of quadriparesis (weakness of all four limbs). It discusses obtaining a detailed history regarding onset and progression of weakness, risk factors, and family history. A neurological examination including assessment of upper and lower motor neuron signs is recommended. Various etiologies are considered depending on examination findings such as compressive vs. non-compressive myelopathy, motor neuron disease, subacute combined degeneration, anterior spinal artery syndrome, and myasthenia gravis. Differential diagnoses are formulated based on characteristics such as sensory involvement, reflex changes, symmetry of weakness, and associated symptoms.
This document discusses tuberculous meningitis (TBM), the most common form of central nervous system tuberculosis. TBM can have rapid or gradual progression and commonly affects children between 6 months and 4 years old. Diagnosis involves lumbar CSF study, which typically shows lymphocytic pleocytosis and high protein levels. Treatment involves 12 months of anti-tuberculosis medications including an intensive initial phase with four drugs for 2 months followed by isoniazid and rifampin for 10 months. Prognosis depends on the clinical stage at treatment initiation, with those in the first stage having the best outcomes and those in the third stage often having permanent disabilities if they survive.
1. Pyrexia of unknown origin (PUO) is defined as a fever that persists for at least 3 weeks with an unknown source despite 1 week of inpatient investigations or 3 outpatient visits. (2) Common causes of PUO include infections (especially tuberculosis), malignancies, and collagen vascular diseases.
2. A thorough history, physical exam, and initial laboratory and imaging tests are used to identify potential sources and guide further testing. Additional tests may include lumbar puncture, bone marrow biopsy, liver biopsy, or exploratory laparotomy.
3. When the source remains unknown after extensive evaluation, infectious disease, rheumatology, or oncology consultations may help identify less common causes or guide further
This document provides information about transverse myelitis (TM), including its definition, etiology, presentation, diagnosis, treatment, and prognosis. Some key points:
- TM is defined as acute spinal cord inflammation and injury that causes neurological deficits. It can be post-infectious, post-vaccination, or associated with MS.
- Presentation involves varying degrees of motor weakness, sensory alterations, and autonomic dysfunction below a certain spinal level. Up to half of idiopathic cases follow a respiratory or gastrointestinal illness.
- Diagnosis involves ruling out other causes through MRI, CSF analysis showing inflammation, and clinical features meeting criteria. Treatment begins with high-dose steroids to reduce inflammation,
Christopher Columbus may have suffered from and died of Reiter's arthritis. Reiter's arthritis is a painful inflammatory arthritis that develops after certain bacterial or viral infections, often in the genitourinary or gastrointestinal tracts. Symptoms include joint pain and swelling, eye inflammation, and genital lesions. Treatment focuses on treating underlying infections, reducing pain and inflammation, and managing joint symptoms.
Dermatomyositis (DM) is an inflammatory myopathy characterized by a distinctive rash that often precedes progressive symmetric muscle weakness. The rash may involve areas of the face, eyelids, knuckles, shoulders, and back. Muscle biopsy is required to confirm diagnosis and shows inflammation around blood vessels in the muscle tissue. Treatment involves immunosuppressive drugs like glucocorticoids to improve muscle strength and function. Prognosis is generally good with most patients improving on therapy, though relapses can occur.
PYREXIA OF UNKNOWN ORIGIN (PUO) refers to unexplained fever that persists for at least 3 weeks. Common causes include infectious diseases (40-60% of cases), autoimmune diseases (10-20% of cases), and malignancies. Evaluation involves detailed history, physical exam, and tiered testing including basic labs, imaging, and potentially bone marrow biopsy depending on findings. The most frequent cause varies by age, with infections more common in children under 6 and autoimmune diseases increasing thereafter. Careful examination and consideration of exposures can help identify infectious etiologies while abnormal findings may suggest alternative diagnoses.
A 60-year-old woman presented with painful, sclerotic hands and fingers due to progressive cutaneous scleroderma. She was started on a compounded topical cream containing ketamine, baclofen, gabapentin, verapamil, and pentoxifylline, which provided significant pain relief and improved sensation within a month. At a 6-month follow up, she had been largely weaned off opioid pain medications. The customized treatment targeted the pathophysiology of the condition and helped manage her debilitating symptoms.
This document provides an overview of how to approach a patient with arthritis. It describes common symptoms of arthritis and how to differentiate between inflammatory and non-inflammatory types based on history, physical exam findings, pattern of joint involvement, onset and duration of symptoms, and additional features. It discusses specific types of arthritis like osteoarthritis, gout, pseudogout, septic arthritis, rheumatoid arthritis, seronegative spondyloarthritides, and others. It provides guidance on diagnostic tests, imaging, and treatment approaches for different arthritis conditions.
A patient presenting with acute febrile illness should be treated with consideration and caution. Most cases will resolve without complication, but identifying the small percentage with potential life-threatening conditions requires careful examination and investigation over time. Making an early diagnosis risks missing unexpected developments, so empirical treatment should not be withheld in severe situations while the illness course is monitored.
This document discusses fever of unknown origin (FUO). It categorizes FUO into classical, nosocomial, neutropenic, and HIV-associated types. The most common etiologies of FUO are infections (30-60%), collagen vascular diseases (20-35%), and malignancies (10-20%). The diagnostic approach involves a careful history, physical exam, and diagnostic testing including blood tests, imaging, and biopsy. Empirical therapeutic drug trials may be used for suspected conditions like tuberculosis or culture-negative endocarditis, but have limitations and risks. The goal is to reach a specific diagnosis to guide appropriate treatment.
Diagnosis and managment of Fever of Unknown Originarahmanzai5
Fever of unknown origin (FUO) is defined as a fever over 38.3°C on at least two occasions lasting more than 3 weeks without a diagnosis. Common causes include infections such as endocarditis, malignancies such as lymphoma, and autoimmune disorders. The evaluation involves blood tests, imaging, and cultures to rule out common causes. If the cause remains unknown after initial testing, more invasive procedures like biopsy may be considered. Empiric treatment is generally avoided due to the risk of masking the underlying diagnosis, but may be considered in rapidly deteriorating patients. The prognosis is generally good, with most cases ultimately receiving a diagnosis and treatment.
This document discusses pyrexia of unknown origin (PUO), also known as fever of unknown origin (FUO). It provides definitions of PUO, outlines the normal human body temperature, and categorizes different types of PUO including classical, nosocomial, neutropenic, HIV-associated, and transplant-associated PUO. It also discusses common causes of PUO including infections, malignancies, and collagen vascular diseases. The document emphasizes the importance of a thorough history and physical examination to identify potential etiologies and key physical signs.
The document provides details on evaluating a patient presenting with fever. It includes sections on taking a thorough history with perspectives on biomedical factors, the patient's experience, and contextual background. A review of systems explores all major organ systems for localizing symptoms. The physical exam findings note vital signs and examination of different body systems. Analyzing symptoms like fever patterns, associated issues, and past medical history are essential for determining the underlying cause.
This document discusses reactive arthritis, beginning with the case of a 36-year-old man who was admitted to the hospital with acute arthritis in both knees after experiencing diarrhea. Reactive arthritis is defined as an infectious-induced systemic illness characterized by aseptic joint inflammation in a genetically predisposed individual following a distant bacterial infection. It commonly follows infections from bacteria like Salmonella, Shigella, Campylobacter, Yersinia, and Chlamydia. The presentation, epidemiology, pathogenesis, clinical manifestations, diagnostic criteria, treatment, and prognosis of reactive arthritis are described in detail.
The document provides guidance on how to take a history and examine a patient presenting with edema. It discusses evaluating the appearance, onset, first site of appearance and associated symptoms to determine if the edema is localized or generalized. Examination of the patient should include assessing nutrition status, pallor, icterus, cyanosis, lymphadenopathy and vital signs. Demonstrating edema clinically involves applying pressure over bony prominences and looking for pitting. Specific examinations are described for cardiac, renal and ascites-related edema.
Rheumatic fever is caused by an autoimmune response following a Group A streptococcal throat infection. It can affect the heart, joints, brain and skin. Heart involvement occurs in 50% of cases and can lead to permanent valve damage over years. Diagnosis is based on Jones criteria of evidence of prior streptococcal infection and major/minor clinical manifestations. Treatment involves bed rest, antibiotics, anti-inflammatories and secondary prophylaxis with antibiotics to prevent recurrence. Recurrence risks are higher if the initial attack involved heart inflammation. Long term follow up is needed due to risk of developing chronic rheumatic heart disease.
This document discusses vasculitis, which is an inflammatory destruction of blood vessels. It can affect all ages but some types are restricted to certain groups. It has both genetic and environmental components. Symptoms vary depending on the size of vessels involved and can include fatigue, rashes, nerve problems, and organ damage. Diagnosis involves clinical features, lab tests, and sometimes biopsies. Treatment is usually with steroids and other immunosuppressants to induce and maintain remission. Complications can be serious if not treated properly.
Dermatomyositis is a chronic inflammatory disorder of the skin and muscles that is characterized by an autoimmune pathogenesis. It commonly presents with characteristic rashes like Gottron's papules and heliotrope rash as well as proximal muscle weakness. Dermatomyositis can also involve internal organs like the lungs, esophagus and heart. Diagnosis involves assessing clinical features, muscle enzymes, electromyography, muscle/skin biopsies and identifying myositis-specific antibodies. Prognosis depends on the severity and organ involvement, with risks of residual weakness, contractures and death from respiratory or cardiac complications.
This document discusses fever with rash and provides details on various conditions that can cause fever and rash. It describes the causes of fever as being pyrogens produced during infection or inflammation. Rash is described as being caused by infectious organisms multiplying in the skin, toxins acting on skin, autoimmune destruction, or vasculature involvement. Several conditions are then discussed in detail, including their causative agents, hosts, modes of transmission, symptoms, rashes, complications, diagnoses, and treatments. These conditions include measles, rubella, erythema infectiosum, roseola, infectious mononucleosis, primary HIV infection, and epidemic typhus.
This document provides an approach to evaluating a case of quadriparesis (weakness of all four limbs). It discusses obtaining a detailed history regarding onset and progression of weakness, risk factors, and family history. A neurological examination including assessment of upper and lower motor neuron signs is recommended. Various etiologies are considered depending on examination findings such as compressive vs. non-compressive myelopathy, motor neuron disease, subacute combined degeneration, anterior spinal artery syndrome, and myasthenia gravis. Differential diagnoses are formulated based on characteristics such as sensory involvement, reflex changes, symmetry of weakness, and associated symptoms.
This document discusses tuberculous meningitis (TBM), the most common form of central nervous system tuberculosis. TBM can have rapid or gradual progression and commonly affects children between 6 months and 4 years old. Diagnosis involves lumbar CSF study, which typically shows lymphocytic pleocytosis and high protein levels. Treatment involves 12 months of anti-tuberculosis medications including an intensive initial phase with four drugs for 2 months followed by isoniazid and rifampin for 10 months. Prognosis depends on the clinical stage at treatment initiation, with those in the first stage having the best outcomes and those in the third stage often having permanent disabilities if they survive.
1. Pyrexia of unknown origin (PUO) is defined as a fever that persists for at least 3 weeks with an unknown source despite 1 week of inpatient investigations or 3 outpatient visits. (2) Common causes of PUO include infections (especially tuberculosis), malignancies, and collagen vascular diseases.
2. A thorough history, physical exam, and initial laboratory and imaging tests are used to identify potential sources and guide further testing. Additional tests may include lumbar puncture, bone marrow biopsy, liver biopsy, or exploratory laparotomy.
3. When the source remains unknown after extensive evaluation, infectious disease, rheumatology, or oncology consultations may help identify less common causes or guide further
This document provides information about transverse myelitis (TM), including its definition, etiology, presentation, diagnosis, treatment, and prognosis. Some key points:
- TM is defined as acute spinal cord inflammation and injury that causes neurological deficits. It can be post-infectious, post-vaccination, or associated with MS.
- Presentation involves varying degrees of motor weakness, sensory alterations, and autonomic dysfunction below a certain spinal level. Up to half of idiopathic cases follow a respiratory or gastrointestinal illness.
- Diagnosis involves ruling out other causes through MRI, CSF analysis showing inflammation, and clinical features meeting criteria. Treatment begins with high-dose steroids to reduce inflammation,
Christopher Columbus may have suffered from and died of Reiter's arthritis. Reiter's arthritis is a painful inflammatory arthritis that develops after certain bacterial or viral infections, often in the genitourinary or gastrointestinal tracts. Symptoms include joint pain and swelling, eye inflammation, and genital lesions. Treatment focuses on treating underlying infections, reducing pain and inflammation, and managing joint symptoms.
Dermatomyositis (DM) is an inflammatory myopathy characterized by a distinctive rash that often precedes progressive symmetric muscle weakness. The rash may involve areas of the face, eyelids, knuckles, shoulders, and back. Muscle biopsy is required to confirm diagnosis and shows inflammation around blood vessels in the muscle tissue. Treatment involves immunosuppressive drugs like glucocorticoids to improve muscle strength and function. Prognosis is generally good with most patients improving on therapy, though relapses can occur.
PYREXIA OF UNKNOWN ORIGIN (PUO) refers to unexplained fever that persists for at least 3 weeks. Common causes include infectious diseases (40-60% of cases), autoimmune diseases (10-20% of cases), and malignancies. Evaluation involves detailed history, physical exam, and tiered testing including basic labs, imaging, and potentially bone marrow biopsy depending on findings. The most frequent cause varies by age, with infections more common in children under 6 and autoimmune diseases increasing thereafter. Careful examination and consideration of exposures can help identify infectious etiologies while abnormal findings may suggest alternative diagnoses.
A 60-year-old woman presented with painful, sclerotic hands and fingers due to progressive cutaneous scleroderma. She was started on a compounded topical cream containing ketamine, baclofen, gabapentin, verapamil, and pentoxifylline, which provided significant pain relief and improved sensation within a month. At a 6-month follow up, she had been largely weaned off opioid pain medications. The customized treatment targeted the pathophysiology of the condition and helped manage her debilitating symptoms.
This document provides an overview of how to approach a patient with arthritis. It describes common symptoms of arthritis and how to differentiate between inflammatory and non-inflammatory types based on history, physical exam findings, pattern of joint involvement, onset and duration of symptoms, and additional features. It discusses specific types of arthritis like osteoarthritis, gout, pseudogout, septic arthritis, rheumatoid arthritis, seronegative spondyloarthritides, and others. It provides guidance on diagnostic tests, imaging, and treatment approaches for different arthritis conditions.
A patient presenting with acute febrile illness should be treated with consideration and caution. Most cases will resolve without complication, but identifying the small percentage with potential life-threatening conditions requires careful examination and investigation over time. Making an early diagnosis risks missing unexpected developments, so empirical treatment should not be withheld in severe situations while the illness course is monitored.
This document discusses fever of unknown origin (FUO). It categorizes FUO into classical, nosocomial, neutropenic, and HIV-associated types. The most common etiologies of FUO are infections (30-60%), collagen vascular diseases (20-35%), and malignancies (10-20%). The diagnostic approach involves a careful history, physical exam, and diagnostic testing including blood tests, imaging, and biopsy. Empirical therapeutic drug trials may be used for suspected conditions like tuberculosis or culture-negative endocarditis, but have limitations and risks. The goal is to reach a specific diagnosis to guide appropriate treatment.
Diagnosis and managment of Fever of Unknown Originarahmanzai5
Fever of unknown origin (FUO) is defined as a fever over 38.3°C on at least two occasions lasting more than 3 weeks without a diagnosis. Common causes include infections such as endocarditis, malignancies such as lymphoma, and autoimmune disorders. The evaluation involves blood tests, imaging, and cultures to rule out common causes. If the cause remains unknown after initial testing, more invasive procedures like biopsy may be considered. Empiric treatment is generally avoided due to the risk of masking the underlying diagnosis, but may be considered in rapidly deteriorating patients. The prognosis is generally good, with most cases ultimately receiving a diagnosis and treatment.
The document discusses fever of unknown origin (FUO). It defines FUO as a fever over 38.3°C on two occasions that lasts longer than 3 weeks and where the cause is not determined after a week of testing. Common causes include infections like tuberculosis, inflammatory diseases, and cancers. The document outlines different categories of FUO and discusses approaches to evaluating potential causes based on factors like location of fever onset and patient immune status. It also lists specific conditions that commonly underlie FUO and notes their distinguishing features.
Here are the key types of fever patterns:
a) Continuous fever - Fever persists continuously without significant variation in temperature. Seen in conditions like tuberculosis, bacterial endocarditis.
b) Intermittent fever - Fever with abrupt onset and remission, such as in malaria. Temperature spikes occur at regular intervals.
c) Remittent fever - Fever that decreases but does not return to normal. The temperature remains elevated between peaks, such as in typhoid fever.
This document provides information on fever of unknown origin (FUO). It defines FUO as a fever over 38.3°C for at least 3 weeks without a confirmed diagnosis after tests and visits. Common causes include infections, cancers, and autoimmune disorders. The evaluation involves medical history, exam, lab tests, imaging and biopsies to identify infectious, inflammatory or malignant sources. Treatment focuses on the underlying cause rather than empiric antibiotics or steroids. Some cases remain undiagnosed, but most adult patients have a good prognosis in these situations.
Diagnosis and examination of swollen lymph nodes ppt.pptxriazsohail448
The document discusses the diagnosis and evaluation of lymphadenopathy. It notes that lymphadenopathy can be localized, involving a single area, or generalized, involving two or more noncontiguous areas. For unexplained lymphadenopathy, localized cases may warrant biopsy if symptoms persist for 3-4 weeks, while generalized cases almost always indicate a systemic disease and biopsy is recommended. Risk factors for lymphoma are also outlined. Proper biopsy is important for diagnosis before treatment decisions. A case study example of a patient with cervical and supraclavicular lymphadenopathy and symptoms is then presented and worked through.
This document describes a case of Fournier's gangrene in a 43-year-old man. The patient presented with flu-like symptoms but upon examination was found to have necrotic scrotal tissue with surrounding erythema and crepitus, indicating necrotizing fasciitis. Treatment for Fournier's gangrene requires aggressive antibiotic therapy, early and repeated surgical debridement of necrotic tissue, and wound care. Scores like LRINEC and FGSI can help predict patient prognosis and risk of mortality from this rare but life-threatening infection.
This document discusses lymphadenopathy and provides information about evaluating and diagnosing causes of lymphadenopathy. It begins by defining lymphadenopathy and describing classifications such as localized versus generalized. For patients presenting with unexplained lymphadenopathy, approximately 3/4 will have localized lymphadenopathy while 1/4 will have generalized. The document then discusses evaluating the history, performing a physical exam, potential causes of lymphadenopathy, and guidelines for biopsy of localized versus generalized lymphadenopathy. It also provides a case study of a patient, M.S., who presented with lymphadenopathy and was ultimately diagnosed with Stage IIB nodular sclerosis Hodgkin's lymphoma.
This document discusses lymphadenopathy and provides information about evaluating and diagnosing causes of lymphadenopathy. It begins by defining lymphadenopathy and describing classifications such as localized versus generalized. For patients presenting with unexplained lymphadenopathy, about 3/4 will have localized lymphadenopathy while 1/4 will have generalized. The document then discusses evaluating the history, performing a physical exam, potential causes of lymphadenopathy, and approaches to localized versus generalized unexplained lymphadenopathy. It provides a case study of a patient named M.S. who was ultimately diagnosed with Stage IIB nodular sclerosis Hodgkin's lymphoma.
This document discusses pyrexia of unknown origin (PUO). It defines PUO as a fever over 38°C lasting more than 3 weeks without an obvious cause despite evaluations. Common causes include infections (40%), malignancies (25%), and autoimmune diseases (15%). The document outlines the pathogenesis of fever and classifications of PUO. It describes the approach to evaluating a PUO patient through history, exam, and staged laboratory/imaging investigations. Empirical treatment trials are generally not recommended until a cause is found due to risks of misleading outcomes. The prognosis is determined by the underlying disease, with neoplasms having the worst outcomes.
The document discusses the evaluation and diagnosis of pyrexia of unknown origin (PUO). It defines PUO and provides classifications. The most common causes are infections (30-40%), neoplasms (20-30%), and non-infectious inflammatory conditions (10-20%). The initial approach involves thorough history, physical exam, and basic lab tests. Further targeted testing is based on clues from initial evaluation and may include specialized cultures, biopsies, and imaging. The goal is to methodically consider and rule out more likely causes through an intensive diagnostic process to identify the underlying condition.
The document discusses symptomatology and fever of unknown origin (PUO). It notes that symptomatology refers to a patient's symptoms and signs. PUO is defined as fever that is unexplained after three outpatient visits or three days of investigation in the hospital. Common causes of PUO include infections, malignancies, and collagen vascular diseases. A thorough history, physical exam, and basic diagnostic tests are important for evaluating PUO.
This document provides information on fever in infants and children, including:
1) It describes the differences between true fever caused by the body's set point being increased due to infection or inflammation, versus false fever which does not directly increase the set point.
2) Evaluation of the febrile infant or child involves obtaining a thorough history, physical exam, and screening tests like CBC, blood cultures, and lumbar puncture if meningitis is suspected, to identify potential causes and focus of infection.
3) Management depends on the age of the child. Neonates less than 1 month require full sepsis workup and antibiotics if febrile. Infants 1-3 months can potentially be treated as out
hodgkin lymphoma in children with case presentationJOEL RAJAN U
childhood Hodgkin lymphoma includes swollen lymph nodes, fever, drenching night sweats, and weight loss. Tests that examine the lymph system and other parts of the body are used to diagnose and stage childhood Hodgkin lymphoma. Certain factors affect prognosis (chance of recovery) and treatment options.Hodgkin lymphoma is a rather rare malignancy in the pediatric population, however, it constitutes approximately 40% of all lymphomas that present during childhood and is the most common malignancy in adolescents and young adults. In all age groups, Hodgkin lymphoma is highly sensitive to chemotherapy and irradiation
This document discusses Acquired Immunodeficiency Syndrome (AIDS) and HIV. It defines AIDS as being caused by HIV, which attacks and destroys the immune system. As the immune system weakens from HIV, opportunistic infections like Pneumocystis pneumonia and cancers like Kaposi's sarcoma can develop. The document covers the normal immune system, stages of HIV infection from acute to AIDS, common opportunistic infections seen at different CD4 counts, and treatments for HIV and associated conditions.
This document discusses Acquired Immunodeficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV). It describes how HIV attacks and destroys the immune system, leading to AIDS. It outlines the stages of HIV infection from initial infection through asymptomatic infection to AIDS. It details many opportunistic infections and conditions that can occur in AIDS patients as a result of their weakened immune systems, such as Pneumocystis pneumonia, toxoplasmosis, cryptococcal meningitis, and Kaposi's sarcoma. It also discusses how antiretroviral therapy and prophylaxis can slow progression to AIDS and prevent opportunistic infections.
This document discusses the presentation, symptoms, and workup of lymphoma. It notes that lymphoma often presents with painless lymph node enlargement, weight loss, fever, and night sweats. The workup involves a physical exam focusing on lymph nodes and organs, as well as blood tests that can show anemia, elevated lactate dehydrogenase, and low albumin. Tissue biopsy is needed for a confirmed diagnosis of lymphoma.
Yersinia and Pasteurella are important bacterial pathogens. Yersinia pestis causes plague via transmission from rodents and their fleas to humans. It can cause bubonic, septicemic or pneumonic plague. Yersinia enterocolitica and Y. pseudotuberculosis can cause gastroenteritis and mesenteric lymphadenitis via the fecal-oral route. Pasteurella multocida is a zoonotic pathogen that can cause abscesses and meningitis in rare cases of human infection. Laboratory diagnosis involves culture, staining and serology of specimens depending on the suspected infection. Control relies on surveillance, treatment of cases, and measures to reduce rodent and flea
This document discusses myocarditis and pericarditis. It begins by describing the objectives of explaining the epidemiology, risk factors, pathogenesis, types, etiological agents, clinical presentation, diagnosis, and management of myocarditis and pericarditis. It then provides details on the definition, causes, clinical presentation and diagnosis of myocarditis. It also discusses the definition, types, pathophysiology, clinical presentation, differential diagnosis, investigations and management of pericarditis. It highlights that viral infections are a common cause of both conditions.
A 46-year-old male presented with sudden onset of chest pain radiating to the left arm and shortness of breath. He has risk factors of smoking but no other medical history. On examination, his vitals were stable and heart and lung sounds were normal. The document discusses the arterial supply of the heart and how electrocardiogram leads correspond to different areas of the heart muscle. It provides detailed descriptions of ST segment changes that would indicate occlusions or blocks in different coronary arteries and the regions of the heart affected.
The document presents the 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery. It was developed by a task force of experts and provides updated recommendations based on evidence levels. New recommendations include structured characterization of AF, screening recommendations, use of patient-reported outcomes, reassessment of stroke and bleeding risk, and considerations for rhythm control including catheter ablation.
This document discusses different types of wheezing in children and approaches to diagnosis and treatment. It addresses acute wheezing in young children which is usually due to bronchiolitis or cold and treated symptomatically. Recurrent wheezing may not indicate asthma, and a risk-based probability approach is recommended to evaluate if symptoms warrant treatment with inhaled corticosteroids. Factors like family history, atopy, frequency of colds can help determine the likelihood that recurrent wheezing is asthma. A trial of ICS may help decide if asthma is present when probability is unclear. Bronchodilators are usually sufficient for infrequent viral-induced wheezing.
1. Imaging plays an important role in the evaluation and management of patients with acute stroke.
2. Different imaging modalities such as CT, CT angiography, CT perfusion, MRI, MR angiography, and MR perfusion have benefits for assessing the brain parenchyma, vasculature, perfusion, and identifying potentially salvageable penumbral tissue.
3. Diffusion-weighted MRI is the most sensitive method for detecting acute ischemia within the first few hours, while perfusion imaging can identify tissue at risk of infarction in the ischemic penumbra that may be rescued with reperfusion therapy.
This document discusses arterial disorders and provides an overview of arterial anatomy, layers of arteries, arterial pulses, and clinical tests. It describes common arterial conditions like stenosis, aneurysms, arteritis, and small vessel abnormalities. Specific disorders discussed in detail include thromboangiitis obliterans, Takayasu's arteritis, Raynaud's phenomenon, aneurysms, and arteriovenous fistulas. Three case scenarios are presented concerning Leriche syndrome, arteriovenous fistula, and dissecting aortic aneurysm.
This document provides an overview of interstitial lung diseases (ILDs). It discusses the protective mechanisms of the lung, pathogenesis of ILDs including different presentation patterns, classification of ILDs, diagnostic testing approaches, treatment options including drug therapy and pulmonary rehabilitation. Key points covered include common causes of different radiographic patterns seen on chest imaging for ILDs and rules for approaching a practical diagnosis of ILD based on clinical and imaging features.
Innovative gadgets in anesthesia and medicine ikramdr01
This document provides information on various innovative medical gadgets classified into different categories such as para operative monitors, anesthesia related gadgets, and operation theatre related gadgets. It describes gadgets such as blood pressure monitors, thermometers, weighing scales, pulse oximeters, stethoscopes, ECG machines, glucometers, spirometers, and telehealth solutions. It also discusses smart contact lenses, insulin pens, adhesive bandages, ventilators and other anesthesia equipment that have been developed with new technologies.
This document describes several patient cases presented to highlight important lessons in clinical cardiology. It emphasizes the importance of a thorough history and physical exam over reliance on tests alone. In case 1, careful auscultation revealed pericarditis, not reinfarction. Case 2 showed occult bleeding, not arrhythmia, caused syncope. Case 3 demonstrated a pleural effusion, not refractory heart failure, as the cause of dyspnea. Clinical clues are key to the appropriate management of each case.
Tuberculosis can manifest as either pulmonary or extra-pulmonary disease. Pulmonary TB, which accounts for over 78% of cases, is divided into primary TB occurring after initial infection and reactivation post-primary TB. Extra-pulmonary TB involves sites outside the lungs, with lymph nodes, pleura, and the genitourinary tract being most commonly affected. Symptoms vary depending on the infected site but may include cough, fever, night sweats, and weight loss.
Gestational diabetes (GDM) is glucose intolerance that begins or is first recognized during pregnancy. It can be caused by either pre-existing type 2 diabetes or a new onset of diabetes during pregnancy. The document discusses screening, diagnosis and management of both pre-existing diabetes and GDM during pregnancy. It aims to provide optimal glucose control to support fetal growth while avoiding risks of hyper- and hypoglycemia. Treatment involves medical nutrition therapy, glucose monitoring and may require insulin therapy in some cases. Close monitoring is needed throughout pregnancy and postpartum to support maternal and fetal health.
Gestational trophoblastic disease is a heterogeneous group of lesions arising from abnormal placental trophoblast proliferation. It includes premalignant conditions like complete and partial hydatidiform moles, as well as malignant gestational trophoblastic neoplasia (GTN). GTN has varying potential for local invasion and metastasis. While rare, GTN is highly curable even with widespread dissemination. Treatment involves chemotherapy, with single or multi-agent regimens depending on risk factors and disease stage according to the FIGO scoring system. Careful monitoring of beta-hCG levels is important for diagnosis and follow-up.
This document provides an overview of heart failure, including different types (e.g. acute vs chronic, systolic vs diastolic), biomarkers used to monitor patients, standard treatment options like diuretics and ACE inhibitors, newer drugs in development, and management challenges like high treatment costs. It uses the analogy of a donkey to describe escalating medical interventions for heart failure, from initial diuretic use to more aggressive ionotropes or devices like LVADs for end-stage cases. The document highlights biomarkers that can guide discharge decisions and newer biomarkers being explored, as well as newer drugs and devices in development or use such as CRT devices, ECLS, and LVADs.
A 14-year-old boy presented to the emergency department with symptoms of an autonomic storm after being bitten by a scorpion. He was diagnosed with scorpion sting in autonomic storm. He was given prazosin, hydrocortisone, and other supportive treatments. His condition stabilized and he was discharged after 6 days. Scorpion stings can cause local effects and a systemic autonomic storm response due to neurotoxins that affect sodium channels and induce catecholamine release. Prazosin is an effective treatment as it blocks alpha receptors and counters the effects of venom.
Sarcoidosis and IgG4-related diseases are inflammatory conditions characterized by granuloma formation. Sarcoidosis is a multisystem disorder involving lungs in over 90% of cases and skin, eyes, and liver in about a third of patients each. It is thought to be triggered by an infectious or environmental agent in a genetically susceptible host. IgG4-related disease is a fibroinflammatory condition that can affect virtually any organ, forming tumefactive lesions. Treatment for both conditions typically involves corticosteroids, with immunosuppressants used for chronic or resistant cases.
Neuropathic pain understanding and managementikramdr01
1. The document discusses diabetic neuropathy, including its classification, clinical characteristics, underlying mechanisms, investigations and pharmacological treatment.
2. Key points include that diabetic neuropathy has many subtypes and involves both large and small nerve fibers. The clinical features progress from negative symptoms like loss of sensation to positive symptoms like pain. Investigations include electrodiagnostic testing and skin or nerve biopsies.
3. Treatment involves first-line options like duloxetine, pregabalin and TCAs. Polypharmacy with combinations from different classes may be considered for refractory cases. Factors like comorbidities, side effects, costs and drug interactions must be evaluated when selecting an individual's treatment plan.
Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) can help optimize heart failure management. CRT improves symptoms, reduces hospitalizations, and increases survival in patients with reduced ejection fraction, left bundle branch block, and wide QRS duration. ICDs prevent sudden cardiac death in high-risk patients with prior heart failure, low ejection fraction, or history of dangerous arrhythmias. New devices use adaptive and multi-point pacing to better resynchronize the left ventricle. Device therapy improves outcomes when guided by clinical evidence and used in appropriate heart failure patients.
Kawasaki disease is an autoimmune disease that causes inflammation in blood vessels throughout the body. It was first described in 1967 by Dr. Kawasaki in Japan. It most commonly affects children under 5 years old. Without treatment, it can lead to fatal coronary artery aneurysms in some children. The cause is unknown but likely involves genetic and environmental factors such as a viral or bacterial infection. Diagnosis is based on symptoms that include prolonged fever and changes in lips, mouth, hands and feet. Echocardiograms are used to check for heart complications which include aneurysms and heart valve issues.
bedside approach to common congenital heart diseasesikramdr01
This document summarizes common congenital heart diseases, their presentations, and physical exam findings. It discusses how conditions like ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), pulmonary stenosis (PS), and tetralogy of Fallot (TOF) can present in neonates, infants, children or adolescents with symptoms like cyanosis, heart failure, or murmurs. Physical exam findings for each condition are provided to help determine the location and nature of cardiac lesions.
This document provides an overview of atrial fibrillation (AF), including its pathogenesis, types, diagnosis, and management. Some key points:
- AF is the most common cardiac arrhythmia, affecting around 6% of those over 65. It increases the risk of stroke.
- It occurs when the normal sinus rhythm is overridden by disorganized electrical impulses, usually originating in the lungs.
- Types include paroxysmal, persistent, and permanent. Symptoms range from none to palpitations, dyspnea, chest pain, and neurological issues.
- Diagnosis is made via ECG showing irregular rhythm without P waves. Workup evaluates for underlying causes and stroke risk factors.
Infective endocarditis is a microbial infection of the heart valves or endocardium. It is characterized by the formation of vegetations composed of platelets, fibrin, microorganisms, and inflammatory cells. It occurs more commonly in males and the elderly. Streptococci and Staphylococcus aureus are the most common causes. Diagnosis involves blood cultures, echocardiography, and applying the Duke criteria. Complications include embolisms, heart failure, and metastatic infections. Treatment involves prolonged antibiotic therapy targeted to the infecting organism. Surgery may be needed for complications or uncontrolled infection. Antibiotic prophylaxis is now restricted to highest risk patients undergoing highest risk procedures.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
9. Epidemiology and Etiology
Infections 30 - 60 %
Collagen Vascular Disease 20 – 35 %
Malignancies 10 – 20 %
Miscellaneous 15 – 20 %
Undiagnosed 10 – 15 %
Categories of PUO in India
Handa et al
Handa et al
(1996)
D Kejarwal et
al (2001)
Di panjan
Bhandyopadha
yay et al (2011)
Infections 43.8% 53% 53.8%
Collagen Vascular
Disease
15.7% 11% 11%
Neoplasm 8.3% 17% 22%
10. Etiologies of FUO
Infection: Three major causes
Intracellular organisms. (Salmonella
Mycobacterium, Brucella)
Intravascular … SBE
Abscess .. especially occult ..
11. Etiologies of FUO
Infection- Tuberculosis: .. Disseminated
Single most common infection in most PUO series
Usually extrapulmonary or miliary, or
Occurs in the lungs and significant pre-existing lung
disease.
Pulmonary TB in HIV is often subtle (normal chest x-
rays 15 – 30%).→
PPD is (+ve) < 50% of TB with FUO.
Diagnosis often requires Bx of LN/Liver/Bone
marrow.
Sputum smear (+) only15- 25%
12. Etiologies of FUO
Bacterial Endocarditis:
Culture remains negative in 5-30% of patient.
Culture negative is likely with the following organisms:
Coxiella burnetii no growth.→
HACEK group incubate blood 7 – 21 days→
Brucella } Special media/
Legionelle } long time
Mycoplasma/Chlamydia }
Fungal usually sterile→
Peripheral signs may not be detected.
Right-side Endocarditis Lack murmurs self antibiotics→ → →
growth (-ve).
13. Etiologies of FUO
Abscess:
Usually located in abdomen or pelvis.
Secondary to appendicitis or diverticulitis.
Pyogenic liver abscess usually follow biliary tract dis./abd.
Suppuration.
Splenic abscess is usually secondary to hematogenous
seeding.
Perinephric or renal abscess is usually secondary to UTI.
Subphrenic Abscess
Retroperitoneal Abscess
Paravertebral Abscess
14. Etiologies of FUO
Collagen-Vascular-Disease
You need to recognize the syndrome otherwise no
diagnosis
SLE
Still’s disease (young or adult)—23-50%
Giant cell arteritis } 15% of PUO→
Polymyalgia Rheumatica }
Behcet’s Disease
Relapsing polychondritis
15. Etiologies of FUO
Malignancy
Lymphoma … Fever is a presenting feature
Leukemia … M. Myeloma
Renal cell carcinoma …
HCC or secondary metastasis to the liver
Benign Neoplasm
16. Etiologies of FUO
Miscellaneous Causes: (Non-Infectious)
Vascular Causes:
Pulmonary Emboli
50% are febrile
Fever is < 39o
C
Patient typically has predisposing factors cancer or recent→
immobility.
Hematoma in closed space
When it cause PUO usually arise from hemorrhage in the→
retroperitoneal space or within the wall of an aneurysm or
dissection of the thoracic or abdominal aorta.
17. Etiologies of FUO
Hyperthyroidism
Occasionally cause PUO most frequently diagnosed clinically.→
Often accompanied by weight loss.
Familial Mediterranean Fever
Recurrent fever
Arthritis pain out of proportional to signs
Polyserositis (peritonitis … may be pleuritis)
Leukocytosis
Not always hereditary
18. Etiologies of PUO
Factitious Fever
Febrile PUO
In one study … 9% of cases of PUO
False fever: thermometer manipulation using external
heat or substitute thermometer.
H/O Psychiatric illness
Increasing somewhat in elderly …
Generally young women with connection to health care
… often NURSES.
21. Drug Fever
No characteristic fever pattern
was observed.
Maximum temperatures
ranged from 38°C to 43°C
The mean lag time between
initiation of a drug and the
onset of fever was 21 days, but
lag times varied considerably.
Alpha methyldopa and
quinidine were the two drugs
most commonly implicated,
but antimicrobials (as a
group) were responsible for
the largest number of
episodes.
EpisodesEpisodes
in Dallasin Dallas
(n=51)(n=51)
EpisodesEpisodes
in Lit.in Lit.
(n=97)(n=97)
TotalTotal
EpisodesEpisodes
(n=148)(n=148)
nn nn %%
Gender (male/female)Gender (male/female) 27/1827/18 53/4453/44 56/4456/44
Hx of atopic diseaseHx of atopic disease 00 33 22
Previous hx of drug allergyPrevious hx of drug allergy 44 1212 1111
Fever patterns reportedFever patterns reported
ContinuousContinuous
RemittentRemittent
IntermittentIntermittent
HecticHectic
5151
00
1919
66
2626
4141
99
77
1313
1212
6262
1010
2828
2121
4141
RigorsRigors 2626 5252 5353
Relative bradycardiaRelative bradycardia 55 44 1111
HypotensionHypotension 66 2121 1818
RashRash
PruritusPruritus
2020
1111
66
00
1818
77
Leukocytosis (>10K)Leukocytosis (>10K) 1111 00 77
Eosinophilia (>300/mmEosinophilia (>300/mm33
)) 2121 1212 2222
HematologicHematologic 11 1212 99
DeathsDeaths 22 44 44
Mackowiak and LeMaistre Ann Intern Med 1997;106:728
23. History
Verify the presence of fever:
Duration & Pattern of Fever
Tertian & Quartian Pattern→ Malaria
Pel-Ebstein Pattern → Lymphoma
Pulse-Temp Dissociation → Typhoid/Brucellosis
24. History
Family History:
Scrutinized for possible infectious or hereditary
disorders
Tuberculosis
FMF
Past Medical Condition:
Lymphoma,Rheumatic Fever,Still’s Disease,Behcet’s
Disease may recur→
Travel History
Work Environment
Exposure to sexual partner … HIV, Syphilis
Illicit drug abuse (IV) … Infective endocarditis,
Hepatitis … HIV
27. Physical Examination
Examine the Skin:
Rash:
SLE ….. All types of rashes is described
Still’s Disease Evanescent erythematous rash over the trunk
Infective Endocarditis (Janeway’s lesion)
Typhoid Fever … rose spots over abdomen
Osler’s Nodes: Painful nodule on the pads of toes & fingers →
Infective Endocarditis
28. Physical Examination
Examine for Oral Ulcer
SLE
Behcet’s Syndrome
Examine for Arthritis
Examine the Fundus
Roth’s spots (white-centered haemorrhage) Infective→
Endocarditis
Yellowish-white choroidal lesion Tuberculosis→
Choriodoretinitis Active Toxo or CMV in HIV patient.→
31. Diagnostic Testing
ESR
If elevated significant inflammatory process→
Greatest use in establishing a serious underlying disease,
esp. if v. high ESR > 100 mm/h …→
Tuberculosis,Myeloma,Temporal arteritis
CRP-closely associated with inflammatory process
• ESR & CRP is elevated in:
• 1.Bacterial Infection 2. Neoplasm
3.Immunological-mediated inflammatory states
4.Tissue infarction
33. Diagnostic Testing- Second Evaluation
Blood Testing
Anti-nuclear Antibodies
Rheumatoid Factor
CMV & EBV Antibody … IgM
Brucellosis AB titre
Thyroid Function Test
HIV Screening
34. Diagnostic Testing- Second Evaluation
CT-Scan CT scan chest→
Mediastinal mass Tuberculosis/Lymphoma/ Sarcoidosis→
Dorsal Spine Spondylitis and disc space disease→
CT-Scan Abdomen very effective to visualize→
All types of abscesses
Retroperitoneal tumor, lymph node or haematoma
ECHO
Bone Marrow Aspiration & Culture
Colonoscopy & Biopsy
Radionucletide scans
PET scan
35. Therapeutic Trials
Limitations and risk of empirical therapeutic trials:
Rarely specific
Underlying disease may remit spontaneously false
impression of success.
Disease may respond partially and this may lead to delay in
specific diagnosis.
Side effect of the drugs can be misleading.
36. Therapeutic Trials
Antimicrobial Trials:
Expected to suppress, but not cure, an infectious process
such as abscess may have false feeling of response.→
Failure to have quick response does not mean wrong→
diagnosis:
Endocarditis
Pelvic inflam. Disease
Typhoid Fever
Start early in certain conditions- Cirrhosis , Asplenia ,
Biologic Therapy, on Immuno Suppressive,Travel
Exposure
38. Therapeutic Trials
Empiric drug trial for suspected T.B:
Presence of granuloma on Bx before culture result.
Elderly or immunocompromised patient with (+ve) TB skin
test and deteriorating clinical condition.
No drug for stable patient without any suggestive features
laboratory result.
39. Therapeutic Trials
Empiric drug trial for suspected culture:
(-ve) Endocarditis:
Patient with new or changing murmur or peripheral signs of
endocarditis.
40. Therapeutic Trials
Empiric drug trials for suspected Vasculitis:
Elderly with weight loss and any symptoms suggestive
(headache, visual disturbance, jaw claudication) and ESR >↑
50 mm/hr →
Patient above 50 yrs who is c/o muscle pain and stiffness
around hip and shoulder with ESR↑ →
Ongoing vasculitis
Dramatic response is enough to establish the DX.
NSAIDS & Colchichine
41. Prognosis
It depends on:
Cause of fever
Nature of the underlying disease(s) BUT .. Generally
poor in:
Elderly
Neoplasm
Diagnostic delay has adverse effect in:
Intra Abdominal Infection
Miliary Tuberculosis
Recurrent Pulmonary Emboli
Disseminated Fungal Infection
Temporal Arteritis
42. Outcome
If the cause of fever remains elusive repeat history→
and examination.
5 – 15% of cases The diagnosis remain obscure.→
However, most of these patients defervesce without
treatment no disease later.→
57. Etiologies of PUO
Alcoholic Hepatitis
Often unsuspected pt. deny→
Fever is usually low grade < 38.5o
C
May have jaundice and hepatomegaly.
AST > ALT 2:1 AST < 500↑
Leukocytosis is often there.
If you do not think about it in the right time and with the
right patient … then you will be troubled and will work a lot
in order to get the etiology.
58. Diagnostic Testing
↑ High ESR lacks specificity:→
Drug Reaction }
Thrombophlebitis } may cause very high ESR
Nephrotic Syndrome }
Normal ESR significant inflammatory process is→ absent with
exception.
59. Diagnostic Testing
Laparoscopy
To visualize and biopsy the pathology in the abdomen
suggestive of:
e.g. Tuberculous peritonitis
Peritoneal carcinomatosis
Biopsy
Enlarged lymph node
Granulomatous disease (Tuberculosis)
Metastatic carcinoma
Others
61. Diagnostic Testing
Cultures
Blood
Obtain more than 3 blood cultures from separate venipunctures
over 24 hr period if you are suspecting inf. Endocarditis prior
antimicrobial use.
Incubate the blood for 4 weeks, to detect the presence of SBE &
Brucellosis
Sputum: For Tuberculosis
63. Management of FUO
Withhold therapy until the cause is found
Exceptions:
Neutropenic Fever
Unstable hospitalized patient
Corticosteroids in suspected Temporal Arteritis
HIV Patients
Editor's Notes
However, Engeron76 studied 100 postoperative cardiac surgery patients and was unable to demonstrate a relationship between atelectasis and fever. Furthermore, when atelectasis is induced in experimental animals by ligation of a mainstem bronchus, fever does not occur.77 78 However, Kisala and coworkers79 demonstrated that IL-1 and TNF- levels of macrophage cultures from atelectatic lungs were significantly increased compared with the control lungs. The role of atelectasis as a cause of fever is unclear; however, atelectasis probably does not cause fever in the absence of pulmonary infection.
76. Engoren, M (1995) Lack of association between atelectasis and fever. Chest 107,81-84[Abstract]
77. Shields, RT (1949) Pathogenesis of postoperative pulmonary atelectasis an experimental study. Arch Surg 48,489-503
78. Lansing, AM (1963) Mechanism of fever in pulmonary atelectasis. Arch Surg 87,168-174[ISI]
79. Kisala, JM, Ayala, A, Stephan, RN, et al (1993) A model of pulmonary atelectasis in rats: activation of alveolar macrophage and cytokine release. Am J Physiol 264(3 Pt 2),R610-R614[Abstract/Free Full Text]