Chapter 3: the febrile patient Flashcards
does core temperature vary at different times of the day
yes, the coldest being in the morning
where is the temperature control center
anterior hypothalamus in combination with brain stem and sympathatic ganglia
mechanism underlying the febrile response
IL1/IL6/TNF alpha released by monocytes and macrophages=> stimulate circumventricular organs near the optic chiasm=> activates phospholipase A2=> stimulates cyclooxygenase=> produce ⬆ prostaglandins=>cross BBB and stimulates anterior hypothalamus
how does acetyl salicylic acid reduce fever
decreases prostaglandin E2 production
do you use ASA for a febrile child?
NOOOOO, it causes reyes syndrome (hepatic and renal failure)
only in kawasaki disease(vasculitis) you are permitted to use aspirin in children
management of a new onset fever in hospitalized patients
find the cause:
key infection sites include:
wounds(predisposed in decubiti)
lungs(differentiate between colonization and infection)
urinary tract(prolonged catheterization, nearly all patient with a catheter develop UTI within 30 days)
sinuses (nasogastric tubes)
empiric antibiotics after culture results, prolonged antibiotic treatment leads to colonization of a antibiotic resistant C.diff/collitis
non-infectious sites:
pulmonary emboli
drug fever
old hemorrhage
what are the diagnostic criteria for FUO fever of unknown origin
illness lasting for more than 3 weeks
fever >38 C on several occasions
no diagnosis after routine workup for 3 or more outpatient visits
what are the causes of FUO fever of unknown origin
infectious neoplasm autoimmune miscellaneous: drug fever familial Mediterranean fever P embolus subacute thyroiditis liver
infections as a cause of FUO
epidemiology : animal exposure insect bites outdoor camping travel and exposure to the infected
physical examination
skin
nail beds
cardiac auscultation
causes:subacute endocarditis
subacute pyelonephritis
miliary tuberculosis must always be considered
rickettsial infection after a history of camping (tic borne)
osteomyelitis
chlamydia and epstein barr virus
neoplasms as a cause of FUO
lymphoma is the most common pel-epstein fever associated with hodgkin lymphoma renal cell carcinoma preleukemia primary hepatoma (metastiatic doesnt) atrial myxoma
causes of autoimmune FUO
bechet disease inflammatory bowel diseae hyperthyroidms kawasaki polyarteritis nodosa systemic lupus subacute thyroidits stills disease (disorder featuring inflammation, is characterized by high spiking fevers, salmon-colored rash that comes and goes, and arthritis) kikuchis disease (Kikuchi disease is a benign (non-cancerous) condition of the lymph nodes . The main symptoms include swollen lymph nodes in the neck, mild fever, and night sweats)
most common drug that causes FUO
phenitoin (anticonvulsants): frequently causes allergic reactions
do you discontinue all drugs in patients with FUO
yes
what’s stuttons law for FUO
go where the money is, don’t over test. tests should be directed toward specific complaints and abnormalities found on preliminary testing
FUO in HIV patients
often the first symptom of an opportunistic infection
mycobacteria is the most common
Cytomegalovirus and cryptococcus and toxoplasma are also common
