Clinical Manifestations in Fever Flashcards
What is bacteremia?
abnormal presence of bacteria in blood stream
Most common sources of bacteremia
skin and soft tissue infections, catheters, bone and joint infections, endocarditis, pneumonia
Clinical manifestations of bacteremia
fever, fatigue, nausea, vomiting, dehydration, leukocytosis and L shift on hemogram
Definition of septicemia
derived from bacteremia or inflammatory responses and can progress to early sepsis, sepsis, and/or septic shock; organ dysfunction
Sepsis determination - SOFA
lengthy, time consuming organ dysfunction score
Sepsis determination - qSOFA
based on resp rate, altered mental status, BP <100 mmHg; predicts chance os sepsis for patients admitted to the medical floor
Sepsis risk factors
ICU admission, bacteremia, age>65yo, immunosupression, diabetes and obesity, CA, CA-pneumonia, previous hospitalizations requiring abx therapy
Clinical manifestations of sepsis
sxs and signs specific to infectious source, arterial hypotension (SBP < 90 mmHg, MAP < 70), temp >38.3 or <36, HR >90 bpm, tachypnea
End-Organ manifestations of sepis
warm, flushed skin, skin may become cool, decreased cap refill, cyanosis, altered mental status, restlessness, oliguria, anuria, ileus or absent bowel sounds
Lab eval in sepsis
leukocytosis or leukopenia, hyperglycemia, arterial hypoxemia, acute oliguria, Cr increase, coag abnormalities, thrombocytopenia, hyperlactemia, hyperbilirubinemia
Diagnosis of sepsis
H&P, clinical reasoning, evidence based medicine
Staphylococcal bacteremia caused by what organisms
Methicillin sensitive S. aureus (MSSA), Methicillin resistant S. aureus (MRSA)
Staph infections are commonly due to…
breaks in skin integrity, IV catheters, pacer, ortho hardware
Signs and sxs of systemic staph ifx
bone or joint pain, protracted fever and/or sweats, abdominal pain, CVA tenderness, HA
Appearance of MRSA infected wounds
erythema with induration and purulent drainage
S. aureus bacteremia can lead to what complications
endocarditis, osteomyelitis, deep-seated systemic infections
Erysipelas
superficial skin infx with well-defined borders
Cellulitis
deeper skin infx involving dermis and subQ fat with indiscrete borders; propensity to lymphangitis, edema, swelling
Risk factors for community-acquired MRSA
contact sports, military service, incarceration, injection drug use
S. pyogenes causes what infections
tonsillopharyngitis (most common cause in children), impetigo, pharyngitis
S. agalactiae causes what infections in pregnant persons
UTI, chorioamnionitis, postpartum endometritis, bacteremia
S. agalactiae causes what infections in nonpregnant adults
sepsis, soft tissue infections, endocarditis, other focal infections
Most common cause of bacterial pharyngitis in children
S. pyogenes
Scarlatiniform rash
“sandpaper” rash appreciated with palpation
Tuberculosis
occurs with airborne droplets containing viable bacilli and subsequent lymphangitic and hematogenous spread
Main sxs of mycobacterium tuberculosis
productive cough, hemoptysis, fatigue, weight loss, fever, night sweats
Risk factors for mycobacterium TB
household exposure, incarceration, rec drug use, travel to endemic area
Latent TB infection
bacilli contained within granuloma, non-transmissible while latent but may become reactivated
Risk factors for TB reactivation
gastrectomy, silicosis, DM, HIV, immunosuppressive drugs
Risk factors for drug resistance
immigration from regions with drug-resistant TB, close pt contact, unsuccessful therapy, pt noncompliance
Clinical manifestations of TB
cough, blood-streaked sputum, pt appears chronically ill, post-tussive apical rales, malaise, anorexia, wt loss, fever, night sweats
Influenza virus category
orthomyxovirus transmitted by respiratory droplets
Systemic symptoms of influenza
fever, chils, HA, malaise, myalgias
Resp symptoms of influenza
rhinorrhea, congestion, pharyngitis, hoarseness, nonproductive cough, substernal soreness
Cytomegalovirus infection
virus isolation or detection in body fluid regardless of symptoms
Cytomegalovirus disease
evidence of CMV infection with attributal symptoms or signs, may manifest as viral or tissue-invasive disease
Perinatal CMV prevents as…
jaudice, hepatosplenomegaly, thrombocytopenia, purpura, microcephaly, periventricular CNS calcifications, mental retardation
Complications of perinatal CMV
hearing loss, neuro deficits
How is perinatal CMV acquired?
breast feeding, blood products
CMV presents similarly to what other infection in immunocompetent persons?
mononucleosis - fever, malaise, myalgias, arthalgias, splenomegaly, lymphocytes, abn LFT
CMV presentation in immunocompromised persons
retinitis, esophagitis, colitis, pneumonitis, neuro manifestations
Complications of CMV
mucosal GI damage, encephalitis, severe hepatitis, thrombocytopenia, Guillain-Barré, pericarditis, myocarditis
Histoplasmosis is common in what areas of the US
Ohio river and Mississippi River valleys
Clinical manifestations of Histo
influenza-like illness, atypical pneumonia with fever and cough, typically normal, PE usually normal
Coccidioidomycosis primary infection
influenza-like illness with malaise, fever, backache, HA, and cough
Coccidioidomycosis dissemination
results in meningitis, arthralgias, bone lesions, skin and soft tissue abscesses
Coccidioidomycosis infections result from what organisms?
Coccidioides immitis, Coccidioides posadasii
Where areas of the world are Coccidioides species common in?
SW US, Mexico, Central and South America
Primary coccidioidomycosis incubation period
10-30 days
Coccidioidomycosis sxs
nasopharyngitis with fever and chills, arthalgias with periarticular swelling of knees and ankles, erythema nodosum
Disseminated coccidioidomycosis sxs
productive cough, enlarged mediastinal lymph nodes, lung abscesses, skin and bone infections, chronic basilar meningitis, subQ abscesses
Disseminated coccidiodomycosis in HIV pts
pulmonary miliary infiltrates, LAD, meningitis
Species of Plasmodium responsible for malaria
P vivax, malariae, ovale, falciparum
Plasmodium responsible for severe disease
P. falciparum
Acute malaria sxs
prodrome followed by fever, HA, malaise, myalgias, cough, anorexia, N/V/D
Plasmodium that causes 48 hour fever cycles
P vivax and ovale
Plasmodium that causes 72 hour fever cycles
P malariae
Malaria signs and sxs
anemia, jaundice, splenomegaly, mild hepatomegaly, hypotension, seizure
Most common HIV related malignancy
Kaposi sarcoma
