Fever

Question 1

Risk factors and co-morbidities important in determining host response to infection

Answer 1

• Neutropenia
• Asplenia
• Cirrhosis
• Alcoholism
• Diabetes
• Corticosteroid use
• Malnutrition
• T-cell dysfunction

Question 2

Etiology of fever in special populations

Answer 2

• Neutropenia due to cancer-related myelosuppression
• HIV
• IV drug use
• Recent international travel or immigration
• Concomitant skin rash and lymphadenopathy

Question 3

Important history in fever

Answer 3

• Chronology, duration, pattern of fever
• Associated symptoms
• Immune status and baseline co-morbidities
• Immunization status
• Relevant history of exposures
• Occupational, travel, family, and sexual history
• Meds history: use of OTC and illicit drugs

Question 4

DDx fever categories

Answer 4

• Infection
• Rheumatologic disease/inflammatory disorder
• Malignancy
• Drug reaction

Question 5

Potential labs in fever

Answer 5

• CBC with diff
• UA with exam of sediment
• CXR
• BCx
• UCx
• Sputum gram stain and Cx
• Sputum AFB stain and Cx
• ESR and/or specific rheumatologic tests
• PPD
• CSF analysis (color, opening pressure, chemistries, cell counts, Cx, cytology, cryptococcal antigen, VDRL)
• If abnormal fluid (pleural effusion, ascities, abscess) get chemistries, gram stain and Cx
• Stool Cx of enteric pathogens
• Stool C-diff assay
• Stains/Cx from throat, urethra, anus, cervix, vagina
• HIV ELISA and western blot
• CT
• Echo
• Tissue biopsy