Fever Considerations

Question 1

What is a significant oral temperature that could indicate fever

Answer 1

> 38C or 100.4F

Question 2

Noninfectious causes of fever (false positives for infection )

Answer 2

• Malignancy
• Drug fever (from the administration of the medication) β-lactam antibiotics, anticonvulsants, allopurinol, hydralazine, nitrofurantoin, sulfonamides, phenothiazines, methyldopa
• Blood Transfusions

Question 3

Causes absence of fever from infected patients

Answer 3

Overwhelming infection
Antimicrobial Therapy
Antipyretics
Corticosteroids

Question 4

Signs and symptoms of infection

Answer 4

Fever >38C 
Increased WBC (>11,000)
Chills rigor
Tachycardia (>90)
Tachypnea (>20)
Hypotension (<90 Systolic or MAP <70)
Malaise 
Mental Status change

Question 5

Normal WBC count

Answer 5

4,500 to 10,500/mm3

Question 6

Normal WBC Breakdown

Answer 6

Granulocytes 
Mature neutrophils (PMNs, polys, segs) 50-70% 
Immature neutrophils (bands) 0-5% 
Eosinophils 0-5% 
Basophils 0-2%

Question 7

Immature WBC (bands)

Answer 7

These are WBCs that are mobilized before maturation in the bone in order to fight off infection

Question 8

Granulocytes

Answer 8

any thing that ends in -phils

Question 9

Agranulocytes

Answer 9

any that that ends in -cytes

Question 10

Leukocytosis

Answer 10

• associated with bacterial infection (higher presence of bands) called a left shift
• could be due to stress, leukemia, lithium, or steroids
• not present in neutropenic hosts and is reduced in elderly
• Leukopenic patients (abnormally low WBC count)

Question 11

Lymphocytosis

Answer 11

• B-lymphocytes ® proliferate into plasma cells, which produce antibodies involved in humoral immunity; some develop into memory cells
• T-lymphocytes – involved in cell-mediated immunity (2 types)
1) T helper/inducer cells (CD4) ® regulation of the immune system; help with antibody production and secrete lymphokines that help protect against bacterial/viral infections and tumors; the major marker of immunocompetence in patients with HIV infection (this cell line is depleted with HIV infection)
2) T suppressor (CD8) ® bind to and directly kill tumor cells; help with regulation of humoral and cell-mediated immunity

Question 12

Monocytosis

Answer 12

important phagocytic cells responsible for antigen processing and presentation; associated with tuberculosis or lymphoma

Question 13

Eosinophilia

Answer 13

associated with allergic reactions or protozoal/parasitic

infections

Question 14

Localized signs of infection

Answer 14

Pain and inflammation – swelling, erythema, tenderness, purulent or abnormal drainage

Inflammation in deep-seated infections (e.g., pneumonia, meningitis, urinary tract infection) – must examine tissues/fluids (sputum, CSF, urine)

Question 15

Inflammation in deep seated infections

Answer 15

pneumonia, meningiti, UTIs (need to assess sputum and fluids)

Question 16

Inflammation in neutropenic hosts

Answer 16

may be absent

Question 17

symptoms can be referable to specific organ systems

Answer 17

ex. flank pain may be indicative of renal issues

Question 18

Erythrocyte sedimentation rate and C-reactive protein

Answer 18

• elevated in inflammatory processes but does not indicate the presence of infection
• ESR = 0 to 15 mm/hr in males and 0 to 20 mm/hr in females
• elevated in otitis media, osteomyelitis, prosthetic joint infections, endocarditis, pelvic inflammatory
  disease, and infections in transplant patients

Question 19

Procalcitonin

Answer 19

A precursor of calcitonin, a calcium regulatory hormone, which is a more specific marker for bacterial infections than ESR or CRP
- Normal value = < 0.05 μg/L
- Current research suggests that the level of PCT elevation may provide useful diagnostic information
• PCT ≥ 10 μg/L ® sepsis/systemic bacterial infection
• PCT between 2 and 10 μg/L ® suggestive of sepsis
• PCT between 0.25 and 2 μg/mL ® other condition or localized infection
- Some data suggest that PCT levels may be useful for assessing the efficacy of empiric antibiotic therapy as well as for determining when antibiotic therapy can be discontinued during the treatment of an infection