Fever profoma

Question 1

Aetiology

Answer 1

Most fevers are caused bye viral or bacterial infections

Other causes:
- Malignancy- e.g. lymphoma, leukaemia or neuroblastoma
- Connective tissue disorders
- Drug reactions
- CNS disorders
- Inflammatory disease

Bacterial infections- Osteomyelitis, TB, typhoid

Viral infections-v adenovirus, Epstein-barr virus, cytomegalovirus

Autoimmune- inflammatory bowel disease, SLE

Miscellaneous- Kawasaki disease, drug fever

Question 2

Presentation of a fever?

Answer 2

• The normal oral temperature is 36°C–37.4°C

In adults, above 37.6ºC is considered a fever.

Shivering

Sweating

Chills

Flushed

Delirium - common in the elderly.

Question 3

Initial investigations for fever

Answer 3

Drug history, family history, medical history & social history

Blood tests- blood culture, FBC, U&E, LFT, ESR, CRP

Urine- urinalysis, urine culture

Imaging- chest x-ray, ECG, ultrasound & CT

Other specimens depending on history- PCR, Micrscopy

Question 4

Key differential diagnosis for fever

Answer 4

1. Meningitis  - headaches, neck stiffness, photophobia.
2. Sinusitis  - sinus tenderness.
3. Otitis  - ear pain, diminished hearing.
4. Pharyngitis  - sore throat, lymphadenopathy.
5. Pneumonia  - cough, pleurisy, dyspnea.
6. Endocarditis  - recent dental or other invasive gastrointestinal or genitourinary procedure, back pain, new skin lesions.
7. Abdominal processes  - pain, change in bowel habits, nausea, vomiting.
8. UTI or pyelonephritis  - dysuria, frequency,suprapubicorcostovertebralangle tenderness.
9. Pelvic infection - discharge, dysuria.
10. Abdominal abscess

Question 5

Management for fever

Answer 5

Paracetamol (1g 4x a day for adults), which should provide pain relief and reduce the patients temperature.

Ibuprofen (800mg 4x a day for adults) can also be used if paracetamol on its own isn’t strong enough.

If signs of a bacterial infection, then antibiotics can be prescribed.

Treat underlying infection or disease.

Replace fluids lost.