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Small Animal Medicine Exam 3 (Spring 2016) > L27: Fever Of Unknown Origin (Harris) > Flashcards

L27: Fever Of Unknown Origin (Harris) Flashcards

1
Q

Fever of unknown origin

A

Fever that does NOT resolve spontaneously, doesn’t respond to abx tx, and for which a dx remains uncertain

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2
Q

Initial diagnostic workup for FUO

A 
Hx
PE
CBC
Chem
UA
urine culture
Thoracic and abd rads
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3
Q

Location of thermoregulatory center in CNS

A 
Anterior hypothalamus (AH)
-stimulated by peripheral and central thermoreceptors
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4
Q

Mechs. To decrease temp when too hot

A 
Cutaneous vasodilation
Panting
Postural changes
Seeking cool env.
Grooming (cats)
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5
Q

Mechs. To increase temp when body too cold:

A
  • cutaneous vasoconstriction
  • piloerection
  • increased heat production (shiver, inc. catecholamines, inc. thyroxine)
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6
Q

Hyperthermia

A

Any elevation in core body temp above accepted reference range for that species
-can be pyrogenic or non-pyrogenic

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7
Q

Pyrogenic hyperthermia

A

(True fever)

-due to an elevation of the thermal set point in the AH 2ary to release of pyrogens

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8
Q

Non-pyrogenic hyperthermia***

A

Heat gain exceeds heat loss

  • inadequate heat dissipation, exercise, pathologic, or pharmacologic causes
  • thermoregulatory set point is UNAFFECTED***
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9
Q

Fever is mediated by:

A

Pyrogens (exogenous and endogenous)

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10
Q

Exogenous pyrogens

A
  • infectious agents
  • Immune complexes
  • tissue inflammation
  • pharmacologic agents (ie. Tetracycline)

**usually INDIRECTLY cause fever by stimulating release of endogenous pyrogens

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11
Q

Endogenous pyrogens

A
  • inflammatory cytokines (released in response to exogenous pyrogens)
  • serve to reset thermostat to new higher temp
  • cytokines bind to vascular endothelium –> release of prostaglandin E –> thermostat set higher –> body tries to warm itself
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12
Q

Main causes of fever (categories)

A

1) Inflammatory (infectious)
2) Non-infectious inflammatory
3) immune-mediated
4) neoplastic
5) drug-associated

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13
Q

Most common causes of fever in DOGS**

A

Infectious
Immune-mediated
Neoplasia

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14
Q

Most common causes of fever in CATS

A

Infectious

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15
Q

Common cause of fever assoc. with a MURMUR

A

Endocarditis

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16
Q

Common cause of fever assoc. with the SPINE

A

Discospondylitis, meningitis

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17
Q

Common cause of fever assoc. with the JOINTS

A

Polyarthritis

18
Q

Common cause of fever assoc. with the LONG BONES

A

Panosteitis, neoplasia, osteomyelitis

19
Q

Common cause of fever assoc. with MUSCLES

A

Polymyositis

20
Q

Common cause of fever assoc. with the PROSTATE

A

Prostatitis, prostatic dz

21
Q

Common cause of fever assoc. with the LYMPH NODES

A

Neoplasia

Infection4

22
Q

2 main forms of diagnostic approach to a fever**

A

1) problem-based

2) staged (use if no abnormalities on PE and can’t find problems)

23
Q

Staging diagnostic approach: stage 1 (least invasive)

A
  • Hx, PE, specialty exams
  • CBC, blood smear, Chem with CK
  • FeLV/FIV
  • UA/urine culture
  • thoracic/abd rads
24
Q

Staging diagnostic approach: stage 2

A
  • repeat stage 1 PRN
  • Abd US
  • arthrocentesis
  • blood cultures
  • LN aspirate or other aspirates
  • Echo
  • long bone/joint rads
  • infectious dz titers
25
Q

Staging diagnostic approach: stage 3 (most invasive/expensive)

A
  • bronchoscopy or BAL
  • CSF tap
  • dental rads
  • bone marrow aspirate
  • CT/MRI
  • laparoscopy/thoracoscopy
  • biopsies PRN
  • exploratory sx
  • Antinuclear antibody
  • Rheumatoid Factor
  • coombs test
26
Q

Changes expected on MDB of fever patient

A

Systemic inflammatory response:

  • inflammatory or stress leukogram
  • anemia of chronic inflammatory dz
  • mild hypoalbuminemia
  • mild hyperglobulinemia
27
Q

See diagram p. 304**

A

:)

28
Q

Why include a CK with chemistry?

A

Look for evidence of underlying myopathy

29
Q

Single most important factor for getting a positive blood culture**

A

Volume of blood taken

-should also collect from multiple sites, preferably during pyrexia

30
Q

Immune-mediated polyarthritis is a common cause of FUO in dogs even when NO signs of arthritis are present!

A

Comprise 20-40% of all FUO cases

31
Q

T/F: a positive serology test automatically confirms infection vs. exposure**

A

FALSE (ie. With most Lyme, FIP, and toxoplasmosis tests). Likewise, a negative titer does not rule out infection

-a very high Ag result, or seroconversion from negative to positive titers DOES suggest presence of active infection

32
Q

High IgM antibody levels against an organism occur when?

A

During early exposure

33
Q

Guidelines for therapeutic trial if a diagnosis for fever can’t be made:

A

1) begin with tentative diagnosis (and avoid therapies that limit what you can do in the future)
2) treat with appropriate dose and duration
3) define parameters
4) consider coincidental response (have a way to measure response)

34
Q

Risks for therapeutic trial

A
  • continued progression of dz
  • medication side effects/toxicities
  • exacerbate underlying infectious dz if immunosuppressive tx used
35
Q

At what temp does fever become life threatening?

A

> 106

36
Q

Why is artificial cooling not indicated in pyrogenic hyperthermia cases?

A
  • thermostat already set higher, so you just end up making body work harder against being cooled
  • only helpful if have non-pyrogenic hyperthermia
37
Q

When is tx with antipyretic therapy (NSAIDs) indicated for hyperthermia?

A
  • uncommonly, since doesn’t tx underlying dz
  • when we have a dx for an underlying cause but there is no specific treatment for it
  • causes transient improvement of CS
38
Q

MOA of NSAIDs

A

-inhibit COX pathway of the arachidonic acid cascade therefore decreasing prostaglandin synthesis

39
Q

Best way to address fever without interfering with many diagnostics

A

Fluid therapy

40
Q

Should NOT have a fever with a simple cystitis*

A

:)

Small Animal Medicine Exam 3 (Spring 2016) (9 decks)

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