L4: Fever Flashcards
Def of Fever
Fever is elevation of the body temperature above the average normal
Grades of Fever
Causes of Fever
Types of Fever
- Continous (Sustained)
- Intermittent
- Hectic
- Remittent
- Saddle Back (Camel-Backed)
- Relapsing
Def of Continuous (sustained) fever
The temperature continues high for days or weeks with difference between morning and evening temperature about 0.5-1 C
Examples of Continuous (sustained) fever
Typhoid fever, pneumonia,
Meningitis and typhus.
Def of Intermittent fever
The temperature falls to normal once or more during the day
Def of Hectic fever
- Marked daily temperature swings usually associated with rigors & sweats
Examples of Hectic fever
Amebic liver abscess and Pyogenic abscess
Examples of Intermittent fever
Abscess, lymphomas and Miliary tuberculosis.
Examples of Remittent fever
Septic conditions & mycoplasma pneumonia
Rheumatic fever & rheumatoid arthritis
SABE & falciparum malaria
Def of Remittent fever
The temperature is always raised, but shows considerable between morning & evening temperature but not return to normal
Def of Saddle back (Camel-backed) fever
- Biphasic remittent fever.
- A continuous fever for a few days is followed by a remission
- A second bout of continuous fever associated with appearance of rash and terminating by lysis
Def of realpsing Fever
Days with fever alternate with days of normal temperature
Examples of Saddle back (Camel-backed) fever
In Dengue fever
Examples ofrealpsing Fever
Brucellosis (undulant fever)
Spirochete( relapsing fever)
Pel-abstain fever of hodgkin’s disease
Charcot’s intermittent fever in biliary obstruction, and malaria.
what is Quotidian Fever?
When a paroxysm of intermittent or relapse fever occurs daily
what is Tertiam Fever?
when on alternate days
Characters of Factitious fever
It is spurious temp. Elevation produced by the pt.
Not associated with organic disease.
Normal ESR.
Failure of pulse rate to rise with temp.
What is quatrain fever?
when 2 days intervene between consecutive attacks
Causes of Hyperpyrexia
Causes of Hypothermia
Manifestations of fever
Physiological response to fever
Specific Manifestations of fever
Salmonellosis in Egypt present the form of …..
Typhoid, paratyphoid fever.
Chronic salmonellosis complicating Schistosoma infection.
Salmonella food poisoning (acute gastroenteritis).
CA of typhod & Paratyphoid fever
Salmonella typhi and salmonella paratyphoid A, B & C.
Characters of CA of typhoid & Paratyphoid fever
It is gram-negative motile bacilli.
Source of Infection by typhoid & Paratyphoid fever
Patient.
Carrier (intestinal, gall bladder or unitary carrier).
MOT of typhoid & Paratyphoid fever
Food & Flies & Foments & Feces & Fingers.
Pathophysiology of typhoid & Paratyphoid fever
After invasion of the intestinal mucosa, bacilli first enter the mesenteric lymph glands through Payer’s patches → blood stream (bactermia) → then pass to
other organs e.g. liver spleen and reticule-endothelial system
IP of typhoid & Paratyphoid fever
4 satges
CP of typhoid & Paratyphoid fever
1-2 Weeks
Stages of typhoid & Paratyphoid fever
…..
1st Week of typhoid & Paratyphoid fever
2nd Week of typhoid & Paratyphoid fever
3rd Week of typhoid & Paratyphoid fever
4th Week of typhoid & Paratyphoid fever
CC of Typhoid
- A patient with persistent fever (38 °C or more) lasting 3 or more days, with laboratory-confirmed S. typhi organisms (blood, bone marrow, bowel fluid)
- A clinical compatible case that is laboratory confirmed
Probable Case of Typhoid
- A patient with persistent fever (38 °C or more) lasting 3 or more days, with a positive sero-diagnosis or antigen detection test but no S. typhi isolation
- A clinical compatible case that is epidemiologically linked to a confirmed case in an outbreak
Chronic Carier of Typhoid
- An individual excreting S. typhi in the stool or urine for longer than one year after the onset of acute typhoid fever
- Short-term carriers also exist, but their epidemiological role is not as important as that of chronic carriers.
- Some patients excreting S. typhi have no history of typhoid fever
Investigations to Dx Typhoid
- PCR
- Blood Culture
- Stool & Urine Culture
- BM Aspirate Culture
- Widal agglutination test
Investigations to Dx Typhoid
- PCR
- Can be performed on peripheral mononuclear cells.
- The test is more sensitive than blood culture alone (92% compared with 50-70%) but requires significant technical expertise
Investigations to Dx Typhoid
- Blood Culture
Positive in 70-80% of cases during the 1st week.
Investigations to Dx Typhoid
- Stool & Urine Culture
Are usually positive (45-75%) during the 2nd - 3rd week.
Investigations to Dx Typhoid
- BM Aspirate Cultures
Give the best confirmation (85-95%)
Investigations to Dx Typhoid
- Widal agglutination reaction (Felix-Widal test)
- Positive from the 2nd week on words, with gradual rising titer.
- It seems unreliable
Procedure of Widal agglutination reaction (Felix-Widal test)
This test measures agglutinating …..
antibody levels against O and H antigens.
The levels are measured by using doubling dilutions of sera in large test tubes.
….
Usually, O antibodies appear on days 6-8 and H antibodies on days 10-12 after the onset of the disease.
….
The test is usually performed on an …. serum (at first contact with the patient)
acute
A convalescent serum should preferably also be collected so that paired titrations can be performed.
…
In practice, however, this is often difficult
…
- In areas of endemicity there is often a low background level of antibodies in the normal population.
- Determining an appropriate cut-off for a positive result can be difficult since it varies between areas and between times in given areas.
…
If paired sera are available a ….. in the antibody titer between convalescent and acute sera is diagnostic.
fourfold rise
When is Widal agglutination reaction False positive?
- Anamanestic reaction ( Cross reaction with other salmonella & gram -ve bacteria )
- Autoimmune diseases.
- Prior vaccination.
- Prior antibiotic treatment
Widal test is → ……. test
unreliable
Types of Complications of Typhoid
- General
- Medical
- Surgical
General Complications of Typhoid
Medical Complications of Typhoid
Medical Complications of Typhoid
- Typhoid lobar pneumonia
- Present with the typical symptoms and signs of lobar pneumonia except that rusty sputum is uncommon and the white blood low.
Medical Complications of Typhoid
- Myocarditis
common particularly in very toxic patients.
Medical Complications of Typhoid
- Typhod Meningitis
- Is rare and must not be confused with meningism, which is common
- Chloramphenicol diffuse well into the cerebrospinal fluid, so it gives good results
Medical Complications of Typhoid
- Peripheral Neuritis
Treated with Vitamin B complex as prophylactic measure.
Medical Complications of Typhoid
- Mild Hemolytic Anemia
- is common in the typhoid patients.
- Treated with prednisone.
Medical Complications of Typhoid
- Febrile Albuminurea
common, but a true acute typhoid
nephritis is rare.
Surgical Complications of Typhoid
Surgical Complications of Typhoid
- Intestinal Perforation
This is one of the most serious complications of typhoid fever, it occurs during the third week of illness but occur before.
Surgical Complications of Typhoid
- Acute Patotitis
- Is a danger complication and pus should be drained by transverse incision under local anaesthetic as early possible.
Surgical Complications of Typhoid
- Intestinal Hemorrhage
- Is a lethal complication which usually occurs 2-3 weeks after the onset of the illness
- The patient may show massive hemorrhage, which
manifested by shock and very pale conjunctiva, or small bleeding.
Surgical Complications of Typhoid
- Typhoid Cholecystitis
Occur more frequent in female more
than male.
Surgical Complications of Typhoid
- Paralytic Ileus
may be secondary to perforation or to severe toxemia.
Surgical Complications of Typhoid
- Intestinal Obstruction
may be due to a localized abscess or
adhesions.
TTT of Typhoid
- Prophylactic
- Curative
Prophylactic TTT of Typhoid
Curative TTT of Typhoid
- general Lines
- Specific TTT
General Lines of TTT of Typhoid
A. Rest in bed.
B. Well balanced diet.
C. Adequate fluid.
Specific Lines in TTT of Typhoid
Vaccines for Typhoid
- Oral – A live vaccine (Typhoral)
- The injectable vaccine (Typhim -VI)
Type of Oral Typhoid Vaccine
Oral – A live vaccine (Typhoral)
Dosage of Oral Typhoid Vaccine
One capsule given orally taken before food, with a glass of water or milk, on day 1, 3, 5 (three doses)
Precautions for Oral Typhoid Vaccine
No antibiotics should be taken during the period of
administration of vaccine
Dosage of Injectable Typhoid vaccine
Given as single S.C or I.M injection
Indications of Typhoid vaccine
Another name of Brucellosis
(Malta fever or Undulant fever)
CA of Brucellosis
MOI by Brucellosis
IP of Brucellosis
1-3 weeks.
Onset of Brucellosis
gradual with malaise & muscular pains.
CP of Brucellosis
CP of Brucellosis
- Constitutional Symptoms
profuse sweating, muscular pain, headache, joint pain and backache.
CP of Brucellosis
- Pulse
relative slow
CP of Brucellosis
- Fever
reach 39-40 C for 1 - 3 weeks then apyrexia for 10 days then relapse and so on (undulant fever).
CP of Brucellosis
- GIT
Nausea, vomiting & constipation.
CP of Brucellosis
- Enlarged Spleen
present in almost half the patients the spleen is tender and firm and usually mild enlarged.
CP of Brucellosis
- Lymph Nodes
In 50% of cases there is generalized enlargement, especially the cervical and axially lymph nodes.
Investigations for Brucellosis
- Direct
- Serological
Direct Investigations for Brucellosis
Direct Investigations for Brucellosis
- Blood Culture
- Positive in the 1st week ( positive in 50% only) may retain up to 6 weeks to give maximum chance of finding this slowly growing organism
Direct Investigations for Brucellosis
- Bone Marrow Culture
positive in 90%
Serological Investigations for Brucellosis
Serological Investigations for Brucellosis
- Agglutination test
- Positive from 2nd week titer over 1/100 or rising 4 fold titer/6h for 24 h. → is diagnostic in the same session.
- It is unreliable test indicate only past infection no correlations with the titre concentrations
Serological Investigations for Brucellosis
- Complement Fixation
To measure IgG antibodies.
Serological Investigations for Brucellosis
- Radio-Immuno Issay
To determine the levels of specific anti-Brucella IgM, IgG & IgA.
Complications of Brucellosis
- Bone and joint complication
- Cardiovascular complication
- Genito-urinary complications
- Nervous complications
Bone & Joint Complications of Brucellosis
1) Brucella spondylitis: Where bone and discs are invaded causing osteomyelitis with destruction of bone giving picture similar to disc prolapsed.
2) Suppuration of large joint.
3) Osteomyelitis of long bone.
CVS Complications of Brucellosis
Bacterial endocarditis usually develops on a congenital or acquired valvular lesion.
Genitourinary Complications of Brucellosis
1) Orchitis.
2) Epididymitis.
3) Chronic pyelonephritis.
Nervos Complications of Brucellosis
1) Meningitis.
2) Encephalitis
3) Myelitis.
4) Paraplegia.
5) Aphasia.
6) Dysarthria.
7) Visual disorders.
8) Deafness.
TTT of Brucellosis
Symptomatic TTT of Brucellosis
Antipyretics and analgesics
Tetracycline Dose in TTT of Brucellosis
50 mg / kg / day in divided dose each 4 hours for 3 - 6 weeks.
Doxycycline Dose in TTT of Brucellosis
oral 100 mg / 12hours for 3 weeks (preferred over tetracycline)
Aminoglycosides Dose in TTT of Brucellosis
for 3-4 weeks.(nephrotoxic)
a) Streptomycin: 1 gm / 24h. IM
b) Gentamycin: 5 mg / kg / 12h. IM
c) Netilmicin: 2 mg / kg / 12h IM or IV
Streptomycin & Tetracycline Dose in TTT of Brucellosis
Streptomycin 1 gm I. M. daily for 3 weeks.
Rifampicin Dose in TTT of Brucellosis
600 mg /1 2 h for 3 weeks.
Which drug is CI in Pregnant & children in TTT of Brucellosis?
Nature of FMF
Periodic fever
Def of FMF
It is a clinical syndrome with a probable genetic basis which give rise to recurrent febrile episodes associated with
Abdominal pain ( peritonism)
Pleurisy
Arthropathy
What is the hallmark of FMF?
Periodicity
Ethnic Groups affected in FMF
Major ethnic groups affected are Jews, Arab, Armenians & Turks.
Etiology of FMF
PPT Factors for FMF
Stress & anxiety
Cold
Physical exercise
Menstruation
CP of FMF
CP of FMF
- Fever
- Has intermittent character
- It is characterized by recurrent acute attacks occurring at intervals varying from days to weeks even months but the attack is short lived usually 3 days & seldom lasts more than 4 days.
CP of FMF
- Severe abdominal Pain
Diffuse (like peritonitis so repeated laparotomies is one of the diagnostic criteria in the past).
CP of FMF
- Arthropathy
(large joint, symmetrical ,non destructive, more in sporadic Jews)
CP of FMF
- Dermatologic Lesion
erysipelas like lesion, Henoch-scholein purpura, urticarial vasculitis, bullous lesion.
Less Common Manifestations of FMF
Ophthalmic (episcleritis)
Acute orchitis
Pharyngitis
Pericarditis
Myocarditis
Complications of FMF
Amyloidosis (Amyloid A formation)
- Common in Jews & Turks
- Arab & Armenians are largely immune from this.
Tel-Hashomer Criteria of FMF
Dx of FMF
TTT of FMF
TTT of FMF
- Colchicine
TTT of FMF
- Biological TTT
Done
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