PUO in a rural context Flashcards
Which disease can you consider is a patient with water exposure?
Leptospirosis
What is the definition of PUO?
Fever >38.3 on several occasions
Over 3 weeks
Uncertain diagnosis after 3 weeks of Ix
What do you think of in a fever in a farmer?
Q fever
Farmers lung
Psittacosis
How long do you treat IE with abx?
4 weeks IV
What are the common infectious causes of PUO?
TB
Infective endocarditis - particularly subacute
Intraabdominal abscess (amoebic)
HIV
What are some causes of PUO that are on the rise?
Vasculitis
Drugs
Which travel infection can be excluded if it present >3 month after return?
P falciparum
Dengue
How do you characterise caues of PUO?
Infectious
Inflammatory
Malignancy
Other
What type of cells do you get in Hodgkin’s lymphoma?
Reid-Sternberg cells
TB presenting one year after aquisition is typically what form of the disease? Why?
Miliary TB
The immune system hasn’t controlled it
What are the common inflammatory causes of PUO?
Vasculitis
Autoimmune
Granulomatous
How long do you treat septic arthritis with abx?
10-14 days IV
4 weeks oral
How does lymphoma cause pancytopenia?
Cytokine effect
(Not necessarily bone marrow infiltration)
What does hepatosplenomegaly make you think in the setting of PUO?
Malignancy
- Lymphoma
- Other haematological malignancy
Likely chronic cause of inflammation
What must be you beware of with CRP?
CRP rise often occurs after the symptoms
What causes dark urine?
Haemoglobinurea (haemolysis)
Myoglobinurea (rhabdo)
DDx for gram positive cocci on blood cultures?
Staph aureus
Streptococcus pneumoniae
Staph epidermitis (contamination)
What are some causes of hospital acquired fever to think about?
Pneumonia
UTI
Line related
Surgical wound
Pressure sore
Drugs
Influenza
PE
What do you think of in fevers in HIV patient?
PJP
MAC
Cryptosporidium
What do you fever of in a neutropenia patient?
Gram negative
Pseudomonal
Fungal
What are the common other causes of PUO?
Drug
How is Q fever treated?
Doxycycline
What are the common malignant causes of PUO?
Lymphoma
Renal cell carcinoma
Necrotic mets
How does Q fever present? Who gets it?
Flu like symptoms
Anyone with animal exposure
