TASHKENT MEDICAL ACADEMY Infectious and children infectious diseases

TASHKENT MEDICAL ACADEMY Infectious and children infectious diseases department Theme: Early and Comparative diagnosis of diseases with the syndrome of fever Lecturer:

What is fever ? FEVER is a Diagnostic Clue It is an essential host defense mechanism Associated with or without localizing signs It can be due to Infection, inflammation or neoplasm

Fever - Magnitude Below 97 degree F – Hypothermia 98. 4 degree F - Normal 98 to 102 degree F – INFECTIONS 106 degree and above – Non- infectious fever (Hyperpyrexia)

Fever- Patterns o Intermittent type – temp return to normal once during most days o Remittent type – temp do not return to normal each day o Sustained/Continuous – temp do not vary more than 1 degree F /day o Relapsing - recurrent over days to weeks

Fever - types

Classical PUO 1. FEVER – MORE THAN 101 F 2. MORE THAN 3 WEEKS 3. CAUSE NOT DIAGNOSED AFTER ONE WEEK OF INTENSIVE HOSP INVESTIGN TYPES OF PUO ü ACUTE, ü NOSOCOMIAL, ü HIV ASSOCIATED ü NEUTROPENIC PUO

PUO – causes INFECTIONS – 30% MALIGNANCY – 20% CONNECTIVE TISSUE D- 15 % OTHERS – 20 % UNDIAGNOSED – 15 %

FEVER - Common Clues RESPIRATORY SYMPTOMS – URTI , LRTI, TB, URINARY SYMPTOMS – UTI, APN, CYSTITIS ABDOMINAL SYMPTOMS – ABSCESS, ACUTE ABDOMEN ARTHRITIS SYMPTOMS –RA, SLE, AS TRAVEL HISTORY DIETARY HISTORY OCCUPATIONAL HISTORY

TRAVEL History ØMALARIA – ENDEMIC AREAS ØDENGUE FEVER - Eg )SINGAPORE ØVIRAL FEVERS ØTYPHOID ØTUBERCULOSIS ØSCHISTOSOMIASIS

Dietary & Occupational History Ø BIRDS – PSITTACOSIS Ø ANIMALS CONTACT- TOXOPLASMOSIS (CAT), BRUCELLOSIS, LEPTOSPIROSIS (RAT) Ø UNCOOKED MEAT/SEA FOOD/ HEPATITIS –A & E, SALMONELLA Ø UNPASTEURIZED MILK – SALMONELLA, TB, BRUCELLOSIS

Drug fever All drugs can produce Drug INDUCED fever except DIGOXIN Bradycardia, hypotension, Skin rash, pruritus +, Eosinophilia eg) pencillin, sulpha, ATT

THERE IS NO SUBSTITUTE FOR OBSERVING THE PATIENT, TALKING TO HIM AND THINKING ABOUT HIM.

FEVER & MYALGIA ØVIRAL FEVERS – LEUCO & THROMBO CYTOPENIA ØINFLUENZA – URTI SYMPTOMS ØPOLYMYOSITIS – PROXIMAL M WEAKNESS, MUSCLE PAIN & TENDERNESS, CPK HIGH ØMENINGOCOCCAL INFECTION -Rash ØSEPSIS

Fever & Night Sweats Ø TUBERCULOSIS Ø LYMPHOMA Ø ABSCESS Ø BRUCELLOSIS Ø INFECTIVE ENDOCARDITIS Ø ALCOHOL WITHDRAWAL SYNDROME

FEVER – Brady, Tachycardia RELATIVE BRADYCARDIA RELATIVE TACHYCARDIA q. TYPHOID FEVER q. MALARIA q. MENINGITIS q. LEPTOSPIROSIS q. VIRAL q. DRUG FEVER q. TOXINS

Fever & Eyes ØEYE PAIN – TEMPORAL ARTERITIS ØWATERY EYES- PAN ØDRY EYES – SLE, RA ØSC HGE –SBE ØCONJUNCTIVITIS – TB, SLE ØCONJUNCTIVAL SUFFUSIONLEPTOSPIROSIS ØUVEITIS- TB, SLE, SARCOIDOSIS

FEVER WITH JAUNDICE ØLEPTOSPIROSIS – RENAL FAILURE + ØHEPATITIS- DRUGS (ATT) , VIRAL ØALCOHOLIC HEPATITIS ØCIRRHOSIS OF LIVER ØHEPATOMA ØVIRAL FEVERS ØMALARIA

GENERALIZED LYMPHADENOPATHY Ø LEUKEMIA – ALL , CLL Ø LYMPHOMA – MEDIASTINAL INVOLVEMENT Ø HIV INFECTION – ORAL CANDIDIASIS, THIN BUILT, Ø TOXOPLASMOSIS- WITH LIVER, SPLEEN Ø DISSEMINATED TUBERCULOSIS – WITH LIVER , SPLEEN Ø BRUCELLOSIS- WITH LIVER, SPLEEN

EPI TROCHLEAR LYMPH NODES ØMILIARY TB ØLYMPHOMA ØHIV INFECTION ØSYPHILIS

FEVER WITH HEPATOSPLENOMEGALY ØMALARIA ØTYPHOID ØLYMPHOMA ØLEUKEMIA ØDISSEMINATED TB ØINFECTIVE ENDOCARDITIS ØBRUCELLOSIS ØKALA AZAR

FEVER WITH MENTAL CONFUSION ØMENINGITIS ØMENINGISM- TYPHOID ØHIV ØBRUCELLOSIS ØCNS NEOPLASMS

LOCAL TENDERNESS ØTONGUE- RELAPSING FEVER ØTRAPEZIUS – SUB DIAPHRAGMATIC ABSCESS ØSTERNAL – METASTASIS, PRE –LEUKEMIA ØSPINAL – BRUCELLOSIS, TYPHOID, SBE, OM ØTHIGH- POLYMYOSITIS, BRUCELLOSIS ØCALF – POLYMYOSITIS, RMSF

FEVER - ARDS SARS INFECTION CEREBRAL MALARIA (P FALCIPARUM ) HANTA VIRUS INFECTION SEPSIS

HIGH ESR ØTB ØTEMPORAL ARTERITIS ØCARCINOMA ØLYMPHOMAS ØABSCESS ØMYELOPROLIFERATIVE DISORDER

FEVER & LOW PLATELETS ØDENGUE FEVER ØVIRAL FEVERS ØLEUKEMIA ØLYMPHOMA ØMYELOPROLIFERATIVE DISORDER ØDRUG FEVER ØSLE ØHIV INFECTION

CHEST X-RAY DIAGNOSIS TB- ANY FORM LYMPHOMAS- MEDIASTINAL INVOLVEMENT SARCOIDOSIS – BHL PNEUMONIAS AUTOIMMUNE DISEASES

DIAGNOSTIC TESTS Ø ANA, ANTI DS DNA – SLE Ø BONE SCAN- OSTEOMYELITIS, METASTASIS Ø ECHO HEART – ATRIAL MYXOMA, IE, PCITIS Ø SMEAR TEST + VE – MALARIA, Ø ELISA IGM AB - LEPTOSPIRA Ø VIRAL CULTURE + IN EBV, CMV INFECTIONS Ø BLOOD CULTURE + IN IE, SEPSIS, Ø AGGLUTININ TEST + IN SALMONELLA , BRUCELLOSIS

ULTRA SOUND ØHEPATOMA ØABSCESS ØHYPERNEPHROMA (PHYSICIAN S TUMOUR) ØLYMPHOMA ØPELVIC TUMORS

THANK YOU ALL WE KNOW IS STILL INFINITELY LESS THAN ALL THAT REMAINS UNKNOWN -WILLIAM HARVEY -