Acute febrile illness.pptx

7/28/2019 Acute febrile illness.pptx

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Kaleab Tesfaye C1

Acute Febrile Illness


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Acute febrile illness is listed as a type of orrelated symptom forfever


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Fever(pyrexia)

Abnormally high temperature

One of bodys immune mechanisms to control

infection.


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core(rectal,esophageal )

Hypothermia 37.5c Hyperthermia >38.4-39.9c

Hyperpyrexia >40.0-41.5c


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Fever is generally agreed to be present if: Temperature in the rectum is at or over 37.5-38.3c

Temperature in the mouth is at or over 37.7c.

Rectal T are generally 0.4 c higher than oral.

These lower readings are attributable to mouth

breathing


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Elderly peoples have a decreased ability togenerate body heat, so even a low-grade

temperature may represent a serious underling

illness.


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Types

The pattern of temperature change mayoccasionally hint at the dx

Intermittent fever-elevated T is present for

some hours of the day & becomes normal for

remaining hours,

e.g. malaria, kala-azar or septicemia

There may be a fever with periodicity of

24hr(quotidian),48hr(tertian),or72hr( quartan

fever)indicating plasmodium malariaea.these

patterns may be less clear in travelers.


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Continuous fever-T remains above normalthroughout the day & doesnt fluctuate >1 c in

24 hrs.

e.g. lobar pneumonia,typhoid,typhus,UTI

Typhoid may show a specific fever pattern, with a

slow stepwise increase & a high plateau.


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Remittent fever-T remains above normalthroughout the day & fluctuate more than 1 c in

24hrs.

e.g. ,infective endocarditis

Febricula is a mild fever of short duration, of

indefinite origin,& without any distinctive

pathology.


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Hyperpyrexia-a fever with an extreme elevationof body T >41.5 c

Such a high fever is a medical emergency, as it may

indicate a serious underlying condition or it might

lead to. The most common cause is IC hemorrhage.

Other causes can be thyroid storm or sepsis.


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Hyperthermia-uncontrolled increase in body T that exceeds the bodys ability to lose heat.

The setting of the hypothalamic thermoregulatory

center is not changed.

E.g., heatstroke ,stimulants such as amphetamineor cocaine


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Hyperpyrexia differ from hyperthermia in that; The bodys T regulation mechanism sets the body

T above the normal T ,then generate heat to

achieve this new T ,while in hyperthermia there is

no new set point .


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Pathphysiology

T is ultimately regulated in the hypothalamus.

Hypothalamus works like a thermostat, when the

set point is raised, the body increases its T

through both active generation of heat & retaining

heat.

Vasoconstriction both reduces heat loss through

the skin & causes the person to feel cold.

If these measures are insufficient to make theblood T in the brain match the new setting in the

hypothalamus,then shivering begins in order to

use muscle movements to produce more heat.


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Pyrogen

Is a substance that induces fever. Can be endogenous(internal) or exogenous

(external) to the body

E.g. of exogenous can be LPS,w/c are present in

the cell wall of some bacteria Cytokines are e.g. of endogenous pyrogen.IL-1&IL-

6 are the major ones.

Pyrogens cause a release of PGE2 this in turn

acts on the hypothalamus w/c generates asystemic response causing heat creating effect to

match a new T level.


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Symptoms

The onset of fever is usually marked by a rigor orshivering .

The skin feels hot and dry, the raised temperature

will often be found to show daily variationsan

evening rise & a morning fall

Tongue is dry & furred

Thirst is intense but appetite usually gone

Pt also experience headache , nausea, childrenmay develop convulsions

There is a relative increase in the pulse &

breathing rates


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Approach to acutely ill febrile

patient

History Presenting symptoms are frequently non specific

Fever (onset,character,duration.

Underlying dz

Recent URTI,HIV infection,alcholism,DM..

Any skin abnormalities(rash.

Surgery,burn,medication use

Travel hx,any contact with pets or other animals or

activities that might result in tick exposure ..

Any genitourinary symptoms

menstrual hx, vaccination


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neurologic sign & abdominal signs

Any prior trauma


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P/E A complete physical exam should be performed Vital sign, General appearance;

The pt may appear either anxious & agitated or lethargic & apathic.

Measurement of BP,HR& RR helps determine the degree ofhemodynamic & metabolic compromise.

The pts airway must be evaluated to rule out the risk ofobstruction, from an invasive oropharyngeal infection,

A skin examination might help us to reach a dx Peticheal rashes are typically seen with meningococcemia or Rocky

mountain spotted fever Erythroderma is associated with TSS & drug fever

Area of erythema,edema & tenderness may indicate underlingnecrotizing fasciitis,myositis or myonecrossis

Neurological exam Assessment of mental status for signs of earl encephalopathy


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Neck stiffness

Kernings sign

Brudzinskis sign


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Diagnostic workup

After a quick clinical assessment, diagnosticmaterial should be obtained rapidly and antibiotic

& supportive treatment begun.

Blood(smear, culture.

CSF if we suspect meningitis -If CSF cultures are negative, blood cultures will provide the

dx in 50-60% of cases

Urinalysis

Culture of wounds CT & MRI if we suspect a focal abscess as part of

an evaluation for surgical intervention.


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Treatment

The correct treatment is that of the underlingcondition.

Though its not necessary to treat any febrile

illness, if there is an intense fever we can reduce

the temperature by more direct method: physicalcooling by tepid sponging

Anti-pyretic( aspirin, paracetamol.


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DDX of Acute Febrile Illness

Fever is a common symptom for many medicalconditions

Infectious

dz,eg,influenza,HIV,malaria,typhoid,typhus

Skin inflammations-boils or abscess

Immunological dz-lupus

erythematous,sarcoidosis

Tissue destructions w/h can occur in

hemolysis,surgery,cerebral hemorrhage. Cancers, most commonly kidney, leukemia

&lymphomas.


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Thank you for yourattention

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Acute febrile illness.pptx