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Fever Diagnosis Patterns and Clues in Infectious Diseases: Tashkent Medical Academy Approach

Learn about fever as a diagnostic clue, magnitude, patterns, and common clues in infections. Dive into PUO types and causes - infections, malignancy, connective tissue disorders, and more. Explore fever's association with myalgia, eyes, jaundice, and other symptoms. Gain insights into fever in various diseases like tuberculosis, lymphoma, malaria, and more through diagnostic tests and X-ray analysis. Expand your knowledge with this comprehensive guide from Tashkent Medical Academy.

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Fever Diagnosis Patterns and Clues in Infectious Diseases: Tashkent Medical Academy Approach

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

  2. 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 toInfection, inflammation or neoplasm

  3. 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)

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

  5. Fever - types

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

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

  8. 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

  9. TRAVEL History • MALARIA – ENDEMIC AREAS • DENGUE FEVER - Eg )SINGAPORE • VIRAL FEVERS • TYPHOID • TUBERCULOSIS • SCHISTOSOMIASIS

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

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

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

  13. FEVER & MYALGIA • VIRAL FEVERS – LEUCO & THROMBO CYTOPENIA • INFLUENZA – URTI SYMPTOMS • POLYMYOSITIS – PROXIMAL M WEAKNESS, MUSCLE PAIN & TENDERNESS, CPK HIGH • MENINGOCOCCAL INFECTION -Rash • SEPSIS

  14. Fever & Night Sweats • TUBERCULOSIS • LYMPHOMA • ABSCESS • BRUCELLOSIS • INFECTIVE ENDOCARDITIS • ALCOHOL WITHDRAWAL SYNDROME

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

  16. Fever & Eyes • EYE PAIN – TEMPORAL ARTERITIS • WATERY EYES- PAN • DRY EYES – SLE,RA • SC HGE –SBE • CONJUNCTIVITIS – TB,SLE • CONJUNCTIVAL SUFFUSION- LEPTOSPIROSIS • UVEITIS- TB,SLE,SARCOIDOSIS

  17. FEVER WITH JAUNDICE • LEPTOSPIROSIS – RENAL FAILURE + • HEPATITIS- DRUGS (ATT) ,VIRAL • ALCOHOLIC HEPATITIS • CIRRHOSIS OF LIVER • HEPATOMA • VIRAL FEVERS • MALARIA

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

  19. EPI TROCHLEAR LYMPH NODES • MILIARY TB • LYMPHOMA • HIV INFECTION • SYPHILIS

  20. FEVER WITH HEPATOSPLENOMEGALY • MALARIA • TYPHOID • LYMPHOMA • LEUKEMIA • DISSEMINATED TB • INFECTIVE ENDOCARDITIS • BRUCELLOSIS • KALA AZAR

  21. FEVER WITH MENTAL CONFUSION • MENINGITIS • MENINGISM- TYPHOID • HIV • BRUCELLOSIS • CNS NEOPLASMS

  22. LOCAL TENDERNESS • TONGUE- RELAPSING FEVER • TRAPEZIUS– SUB DIAPHRAGMATIC ABSCESS • STERNAL – METASTASIS, PRE –LEUKEMIA • SPINAL – BRUCELLOSIS,TYPHOID,SBE,OM • THIGH- POLYMYOSITIS,BRUCELLOSIS • CALF – POLYMYOSITIS, RMSF

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

  24. HIGH ESR • TB • TEMPORAL ARTERITIS • CARCINOMA • LYMPHOMAS • ABSCESS • MYELOPROLIFERATIVE DISORDER

  25. FEVER & LOW PLATELETS • DENGUE FEVER • VIRAL FEVERS • LEUKEMIA • LYMPHOMA • MYELOPROLIFERATIVE DISORDER • DRUG FEVER • SLE • HIV INFECTION

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

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

  28. ULTRA SOUND • HEPATOMA • ABSCESS • HYPERNEPHROMA (PHYSICIAN S TUMOUR) • LYMPHOMA • PELVIC TUMORS

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

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