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Febrile states

Febrile states. as. MUDr. Dagmar Holá. The human is homiotermic organism , k eeping constant temperature . The temperature is a terminal balance state between production and expenditure of warmth . Temperature is controled reflexly from

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Febrile states

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  1. Febrile states as. MUDr. Dagmar Holá

  2. The human is homiotermicorganism, keepingconstant temperature. The temperature is a terminal balance state betweenproduction and expenditureof warmth. Temperatureiscontroledreflexlyfrom termoregulatory center in thehypothalamus.

  3. Deeptemperature (homiotermicnucleusof organism) is 36 – 37°C. Wemeasureit in mouth, rectumor vagina. Cutaneustemperature (poikilotermiccoat) islower, wemeasureit in axilla by medical thermometer.

  4. Temperature: • subnormal • subfebrile • fever

  5. Subnormal temperature islowerthan 36,2 °C and isrelated to restrainedmetabolism. Itcan by observed in olderlypeople, in chroniccachexia – causingdiseases (tumors), in hypopituitarism, hypothyroidism, afterexcessivebleeding, and in shock.

  6. Subfebrile temperature does not exceed 38°C, itaccompaniesfocalinfections (chronictonsillitisorsinusitis, urinary infections, adnexitis).

  7. Fever (pyretic, febrile state) ismarked by the body temperatureraising above 38°C. Conditionwithtemperaturerangingfrom 40 to 41°C iscalledhyperpyrexia. Feveroccurs in inflammations, infectious diseases, systemicdiseases and in certain tumours (lymphomas, Grawitz’stumour).

  8. Just for completeness, we add the overview of the temperature types: Febris 1. continua 2. remittens 3. intermittens 4. recurrens 5. undulans 6. efemera 7. hectica

  9. Febris continua ismarked by temperaturefluctuationwithin 1°C rangeduring a 24 hour period (abdominaltyphus, paratyphoid, croupous pneumonia, erysipelas).

  10. Febris remittens dailyfluctuationsexceedsthe 1°C range, thetemperaturedoes not return to the normalvalue (infectiousdiseases).

  11. Febris intermittens (septic temperature) temperatureswiftlyraises to 39°C, swiftlyfallsbelow 37°C, in 24 hour period the differenceofthe maximum and minimum temperaturesisbiggerthan 1°C (sepsis, e.g. cholangitis, urosepsis, infectiousendocarditis).

  12. Febris recurrens alternationoffever and apyreticperiods ofvariousduration.

  13. Febris undulans periodsofraising and fallingtemperatures alternatingwithapyreticperiods (abdominallymphomas, brucellosis).

  14. Febris efemera one-dayfeveriscaused by mild advancementof a respiratoryinfection, by bloodtransfusion, or by intravenous applicationsofcertaindrugs.

  15. Febris hectica long-lastingintermittendtemperature, common in tuberculosis.

  16. Diagnostic methods - anamnesis (case history) - objectiveexamination - laboratory and technicalmethods

  17. Anamnesis (case history) - how long isfever - course - hithertoexistingexaminations - therapy (? antibiotics, …) • epidemiology continuity (f.e. diarrhoea in family, in employement, atschool…)

  18. Laboratory methods a) FWincreasebacterialinfections lowerviralinfections b) Bloodcount: leucocytosis – bacterialinfections, tumours, non-infections case – acutemyocardialinfarct leucopenia – viralinfections, abdominal typhus, paratyphoid, tularemia eosinophylia – alergicdisease, parasitic disease

  19. Laboratory methods c) Haemoculture d) Microbialcultivation (sputum, urine,exudates) e) Immunologicalexaminations (LE cells, ANF, dsDNA, ASLO, LATEX, CRP, cells and humoralimmunity f) Serologicalexaminations

  20. Technical methods f.e.: • rentgenology • ultrasonography • echocardiography (+ transesophageal echo) • CT, MR • endoscopy • biopsy (oflymphonody, marrow…)

  21. Respiratory infections a) viral: Rinoviry, Coronaviry, Adenoviry, Myxoviry influenzae, parainfluenzae, atypical pneumonie – Mycoplasma pneumonie b) bacterial: oftenviralinfections and than bacterialsuperinfectionsbronchitis, pneumonie, StreptococcusPyogenes, Haemophillusinfluenzae, Klebsiella pneumonie, Staphylococcus, Proteus, Pseudomonas, Streptococcus Pneumonie

  22. Long time lasts fever Itisdiagnosticproblem in internalmedicine. Ethiologyoffeveris non-elucidateduringsome weeksormonths. Feverisusuallyconstantwithsmallfluctuate, but typicalsignsmissing. Etiology: - Infectional - Tumours - Systemicdisease

  23. Subfebrile temperature isalsodiagnosticproblem, occur in young and middleage and wemustitthrough examine. Wemusteliminatefocalinfection (in dental, ORL, gynecology, urogenital, gastrointestinalparts), immunodeficiency.

  24. Invasive methods (f.e. peripheralorcentralcatheter, pacemaker, urinarycatheter, endoscopy…) can by source offever and infections.

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