pyrexia of unknown origin Year 4 Paediatrics Notes OmpathStudy

pyrexia of unknown origin Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / PAEDS 4.3 / Agisa -- FEVER OF UNKNOWN ORIGIN\n- Dr.Apoorva.E\nPG,DCMS \n\n NORMAL BODY TEMPERATURE The hypothalamus is the heat-regulating center of\nthe body The normal body temperature ranges from 37.0\ndegree C and 37.5 degree C Evening temperatures being 0.5 degree C higher\nthan in the morning. Rectal temperature oral temperature (0.4 degree C)\n axillary temperature (1 degree C) \n\n• A rectal temperature with a glass- mercury or\ndigital-electronic thermometer is considered the\ngold standard for taking temperatures Liebermeisters rule -The pulse rate rises about 15\nbeats/min for each degree centigrade rise of fever \n\n FEVER Fever is a controlled increase in body\ntemperature above the normal hypothalamic\nset point A rectal temperature of 38 degree C or more\n(100.4 degree F) A temperature of 40 degree C or more is\ntermed as hyperpyrexia \n\nPATHOGENESIS OF FEVER \n\n\n\n\n\n PATTERNS OF FEVER\nIntermittent fever - Fever that touches the\nbaseline for a few hours during the day. Seen in malaria, acute pyelonephritis, local\nboils,furuncles,kala azar,sepsis \n\n• Types of intermittent fever: Quotidian fever, with a periodicity of 24 hours,\ntypical of Plasmodium falciparum Tertian fever,with a 48 hour periodicity,typical\nof Plasmodium vivax or Plasmodium ovale -Quartan fever,with a 72 hour periodicity,typical\nof Plasmodium malariae \n\n\n\n Remittent fever - Fever that fluctuates by more\nthan 1.5 degree F but never touches the baseline\nin 24 hours Seen in infective endocarditis \n\nContinuous fever - Fever that never touches the\nbaseline in 24 hours and fluctuates by less than\n1.5 degree F in a day. Seen in enteric fever,lobar\npneumonia,brucellosis,typhus. \n\n\n\n Pel-ebstein fever - Fever lasting for 3-10 days\nfollowed by an afebrile period of 3-10 days Seen in hodgkins lymphoma \n\n CLASSIFICATION OF FEVER Fever with focus Fever without focus\n( refers to a rectal\ntemperature of 38 degree\nC or higher as the sole\npresenting feature)\n\n Fever of Fever\nunknown without\norigin localizing\nsigns \n\n FEVER OF UNKNOWN ORIGIN Children with fever,documented by a health care\nprovider,for which cause could not be identified\neven after 3 weeks of evaluation as an outpatient\nor after 1 week of evaluation in the hospital \n\n CLASSIFICATION 4 categories: 1. Classic FUO 2. Health care associated FUO 3. Immune deficient FUO 4. HIV – related FUO \n\n CLASSIC FUO Definition: fever of 38 degree C,lasted for 3\nwks, 2 visits or 1 wk in hospital Patient location: community, clinic or hospital Leading causes: cancer, infections, inflammatory\nconditions, undiagnosed, habitual hyperthermia History emphasis: H/O travel, contacts, animal &\ninsect exposure, medications, immunization,\nfamily history, cardiac valve disorder \n\n• Examination emphasis: oropharynx, temporal\nartery, abdomen, lymph nodes, spleen, joints,\nskin, nails, genitalia, lower limb deep veins. Investigation emphasis: Imaging, biopsies,\nerythrocyte sedimentation rate, skin test Management: Observation, outpatient\ntemperature chart, investigations, avoidance of\nempirical drug treatment Time course of disease: For months \n\n HEALTH CARE ASSOCIATED FUO Definition: Fever of 38 degree C,lasted for 1\nweek, not present or incubating on admission Patient location: Acute care hospital Leading causes: Hospital acquired infections,\npost- operative complications, drug fever History emphasis: Operation & procedures,\ndevices used, anatomic considerations, drug\ntreatment \n\n• Examination emphasis: Wounds, drains, devices , sinuses, urine Investigation emphasis: Imaging, bacterial\ncultures & other microbiological investigations Management: Depends upon situation Time course of disease: Lasts for weeks. \n\n IMMUNE DEFICIENT FUO Definition: Fever of 38 degree C, lasted for\n 1 wk & negative culture after 48 hrs Patient location: Hospital or clinic Leading causes: Majority are due to\ninfections but cause has been documented in\nonly 40-60% History emphasis: Stage of chemotherapy,\ndrugs administered, underlying\nimmunosuppressive disorders \n\n• Examination emphasis: Skin folds, IV sites,\nlungs, perianal area Investigation emphasis: Chest radiograph,\nbacterial cultures Management: Antimicrobial treatment Time course of disease: Lasts for days. \n\n HIV – RELATED FUO Definition: Fever of 38 degree C, 3 wks for\noutpatients, 1 wk for inpatients & HIV infection\nconfirmed Patient location: Community, clinic or hospital Leading causes: HIV (primary infection), typical\n& atypical mycobacteria, CMV, toxoplasmosis,\ncryptococcosis, lymphomas, immune\nreconstitution inflammatory syndrome (IRIS) History emphasis: drugs,exposures,risk\nfactors,travel,contacts,stage of hiv infection \n\n• Examination emphasis: Mouth, sinuses, skin,\nlymph nodes, eyes, lungs,perianal area. Investigation emphasis: Blood & lymphocyte\ncount, serologic tests, chest X-ray, stool\ne