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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