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Fever

Fever. James Nixon, MD Assistant Professor Internal Medicine and Pediatrics. Case Presentation. 21 year old male referred in from a rural clinic for fever. Fevers off and on for almost 3 weeks. Fever of Unknown Origin. Definition T>38.3 (101 F)on several occasions

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Fever

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  1. Fever James Nixon, MD Assistant Professor Internal Medicine and Pediatrics

  2. Case Presentation • 21 year old male referred in from a rural clinic for fever. Fevers off and on for almost 3 weeks.

  3. Fever of Unknown Origin • Definition • T>38.3 (101 F)on several occasions • Duration of fever 3 weeks or longer • Cause not diagnosed after 1 week of intensive in hospital investigation

  4. Etiologies of FUO • Infection (40%) • Malignancy (30%) • Collagen Vascular Disease (20%) • Undiagnosed (10%)

  5. History • Travel • Immunosuppression • Drug and toxin history, including antimicrobials • Localizing symptoms • Subtle findings • subtle changes in behavior granulomatous meningitis; • jaw claudication consistent with giant cell arteritis; • nocturia consistent with prostatitis. • Revisiting the history on several occasions

  6. Physical

  7. Complete blood count Erythrocyte sedimentation rate Routine blood chemistries, including liver enzymes, bilirubin, and lactate dehydrogenase Urinalysis, including microscopic Chest radiograph Routine blood cultures Tuberculin skin test with control(s) HIV antibody assay Antinuclear antibodies Rheumatoid factor Heterophile antibody test in children and young adults CT scan of abdomen. Labs

  8. Consider the Patient: Age of the patient Season of the year Travel history Geographic location Immunizations and history of childhood illnesses Exposures: insects, animals, and ill contacts Medications Immune state of the host. Consider the rash: Characteristics of the lesions Distribution and progression of the rash Timing of the onset in relation to fever Progression, if any, of the lesions such as papules to vesicles or petechiae. Fever and Rash

  9. Jones Criteria: Rheumatic Fever

  10. Fever • Hyperthermia • Hyperpyrexia

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