L4: Fever Flashcards
(137 cards)
1
Q
Def of Fever
A
Fever is elevation of the body temperature above the average normal
2
Q
Grades of Fever
A
3
Q
Causes of Fever
A
4
Q
Types of Fever
A
- Continous (Sustained)
- Intermittent
- Hectic
- Remittent
- Saddle Back (Camel-Backed)
- Relapsing
5
Q
Def of Continuous (sustained) fever
A
The temperature continues high for days or weeks with difference between morning and evening temperature about 0.5-1 C
6
Q
Examples of Continuous (sustained) fever
A
Typhoid fever, pneumonia,
Meningitis and typhus.
7
Q
Def of Intermittent fever
A
The temperature falls to normal once or more during the day
8
Q
Def of Hectic fever
A
- Marked daily temperature swings usually associated with rigors & sweats
9
Q
Examples of Hectic fever
A
Amebic liver abscess and Pyogenic abscess
9
Q
Examples of Intermittent fever
A
Abscess, lymphomas and Miliary tuberculosis.
10
Q
Examples of Remittent fever
A
Septic conditions & mycoplasma pneumonia
Rheumatic fever & rheumatoid arthritis
SABE & falciparum malaria
10
Q
Def of Remittent fever
A
The temperature is always raised, but shows considerable between morning & evening temperature but not return to normal
11
Q
Def of Saddle back (Camel-backed) fever
A
- Biphasic remittent fever.
- A continuous fever for a few days is followed by a remission
- A second bout of continuous fever associated with appearance of rash and terminating by lysis
12
Q
Def of realpsing Fever
A
Days with fever alternate with days of normal temperature
12
Q
Examples of Saddle back (Camel-backed) fever
A
In Dengue fever
13
Q
Examples ofrealpsing Fever
A
Brucellosis (undulant fever)
Spirochete( relapsing fever)
Pel-abstain fever of hodgkin’s disease
Charcot’s intermittent fever in biliary obstruction, and malaria.
14
Q
what is Quotidian Fever?
A
When a paroxysm of intermittent or relapse fever occurs daily
15
Q
what is Tertiam Fever?
A
when on alternate days
16
Q
Characters of Factitious fever
A
It is spurious temp. Elevation produced by the pt.
Not associated with organic disease.
Normal ESR.
Failure of pulse rate to rise with temp.
17
Q
What is quatrain fever?
A
when 2 days intervene between consecutive attacks
18
Q
Causes of Hyperpyrexia
A
19
Q
Causes of Hypothermia
A
20
Q
Manifestations of fever
A
21
Q
Physiological response to fever
A
22
Specific Manifestations of fever
23
Salmonellosis in Egypt present the form of .....
Typhoid, paratyphoid fever.
Chronic salmonellosis complicating Schistosoma infection.
Salmonella food poisoning (acute gastroenteritis).
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CA of typhod & Paratyphoid fever
Salmonella typhi and salmonella paratyphoid A, B & C.
25
Characters of CA of typhoid & Paratyphoid fever
It is gram-negative motile bacilli.
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Source of Infection by typhoid & Paratyphoid fever
Patient.
Carrier (intestinal, gall bladder or unitary carrier).
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MOT of typhoid & Paratyphoid fever
Food & Flies & Foments & Feces & Fingers.
28
Pathophysiology of typhoid & Paratyphoid fever
After invasion of the intestinal mucosa, bacilli first enter the mesenteric lymph glands through Payer's patches → blood stream (bactermia) → then pass to
other organs e.g. liver spleen and reticule-endothelial system
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IP of typhoid & Paratyphoid fever
4 satges
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CP of typhoid & Paratyphoid fever
1-2 Weeks
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Stages of typhoid & Paratyphoid fever
.....
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1st Week of typhoid & Paratyphoid fever
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2nd Week of typhoid & Paratyphoid fever
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3rd Week of typhoid & Paratyphoid fever
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4th Week of typhoid & Paratyphoid fever
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CC of **Typhoid**
- A patient with persistent fever (38 °C or more) lasting 3 or more days, with laboratory-confirmed S. typhi organisms (blood, bone marrow, bowel fluid)
- A clinical compatible case that is laboratory confirmed
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Probable Case of **Typhoid**
- A patient with persistent fever (38 °C or more) lasting 3 or more days, with a positive sero-diagnosis or antigen detection test but no S. typhi isolation
- A clinical compatible case that is epidemiologically linked to a confirmed case in an outbreak
37
Chronic Carier of **Typhoid**
- An individual excreting S. typhi in the stool or urine for longer than one year after the onset of acute typhoid fever
- Short-term carriers also exist, but their epidemiological role is not as important as that of chronic carriers.
- Some patients excreting S. typhi have no history of typhoid fever
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Investigations to Dx **Typhoid**
- PCR
- Blood Culture
- Stool & Urine Culture
- BM Aspirate Culture
- Widal agglutination test
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Investigations to Dx **Typhoid**
- PCR
- Can be performed on peripheral mononuclear cells.
- The test is more sensitive than blood culture alone (92% compared with 50-70%) but requires significant technical expertise
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Investigations to Dx **Typhoid**
- Blood Culture
Positive in 70-80% of cases during the 1st week.
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Investigations to Dx **Typhoid**
- Stool & Urine Culture
Are usually positive (45-75%) during the 2nd - 3rd week.
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Investigations to Dx **Typhoid**
- BM Aspirate Cultures
Give the best confirmation (85-95%)
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Investigations to Dx **Typhoid**
- Widal agglutination reaction (Felix-Widal test)
- Positive from the 2nd week on words, with gradual rising titer.
- It seems unreliable
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Procedure of Widal agglutination reaction (Felix-Widal test)
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This test measures agglutinating .....
antibody levels against O and H antigens.
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The levels are measured by using doubling dilutions of sera in large test tubes.
....
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Usually, O antibodies appear on days 6-8 and H antibodies on days 10-12 after the onset of the disease.
....
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The test is usually performed on an .... serum (at first contact with the patient)
acute
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A convalescent serum should preferably also be collected so that paired titrations can be performed.
...
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In practice, however, this is often difficult
...
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- In areas of endemicity there is often a low background level of antibodies in the normal population.
- Determining an appropriate cut-off for a positive result can be difficult since it varies between areas and between times in given areas.
...
52
If paired sera are available a ..... in the antibody titer between convalescent and acute sera is diagnostic.
fourfold rise
53
When is Widal agglutination reaction False positive?
1. Anamanestic reaction ( Cross reaction with other salmonella & gram -ve bacteria )
2. Autoimmune diseases.
3. Prior vaccination.
4. Prior antibiotic treatment
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Widal test is → ....... test
unreliable
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Types of Complications of Typhoid
- General
- Medical
- Surgical
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General Complications of Typhoid
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Medical Complications of Typhoid
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Medical Complications of Typhoid
- Typhoid lobar pneumonia
- Present with the typical symptoms and signs of lobar pneumonia except that rusty sputum is uncommon and the white blood low.
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Medical Complications of Typhoid
- Myocarditis
common particularly in very toxic patients.
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Medical Complications of Typhoid
- Typhod Meningitis
- Is rare and must not be confused with meningism, which is common
- Chloramphenicol diffuse well into the cerebrospinal fluid, so it gives good results
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Medical Complications of Typhoid
- Peripheral Neuritis
Treated with Vitamin B complex as prophylactic measure.
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Medical Complications of Typhoid
- Mild Hemolytic Anemia
- is common in the typhoid patients.
- Treated with prednisone.
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Medical Complications of Typhoid
- Febrile Albuminurea
common, but a true acute typhoid
nephritis is rare.
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Surgical Complications of Typhoid
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Surgical Complications of Typhoid
- Intestinal Perforation
This is one of the most serious complications of typhoid fever, it occurs during the third week of illness but occur before.
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Surgical Complications of Typhoid
- Acute Patotitis
- Is a danger complication and pus should be drained by transverse incision under local anaesthetic as early possible.
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Surgical Complications of Typhoid
- Intestinal Hemorrhage
- Is a lethal complication which usually occurs 2-3 weeks after the onset of the illness
- The patient may show massive hemorrhage, which
manifested by shock and very pale conjunctiva, or small bleeding.
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Surgical Complications of Typhoid
- Typhoid Cholecystitis
Occur more frequent in female more
than male.
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Surgical Complications of Typhoid
- Paralytic Ileus
may be secondary to perforation or to severe toxemia.
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Surgical Complications of Typhoid
- Intestinal Obstruction
may be due to a localized abscess or
adhesions.
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TTT of Typhoid
- Prophylactic
- Curative
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Prophylactic TTT of Typhoid
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Curative TTT of Typhoid
- general Lines
- Specific TTT
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General Lines of TTT of Typhoid
A. Rest in bed.
B. Well balanced diet.
C. Adequate fluid.
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Specific Lines in TTT of Typhoid
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Vaccines for Typhoid
- Oral – A live vaccine (Typhoral)
- The injectable vaccine (Typhim -VI)
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Type of Oral Typhoid Vaccine
Oral – A live vaccine (Typhoral)
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Dosage of Oral Typhoid Vaccine
One capsule given orally taken before food, with a glass of water or milk, on day 1, 3, 5 (three doses)
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Precautions for Oral Typhoid Vaccine
No antibiotics should be taken during the period of
administration of vaccine
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Dosage of Injectable Typhoid vaccine
Given as single S.C or I.M injection
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Indications of Typhoid vaccine
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Another name of Brucellosis
(Malta fever or Undulant fever)
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CA of **Brucellosis**
79
MOI by **Brucellosis**
80
IP of **Brucellosis**
1-3 weeks.
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Onset of **Brucellosis**
gradual with malaise & muscular pains.
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CP of **Brucellosis**
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CP of **Brucellosis**
- Constitutional Symptoms
profuse sweating, muscular pain, headache, joint pain and backache.
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CP of **Brucellosis**
- Pulse
relative slow
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CP of **Brucellosis**
- Fever
reach 39-40 C for 1 - 3 weeks then apyrexia for 10 days then relapse and so on (undulant fever).
86
CP of **Brucellosis**
- GIT
Nausea, vomiting & constipation.
87
CP of **Brucellosis**
- Enlarged Spleen
present in almost half the patients the spleen is tender and firm and usually mild enlarged.
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CP of **Brucellosis**
- Lymph Nodes
In 50% of cases there is generalized enlargement, especially the cervical and axially lymph nodes.
89
Investigations for **Brucellosis**
- Direct
- Serological
90
Direct Investigations for **Brucellosis**
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Direct Investigations for **Brucellosis**
- Blood Culture
- Positive in the 1st week ( positive in 50% only) may retain up to 6 weeks to give maximum chance of finding this slowly growing organism
92
Direct Investigations for **Brucellosis**
- Bone Marrow Culture
positive in 90%
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Serological Investigations for **Brucellosis**
94
Serological Investigations for **Brucellosis**
- Agglutination test
- Positive from 2nd week titer over 1/100 or rising 4 fold titer/6h for 24 h. → is diagnostic in the same session.
- It is unreliable test indicate only past infection no correlations with the titre concentrations
95
Serological Investigations for **Brucellosis**
- Complement Fixation
To measure IgG antibodies.
96
Serological Investigations for **Brucellosis**
- Radio-Immuno Issay
To determine the levels of specific anti-Brucella IgM, IgG & IgA.
97
Complications of **Brucellosis**
- Bone and joint complication
- Cardiovascular complication
- Genito-urinary complications
- Nervous complications
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Bone & Joint Complications of **Brucellosis**
1) Brucella spondylitis: Where bone and discs are invaded causing osteomyelitis with destruction of bone giving picture similar to disc prolapsed.
2) Suppuration of large joint.
3) Osteomyelitis of long bone.
99
CVS Complications of **Brucellosis**
Bacterial endocarditis usually develops on a congenital or acquired valvular lesion.
100
Genitourinary Complications of **Brucellosis**
1) Orchitis.
2) Epididymitis.
3) Chronic pyelonephritis.
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Nervos Complications of **Brucellosis**
1) Meningitis.
2) Encephalitis
3) Myelitis.
4) Paraplegia.
5) Aphasia.
6) Dysarthria.
7) Visual disorders.
8) Deafness.
102
TTT of **Brucellosis**
103
Symptomatic TTT of **Brucellosis**
Antipyretics and analgesics
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Tetracycline Dose in TTT of **Brucellosis**
50 mg / kg / day in divided dose each 4 hours for 3 - 6 weeks.
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Doxycycline Dose in TTT of **Brucellosis**
oral 100 mg / 12hours for 3 weeks (preferred over tetracycline)
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Aminoglycosides Dose in TTT of **Brucellosis**
for 3-4 weeks.(nephrotoxic)
a) Streptomycin: 1 gm / 24h. IM
b) Gentamycin: 5 mg / kg / 12h. IM
c) Netilmicin: 2 mg / kg / 12h IM or IV
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Streptomycin & Tetracycline Dose in TTT of **Brucellosis**
Streptomycin 1 gm I. M. daily for 3 weeks.
108
Rifampicin Dose in TTT of **Brucellosis**
600 mg /1 2 h for 3 weeks.
109
Which drug is CI in Pregnant & children in TTT of **Brucellosis**?
110
Nature of **FMF**
Periodic fever
111
Def of **FMF**
It is a clinical syndrome with a probable genetic basis which give rise to recurrent febrile episodes associated with
Abdominal pain ( peritonism)
Pleurisy
Arthropathy
112
What is the hallmark of **FMF**?
Periodicity
113
Ethnic Groups affected in **FMF**
Major ethnic groups affected are Jews, Arab, Armenians & Turks.
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Etiology of **FMF**
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PPT Factors for **FMF**
Stress & anxiety
Cold
Physical exercise
Menstruation
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CP of **FMF**
117
CP of **FMF**
- Fever
- Has intermittent character
- It is characterized by recurrent acute attacks occurring at intervals varying from days to weeks even months but the attack is short lived usually 3 days & seldom lasts more than 4 days.
118
CP of **FMF**
- Severe abdominal Pain
Diffuse (like peritonitis so repeated laparotomies is one of the diagnostic criteria in the past).
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CP of **FMF**
- Arthropathy
(large joint, symmetrical ,non destructive, more in sporadic Jews)
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CP of **FMF**
- Dermatologic Lesion
erysipelas like lesion, Henoch-scholein purpura, urticarial vasculitis, bullous lesion.
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Less Common Manifestations of **FMF**
Ophthalmic (episcleritis)
Acute orchitis
Pharyngitis
Pericarditis
Myocarditis
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Complications of **FMF**
Amyloidosis (Amyloid A formation)
- Common in Jews & Turks
- Arab & Armenians are largely immune from this.
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Tel-Hashomer Criteria of **FMF**
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Dx of **FMF**
125
TTT of **FMF**
126
TTT of **FMF**
- Colchicine
127
TTT of **FMF**
- Biological TTT
128
Done
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