1. TASHKENT MEDICAL ACADEMY
Infectious and children infectious diseases department
Theme: Early and Comparative diagnosis of diseases with the syndrome of fever
Lecturer:

2. What is fever ? FEVER is a Diagnostic Clue
It is an essential host defense mechanism
Associated with or without localizing signs
It can be due to Infection, inflammation or neoplasm

3. Fever - Magnitude Below 97 degree F – Hypothermia
98.4 degree F - Normal
98 to 102 degree F – INFECTIONS
106 degree and above – Non- infectious fever (Hyperpyrexia)

4. Fever- Patterns
Intermittent type – temp return to normal once during most days
Remittent type – temp do not return to normal each day
Sustained/Continuous – temp do not vary more than 1 degree F /day
Relapsing - recurrent over days to weeks

5. Fever - types

6. Classical PUO FEVER – MORE THAN 101 F MORE THAN 3 WEEKS
CAUSE NOT DIAGNOSED AFTER ONE WEEK OF INTENSIVE HOSP INVESTIGN
TYPES OF PUO
ACUTE,
NOSOCOMIAL,
HIV ASSOCIATED
NEUTROPENIC PUO

7. PUO – causes INFECTIONS – 30% MALIGNANCY –20%
CONNECTIVE TISSUE D- 15 %
OTHERS – 20 %
UNDIAGNOSED – 15 %

8. FEVER - Common Clues RESPIRATORY SYMPTOMS – URTI ,LRTI,TB,
URINARY SYMPTOMS – UTI,APN,CYSTITIS
ABDOMINAL SYMPTOMS – ABSCESS,ACUTE ABDOMEN
ARTHRITIS SYMPTOMS –RA,SLE,AS
TRAVEL HISTORY
DIETARY HISTORY
OCCUPATIONAL HISTORY

9. TRAVEL History MALARIA – ENDEMIC AREAS DENGUE FEVER - Eg )SINGAPORE
VIRAL FEVERS
TYPHOID
TUBERCULOSIS
SCHISTOSOMIASIS

10. Dietary & Occupational History
BIRDS – PSITTACOSIS
ANIMALS CONTACT- TOXOPLASMOSIS (CAT), BRUCELLOSIS,LEPTOSPIROSIS (RAT)
UNCOOKED MEAT/SEA FOOD/ HEPATITIS –A & E,SALMONELLA
UNPASTEURIZED MILK – SALMONELLA,TB,BRUCELLOSIS

11. Drug fever Bradycardia, hypotension, Skin rash, pruritus +,
All drugs can produce Drug INDUCED fever except DIGOXIN
Bradycardia, hypotension, Skin rash, pruritus +,
Eosinophilia
eg) pencillin, sulpha, ATT

12. THERE IS NO SUBSTITUTE
FOR OBSERVING THE PATIENT,
TALKING TO HIM AND
THINKING ABOUT HIM.

13. FEVER & MYALGIA VIRAL FEVERS – LEUCO & THROMBO CYTOPENIA
INFLUENZA – URTI SYMPTOMS
POLYMYOSITIS – PROXIMAL M WEAKNESS, MUSCLE PAIN & TENDERNESS, CPK HIGH
MENINGOCOCCAL INFECTION -Rash
SEPSIS

14. Fever & Night Sweats TUBERCULOSIS LYMPHOMA ABSCESS BRUCELLOSIS
INFECTIVE ENDOCARDITIS
ALCOHOL WITHDRAWAL SYNDROME

15. FEVER – Brady, Tachycardia
RELATIVE BRADYCARDIA
TYPHOID FEVER
MALARIA
MENINGITIS
LEPTOSPIROSIS
VIRAL
DRUG FEVER
RELATIVE TACHYCARDIA
TOXINS

16. Fever & Eyes EYE PAIN – TEMPORAL ARTERITIS WATERY EYES- PAN
DRY EYES – SLE,RA
SC HGE –SBE
CONJUNCTIVITIS – TB,SLE
CONJUNCTIVAL SUFFUSION- LEPTOSPIROSIS
UVEITIS- TB,SLE,SARCOIDOSIS

17. FEVER WITH JAUNDICE LEPTOSPIROSIS – RENAL FAILURE +
HEPATITIS- DRUGS (ATT) ,VIRAL
ALCOHOLIC HEPATITIS
CIRRHOSIS OF LIVER
HEPATOMA
VIRAL FEVERS
MALARIA

18. GENERALIZED LYMPHADENOPATHY
LEUKEMIA – ALL , CLL
LYMPHOMA – MEDIASTINAL INVOLVEMENT
HIV INFECTION – ORAL CANDIDIASIS,THIN BUILT,
TOXOPLASMOSIS- WITH LIVER,SPLEEN
DISSEMINATED TUBERCULOSIS – WITH LIVER ,SPLEEN
BRUCELLOSIS- WITH LIVER,SPLEEN

19. EPI TROCHLEAR LYMPH NODES
MILIARY TB
LYMPHOMA
HIV INFECTION
SYPHILIS

20. FEVER WITH HEPATOSPLENOMEGALY
MALARIA
TYPHOID
LYMPHOMA
LEUKEMIA
DISSEMINATED TB
INFECTIVE ENDOCARDITIS
BRUCELLOSIS
KALA AZAR

21. FEVER WITH MENTAL CONFUSION
MENINGITIS
MENINGISM- TYPHOID
HIV
BRUCELLOSIS
CNS NEOPLASMS

22. LOCAL TENDERNESS TONGUE- RELAPSING FEVER
TRAPEZIUS – SUB DIAPHRAGMATIC ABSCESS
STERNAL – METASTASIS, PRE –LEUKEMIA
SPINAL – BRUCELLOSIS,TYPHOID,SBE,OM
THIGH- POLYMYOSITIS,BRUCELLOSIS
CALF – POLYMYOSITIS, RMSF

23. FEVER - ARDS SARS INFECTION CEREBRAL MALARIA (P FALCIPARUM )
HANTA VIRUS INFECTION
SEPSIS

24. HIGH ESR TB TEMPORAL ARTERITIS CARCINOMA LYMPHOMAS ABSCESS
MYELOPROLIFERATIVE DISORDER

25. FEVER & LOW PLATELETS DENGUE FEVER VIRAL FEVERS LEUKEMIA LYMPHOMA
MYELOPROLIFERATIVE DISORDER
DRUG FEVER
SLE
HIV INFECTION

26. CHEST X-RAY DIAGNOSIS TB- ANY FORM LYMPHOMAS- MEDIASTINAL INVOLVEMENT
SARCOIDOSIS – BHL
PNEUMONIAS
AUTOIMMUNE DISEASES

27. DIAGNOSTIC TESTS ANA,ANTI DS DNA – SLE
BONE SCAN- OSTEOMYELITIS,METASTASIS
ECHO HEART – ATRIAL MYXOMA,IE,PCITIS
SMEAR TEST + VE – MALARIA,
ELISA IGM AB - LEPTOSPIRA
VIRAL CULTURE + IN EBV,CMV INFECTIONS
BLOOD CULTURE + IN IE,SEPSIS,
AGGLUTININ TEST + IN SALMONELLA , BRUCELLOSIS

28. ULTRA SOUND HEPATOMA ABSCESS HYPERNEPHROMA (PHYSICIAN S TUMOUR)
LYMPHOMA
PELVIC TUMORS

29. THANK YOU
ALL WE KNOW IS STILL INFINITELY LESS THAN ALL THAT REMAINS UNKNOWN WILLIAM HARVEY -