Professional Documents
Culture Documents
TOPICS
oDefinition
oPathophysiology of fever
oManagement of fever
oFever of unknown origin
oDrug fever
Definition
Fever
o Fever:
Definition
Pyrogens
Pyrogens any substance that causes fever
oEndogenous
qclass of biologically active proteins called cytokines
pyrogenic cytokines
qrelated to activation of TLR
qE.g.: IL-1, IL-6, TNF-, IFN-
oExogenous
qderived from outside the host
qmainly microbes or their products: toxins
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Definition
Infectious diseases
Autoimmune disease
Malignancy
Hyperthermia
Heat stroke
Neuroleptic Malignant Synd
drug-induced hyperthermia
serotonin syndrome
malignant hyperthermia
Thyrotoxicosis
Pheochromocytoma
cerebral hemorrhage
status epilepticus
hypothalamic injury
Hyperpyrexia
Most commonly
occurs in patients
with CNS
hemorrhages
Definition
Temperature-pulse relationship
oThe temperature-pulse relationship is linear with an
increase in heart rate of 4.4 beats/ minute for each 1C
oTemperature-pulse dissociation (relative bradycardia)
typhoid fever, brucellosis, leptospirosis, some druginduced fevers and factitious fever
oFever may not be present during infection in newborns,
the elderly, patients with chronic renal failure, and in
patients taking corticosteroids
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Patterns:
o Continuous fever: Temperature remains above normal throughout
the day and does not fluctuate more than 1 C in 24 hours
o Intermittent fever: The temperature elevation is present only for a
certain period, later cycling back to normal
o Remittent fever: Temperature remains above normal throughout
the day and fluctuates more than 1 C in 24 hours
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Fever Onset
< 1 week
Dengue
Chikungunya
Leptospirosis
JEV
SARS
Ebola
Hepatitis A
> 3 weeks
Tuberculosis
HIV
CMV
Autoimmune disease
Malignancies
PATHOGENESIS OF FEVER
Heat conservation
Heat production
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TREATING FEVER
Antimicrobial
drugs
Corticosteroids
Anti-cytokines
drugs
Acetaminophen
NSAIDs
Antimicrobial
drugs 11
Treatment of Fever
oAntipyretics:
qAcetaminophen
qNSAIDs side effects !
Drug Fever
Definition (Mackowiak & LeMaistre, 1987):
o a disorder characterized by fever coinciding with administration of a drug and
disappearing after the discontinuation of the drug
o no other cause for the fever is evident after a careful physical examination and
laboratory investigation
o usually a diagnosis of exclusion
Important drugs related to drug fever:
o Antimicrobials: beta-lactams, sulfonamides and nitrofurantoin
o Anticonvulsant
o Minocycline
o Allopurinol
o Sympathomimetic drugs: amphetamines, cocaine
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Virology Tests
Virus penyebab
Jenis Uji
Penyakit
Dengue
Cytomegalovirus (CMV)
Infeksi - cytomegalovirus
Epstein - Barr
Paul Bunnel
Mononukleosis Infeksiosa
Virus (EBV)
Anti EBV
Hepatitis A s/d E
Hepatitis akut
Coxiella burnetti
IFA
Demam Q
Anti HIV-Elisa
Anti HIV-Western Blot
PCR
AIDS
AIDS
AIDS
Jenis Uji
Penyakit
Salmonella typhi
Demam tifoid
S. Paratyphi A/B/C
Widal
Demam paratifoid
Streptokokkus
ASTO
Demam reumatik
Mikobakteria
Leptospira spp
MAT
Leptospirosis
Brucella spp
Aglutinasi
Brusellosis
Rickettsia spp
Well felix
Ricketsiosis
Mycoplasma pneum
IF
Mycoplasmosis
Legionella
IF
Legionellosis
Toxoplasma gondii
Elisa IgG/IgM
Tokoplasmosis
Entamoeba histolitica
IDT
Amubiasis
Filaria spp
IFAT
Filariasis
Candida spp
Candidiasis
Histoplasma capsulatum
IDT
Histoplasmosis
Key Points
oHistory taking
oPhysical examination
oImaging
oLaboratory tests:
qCBC, urinalisys, BUN/ SC, SGOT/ SGPT, LED,
[CRP, lactate, procalcitonine]
qBlood/ urine/ body fluid culture
qSerology, antigen-based test
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THANK YOU
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