Professional Documents
Culture Documents
Musofa Rusli
Dep/SMF Ilmu Penyakit Dalam – Divisi Tropik - Infeksi
FKUA – RSUD Dr. Soetomo Surabaya
TOPICS
oDefinition
oPathophysiology of fever
oManagement of fever
oFever of unknown origin
oDrug fever
1
3/3/2019
Definition
Fever oFever:
an elevation of body temperature that exceeds the normal daily
variation and occurs in conjunction with an increase in the
hypothalamic set point [e.g., above 37.2°C].
Heat conservation (vasoconstriction) and heat production (shivering, fat
tissue thermogenesis)
Anatomic variations: rectal > oral > axillar rectal 0.4 oC higher than
oral
2
3/3/2019
Wunderlich’s Maxim
3
3/3/2019
Definition
Pyrogens
Pyrogens any substance that causes fever
oEndogenous
class of biologically active proteins called cytokines pyrogenic cytokines
related to activation of TLR
E.g.: IL-1, IL-6, TNF-α, IFN-γ
oExogenous
derived from outside the host
mainly microbes or their products: toxins
Definition
Elevated body temperature
oHyperthermia:
An uncontrolled increase in body temperature that
exceeds the body's ability to lose heat
thermoregulatory center is unchanged
Does not involve pyrogenic molecules
Exogenous heat exposure and endogenous heat
production
oHyperpyrexia:
an extraordinarily high fever (>41.5ºC)
8
4
3/3/2019
PATHOGENESIS OF FEVER
Heat conservation
Heat production
10
5
3/3/2019
TREATING FEVER
Antimicrobial Acetaminophen
drugs Corticosteroids NSAIDs
Anti-cytokines Antimicrobial
11
drugs drugs
Definition
Temperature-pulse relationship
6
3/3/2019
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
13
Fever Onset
< 1 week Within 1-3 weeks > 3 weeks
Dengue Typhoid fever Tuberculosis
Chikungunya Typhus HIV
Leptospirosis Leptospirosis CMV
JEV Ebola Autoimmune disease
SARS CMV Malignancies
Ebola Rabies
Hepatitis A Acute HIV
14
7
3/3/2019
oTyphoid fever
oDengue fever/ DHF
oRickettsiosis
oLeptospirosis
oChikungunya fever
oHantavirus
15
Thrombotic (DVT/PE/MI)
8
3/3/2019
Treatment of Fever
oAntipyretics:
Acetaminophen
NSAIDs side effects !
oCorticosteroids side effects !!!
oCool damp sponges
oSubmersion should be avoided
17
Complications:
o a state of catabolism detrimental to body
o fluid and electrolyte imbalance - due to sweating and loss of minerals
o high grade fevers can lead to convulsions, brain damage, circulatory overload
and arrhythmia
o increase oxygen consumption COPD, CHD
18
9
3/3/2019
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
19
20
10
3/3/2019
“Classic”etiology:
o Infections: tuberculosis, infectious mononucleosis
o Malignancies
o Noninfectious inflammatory diseases (eg, vasculitis, systemic lupus erythematosus, polymyalgia
rheumatica)
21
o Connective tissue diseases (eg, vasculitis, rheumatoid arthritis)
11
3/3/2019
1. Infections:
Endocarditis
Tuberculosis
Abdominal abscesses FUO: most common causes
EBV/CMV infections
2. Malignancies:
Lymphoma
Leukemia
4. Miscellaneous disorders
Habitual hyperthermia
Drug fever Vanderschueren S. et al. From prolonged febrile illness to
Fever of Unknown Origin: The challenge continues. Arch
Subacute thyroiditis Intern Med 2003;163:1033.
Key Points
oHistory taking finding source/ site of infection
oPhysical examination
oImaging
oLaboratory tests:
CBC, urinalisys, BUN/ SC, SGOT/ SGPT, LED, [CRP, lactate,
procalcitonine]
Blood/ urine/ body fluid culture
Serology, antigen-based test
24
12
3/3/2019
25
o PCT improves the management of patients with lower respiratory tract infections and
critically ill sepsis patients, as well as patients with UTIs, postoperative infections,
meningitis, and acute heart failure with possible superinfection (i.e., pneumonia)
o PCT-guided protocol shortened length of antibiotic treatment
o PCT is far from being a perfect marker and levels must be evaluated in the context of a
careful clinical and microbiological patient assessment 26
13
3/3/2019
27
28
14
3/3/2019
29
THANK YOU
30
15