Fever
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Fever is defined as "an abnormal elevation of body temperature, usually as a result of a pathologic process."[1]
Acute febrile illness in a healthy adult
Assuming that local inflammatory processes such as an abscess or cellulitis are not present, several clinical findings can suggest the underlying cause of an acute fever.
- Influenza-like illness is defined as "fever (temperature of 100°F [37.8°C] or greater) and a cough and/or a sore throat in the absence of a known cause other than influenza."[2] Possible causes include respiratory syncytial virus, rhinovirus, adenovirus, parainfluenza viruses, coronaviruses, and metapneumovirus.[3]
- Mononucleosis-like illness is the triad of fever, pharyngitis, and lymphadenopathy which suggests infectious mononucleosis. Other possible causes include cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), human immunodeficiency virus (HIV), human adenovirus, herpes simplex virus (HSV), Streptococcus pyogenes, and Toxoplasma gondii.[4]
- Relative bradycardia is when the "pulse is less than expected at a given body temperature"[5] Relative bradycardia suggests an intracellular organism such as salmonella, legionella, and chlamydia.[5] Other causes include Sandfly fever and Dengue fever.
- Arthropathy, when prominent, suggests Parvovirus B19.
- Myalgias, when prominent, suggests Dengue fever.
- Headache, when prominent, suggests West Nile Virus.
Acute febrile illness in an adult with neutropenia
Clinical practice guidelines define febrile neutropenia as "a single oral temperature of >=38.3°C (101°F) or a temperature of >=38.0°C (100.4°F) for >= 1 h. Neutropenia is defined as a neutrophil count of <500 cells/mm3, or a count of <1000 cells/mm3 with a predicted decrease to <500 cells/mm3"[6]
A clinical prediction rule can estimate the risk of mordidity in the febrile patient with neutropenia.[7] A score of >=21 indicates low risk.
Fever of unknown origin
References
- ↑ National Library of Medicine. Fever. Retrieved on 2007-11-16.
- ↑ Centers for Disease Control and Prevention (2007). CDC - Influenza (Flu) - Flu Activity. Retrieved on 2007-11-19.
- ↑ Kelly H, Birch C (2004). "The causes and diagnosis of influenza-like illness". Australian family physician 33 (5): 305–9. PMID 15227858. [e]
- ↑ Hurt C, Tammaro D (2007). "Diagnostic evaluation of mononucleosis-like illnesses". Am. J. Med. 120 (10): 911.e1–8. DOI:10.1016/j.amjmed.2006.12.011. PMID 17904463. Research Blogging.
- ↑ 5.0 5.1 Babyatsky MW, Keroack MD, Blake MA, Rosenberg ES, Mino-Kenudson M (2007). "Case 35-2007 -- A 30-Year-Old Man with Inflammatory Bowel Disease and Recent Onset of Fever and Bloody Diarrhea" 357 (20): 2068–2076. DOI:10.1056/NEJMcpc079029. PMID 18003964. Research Blogging.
- ↑ Hughes WT, Armstrong D, Bodey GP, et al (2002). "2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer". Clin. Infect. Dis. 34 (6): 730–51. PMID 11850858. [e]
- ↑ Klastersky J, Paesmans M, Rubenstein EB, et al (2000). "The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients". J. Clin. Oncol. 18 (16): 3038–51. PMID 10944139. [e] (See Table 4 for the prediction rule)