Fever

[DR:Blue Angel]

Fever takes a characteristic course in many diseases and the pattern of rise and fall of temperature may itself be a clue for diagnosis.
Sustained: Persistent elevation in temperature with minimal diurnal variation (< 10C)
Intermittent: Circadian rhythm is exaggerated, with wide variations; when the variation is extremely large, it is called hectic or septic. If this occurs daily, it is called quotidian fever.
Remittent: Temperature variation is > 20C, but does not touch normal. e.g. Tuberculosis, viral fever, many bacterial infections etc. Step - ladder fever is the one where the temperature rises gradually to a higher level with every spike.
Relapsing: Febrile episodes are separated by intervals of normal temperature. Examples are: Tertian fever - fever occurs once in 3 days or 48 hours (vivax, falciparum malaria);
Quartan fever - fever occurs once in four days or 72 hours (P. malariae);
Pel Ebstein: fever occurs once in 7-20 days (Hodgkin’s and other lymphomas)
Saddle Back: Patient has fever for 1-2 days, followed by remission for 2-3 days and then relapse of fever
Double Quotidian: Patient gets two spikes of fever every day, generalyy once in the morning and once in the evening. May be a feature of miliary tuberculosis
Inverse fever: The temperature rises in the early hours of morning rather than in the evening, seen in some cases of miliary tuberculosis.

[DR:Blue Angel]

Fever of Unknown Origin (F.U.O.) is one of the most challenging and interesting problems in clinical medicine
Definition of F.U.O.:
Fever of ³38.30 C ( 1010F) on several occasions
Classic: Fever for ³2 weeks OR in hospital investigations for 3 days OR 3 out patient visits
Nosocomial: Hospitalized for 3 days, no fever on admission.
Neutropenic: Neutrophil count £500 / mm3, in hospital investigations for 3 days
H.I.V. associated: Proven H.I.V. infection, 3 days in hospital or 4 weeks out patient
F.U.O. - Common Causes
Infections: Infections account for 40% of cases of F.U.O.
Localised: Appendicitis, cholangitis, cholecystitis, diverticulitis, dental sepsis, liver abscess, osteomyelitis (with prosthesis), P.I.D., prostatic abscess, sinusitis, intra-abdominal abscess, thrombophlebitis etc.
Intravascular: Endocarditis, aortitis
Systemic:
Bacterial - Tuberculosis, mainly extra pulmonary; Brucellosis, Leptospirosis, Salmonellosis, atypical mycobacteria, nocardia, actinomycosis
Rickettsial, mycopalsma
Fungal - Aspergillosis, candidiasis, cryptococcosis, P.carinii
Viral - Hepatitis A, B, C, D, E.; EBV, CMV, HIV
Parasitic - Malaria, Leishmania, Amebiasis
Other causes:
Neoplasms -
Malignant - Hodgkin’s and Non Hodgkin’s lymphoma, Immunoblastic lymphadenopathy, leukemia, renal cell carcinoma, hepatoma, sarcoma, pancreatic cancers.
Benign - Atrial myxoma, renal angiomyolipoma
Auto immune syndromes - Rheumatoid arthritis, S.L.E., P.A.N., M.C.T.D. etc.
Granulomatous diseases - Crohn’s disease, Idiopathic granulomatous hepatitis, Sarcoidosis
Miscellaneous - Drug fever, sub-acute thyroiditis, hematomas, gout, post MI, tissue infarction/ necrosis, cyclic neutropenia, adrenal insufficiency, brain tumor, hyperthyroidism, phaeochromocytoma, factitious fevers, habitual hyperthermia
F.U.O of more than > 6 months is less likely to be due to an infection
F.U.O. - Investigations
F.U.O. may require a wide array of investigations to locate the cause of the fever. History, clinical findings and findings of routine investigations should guide the selection of these special investigations.
· HEMATOLOGICAL: Blood count, ESR, P.S. study, Malarial Parasite, Microfilaria, Leishmania
· BIOCHEMICAL: L.F.T., C.S.F. study, analysis of pleural / peritoneal fluids
· SEROLOGICAL: Widal, Brucellosis, Weil - Felix, Amebiasis, Hepatitis, H.I.V., EBV, CMV, Leptospira, Tuberculosis etc., Anti nuclear antibody, RA factor
· MICROBIOLOGICAL: Cultures of blood, body fluids, secretions; staining and examination of secretions
· PATHOLOGICAL: Bone marrow aspiration, F.N.A.C., examination of fluids and secretions, histopathology - Biopsy of liver, lymphnodes
· SKIN TESTS: Tuberculosis, sarcoidosis
· RADIOLOGICAL: X - Ray of chest (P.A., lateral, apical, under penetrated A.P.), sinuses, bones, joints, Barium Series etc.; Ultra sound studies, C.T. scan / M.R.I. Scan
· INVASIVE: Biopsy of lymph nodes, liver, bone marrow; exploratory laparotomy; Ultra sound / C.T. guided aspiration / biopsy Aspiration of fluids - pleural /peritoneal/Lumbar Puncture
· ENDOSCOPY: Gastroscopy/colonoscopy/ cystoscopy/arthroscopy/laparoscopy etc.
F.U.O. - Empirical Therapy
Empirical therapy should be avoided as far as possible. However, on certain demanding situations, one may have to resort to empirical treatment. Some examples are given below:
Presumptive therapy for malaria: For ALL cases of fever in an malarious area or in a visitor to malarious area. Only the first full dose of chloroquine should be used for presumptive treatment and second line drugs should be avoided. In areas with known resistance to chloroquine, pyrimethamine/sulfadoxine can be added.
Empirical antimicrobial therapy: Severe sepsis, shock, severe neutrophilic leukocytosis, immunocompromised patients F.U.O. are indications to start empirical broad spectrum antibacterial therapy (to cover Gram positive, Gram negative and anaerobes). Examples include 3rd generation cephalosporins + Aminoglycosides + Metronidazole OR Pseudomonas specific penicillins / cephalosporins + Metronidazole.
Empirical antitubercular therapy: This can be used when all investigations are negative and there is reasonable doubt about Tuberculosis, particularly in areas where tuberculosis is common. Only INH and Ethambutol should be used in this therapeutic trial (since other antitubercular drugs like rifampicin and streptomycin are effective against other bacterial infections as well). A fair trial for up to 8 weeks should be given and if the disease is indeed tuberculosis, the patient will show signs of recovery and may become apyrexial.
Empirical steroids: It can be tried only when all infections are ruled out and reasonable doubt of autoimmune syndromes exists
Common Causes of Fever
Viral Fever
Malaria
Enteric Fever
Tuberculosis
Brucellosis
Filariasis
Leptospirosis
H.I.V.

[DR:Blue Angel]

Like in any other illness, a detailed history plays a vital role in making a diagnosis. Attention should be paid to the following details:
· Onset - Sudden / insidious / unnoticed
· Type - Sustained / intermittent / remittent / relapsing
· Duration
· Associated complaints - head ache, body ache, running nose, rashes, sore throat, cough,
· Chest pain, breathlessness, dysuria, frequency of micturition, diarrhoea, vomiting, abdominal pain,
· Pain / redness of limbs, swellings, joint pains etc.
· Weight loss
· Contacts
· Occupation
· Travel - Trekking / endemic areas
· Stay ( hotel, hostel, ashram, hospital)
· Habits
· Past history
· Treatment history - Transfusions, injections, allergies, medications, hospital interventions
· Sexual practice

[وادى حبونا]

DR:Blue Angel

can you translat that in arabc please


thankyou

[كاتم الأحزان]

بسم الله الرحمن الرحيم

DR:Blue Angel

welcome to come here with your brother and sister and thank you for this information about

Fever of Unknown Origin


I know some information about it

Fever of Unknown OriginWhen health care providers cannot diagnose the cause of a patient's temperature that reaches 101 degrees Fahrenheit on and off for at least three weeks, they call it a fever of unknown origin (FUO). If the fever persists, your health care provider will continue to carry out tests to narrow down the causes. But in 5 to 15 percent of cases, they fail to find the reason for the fever.

Your health care provider may prefer not to give you medication for your fever while it remains undiagnosed. Research suggests that fever helps fight off infections, so treating the fever without knowing the cause might reduce the body's ability to deal with the possible infection. However, providers will prescribe drugs to reduce fever in children who suffer seizures induced by fever. Because a higher temperature increases a person's need for oxygen, your provider may prescribe fever-reducing drugs if you have heart or lung problems

Signs and Symptoms

Fever of more than 101°F (38.3°C), either continuous or intermittent, for at least two weeks

Fever above 101°F whose cause remains unknown even after extensive diagnostic testing

Causes

By carrying out a series of tests, health care providers try to narrow down the list of possible reasons for a high temperature


What to Expect at Your Provider's Office

A provider trying to diagnose the cause of a fever of unknown origin must seek out every possible clue. He or she may ask you questions about

Your work, because some workplaces contain organisms that can cause fever

Places you have visited recently. Locations overseas, and even areas in the United States, can harbor diseases that can cause fever

Your health care provider will also examine you closely, paying particular attention to your skin, eyes, nails, lymph nodes, heart, and abdomen. He or she will also take blood and urine samples. You may have an ultrasound examination, as well as computed tomography (CT scan) and magnetic resonance imaging (MRI). If the cause of the fever still can't be found, your provider may want to inject you with "labeled white blood cells." These are white blood cells that contain a harmless radioactive compound. Once injected, the white blood cells travel to infected parts of your body. The radioactivity allows your provider to see on an X ray just where they have moved and thus locate the infection responsible for your fever. If that fails, your provider may want to perform minor surgery to take biopsy samples of, for example, your liver or bone marrow

Treatment Options

Your health care provider will advise you to rest and drink plenty of fluids, and may even take you off medications for other ailments, because those medications may be causing your fever. If you have a heart or lung condition, or if your child has seizures as a result of the fever, your provider will probably prescribe over-the-counter remedies to bring down the temperature. The most popular are acetaminophen and aspirin

Drug Therapies

Acetaminophen

Aspirin and other nonsteroidal anti-inflammatory drugs. Avoid aspirin for children and teenagers, as it increases the risk of Reye's syndrome

In cases of infection, your doctor may also prescribe an antibiotic, antifungal, or antiviral drug, depending on the cause of the infection

Complementary and Alternative Therapies

General immune support with nutrition and herbs may alleviate fevers

Nutrition
Eliminate alcohol, caffeine, refined foods, and sugar
Drink water or electrolyte replacement (sports) drinks
Vitamin C (250 to 500 mg two times per day), beta-carotene (15,000 to 50,000 IU per day), and zinc (10 to 30 mg per day) help your immune system work better and reduce inflammation

Herbs
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

The following herbs may be helpful in reducing fever and improving immune response: coneflower (Echinacea purpurea), yarrow (Achillea millefolium), white willow bark (Salix alba), lemon balm (Melissa officinalis), spearmint (Mentha spicata), catnip (Nepeta cateria), and elder (Sambucus nigra). Combine 1 part coneflower and 1 part white willow bark with equal parts of two or more herbs. Drink 3 to 4 cups per day, 2 to 4 oz. three to four times per day for children

Homeopathy
Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of fevers based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual

Aconitum -- for fever that comes on suddenly and alternates with chills, heat, and flushing of the face; the individual may be anxious and crave cold drinks
Apis mellifica -- for fever associated with alternating bouts of wet (sweating) and dry body heat
Belladonna -- for sudden onset of high fever with hot, red face, glassy eyes, lack of thirst, and hot body with cold hands
Bryonia -- for fever with symptoms that are aggravated by the slightest movement
Ferrum phosphoricum -- for the first stages of a fever with a slow onset; this remedy is generally used if Belladonna is ineffective

Acupuncture
Acupuncture may be helpful in supporting immune function


Special Considerations
Fever can be dangerous if you are pregnant. Nutritional, herbal, and homeopathic treatments for fevers are generally safe in pregnancy, yet use with caution



thank you very much and Ihope see you her in another informatiom

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كــــــــــاتم الاحزان

[السندباااد]

السلام عليكم

thank you DR:Blue Angel .............thank you very much


see you

السندباااد

[كاتم الأحزان]

يرفع ليتم ترجمة بعض من الموضوع من قبل الأخ العزيز : حسن ,,