Approach to Fever and Heat Disorders

Approach to Fever and Heat Disorders

• Hyperthermia: A rapid increase in core body temperature above 40°C due to the body producing or absorbing more heat than it dissipates.
• Hyperpyrexia: An extremely high fever, greater than 41.5°C, often seen with central nervous system (CNS) hemorrhages or severe infections.
• Hypothermia: A dangerously low body temperature, can signal an overwhelming infection and should be carefully evaluated.
• Fever Patterns: Different patterns of fever can offer clues toward the diagnosis:
  • Continuous/Sustained Fever: Temperature remains above normal throughout the day and fluctuates less than 1°C within 24 hours. Examples include lobar pneumonia, typhoid, UTI, and brucellosis.
  • Remittent Fever: Temperature stays above normal throughout the day, but fluctuates more than 1°C within 24 hours. Infective endocarditis is an example.
  • Intermittent Fever: Temperature elevation occurs only for certain periods during the day, alternating with periods of normal temperature. Examples include pyemia and septicemia.
  • Relapsing Fever: Temperature returns to normal for periods before rising again, with a pattern of periodic fever. This can be seen with specific malaria types.
  • Pel-Ebstein Fever: A pattern of fever alternating between high and low periods, often associated with Hodgkin's lymphoma.

Presentation of Fever

• Feeling Hot: A feeling of heat is not always an indicator of fever, often accompanied by shivering chills and rapid temperature rise.
• Rigors: Severe shivering, teeth chattering, rapid temperature increase.
• Excessive Sweating: Night sweats are typical in some conditions such as tuberculosis.
• Headache: A common symptom that might indicate meningitis if severe.
• Delirium: Mental confusion that might be seen in extreme ages during fever.
• Muscle Pain: Myalgia is characteristic of viral infections, malaria and brucellosis.

Symptom Analysis for Fever

• Verification of Fever: Crucial to verify if the fever is genuine.
• Fever Duration: Acute or Chronic.
• Mode of Onset: Abrupt or Gradual
• Progression: Continuous or Intermittent
• Severity: How much the fever impacts daily activities.
• Relieving and Aggravating Factors: Note factors that cause the fever to worsen or improve.
• Associated Symptoms: Any other symptoms may be helpful to indicate the source of fever.

Pattern of Temperature Changes

• Various fever patterns are discussed and associated with possible diseases and conditions.

Chills and Rigors

• Profound chills accompanied by shivering and teeth chattering are common indicators of issues like malaria, sepsis, or infections.

Night Sweats

• A common symptom found in conditions such as lymphoma and tuberculosis

Headaches and Delirium

• Headache during fever may indicate more severe conditions such as meningitis.

Muscle Pain

• Muscle aches such as myalgias often occur with conditions involving infections.

Respiratory Tract Symptoms

• Sneezing, sore throat, purulent discharge suggest upper respiratory tract infection.
• Pain, headache, or respiratory distress indicate sinusitis or lower respiratory infections.

Genitourinary Symptoms

• Increased urination frequency or burning sensation may point toward urinary tract infections.

Abdominal Symptoms

• Abdominal pain and/or diarrhea can indicate gastrointestinal issues or abdominal infections

Joint Symptoms

• The nature and number of joints involved during the fever is important in diagnosing conditions.

Constitutional Symptoms

• Weakness, anorexia, weight loss, and night sweats often observed in more extensive infections and conditions.

Fever with Generalized Lymphadenopathy

• Important to examine all lymph nodes.
• Enlargement and tenderness can signify severe conditions like TB or lymphoma, beyond localized infection.

Contextual History

• Important medical history, past surgeries or transfusions, medications, including allergies, and previous infections can help point to relevant factors.

Examination Details

• Skin, Eyes, Throat, Nail beds, lymph nodes, abdomen and heart: Examinations focus on identifying specific signs and symptoms that could be indicative of severe conditions.
• Blood Pressure and its Variations: Hypotension could suggest potentially life-threatening infections.
• Mental Status Alterations: Any alterations to mental status in a febrile patient suggest potentially serious underlying conditions.
• Mouth and Oropharynx: Lesions or exudates in the mouth may indicate specific infectious causes.

Laboratory Investigations

• CBC with differential: This should be done for evaluating patients.
• Urine Analysis, Blood Films, Bone Marrow Aspiration, Stool Studies, Sputum Studies (gram stain/ZN staining): These studies can identify bacteria, parasites, fungal infections and other conditions.
• Chest X-rays: Important for evaluating the chest and lungs, when fever is unexplained.
• Abdominal X-rays: Often helpful to diagnose possible abdominal conditions, such as free air or fluid, when abdomen pain might be associated with fever.

Treatment

• General Measures: Fluids are key. Consider discontinuation of potentially fever-inducing medications.
• Empiric Antibiotic Therapy: In cases of suspected severe infection, empiric antibiotic treatment may be required and need to be narrowed once etiology is apparent, in patients with critical illness and suspected meningeal infection, and in immunocompromised patients or those with critical illness.
• Antipyretic Therapy: Medications to lower fever such as acetaminophen and ibuprofen may be helpful for controlling fever.
• Hospitalization may be necessary in certain situations based on the patient's needs and the potential severity of the condition.

Explore the critical aspects of fever and heat disorders, including hyperthermia, hyperpyrexia, and hypothermia. Understand various fever patterns and their implications for diagnosis. This quiz provides valuable insights into the management and evaluation of patients experiencing heat-related conditions.