Tiêu đề Fever ✅

FEVER OF UNKNOWN ORIGIN Approach to Fever •Onset •Duration •Characteristics (e.g., continuous vs. intermittent or nocturnal, high grade vs. low grade) Recent exposures • Travel (see below) • Sick contacts • New medication or substance • Animals, including farm and wild animals Associated symptoms • General o Chills, rigors ENT ● Nasal congestion and/or rhinorrhea ● Odynophagia Iman, Nisa, Lissa, Izzaty (16/7/2021) Forti

● Prophylactic medication CAUSES OF PROLONGED FEVER HIV Ask all symptoms of HIV - rash, neck swelling (cervical) - oral: oral thrush (whitish tongue), ulcer, - LOW (>10%) - GIT: nausea, diarrhoea, LOA Hx of IVDU (+ ask if sharing needles) Sexual hx Malaria Recent travelling Dengue Febrile phase 2-7 days : Fever, headache, N/V, rash IE HF symptoms: SOB, PND, orthopnea, reduced effort tolerance Typhoid fever Dry Cough, Malaise, Headache, Rising step like Fever 39°C. May be constipation or diarrhoea. Haematological Malignancy (Leukemia, Lymphoma) - Neck swelling → lymphoma - Gum bleeding, bruises, neck swelling → leukemia TB - Neck swelling - Chronic cough - Night sweats SLE - Systemic symptoms - Malar rash, discoid rash INFECTIVE ENDOCARDITIS Defined as an infection of the endocardial surface (innermost layer) of the heart may include one or more heart valves, the mural endocardium, or a septal defect by microorganisms (mainly bacteria). - Pathological findings include the presence of friable valvular vegetations containing bacteria, fibrin and inflammatory cells Epidemiology : - 3-9 per 100,000 subjects per year - Age : Developed (50-60y/o) Developing (20-40y/o) - M>F (2:1) - Commonly affects native valves (Usually affect Mitral valve) Iman, Nisa, Lissa, Izzaty (16/7/2021) Forti
PP: - Structural abnormality of heart or great artery by turbulent flow / pre-existing endocardial damage due to jets and turbulence from MR/VSD which is vulnerable to infection→ platelet-fibrin deposition → Non-bacterial thrombotic endocarditis → adherence - Bacteremia resulting in endothelial damage + platelet → adherence → colonisation → fibrin (thrombus) formation Classification: **Acute IE: caused by virulent organisms lead to serious destruction in the valve, Irregular, reddish tan vegetations overlying valve cusps that are being destroyed. Portions of the vegetation can break off and become septic emboli Organism: Bacteria: ● Staph Aureus (Severe acute infection. IV Drug users) ● Strep Viridans(subacute, oral/resp) ● Staph. Epidermidis (Skin, Post cardiac op) Fungi: ● Candida ● Aspergillus Rickettsiae Chlamydia Pseudomonas Enterococci (subacute, Gut/Urinary) Gram negative bacteria: HACEK - Haemophilus - Actinobaciluus - Cardiobacterium hominis - Eikenella corrodens - Kingella kingae - Coxiella burnetti (q fever) - Chlamydia Presence of organism in blood •Leads to bacteraemia due to breach in the body’s innate defences •Poor dental hygiene, IV drug abuser, soft tissue infection, iatrogenic, dental treatment, intravascular cannulae, cardiac surgery, permanent pacemakers Hx General PE Classic signs of IE (peripheral) Iman, Nisa, Lissa, Izzaty (16/7/2021) Forti