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8 views

Introduction ID Part 1 2

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phatchara
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Introductionto

Infectious disease
Causes of fever
Infection
Trauma
Malignancy
Autoimmune diseases
Metabolic disorders: gout, pseudogout
Endocrine disease
- hyperthyroidism
- adrenal crisis
Drug fever
Fastitious fever
Malignancies associated with Fever
Hodgkin’s disease
Non-hodgkin’s lymphoma
Leukemia
Renal cell carcinoma
Hepatoma
Atrial myxoma
Immunological diseases
SLE
sarcoidosis
inflammatory bowel diseases
Still disease
autoimmune hepatitis
relapsing polychondritis

Tissue destruction
- hemolysis, rhabdomyolysis
- surgery, crush syndrome
- infarction
- cerebral bleeding
DISCOMFORT DUE TO FEVER
For each 1 °C elevation of body
temperature:
Metabolic rate increase 10-15%
Insensible water loss increase 300-
500ml/m2/d
O2 consumption increase 13%
Heart rate increase 10-15/min
TREATMENT OF FEVER
Most fevers are associated with self-
limited infections, most commonly of viral
origin.
Response to treatment
TREATMENT OF FEVER
Reasons not to treat fever:
The growth and virulance of some organisms
Host defense-related response
Fever is an indicator of disease
Adverse effect of antipyretic drugs
- paracetamol: hepatitis
- NSAIDS; kidney injury
Gastritis
Iatrogenic stress
Social benefits
TREATMENT OF FEVER

Reasons to treat fever:


The elderly individual with pulmonary or
cardiovascular disease
The patient at additional risk from the
hypercatabolic state (Poor nutrition, Dehydration)
The young child with a history of febrile
convulsions
Toxic encephalopathy or delirium
Pregnant women (controversy)
For the patient comfort
Hyperpyrexia
Pattern of fever from infection

Fever with chill


- biliary tract infection
- urinary tract infection
- bacteremia; IE
- Systemic infection
malaria
rickettsial infection
Leptospirosis
Infectious disease

Transmissible
or
communicable disease
Pathogens
- Viruses, viroids and prions
- Bacteria
- Spirochete; leptospirosis, syphilis
- Rickettsia; Scurb typhus
- Fungi
- yeasts ; Candida,
- filamentous fungi (mold); Aspergillus, Mucor
- dimorphic fungi; Cryptococcus, Penicilium,
Histoplasma
- Parasites
- unicelllular; malaria, Toxoplasma
- macroparasites (helminths)
roundworms , pinworms, tapeworms, and
flukes
Transmission
Respiratory route
- droplet or air borne
Fecal-oral ; Vibrio, Rotavirus, HAV
Sexual transmission
-bacteria, virus, spirochete, parasite
Vehicle transmission(food, water,
soil)
Vector-borne
- Dengue
- Malaria
- ricketsia
Pathogenesis of Infectious disease
Host
organism environment
Host defense mechanism
1.Physical and chemical barrier
2.Inflammatory response
3.Reticuloendothelium System
4.Immune response
ยุง
ลาย
บ้าน

ยุง
ลาย
สวน
APPROACH TO FEVER
Physical Examination:
Vital Signs
Neurological Exam.
Skin Lesions,Mucous Membrane
Eyes
ENT
Lymphadenopathy
Lungs and Heart
Abdominal Region (Hepatomegaly,Splenomegaly)
Musculoskeletal
Conditions Affecting Secondary
Host Immune Defense
Conditio Effects
n Decreased CMIR
Age < 65 Possibly Impaired
macrophage function
Coexisting illness
Blunted CMI
Impairment of neutrophill
and
Diabetes macrophage function
Bunted HI
Renal Decreased neutrophill and
failure macrophage
response
Conditions Affecting Secondary
Host Immune Defense
Condition Effects
Liver Blutned CMI & HI
failure Impair neutrophill
Function
Malnutriti
on Blutned CMI & HI
Malignan Altered oropharyngeal
cy colonization
AIDS Neutropenia
Corticost Blutned CMI & HI
eroid
Blutned CMI & HI
Diagnosis in Infectious disease
Clinical manifestation ; Acute
→ chronic
death mild → fulminant →
History
1. Chief
illnesscomplain and present
2. Underlying disease
3. Risk factor eg. Sexual contact,
IVDU
4. Bites of insect vectors
5. Medication
Physical Examination
1. Vital sign
2. HEENT
3. Lung
4. Heart
5. Abdomen
6. Genitourinary tract
7. Skin, soft tissue and
musculokeleton
8. CNS
Signs and symptoms in Infectious disease
1.Nonspecific features : fever, fatigue, myalgia
2.Specific features
CNS; : headache, alternation of conscious,
seizure
: stiff neck, focal neurological deficit
Respiratory: cough, sore throat, dyspnea,
pleuritic chest pain
: consolidation, crepitation
CVS : dyspnea, orthopnea, PND, chest pain
: CHF, heart murmur, Pericardial rub
GI : vomiting, diarrhea, jaundic,abdominal
pain
: hepatomega, splenomegaly, abdominal
tenderness
with rigidity
GU : dysurination, cloudy urine, back pain
: CVA tender
Skin : Ulcer cellulitis, vescicle,
petichia,echymosis
Bone and joint: arthritis, fluid in joint space
bone tenderness
Lymph node : Lymphadinopathy, ulcer at LN
Skin lesion Organism

: Hemorrhagic : Vibrio
belb vulnificus
Aeromonas
: Small purpura
: cellulitis c : N. meningiditis
crepitus : Anaerobic
+
: Myonecrosis Enterobacteriac
: Ecthyma eae
ganggrenosum : C. perfringens
: P. aeruginosa
Skin lesion Organism
-
Thrombophebitis
-
pyomyositis
-
pustule S.aureus
-
toxic shock syndrome
-
cellulitis
-
cellulitis + lymphangitis
-
scarlet fever
Streptococcus (GAS)
-
necrotizing fasciitis
Oral candidiasis

Immunodeficiency
- HIV
- old aged DM,
- received broad sprectrum ATB
Wok up HIV TEST
Not OI
Thrombophlebitis
cellulitis; Streptococcus
cellulitis
Staphylococc
Conjunctival hemorrhages
Embolic phenomenon; IE
Umbilicated papule in AIDS

Cryptococus
Histoplasmosis
Taralomycosis
Erythema
nodusum

Mycobacterium
Infection
Herpes ophthalmicus
Eschar lesion

Scrub typhus
Ecthyma gangrenosum
Gram negative septicemia ; esp Pseudomonas
Purpura fulminans

Meningococcal infection
Splinter hemorrhages
Embolic phenomenon; IE
Embolic phenomenon; IE
Hemorrhagic bleb

Normal host: GAS


Cirrhosis:
น้ำจืด; Aeromonas
น้ำทะเล : Vibrio

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