How to approach fever | Dr Arvind Kumar

Summary

This video script offers a comprehensive guide to fever management in primary care, detailing the classification of fever into acute, localized infections, and fever of unknown origin. It discusses symptom patterns like continuous, intermittent, and remittent fevers, and their causes. The script also covers organ-specific signs and symptoms, important for diagnosing conditions like pneumonia, meningitis, and endocarditis. It highlights the significance of thorough history taking, physical examination, and appropriate investigations to determine the etiology of fever, setting the stage for the next video on diagnostic procedures.

Takeaways

• 🌡️ Fever is a common symptom in primary care and can be classified into acute fever, acute focal illness, and fever of unknown origin.
• 🔍 Acute focal illness is characterized by localized infections such as throat, respiratory, urinary, skin, or bone and joint infections.
• 🔬 Acute undifferentiated fever is diagnosed when there is a fever of over 101° F for more than 2 days without any organ-specific signs.
• 🌐 Fever of unknown origin is defined by a fever of over 101° F on two occasions, lasting more than 3 weeks, with no known cause after thorough examination and investigations.
• 📈 Fever patterns include continuous, intermittent, remittent, relapsing, and double quotidian, each with different potential causes.
• 🏥 Symptoms and signs should be assessed according to organ-specific involvement to help diagnose the cause of the fever.
• 📝 Important symptoms to inquire about include sore throat, cough, urinary frequency, abdominal pain, skin changes, and joint pain.
• 👨‍⚕️ Clinical signs such as throat congestion, sinus tenderness, chest examination findings, and joint tenderness are crucial for diagnosis.
• 🧬 Some specific diseases like malaria, dengue, typhoid, and leptospirosis have characteristic symptoms and signs that aid in diagnosis.
• 🧪 In resource-poor settings, clinical features like relative bradycardia and rose spots can be relied upon for diagnosing conditions like typhoid fever.
• 📚 The next video will discuss appropriate investigations for different types of fever, providing further guidance for diagnosis and management.

Q & A

What are the three main classifications of fever discussed in the script?

The three main classifications of fever discussed are acute fever, acute localized illness due to systemic specific signs, and fever of unknown origin.

What is the definition of acute undifferentiated fever?

Acute undifferentiated fever is defined by a fever of more than 101° F for more than 2 days without any organ-specific sign, meaning there are no localized signs like sore throat, cough, or loose motions.

What are some important causes of acute undifferentiated fever in India?

Important causes of acute undifferentiated fever in India include malaria, dengue fever, typhoid, scrub typhus, chikungunya, and leptospirosis.

How is fever of unknown origin defined in terms of temperature and duration?

Fever of unknown origin is defined by a fever of more than 101° F on two occasions with a duration of more than or equal to 3 weeks, without any known immunocompromised state.

What are the different patterns of fever mentioned in the script, and what do they indicate?

The different patterns of fever include continuous fever, intermittent fever, remittent fever, relapsing fever, double Quan fever, and periodic fever. Each pattern can indicate different underlying conditions such as pneumonia, meningitis, typhoid, dengue, infective endocarditis, and others.

What are the symptoms that suggest an upper respiratory tract infection?

Symptoms suggesting an upper respiratory tract infection include sore throat, pain in the throat, runny or blocked nose, and cough.

How can one identify a lower respiratory tract infection based on symptoms?

A lower respiratory tract infection can be identified by symptoms such as cough with sputum production, increased respiratory rate, chest pain, fever, and chills.

What symptoms are indicative of a urinary tract infection?

Symptoms indicative of a urinary tract infection include increased frequency of urination, urgency, dysuria (pain or burning sensation while urinating), and flank pain at the renal angles.

What are the clinical features that suggest typhoid fever?

Clinical features suggesting typhoid fever include continuous fever, loss of appetite, relative bradycardia, rose spots, and a characteristic step-ladder pattern of fever progression.

How can one differentiate malaria from other types of fever based on symptoms?

Malaria can be differentiated by the presence of intermittent fever with characteristic chills every 48 to 72 hours, along with splenomegaly and hemolysis, especially seen in falciparum malaria.

What are some of the miscellaneous causes of fever mentioned in the script?

Some miscellaneous causes of fever mentioned include drug-induced fever, thyroiditis, cyclic neutropenia, and diseases like SLE and polyarthritis nodosa.

What is the significance of relative bradycardia in the context of fever?

Relative bradycardia, where the pulse does not increase as much as expected with fever, is a significant feature of conditions like typhoid fever.

How can one identify signs of endocarditis during a physical examination?

Signs of endocarditis can be identified through a physical examination by checking for heart murmurs, Osler nodes, Roth spots, and Janeway lesions.

What are the typical symptoms of leptospirosis?

Typical symptoms of leptospirosis include fever, headache, myalgia, and a maculopapular rash, along with lymphadenopathy.

What is the significance of a morning temperature spike in the diagnosis of fever?

A morning temperature spike is highly suggestive of diseases like brucellosis and Whipple's disease, which can be part of the differential diagnosis for fever of unknown origin.