00- Approach_to_Fever_for_Interns useful and important.pptx

00- Approach_to_Fever_for_Interns useful and important

1. Approach to Fever A c linical Guide for Intern Doctors

2. Objectives Define fever List common causes Systematic approach: history, exam, investigations Recognize red flags Discuss management principles

3. Definition of Fever Normal: 36.5–37.5 °C (oral) Fever: ≥ 38 °C (oral/rectal) Hyperpyrexia: > 41 °C Hyperthermia: elevated temp without hypothalamic set-point change

4. Pathophysiology Hypothalamic set-point regulated by prostaglandins Exogenous pyrogens (bacteria, viruses) → endogenous cytokines Cytokines: IL-1, IL-6, TNF-α → trigger fever

5. Classification of Fever By duration: Acute (<7d), Subacute (1–2w), Chronic (>2w) By pattern: Intermittent, Remittent, Continuous, Relapsing

6. Causes by Duration Acute: viral infection, pneumonia, UTI, malaria Subacute: typhoid, TB, connective tissue disease Chronic: malignancy, autoimmune, FUO

7. History Taking Onset, duration, pattern of fever Associated symptoms: cough, diarrhea, rash, dysuria Travel history, drug use, animal exposure Past history: TB, HIV, malignancy, immunosuppression

8. Examination General: pallor, jaundice, lymphadenopathy, rash Vitals: HR, BP, RR, SpO2 Systemic exam: chest, abdomen, CNS, skin

9. Red Flag Signs Hypotension / septic shock Altered mental status Respiratory distress Meningeal signs Purpura / hemorrhagic rash

10. Investigations (Stepwise) Basic: CBC, ESR/CRP, renal/liver function Urinalysis, blood cultures Imaging: chest X-ray, ultrasound abdomen Special tests: malaria, typhoid, viral panels depending on suspicion

11. Approach Algorithm History + Examination Basic labs Focused investigations guided by clinical suspicion Diagnosis Management

12. Fever in Immunocompromised Neutropenic fever: medical emergency HIV-related infections Post-transplant infections

13. Special Situations Fever in postoperative patient: consider wound infection, DVT, pneumonia, UTI Fever in ICU: catheter infection, ventilator pneumonia, drug fever Fever of Unknown Origin (FUO): >38°C for >3 weeks, no diagnosis after 1 week workup

14. Management Principles Symptomatic treatment: antipyretics, fluids Empiric antibiotics only if bacterial infection likely Antimicrobial stewardship: avoid unnecessary antibiotics Treat underlying cause

15. Key Takeaways Start with careful history and exam Recognize red flags early Investigations should be guided, not excessive Avoid overuse of antibiotics Always consider special populations

16. References Harrison’s Principles of Internal Medicine WHO Guidelines for Fever Management Local Hospital Protocols