pyrexia final ppt.pptx for physiotherapy students

Study purpose

1. Pyrexia of unknown origin Darshini venkatesh Apoorva Smitha Uma Aishwarya bhavani Aftab Sreekanth

2. Introduction Temperature >38°C lasting for more than 14 days without an obvious cause despite a complete history, physical examination and routine screening with laboratory evaluation It is also know as fever of unknown origin(FUO)

3. Classification Classical Nosocomial Neutropenic Associated with HIV infection

4. 1)Neutropenic PUO/immune deficient Patients with immune deficiencies are susceptible to Opportunistic bacterial infection Fungal infection such as candidiasis Perianal infections Infections involving catheters

5. 2) HIV – associated PUO HIV infection alone may be a cause of fever Common secondary causes include Tuberculosis Cytomegalovirus infection (CMV) Non-hodgkin’s lymphoma Drug-induced fever

6. 3. Classic Etiologies 1.Infections 2.Malignancies 3.Collagen Vascular Disease Infections A] Bacterial: abscesses,TB,sinusitis ,biliary tract infection B]Viral :CMV,infectious mononucleosis,HIVetc C]Parasites: Malaria,toxoplamosis etc D]Fungal : histoplamosis etc 2. Malignance Haematological Non - Haematological A] Lymphoma A] Renal cell cancer D]Colon cancer B]Chronic leukemia B] Pancreatic cancer E] Hepatoma

7. 3. Collagen vascular Disease A] Temporal arteritis B]Rheumatoid arteritis C]Rheumatoid fever D] Inflammatory bowel disease E] Giant cell arteritis 4]Nosocomial A]More than 50% of patients with nosocomial PUO are due to infection B] Focus on sites where occult infections may be sequestered

8. Morphology and clinical manifestations

9. Pyrexia Morphology Pyrexia, commonly known as fever, is a temporary increase in body temperature due to the body's natural response to an infection or other medical conditions. The morphology of pyrexia involves several key aspects Temperature Elevation: Pyrexia is characterized by a rise in body temperature above the normal range, typically measured as an oral temperature exceeding 98.6°F (37°C).

10. Pattern of Fever : Fevers can have different patterns, such as intermittent (comes and goes), remittent (fluctuates but doesn't return to normal), sustained (remains consistently elevated), or relapsing (recurs after brief periods of normal temperature). Duration : The duration of fever varies depending on its underlying cause. It can be acute (short-term) or chronic (long-term).

11. Clinical Manifestations: The clinical manifestations of pyrexia are the observable signs and symptoms associated with an elevated body temperature. These can vary depending on the underlying cause but often include: Elevated Temperature: The hallmark of pyrexia is an elevated body temperature, usually accompanied by chills or shivering. Malaise : Patients with fever often experience a general feeling of discomfort, fatigue, and weakness. Headache : Headaches are common during fever and may be due to the body's response to infection or inflammation. Muscle Aches : Patients may complain of muscle aches and joint pain, which can be caused by the release of inflammatory chemicals in response to the fever-inducing stimulus.

12. Sweating : Profuse sweating can occur as the body attempts to cool down and regulate temperature Tachycardia : An increased heart rate is often observed as the body works harder to distribute heat and oxygen Other Symptoms: Depending on the underlying cause of the fever, additional symptoms such as cough, sore throat, abdominal pain, or skin rashes may be present.

13. Pathogenesis PYROGENS ▸ Pyrogens are fever producing substances, which are metabolic products of microorganisms. Chemically, they are lipid substances associated with a carrier molecule, which is usually a polysaccharide. The carrier may also be a peptide. These carriers increase the solubility of the lipid. ▸ Pyrogens are produced by many microorganisms including bacteria, yeasts and moulds. Most potent pyrogens are the endotoxins produced from the cell walls of the Gram-negative bacteria.

14. Classification of pyrogens Classification of Pyrogens ▸ Exogenous Pyrogen (Exotoxins) > Endogenous Pyrogen (Endotoxin)

15. Classification of pyrogens 1.Endogenous pyrogen low-molecular-weight protein is produced by phagocytic leukocytes in response to stimulation by exogenous pyrogens and released into the circulation. It induces fever by acting on the preoptic area of the hypothalamus to raise the set-point of the hypothalamic thermostat..

16. Classification of pyrogens 2.Exogenous pyrogen fever-producing agents of external origin, e.g., bacterial endotoxins and other microbial products, antigen-antibody complexes, viruses and synthetic polynucleotides, incompatible blood and blood products, and androgen breakdown products such as etiocholanolone.

17. Source of pyrogens Source of pyrogen water used at the end stages of the purification. ⚫ crystallization of the drug or excipients: water used during processing. ⚫ packaging components; chemicals, raw materials or equipment used in the preparation of the product. • The presence of endotoxins on devices may be attributed to water in the manufacturing process. Washing of components such as filter media (filters). Washing/rinsing of tubing or other plastic devices prior to their sterilization.

18. LABORATORY DIAGNOSIS Specimen collection Prior to specimen collection, a complete clinical history and physical examination should be carried out that maybe helpful in choosing appropriate specimen such as blood, urine, bone marrow, aspirate, pus etc. Microscopy Blood microscopy – useful for detection of malaria parasites, microfilariae, leishmania donovani, and trypanosomes. stool wet mount- for detection of cyst, trophozoitie or ova of parasitic agent of FUO. gram stain- of pus, sputum and ither specimen for detection of causative agent Ziehl Ne elsen stain- for M. tuberculosis. periodic acid Schiff[PAS] – for detection of fungal morphology.

19. Culture Blood culture is done for typhoid fever. culture on Lowenstein Jensen medium is done for tuberculosis. culture of pus and exudate specimen for detection of causative agent Sabouraud dextrose agar [SDA] culture for fungal isolation. Cell line culture is useful for isolation of virus. Serological test ELISA and rapid test for viral disease such as Hepatitis, HIV etc. Standard agglutination test for brucellosis cold agglutination test for mycoplasma

20. Paul Bunnell test for infectious mononucleosis. widal test for typhoid fever. complement fixation test for chlamydial infection R heumatoid arthritis factor for rheumatoid arthritis. Immunoflurescence for detection of Antinuclear antibody. Molecular tests If infective organism load is vey low, PCR can be carried out to amplify specific genes, even if few copies are present will be detected.

21. Other tests Complete blood count- increased neutrophil count indicates pyogenic infection. Raised erythrocyte sedimentation rate [ESR] – it may indicate tuberculosis. Imaging methods- chest x ray [for diagnosis of tuberculosis] and CT or MRI scan to identify the malignant tumours and their extension. ECG – for rheumatic fever and endocarditis.