Approach to Fever Evaluation/ short Febrile Illness

Sepsis: In infants and children sick looking, poor activity, toxic. Ask about feeding and urine output.
Myocarditis: Tachycardia out of proportion (>10 beats/ degree F Or >18 beats/degree C.
Pneumonia: Tachypnea out of proportion (RR>30/’)
Meningitis: Altered sensorium
Impeding shock: Always check BP sick patients

Common foci of infection:

Meningitis: neck stiffness, Altered sensorium, Tense bulging anterior fontanelle in infants.

Pneumonia: Tachypnea, X ray to be taken on day 3.

UTI: Dysuria, Chills and rigor

Cellulitis and sepsis: Do a local examination.

General symptom based Approach for Fever Evaluation

Without infective focus:

Upper respiratory symptoms– sore throat, Rhinorrhea, sneezing- ARI, influenza, etc
No upper respiratory symptoms: Leptospirosis, chikunguniya, Dengue, Malaria.
With rash: consider dengue, IMN, Rubella.

With infective focus

Investigations and management.

Hints with public health perspective, Fever Evaluation:

Fever, conjunctival congestion, myalgia, calf or other muscle tenderness, risk (farmer) -Leptospirosis (start Doxycycline)
Fever, myalgia, conjunctival congestion and rashes- Dengue.
Fever with chills and rigor, swetting on alternate days, Splenomegaly, Migrant patient- malaria.
Fever with rash, toxic look, Eschar- Scrub Typhus. (start Doxycycline.)

Investigation, Fever Evaluation

CBC, PS, BLOOD CULTURE, URINE CULTURE, SENSITIVITY, GRAM AND AFB STAIN, USG ABDOMEN, CHEST X RAY, SPUTUM EXAMINATION, CSF STUDY, PLEURAL AND ASCITIC FLUID EXAMINATION, PET SCAN, CT, MRI, FNAC, BIOPSY, ETC IF NEEDFUL ACCORDING TO SYMPTOMS AND SIGNS.

Treatment:

Tepid sponging
Paracetamol tablet sos
oral fluid

Integrated disease Surveillance project Fever Evaluation

Case definitions for infectious disease:

1) ACUTE DIARRHOEAL DISEASE:

>/= 3 loose stools in 24 hours with/ without dehydration.

2) CHOLERA:

Capsule Doxycyclin 300 mg stat.

Child and pregnancy Azithromycin, hospitalise.

3) DYSENTRY:

Acute Diarrhea with blood loss in the stool.

T. Ofloxacin 200mg + Ornidazole 500 mg bd, ORS, Supportive care, hospitalise.

4) DENGUE:

A fever 2-7 days duration with 2/ more following symptoms-

Arthrallgia.
Rash
Haemorrhagic manifestations
Leucopenia
Headache
Retro orbital pain
Myalgia

& >/= 1 of the following

+ serological test: (PCR) NS1, IgM or IgG.

5) DENGUE HAEMOR RHAGIC FEVER (DHF):

Haemorrhagic tendencies

– Positive tourniquest test

– petechiae, Ecchymoses or purpura

– Bleeding mucosal, gastrointestinal tract, hematemesis, malena.

Thrombocytopenia : (platelet count 150000 or less)

Plasma leakage

-20℅ rise in average hematocrit

– 20℅drop in hematocrit after volume replacement.

– Plasma leakage signs eg. pleural effusion

6) DENGUE SHOCK SYNDROME:

All of the above + circulatory failure.

7) CHIKUNGUNYA:

Acute onset of fever, severe arthralgia, rash, headache, photophobia, & positive serology.

8) ACUTE ENCEPHALITIS SYNDROME (AES) :

Acute onset of fever with

Altered sensorium (Confusion, coma)
New onset of seizures.
Increase in irritability, Somnolence, or abnormal behavior.

9) JAPANESE ENCEPHALITIS:

IgM ELISA for JE +

10) LEPTOSPIROSIS:

Fever with headache, myalgia:

Conjunctival suffusion
Hemorrhage (from intestine or lungs)
Meningeal irritation
Anuria, oliguria and/or proteinuria
Jaundice
Cardiac arrhythmia or failure
Skin rash

And a history of exposure to infectted animal or an environment contaminated with animal urine. Other common symptoms may include nausea, vomiting, abdominal pain, diarrhe & arthralgia.

11) MEASLES:

Fever
Cough, coryza and conjunctivitis.
Maculopapular rash >3 days.

12) DIPHTHERIA:

Laryngitis or pharyngitis or tonsillitis.
Adherent membrane to tonsils, pharynx, and or nose.

13) PERTUSSIS:

Paroxysms of coughing.
Inspiratory whooping
Posttussive vomiting (vomiting after coughing).

14) CHICKENPOX:

Fever with diffuse maculopapular rash.

15) ACUTE RESPIRATORY INFECTION:

fever cough, sore throat

16) VIRAL HEPATITIS:

Fever, dark urine, anorexia, fatigue, vomiting and right upper quadrant pain. Increased SGOP, SGPT, BILIRUBIN.

17) ENTERIC FEVER:

Fever, Toxic looking.
Coated tongue.
Relative bradycardia.
Splenomegaly.
Complications eg: GI Bleed, perforation etc.

18) MALARIA:

Fever, chills, rigors, sweating, myalgia, Headache, backache, nausea and vomiting.
Splenomegaly and Anaemia.
Convulsions, coma, shock, bleeding, renal failure and death. Endemic area patient.

19) SCRUB TRYPHUS:

Fever, bradycardia, cough, headache, lymphadenopathy.

Exposure to chigger.
Black scab with erythematous hallo (eschar).
Positive weil Felix reaction.
Scrub typhus IgM+.

20) HAND FOOT MOUTH DISEASE (HFMD):

Fever in young children-

Ulcers oral cavity.
Papulovesicular rash in palms, soles, and buttocks.

Viral confirmation.