Practice of Medicine

POM2 9/1/15 - Summary Sheet: Fever and Malignancy – 9/1/15 –Mitchell

* Learning Objectives for the day:

* Understand the approach to a patient with a complaint of fever.

* Understand the difference between acute fever, and fever of unknown origin.

* Identify elements in the history and physical exam that help narrow the differential diagnosis of fever.

* Describe the initial evaluation and treatment for a patient presenting with an acute fever.

* Fever = elevation of temperature > 38.4 C, or > 101 F.

* (Normal temperature is 98.6F or 36.8C +/- 0.4).

* Pattern of temperature changes may hint at the diagnosis:

* Continuous (bacterial infection)

* Intermittent (malaria, bacterial septicemia)

* Remittent (fluctuates more than 1 degree C in 24 hrs, endocarditis)

* FUO: Fever of unknown origin – Elevated body temperature (>38.3C) persisting for more than 3 weeks without diagnosis despite one week of investigations in the hospital.

* The most common cause of FUO is a common disease presenting atypically.

* As the duration of fever increases, the likelihood of an infectious cause decreases.

* The majority of illnesses that cause FUO are treatable, making pursuit of the diagnosis particularly rewarding.

* Etiology: Infections 30%, Malignancy 20%, connective Tissue Disorder 15%, Miscellaneous 20%, and unknown 15%.

* Infection is the most common cause in children

* In adults, abscess and TB most common

* Infections: Sepsis/Abscess, TB, cholecystitis, UTI, dental/sinus infections, bone/joint infections, typhoid fever, infective endocarditis, viral infections (CMV, EBV, HIV, hepatitis A & B), and fungal infections

* Malignancy: Lymphomas, Leukemia, Myeloma, and solid tumors (renal, liver, colon, stomach, and pancreas).

* Constitutional (“B”) symptoms – Weakness, fatigue, anorexia, weight change,...