วันพุธที่ 11 กรกฎาคม พ.ศ. 2555

Undifferentiated fever

Assessment of airway, breathing, circulation, Disability (if sepsis see sepsis)

History

Host high risk : <5y, advanced age, DM, pregnancy, Immunocompromised

Exposure risk : เข้าป่า เล่นน้ำตก เที่ยวถ้ำ sexual intercourse, high risk food, expose ต่อสัตย์ เช่นหมา แมว หนู ประวัติ แผล IVDU

Clinical symptom

Rash:  Dengue fever, typhus, syphilis, gonorrhea, Chikungunya, HIVseroconversion
Jaundice:  Hepatitis, malaria, leptospirosis
Lymphadenopathy:  Rickettsial infections, HIV, Epstein-Barr virus, cytomegalovirus, toxoplasmosis
Hepatomegaly: Amebiasis, malaria, typhoid, hepatitis, leptospirosis
Splenomegaly:  Malaria, typhoid, typhus, dengue fever
Eschar: Typhus, anthrax
Hemorrhage:  Meningococcemia, hemorrhagic fever, leptospirosis

Investigations

• CBC c plt, LFTs, UA, CXR

• Malaria thick, thin film

• H/C, UC, Stool C/S

• IFA for rickettsial

• Deugue IgM (positive >d5), NS1 recombinant (d1-9)

• Influenza A and B nasal swab

• ESR, VDRL, HIV

Diseases Commonly Associated with Fever

Undifferentiated fever: malaria, dengue, chikugunya, leptospirosis, HIV, samonellosis, shigellosis, campylobacteriosis, hepatitis

Fever with respiratory symptom: Influenza, SARS

Fever with hemorrhage: viral hemorrhagic fever, meningococcemia, leptospirosis

Fever with CNS symptom: meningococcemia, rabies, malaria, encephalitis, poliomyelitis

Empirical treatment

• Ceftriaxone 2 gm IV OD, ciprofloxacin, 400 mg IV q 12hr or ciprofloxacin(500) 1x2 for 14 days. Alternatives: azithromycin 1 gm PO on d1; 500 mg PO OD for 6 days

+ Doxycycline(100) 1x2 for 7 days

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