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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