Fever Associations and Clinical Presentations in Tropical Medicine and Gastroenterology
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By Dr/ Amr Ahmed Hamed
Lecturer of Tropical Medicine and
Gastroenterology
Faculty of Medicine Sohag
University
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Fever
with
s
weating
Fever with jaundice
Fever with relative bradycardia
Fever with lymphadenopathy
Fever with hepatomegaly
Fever with rigors
Fever with splenomegaly
Fever with rash
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A.
Infectious causes:
•
Brucellosis
may be
liters
/ day .
•
Tuberculosis.
•
Malaria.
•
Toxemia, septicemia, puerperal sepsis, and closed abscesses.
B.
Non-infectious causes:
•
Hodgkin’s lymphoma (Pel-Ebstein fever).
•
Rheumatic fever.
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Rigors (i.e., bed-shaking chills) indicate sudden onset of fever
Rigors often mark the onset of bacterial infection, typically
bacteremia, although they may occur in other clinical situations
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•
A. infectious causes:
1. Bacterial:
•
Acute pyelonephritis.
•
Lobar pneumonia
•
Meningitis
•
Cholangitis
•
Acute bacterial endocarditis.
•
Pyogenic abscess (rigors are repeated).
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2. Viral:
•
COVID-19
•
Influenza
3. Parasitic:
•
Malaria (rigors are repeated (with release of merozoites from R.B.Cs)
•
Amoebic hepatitis
B. Non-infectious causes:
•
Drug-induced fever
•
Transfusion reaction
•
Heat stroke
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c
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i
a
Relative bradycardia is defined as pulse temperature
dissociation
.
Every rise in temperature by 1° C is usually accompanied by
increased heart rate by 10 beats/minute
In some fevers, this relation is not kept, and pulse is relatively
slow.
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b
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c
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A. infectious causes:
1. Bacterial:
•
Typhoid fever
•
Leptospirosis
2. Rickettsial: Q-fever
3. Viral: viral hemorrhagic fevers (yellow fever, dengue).
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r
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d
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c
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a
4. Parasitic:
•
Malaria
•
Chagas disease
B. Non-infectious causes:
•
Lymphoma.
•
Drug induced fever.
•
Factitious fever.
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A. Infectious causes:
1. Bacterial:
•
Bacterial Meningitis
•
Scarlet fever
•
Enteric fever (
rose spots: uncommon finding(
2. Rickettsial: typhus and rickettsioses
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3. Viral:
•
Viral hemorrhagic fever
•
Acute HIV infection
•
Measles
•
Varicella-zoster virus infection (chickenpox or herpes zoster )
•
Infectious mononucleosis
4. Parasitic:
acute schistosomiasis
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B. Non-infectious causes:
•
Blood diseases as purpura
•
Drug induced fever
C. Skin diseases: e.g., impetigo, infected eczema, syphilis, etc
.
Meningococcal septicemia (glass test)
Scarlet fever rash (sandpaper
like skin)
Rose spots (typhoid fever)
Measles rash
Chickenpox rash
Heroes zoster rash
Impetigo
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A. Hepatocellular jaundice:
1. Viral infections:
•
Acute viral hepatitis
•
Yellow fever
•
Infectious mononucleosis
2. Bacterial infections:
•
Leptospirosis
•
Septicemias
3. Parasitic infections: Amoebic hepatitis
4. Liver cirrhosis with liver cell failure
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2. Cholestatic jaundice:
•
Cholangitis
3. Hemolytic jaundice:
•
Malaria (Black water fever)
•
Sickle cell crisis with infective trigger.
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A. Tender liver:
•
Acute viral hepatitis
•
Amoebic hepatitis
•
Pyogenic liver abscess
•
Leptospirosis (Weil's disease)
•
Liver metastasis
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B. Non-tender liver:
•
Bacterial infections: Tuberculosis, Typhoid fever, brucellosis
•
Viral infections: infectious mononucleosis
•
Parasitic infections: malaria, Kala azar, acute bilharziasis
(Katayama fever)
•
Blood diseases: lymphoma, leukemias
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A. Infectious causes:
1. Bacterial :
•
Typhoid fever
•
Brucellosis
•
Tuberculosis
•
Subacute bacterial endocarditis
•
Septicaemia
•
Splenic abscess
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s
p
l
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n
o
m
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g
a
l
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2. Viral:
•
Infectious mononucleosis
•
Cytomegalovirus infection
3. Parasitic:
•
Malaria
•
Toxoplasmosis
•
Kala-azar
•
African trypanosomiasis (Sleeping sickness)
•
Acute stage of American trypanosomiasis.
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B. Non-infectious causes:
1. Blood diseases: Leukaemia, lymphoma
2. Collagen diseases: Systemic lupus erythematosus(SLE), Still's disease,
Felty's syndrome
3. Others : Ulcerative colitis
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A. Infectious causes:
1. Bacterial:
•
Tuberculosis (cervical adenitis)
•
Brucellosis
•
Pyogenic lymphadenitis (draining a septic focus)
•
Diphtheria
•
Plague
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2. Viral:
•
Infectious mononucleosis (triad of fever, tonsillar pharyngitis,
and lymphadenopathy).
•
Acute HIV (fever, generalized lymphadenopathy, sore throat, rash)
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3. Parasitic:
•
Toxoplasmosis
•
African trypanosomiasis (Winterbottom sign)
•
Acute stage of American trypanosomiasis.
•
Acute bilharziasis (Katayama fever)
B.Non-infectious:
•
Blood Diseases: Acute leukemias, chronic lymphcytic leukemia,
Hodgkin's disease
•
Cholagen disease: SLE, Still's disease, Felty's syndrome
•
Metastatic malignancies
This presentation by Dr. Amr Ahmed Hamed, a lecturer at Sohag University, explores various fever associations and clinical presentations related to tropical medicine and gastroenterology. Topics covered include fever with jaundice, sweating, rigors, hepatomegaly, splenomegaly, rash, lymphadenopathy, and relative bradycardia. It discusses infectious and non-infectious causes, along with specific conditions such as brucellosis, tuberculosis, malaria, Hodgkin's lymphoma, and more. The presentation also delves into the significance of rigors in indicating sudden onset of fever, particularly in bacterial infections.
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Presentation Transcript
By Dr/ Amr Ahmed Hamed Lecturer of Tropical Medicine and Gastroenterology Fever Associations Fever Associations Faculty of Medicine Sohag University
Agenda Agenda Fever with jaundice Fever with sweating Fever with rigors Fever with hepatomegaly Fever with relative bradycardia Fever with splenomegaly Fever with rash Fever with lymphadenopathy
Fever with sweating Fever with sweating A. Infectious causes: Brucellosis may be liters / day . Tuberculosis. Malaria. Toxemia, septicemia, puerperal sepsis, and closed abscesses. B. Non-infectious causes: Hodgkin s lymphoma (Pel-Ebstein fever). Rheumatic fever.
Fever with rigors Fever with rigors Rigors (i.e., bed-shaking chills) indicate sudden onset of fever Rigors often mark the onset of bacterial infection, typically bacteremia, although they may occur in other clinical situations
Fever with rigors Fever with rigors A. infectious causes: 1. Bacterial: Acute pyelonephritis. Lobar pneumonia Meningitis Cholangitis Acute bacterial endocarditis. Pyogenic abscess (rigors are repeated).
Fever with rigors Fever with rigors 2. Viral: COVID-19 Influenza 3. Parasitic: Malaria (rigors are repeated (with release of merozoites from R.B.Cs) Amoebic hepatitis B. Non-infectious causes: Drug-induced fever Transfusion reaction Heat stroke
Fever with relative bradycardia Fever with relative bradycardia Relative bradycardia is defined as pulse temperature dissociation. Every rise in temperature by 1 C is usually accompanied by increased heart rate by 10 beats/minute In some fevers, this relation is not kept, and pulse is relatively slow.
Fever with relative bradycardia Fever with relative bradycardia A. infectious causes: 1. Bacterial: Typhoid fever Leptospirosis 2. Rickettsial: Q-fever 3. Viral: viral hemorrhagic fevers (yellow fever, dengue).
Fever with relative bradycardia Fever with relative bradycardia 4. Parasitic: Malaria Chagas disease B. Non-infectious causes: Lymphoma. Drug induced fever. Factitious fever.
Fever with rash Fever with rash A. Infectious causes: 1. Bacterial: Bacterial Meningitis Scarlet fever Enteric fever (rose spots: uncommon finding( 2. Rickettsial: typhus and rickettsioses
Fever with rash Fever with rash 3. Viral: Viral hemorrhagic fever Acute HIV infection Measles Varicella-zoster virus infection (chickenpox or herpes zoster ) Infectious mononucleosis 4. Parasitic: acute schistosomiasis
Fever with rash Fever with rash B. Non-infectious causes: Blood diseases as purpura Drug induced fever C. Skin diseases: e.g., impetigo, infected eczema, syphilis, etc.
Meningococcal septicemia (glass test) Rose spots (typhoid fever) Scarlet fever rash (sandpaper like skin) Impetigo Heroes zoster rash Chickenpox rash Measles rash
Fever with jaundice Fever with jaundice A. Hepatocellular jaundice: 1. Viral infections: Acute viral hepatitis Yellow fever Infectious mononucleosis 2. Bacterial infections: Leptospirosis Septicemias 3. Parasitic infections: Amoebic hepatitis 4. Liver cirrhosis with liver cell failure
Fever with jaundice Fever with jaundice 2. Cholestatic jaundice: Cholangitis 3. Hemolytic jaundice: Malaria (Black water fever) Sickle cell crisis with infective trigger.
Fever with hepatomegaly Fever with hepatomegaly A. Tender liver: Acute viral hepatitis Amoebic hepatitis Pyogenic liver abscess Leptospirosis (Weil's disease) Liver metastasis
Fever with hepatomegaly Fever with hepatomegaly B. Non-tender liver: Bacterial infections: Tuberculosis, Typhoid fever, brucellosis Viral infections: infectious mononucleosis Parasitic infections: malaria, Kala azar, acute bilharziasis (Katayama fever) Blood diseases: lymphoma, leukemias
Fever with splenomegaly Fever with splenomegaly A. Infectious causes: 1. Bacterial : Typhoid fever Brucellosis Tuberculosis Subacute bacterial endocarditis Septicaemia Splenic abscess
Fever with splenomegaly Fever with splenomegaly 2. Viral: Infectious mononucleosis Cytomegalovirus infection 3. Parasitic: Malaria Toxoplasmosis Kala-azar African trypanosomiasis (Sleeping sickness) Acute stage of American trypanosomiasis.
Fever with splenomegaly Fever with splenomegaly B. Non-infectious causes: 1. Blood diseases: Leukaemia, lymphoma 2. Collagen diseases: Systemic lupus erythematosus(SLE), Still's disease, Felty's syndrome 3. Others : Ulcerative colitis
Fever with lymphadenopathy Fever with lymphadenopathy A. Infectious causes: 1. Bacterial: Tuberculosis (cervical adenitis) Brucellosis Pyogenic lymphadenitis (draining a septic focus) Diphtheria Plague
Fever with lymphadenopathy Fever with lymphadenopathy 2. Viral: Infectious mononucleosis (triad of fever, tonsillar pharyngitis, and lymphadenopathy). Acute HIV (fever, generalized lymphadenopathy, sore throat, rash)
Fever with lymphadenopathy Fever with lymphadenopathy 3. Parasitic: Toxoplasmosis African trypanosomiasis (Winterbottom sign) Acute stage of American trypanosomiasis. Acute bilharziasis (Katayama fever) B.Non-infectious: Blood Diseases: Acute leukemias, chronic lymphcytic leukemia, Hodgkin's disease Cholagen disease: SLE, Still's disease, Felty's syndrome Metastatic malignancies
