febrile states as. mudr. dagmar holá. the human is homiotermic organism, keeping constant...
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Febrile states
as. MUDr. Dagmar Holá
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The human is homiotermic organism,
keeping constant temperature.
The temperature is a terminal balance state
between production and expenditure of
warmth.
Temperature is controled reflexly from
termoregulatory center in the hypothalamus.
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Deep temperature (homiotermic nucleus of
organism) is 36 – 37°C. We measure it in
mouth, rectum or vagina.
Cutaneus temperature (poikilotermic coat)
is lower, we measure it in axilla by medical
thermometer.
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Temperature:
subnormal subfebrile fever
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Subnormal temperature
is lower than 36,2 °C and is related to
restrained metabolism.
It can by observed in olderly people,
in chronic cachexia – causing diseases (tumors),
in hypopituitarism, hypothyroidism,
after excessive bleeding, and in shock.
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Subfebrile temperature
does not exceed 38°C, it accompanies focal infections (chronic tonsillitis or sinusitis, urinary infections, adnexitis).
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Fever (pyretic, febrile state)
is marked by the body temperature raising
above 38°C.
Condition with temperature ranging from
40 to 41°C is called hyperpyrexia.
Fever occurs in inflammations, infectious
diseases, systemic diseases and in certain
tumours (lymphomas, Grawitz’s tumour).
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Just for completeness, we add the overview of the temperature types:
Febris 1. continua2. remittens3. intermittens4. recurrens5. undulans6. efemera7. hectica
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Febris continua
is marked by temperature fluctuation within 1°C range during a 24 hour period (abdominal typhus, paratyphoid, croupous pneumonia, erysipelas).
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Febris remittens
daily fluctuations exceeds the 1°C range, the temperature does not return to the normal value (infectious diseases).
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Febris intermittens (septic temperature)
temperature swiftly raises to 39°C, swiftly falls below 37°C, in 24 hour period thedifference of the maximum and minimum temperatures is bigger than 1°C (sepsis, e.g. cholangitis, urosepsis, infectious endocarditis).
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Febris recurrens
alternation of fever and apyretic periods of various duration.
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Febris undulans
periods of raising and falling temperatures alternating with apyretic periods (abdominal lymphomas, brucellosis).
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Febris efemera
one-day fever is caused by mild advancement of a respiratory infection, by blood transfusion, or by intravenous applications of certain drugs.
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Febris hectica
long-lasting intermittend temperature, common in tuberculosis.
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Diagnostic methods
- anamnesis (case history)- objective examination- laboratory and technical methods
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Anamnesis (case history)
- how long is fever- course- hitherto existing examinations- therapy (? antibiotics, …)- epidemiology continuity (f.e. diarrhoea in family, in employement, at school…)
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Laboratory methods
a) FW increase bacterial infections lower viral infections
b) Blood count:leucocytosis – bacterial infections, tumours,non-infections case – acute myocardial infarctleucopenia – viral infections, abdominal typhus, paratyphoid, tularemiaeosinophylia – alergic disease, parasitic disease
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Laboratory methods
c) Haemocultured) Microbial cultivation (sputum, urine,
exudates)e) Immunological examinations (LE cells,
ANF, dsDNA, ASLO, LATEX, CRP, cells and humoral immunity
f) Serological examinations
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Technical methods
f.e.:• rentgenology• ultrasonography• echocardiography (+ transesophageal echo)• CT, MR• endoscopy• biopsy (of lymphonody, marrow…)
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Respiratory infections
a) viral: Rinoviry, Coronaviry, Adenoviry, Myxoviry influenzae, parainfluenzae, atypical pneumonie – Mycoplasma pneumonieb) bacterial: often viral infections and than bacterial superinfections bronchitis, pneumonie, Streptococcus Pyogenes, Haemophillus influenzae, Klebsiella pneumonie, Staphylococcus, Proteus, Pseudomonas, Streptococcus Pneumonie
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Long time lasts fever
It is diagnostic problem in internal medicine. Ethiology of fever is non-elucidate during some weeks or months.Fever is usually constant with small fluctuate, but typical signs missing.Etiology:- Infectional- Tumours- Systemic disease
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Subfebrile temperature
is also diagnostic problem, occur in young and middle age and we must it through examine.We must eliminate focal infection (in dental, ORL, gynecology, urogenital, gastrointestinal parts), immunodeficiency.
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Invasive methods
(f.e. peripheral or central catheter, pacemaker, urinary catheter, endoscopy…) can by source of fever and infections.