Fever

GENERAL PRINCIPLES

Fever accompanies many illnesses and is a valuable marker of disease activity. Infection is a primary concern. Drug reaction, malignancy, VTE, vasculitis, central fever, and tissue infarction are other possibilities but are diagnoses of exclusion.

DIAGNOSIS

History and Physical Examination

• History should include chronology of the fever and associated symptoms, medications, potential exposures, and a complete social and travel history.

• In the hospitalized patient, special attention should be paid to any IV lines, asymmetric edema, a thorough skin examination, and indwelling devices such as urinary catheters.

Diagnostic Testing

• Testing includes blood and urine cultures, complete blood count (CBC) with differential, and serum chemistries with liver function tests.

• Diagnostic evaluation generally includes CXR.

• Cultures of abnormal fluid collections, sputum, cerebrospinal fluid, urine, and stool should be sent if clinically indicated. Cultures are ideally obtained prior to initiation of antibiotics; however, antibiotics should not be delayed if serious infection is suspected.

TREATMENT

• Antipyretic drugs may be given to decrease associated discomfort.

• Empiric antibiotics should be considered in hemodynamically unstable patients in whom infection is a primary concern, as well as in neutropenic and asplenic patients.

• Heat stroke and malignant hyperthermia are medical emergencies that require prompt recognition and treatment (see Chapter 26, Medical Emergencies).