n CME : Your SA Journal of CPD - Unexplained fever - an approach to defining the aetiology : main topic

Volume 22, Issue 4
  • ISSN : 0256-2170



A thorough history and examination will often elucidate a focus of bacterial sepsis. <br>The signs and site of bacterial sepsis may be masked in elderly and immunocompromised patients. <br>Clues to a septicaemic illness are hypotension, poor peripheral perfusion, confusion, marked tachycardia and tachypnoea in the absence of pneumonia. <br>The most important communityacquired septicaemic illnesses to consider are: staphylococcal, salmonella, meningococcal and septicaemia secondary to pneumonia or pyelonephritis. <br>The presence of a rash may point to a specific aetiology such as tick bite fever or meningococcaemia. <br>A history of recent travel to a malaria area should be sought. <br>In HIV-positive patients the diagnostic possibilities are wider, and include pulmonary and extrapulmonary TB, cryptococcosis and PCP. <br>HIV seroconversion illness is frequently missed. Signs that suggest it are a morbiliform rash, orogenital ulcers and generalised lymphadenopathy. <br>The most important diagnoses not to miss initially are: the septicaemic illnesses mentioned above, malaria, a pus collection, infective endocarditis, thrombotic thrombocytopenic purpura and acute leukaemia.

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