Category: Fever

The title fever of unknown origin is foremost aloof for children with a fever documented by a healthcare provider (physician) and for which the cause could not be identified after 3 weeks of estimation as an outpatient or after 1 week of evaluation in the hospital. Patients with fever not meeting these criteria and especially those admitted to hospital with neither an apparent site of infection nor a noninfectious diagnosis may be considered to have a fever without localizing symptoms.

The causes of life-threatening fever includes:

1. Infections: enteric fever, malaria, tuberculosis, chronic hepatitis, urinary tract infection (UTI), human immunodeficiency virus (HIV) infection, hidden abscesses (live, pelvic), mastoiditis, meningitis, osteomyelitis, sinusitis, infectious mononucleosis, brucellosis, infective endocarditis, cytomegalovirus, kala-azar, and toxoplasmosis, etc.
2. Autoimmune: Systemic onset juvenile rheumatoid arthritis, polyarteritis nodosa, Systemic lupus erythematosus (SLE), Kawasaki disease (KD), and Inflammatory bowel disease (IBD).
3. Malignancies: Lymphoma, leukemia, Langerhans cell histiocytosis (LCH).

Most fevers of unknown or masquerading origin result from average presentations of normal diseases. In some cases, the presentation as a fever of unknown origin (FUO) is characteristic of the disease, for example, juvenile rheumatoid arthritis (JRA), but the definitive diagnosis can be established only after prolonged observation because initially there is no connected or special finding on physical examination and all laboratory results are negative or normal. Drugs fever is nor unusual in children. Infections account for most of the cases of FUO in children (60-70%). Even with extensive researches, the cause of FUO remains undiagnosed in 10-20% of the cases.

The first step is to identify ill patients who require stabilization and urgent referral to a tertiary care center. Subsequently, all attempts should be made to reach an etiologic diagnosis. A detailed history is of paramount importance. History should include the following:

• Where and how fever was documented.
• Duration and pattern of fever.
• Symptoms are preferable to all organ systems, weight loss.
• History of recurrent infections, oral thrush HIV infection).
• History of contact with tuberculosis and animals.
• Drug history specifically anticholinergics.
• History of joint pains, rash, photosensitivity.
• Travel to endemic sones.
• History of pica, ingestion of dirt could be an essential clue towards the diagnosis of Toxocara (Toxoplasma Gondii).

Careful and meticulous physical checkup is necessary for all children who have an undiagnosed fever. Repetitive checkup, preferably daily, is also essential to pick up subtle or new symptoms, which may appear during the disease. The continuing absence of seat in the presence of an elevated or changing body temperature recommends dehydration due to vomiting, diarrhea or central nephrogenic diabetes insipidus.

A careful ophthalmic checkup is very important: 1) red, weeping eyes connective tissue disease, specifically polyarteritis nodosa; 2) bulbar conjunctivitis Kawasaki disease (leptospirosis); 3) petechial conjunctival hemorrhages infective endocarditis; 4) palpebral conjunctivitis measles, coxsackievirus infection, tuberculosis, infectious mononucleosis, lymphogranuloma venereum, and cat-scratch disease; 5) chorioretinitis CMV, toxoplasmosis, and syphilis; 6) uveitis sarcoidosis, JRA, systemic lupus erythematosus, Kawasaki disease, Behcet disease, and vasculitis; 7) proptosis orbital tumor, metastasis or neuroblastoma, thyrotoxicosis, orbital infection, Wegener granulomatosis (pseudotumor).

Tenderness to tapping over the sinuses or the upper teeth recommends sinusitis. Hyperemia of the pharynx (throat), with or without exudate infectious mononucleosis, CMV infection, salmonellosis, toxoplasmosis, tularemia, Kawasaki disease. Fever blisters common findings in patients with pneumococcal, malarial, streptococcal, and rickettsial infection meningococcal meningitis, rarely are seen in children with meningococcemia, salmonella (staphylococcal infections). Recurrent oral candidiasis may be a clue to different diseases of the immune system. Point tenderness over a bone occult osteomyelitis bone marrow invasion from the neoplastic disease. Generalized muscle tenderness dermatomyositis, polyarteritis, mycoplasma infection or Kawasaki disease. Tenderness over the trapezius muscle may be a clue subdiaphragmatic abscess. Repetitive chills and temperature spikes septicemia, especially when connected with renal disease, infective endocarditis, liver disease, malaria, rat-bite fever, brucellosis. Hyperactive deep tendon reflexes may recommend thyrotoxicosis as the cause of FUO. Rectal examination perirectal tenderness, which recommends a deep pelvic abscess, and pelvic osteomyelitis. Occult blood loss my recommend granulomatous colitis. The general activity of the patient and the presence or absence of rashes should be noted. Careful palpation for all groups of lymph nodes and detection of hepatic and splenic enlargement may be essential to follow the appropriate line of investigation.

However, a physical checkup not always conclusive in defining the cause of a prolonged fever so that researches are always essential to determine the diagnosis and to confirm the etiology. Main researches/investigations:

• CBC (Canadian Broadcasting Corporation), ESR (Erythrocyte Sedimentation Rate), PBF (Performance-based financing), MP, MT, gastric washings for AFB (Acid-Fast Bacillus), RA, ANA (antinuclear antibodies).
• Tests for brucella, rickettsiae, salmonella (taste for febrile triple antigen), RA, ANA.
• Chest X-ray, blood of urine cultures, urine analysis, stool examination, LFT, and CSF analysis.
• Liver biopsy.
• Ultrasound examination, bone marrow aspiration, IVU, and biopsy, FNAC/biopsy of the lymph node.

As for as possible, any kind of treatment for FUO should be started only when sufficient ground for the diagnosis are nor available; mild antipyretics (paracetamol + tepid sponging) may be given. Hydration should be maintained. Empirical trials with antibiotics may mask the diagnosis of subacute bacterial endocarditis, meningitis, or osteomyelitis, in common observation of the temperature pattern repeated clinical examination, and careful laboratory evaluation and interpretation of the results might throw light on the diagnosis. Empirical treatment is ordinarily avoided, except in critically sick patients where anti-TB treatment can be given in suspicion of disseminated TB. Special treatment depends on the diagnosis.

Query fever is a zoonotic disease, more commonly known as Q fever is a bacterial disease that has become one of the most infectious agents known to man, spread worldwide besides new zealand. Coxiella burnetii is the infectious agent that causes Q Fever.

Q fevers sources of infection lie mainly within animals: Cattle, Sheep, Goats, horses, Domestic and feral cats and dogs, Wildlife, camels, birds and some invertebrates. Although most animals may not show signs they can be asymptomatic carriers.

Mode of transmission example: 1) aerosols (urine, milk, faeces and parturient fluids), 2) direct contact (meat processing, necropsies, assisting with parturition, manure); 3) fomites/equipment (clothing, wool, bedding, newborn animals), 4) ingestion (unprocessed milk, water, soil, dust); 5) ticks (faeces of ticks). Person to person transmission is uncommon, although the main portal of entry for Q fever in humans is primarily blood related (blood infusions, bone marrow transplants) although cases of sexual transmission has been hypothesised by scientists. Coxiella burnetii is known to survive in soil and dust for many years, wind can cause the dust to be moved across several kilometres

Q fever has an average incubation period of: 14 – 35 days, as little as one organism has the ability to cause infection in humans. Humans as a species are thought to be a Dead-end host to Q fever as it is rare to pass C burnetii onto a susceptible individual. Fifty percent of cases are often asymptomatic. There are also acute and chronic infections associated with Q fever. As Q fever can be easily mistaken for different conditions (examples include: Leptospirosis, Brucellosis). Symptoms may include the following: feverish symptoms of up to 4 weeks, severe headaches (especially behind eyes), fatigue (can be prolonged follow post Q fever), chest and abdominal pain, nausea, vomiting and diarrhoea, sore throats and a dry cough, respiratory problems, brain and heart inflammation, weakness in muscles and joint pain. Can cause birth defects and abortions.

Q fever is known to have a high risk for occupations relating to the animal and agricultural industry: 1) abattoir and meat butchers; 2) dairy farmers, livestock and farm workers; 3) sheep shearers and wool class sorters; 4) wildlife rescue workers; 5) agriculture students and teachers; 6) lab workers (bacteria and high risk veterinary specimens); 7) hunters; 8) animal breeders (dogs and cats); 9) general caretakers of areas affected by Q fever (lawn mowing and golf courses in regional and rural areas).

Q fever can be prevented by vaccination (Q-Vax is a vaccination that has been developed here in Australia that is only available with a doctors prescription), although it is a crucial part that workers within the industry follow correct hygiene practices. The use of the following PPE gear can prevent outbreaks of Q fever from happening:

• Disposable P2 mask. To avoid the inhalation of potentially contaminated aerosols entering the lungs. Dispose of after use.
• Disposable Gloves. Potential contaminates such as disposing of animal products, waste, placentas, and aborted foetuses. Disposable after use.

Proper hygiene practices are crucial to avoid Q fever spreading elsewhere. Where possible disinfect equipment and surfaces with a cleaning agent to kill the C. burnetii bacteria that can be from urine, faeces, blood or other bodily fluids from animals. Outdoor wash areas are provided in some workplaces so that high risk activities are able to control the amount of exposure Q fever gets, it is advised that all dirty clothing, work boots and other clothes that may be worn can be thoroughly washed, this avoids the instance of which that people who are not vaccinated for Q fever are less likely to aquire the disease as the clothing should be left at the workplace or bagged securely and washed separately by someone wo is immune to Q fever.

Diagnosis of Q fever can be challenging to diagnose with the flu like symptoms it can hide as many different diseases and be mistreated for them too. When going to the doctor you should explain that you belong to one of the high risk areas Q fever exists within and understand that the possibility of contracting the disease in the previous 6 weeks. Blood tests will be required and may be repeated after two to three weeks of the symptoms to ensure a reading is not a false negative or positive.

Early treatment of Q fever with the antibiotic doxycycline for the acute sufferers. Chronic sufferers can endure, other prolonged symptoms which may include: vascular infections, endocarditis, hepatitis and osteomyelitis (usually in children). Chronic Q fever, causes treatment dilemmas and may require an infectious disease specialist to intervene.

Q fever in Australia has a well-managed program to stop Q fever from causing major illnesses in workers and individuals. The outlook is good for those infected acutely and can be treated accordingly to ensure a fast recovery. 852 cases of Q fever were notified between January 2006 and December 2007 only 360 of them required hospitalisation in July 2005 and June 2007.

In September of 2014 my grandma was diagnosed with a semi deadly disease known as Q Fever. She was flown out to UK hospital after having a seizure. She was transferred only once to a slightly smaller hospital after getting out of ICU. At the time I was 8 years old. In this speech I will cover three main points. How you get it, what happens when you get it, and best of all how you can prevent it.

Q Fever is a disease transmitted by the milk of cows, sheep, and goats. You can a also catch it from being bit by infected ticks. The bacteria in the milk is the bacterium Coxiella burnetii. The bacteria is an obligate intracellular bacterial pathogen. The bacteria can also infect dogs, cats, and rabbits. Q Fever is also hard to diagnose due to many human infections resulting in nonspecific or benign constitutional symptoms. A quick fact about this disease is it is one of the most contagious diseases animal to human but is rarely contagious from human to human interaction.

The diseases symptoms include a high fever up to 105℉, fatigue, chills, coughing, nausea, vomiting, and sensitivity to light. You can even become very confused as if you had just been under laughy gas.

Going farther into how Q Fever is transmitted let’s talk about exactly how it happens. When the bacteria in the milk dries and hardens the bacteria is then released along with the dust into the air. When we breathe this air the bacteria is inserted into our lungs.

As you have probably guessed if you work with animals you are at a higher risk to Q Fever. Many jobs including veterinary medicine, meat processing, livestock farming, and animal research. Even if you just work near a farm you are still at risk. So, if you live or work near a field the air can still get to where you are. Also, if it is April or May Q Fever rates spike but it can still be caught anytime of the year.

You are also at risk to the more deadly Chronic Q Fever if you have heart valve disease, blood vessel abnormalities, weakened immune systems, and impaired kidney function.

Q Fever just like any disease comes with it’s own set of some possible complications. This may include endocarditis which is the inflammation of the membrane in your heart, this can severely damage your heart valves and is the most deadly of Q Fevers complications. Lung issues are common along with liver damage. Another complication is pregnancy issues. This in my opinion is the most sad cause 2 lives are at risk not just one. The problems can include miscarriage, low birth weight, premature birth, and stillbirth. You can also be diagnosed with myocarditis which is the inflammation of a different part of your heart.

Last but not least let’s talk about how you can prevent Q Fever. Although there is a vaccine in Australia it is not yet available in the U.S. Although there is not very many ways to prevent it but the best way is to only drink pasteurized milk. Pasteurization is the process in which all bacteria is destroyed and killed in milk.

In conclusion Q Fever is a rare disease with less than 1,000 cases per year in the U.S. I am so thankful my grandma survived this and I thank you all for listening. I hope you all learned something.