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18 Cards in this Set
- Front
- Back
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Fever
What are major causes of fever? |
Pyrexia: elevation in body temp & clinical hallmark of inflammation due to # of causes
assoc. w/ -infection -manifest. of cancer -autoimmune disease -strenous exercise -increase environmental temp -acute coronary artey/cerebral occlusion (myocardial infarct/stroke) |
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Causes of Fever-Neoplasms?
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-acute leukemia (myelogenous & lymphoblastic)
-hodgkins & non-hodgkins lymphoma -renal cell carcinoma -hepatocellular carcinoma -primary brain tumors (hypothalamus) |
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Cause of Fever-Infalmmatory Disease?
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-inflamm disease caused by fever:
-autoimmune disease: systemic lupus, rheumatoid arthritis, vasculities =granulomatous: sarcoidosis, chron's disease & giant cell arteritis |
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Drugs that have the ability to cause fever?
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-antihistamine
-antipsychotics (thorazine, haldol) -tricyclic antidepressents (TCAs) -monoamine oxidase inhibitors -cocaine -Phencyclidine PCP -amphetamines -Lysergic Acid Diethylamide (LSD) |
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Conditions that can cause fever?
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1. Malignant Hyperthermia (genetic disorder after anesthesia)
2. Neuroleptic Malignant Syndrome (adverse rxn to anti-psychotic drugs) 3. Hyperthyroidism (thyrotoxicosis) & Pheochromocytoma (tumor of adrenal medulla) 4. Evirontmental (heat stroke/hyperthermia) 5. AMI, Stroke,CHF, Transfusion Rxn, Transplant Rejection, Sickle Cell, Seizure, Pancreatitis, Dehydration, Gout |
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Body Systems responsible for most infection?
Which area of brain regulates our temperature? |
-3 body systems = 80% infection
1. Respiratory 2. Urinary 3. Skin & Soft Tissue Hypothalamus (create heat loss via vasodilation & sweating) |
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What is the Pathophysiology of fever caused by infection?
What is the definition of a pyrogen? |
-fever = elevation of body temp >37 degrees C
-typical response to acute inflam caused by endogenous pyrogen -any substance that cause fever = portion of microbial cell wall (endotoxin or LPS) of gram - or enterotoxin from st. aureus or toxin from Group A beta-hemolytic strep |
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How microbes release their pyrogens?
Dominate cytokines that cause fever? |
-release exogenous pyrogen by bacteria, virus, fungi (directly affect hypothalamic thermoregulatory center)
-also stim. endogenous pyrogenic mediators of inflammation (cytokines) -IL-1, IL2, IL6, & TNF |
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Innate Immune Receptors
What are the name of these Receptors on our Immune Cells? |
-microbes that penetrate an epithelial barrier to enter a tissue site are encountered by tissue sentinel immune cells: macrophages, monocytes, mast cells, dendritic cells
-Toll like receptors (TLRs) |
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How TLRs work?
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-stim of receptors on macrophages, monocytes, etc by microbe
-leads to synthesis & secretion of endognenous cytokines = initiate inflamm response -leads to further recruit of blood infection fighters (ex; neutrophils) -recognize microbial cell walls or viral-specific nucleic acids |
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Which of cytokines affect the hypothalamus?
How does aspirin work? |
IL-1, IL-2, TNF --> stim prostoglandins (PGE-2)
-synthesis from hypothalamic thermoregulatory center (altering body "thermostat") -aspirin blocks fever by inhibiting IL-1 stimulated PGE-2 synth. in hypothalamus |
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What is septic or endotoxic shock?
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-gram - endotoxic shock result from spread of bacteria from severe localized infection into blood stream (ex: abscess, pneuomonia, peritonitis)
-can also occur w/ gram + & fungal infection -most common cause of death in ICUs >100,000/year |
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Most common organisms of septic shock?
What are endotoxins? |
-endotoxin producing gram - bacteria
-E. coli, Proteus Serratia, Pseudomonas, K. pneumoniae, & anarobe Bacteriodes LPS in gram - form complexes w/ LPS bind protein in serum -complex binds to TLR on WBC & cause inflamm. mediator response |
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Association of Cancer & Fever?
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-fever may correlate w/ tomor growth (disappear after treatment & reappear w/ occurance)
-tumor cells may release pyrogens or inflamm. cells in tumor strome can produce IL-1 |
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What is hypothalamic Fecer?
Is it common? What are causes of hypothalamic fever? |
-elevation of temp caused by abnormal hypthalamic fxn causeing supranormal body temp
-no, rare -local head trauma, hemorrhage, or tumor in hypothalamic area |
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What is Malignanat Hyperthermia?
What are causes? Clinical Presentation? |
-autosomal dominant inherited abnormality of skeletal muscle sarcoplasmic reticulum cause ripid increase in intercull Ca levels (rare)
-Halothane or other inhalation anesthetics or succinylcholine -increase temp & muscle metabolism w/ rigidity, rhabdomyolysis, & CV instability which develops w/in minutes |
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What is Neuroleptic Malignant Syndrome?
What is cause & clinical features of NMS? |
-disorder seen in setting of neuroleptic agent use: anti-psychotics, phenothiazines, Haloperidol, & metoclopramide
-cause by inhibition of central dopamine receptors in hypothalamus --> increase heat generation & dissapation lead to muscle rigidity autonomic dysregulation & hyperthermia |
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Clinicopathologic Correlations of Fever
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leukocytosis
-normal blood <10,000 WBC/mm3 -mediators of inflam act on bone marrow stim. rapid release of leukocytes -when # >12-15,000 = acute inflamm |
