SPM Practical Viva on Fever & Related Conditions:
1. Fever – Definition & Basics
• Fever: Elevated core body temperature ≥38.0°C (oral/rectal).
• Mechanism: Response to cytokines (IL-1, IL-6, TNF-α) & acute-
phase proteins.
• Not all “feeling hot” means fever → Confirm with a thermometer.
• Common symptoms: Rigors (shivering), night sweats, headache,
myalgia, delirium (common in children & elderly).
2. Types of Fever
1. Continuous Fever – Persistent ↑temp with minimal fluctuation
(e.g. Typhoid).
2. Intermittent Fever – Fever spikes with normal temp in between
(e.g. Malaria).
3. Remittent Fever – Fever fluctuates but never normalizes (e.g.
Endocarditis).
4. Relapsing Fever – Fever-free intervals with recurrence (e.g.
Borrelia recurrentis).
5. Undulant Fever – Gradual rise & fall (e.g. Brucellosis).
6. Pel-Ebstein Fever – Fever in Hodgkin’s Lymphoma.
7. Fever of Unknown Origin (FUO) – Fever >3 weeks, unknown
cause.
3. Common Febrile Illnesses
(A) Dengue Fever
Causative Agent: Dengue virus (Flavivirus) → Aedes mosquito-borne.
Suspect Dengue (Without Lab Test):
• Sudden high fever
• Retro-orbital pain
• Severe myalgia (“Breakbone fever”)
• Rash, petechiae
• Thrombocytopenia (Platelets <1,00,000)
Classification of Dengue:
1. Dengue without warning signs – Fever, rash, body aches.
2. Dengue with warning signs – Abdominal pain, persistent
vomiting, bleeding, fluid accumulation.
3. Severe Dengue (Dengue Shock Syndrome) – Shock, severe
bleeding, organ failure.
Platelet Cutoff for Thrombocytopenia: <1,50,000/mm³
Management: Avoid NSAIDs (bleeding risk), give IV fluids. Platelet transfusion only if
<10,000/mm³ with bleeding.
(B) Malaria
Causative Agent: Plasmodium (P. falciparum, P. vivax, P. ovale, P. malariae).
Vector: Anopheles mosquito.
Symptoms: Fever, chills, rigors, sweating, hepatosplenomegaly.
Diagnosis: Peripheral smear (Thick & Thin), Rapid Antigen Test.
Treatment: Artemisinin-based combination therapy (ACT) for falciparum, Chloroquine
for vivax.
(C) Typhoid Fever
Causative Agent: Salmonella Typhi/Paratyphi (Fecal-oral transmission).
Symptoms: Step-ladder fever, relative bradycardia, rose spots, constipation → diarrhea.
Diagnosis: Blood culture, Widal test (after 1 week).
Treatment: Ceftriaxone, Azithromycin, Ciprofloxacin (based on resistance).
(D) COVID-19
Causative Agent: SARS-CoV-2 (Coronavirus).
Symptoms: Fever, cough, anosmia, pneumonia, ARDS (severe cases).
Diagnosis: RT-PCR, Rapid Antigen Test.
Treatment: Supportive, oxygen therapy, antivirals (Molnupiravir, Remdesivir), steroids (if
severe).
(E) Fever of Unknown Origin (FUO)
Definition:
• Fever >3 weeks
• Temperature >38.3°C
• Unclear cause after 1 week of investigation
Common Causes:
1. Infections (30%) → TB, Endocarditis, Abscess, CMV, HIV.
2. Malignancies (20%) → Lymphoma, Leukemia.
3. Autoimmune (15%) → SLE, Rheumatoid Arthritis, Vasculitis.
4. Miscellaneous (20%) → Thyrotoxicosis, Drug Fever,
Sarcoidosis.
5. Idiopathic (15%) → No cause found.
Workup for FUO:
• Blood culture, CBC, ESR, CRP, LFT, RFT
• Chest X-ray, ECG
• Urinalysis, HIV, TB tests
• Autoimmune markers (ANA, RF, dsDNA)
4. Notifiable Fevers
(Fever cases that must be reported to health authorities)
1. Dengue
2. Malaria
3. Typhoid
4. COVID-19
5. Leptospirosis
6. Chikungunya
5. Thermometers & Fever Measurement
1. Mercury Thermometer – Oral/Rectal (More accurate).
2. Digital Thermometer – Fast & Safe.
3. Infrared Thermometer – Forehead measurement.
4. Tympanic (Aural) Thermometer – Less reliable.
5. Axillary Temperature – Least accurate.
6. Whole Blood Transfusion in Fever Cases
• Used only if severe anemia (<7 g/dL) or bleeding complications.
• Dengue: Platelet transfusion only if <10,000/mm³ with bleeding.
• Malaria: Exchange transfusion for severe falciparum malaria.
7. Investigations in Fever Cases
Basic Tests:
• CBC (WBC count, Hemoglobin, Platelets)
• LFT, RFT (Liver & kidney function)
• Blood culture (Sepsis, Typhoid)
• Urinalysis (UTI, Pyelonephritis)
• Chest X-ray (Pneumonia, TB)
Specific Tests:
• Malaria Smear/RDT (Rapid Diagnostic Test)
• Dengue NS1, IgM, IgG
• COVID-19 RT-PCR
• Widal Test for Typhoid
• Leptospira IgM
8. Management of Fever
General Measures:
Paracetamol (Avoid NSAIDs in dengue)
Tepid sponging (For high fever)
Hydration (Oral & IV fluids)
Salt replacement (ORS)
Empirical Antibiotic Therapy:
• Bacterial Infection Suspected: Ceftriaxone/Azithromycin.
• Sepsis Suspected: Broad-spectrum (Piperacillin-Tazobactam +
Vancomycin).
• Malaria: Artemisinin-based therapy.
• Typhoid: Ceftriaxone or Azithromycin.
9. Special Considerations
• HIV patients → Prone to FUO (CMV, TB, PCP pneumonia).
• Travel History Important → Malaria, Leptospirosis, Rickettsial
Infections.
• Autoimmune Causes of Fever → SLE, Vasculitis.
This should help in your SPM practical viva preparation! Let me know if you need any
clarifications or extra details.
