Pyrexia

• Pulmonary aspiration
• Postoperative fever (<48h)
• Trauma/haematoma
• Thromboembolism
• Gastrointestinal bleeding
• Drug-induced fever
• Febrile non-haemolytic red cell and platelet transfusion reactions
• Alcohol withdrawal
• Neuroleptic malignant syndrome
• Cerebral disease, including subarachnoid haemorrhage
• Gout
• Transplant rejection
• Neoplasia, including lymphoma
• Haematoma
• Myocardial infarction
• Addisonian crisis, acute adrenocortical insufficiency
• Acute pancreatitis

Clinical pulmonary infection score

Clinical pulmonary infection score

I    Three or more of the following:
a) Rectal temperature >38.0 °C or <35.5 °C
b) Leukocytes (<10.0 x 10⁹ /L) and/or left shift or leukopoenia (<3.0 x 10⁹/L)
c) >10 leukocytes per high power field in Gram stain of tracheal aspirate 
d) Positive (qualitative) culture of tracheal aspirate 

AND
II    New, persistent or progressive infiltrate on chest radiograph

AND
III    One or more of the following
a) Positive quantitative culture of bronchoalveolar lavage fluid (>10⁴cfu/mL) or PSB (>10³ cfu/L) or >5% of leukocytes containing phagocytosed bacteria.
b) Positive blood culture with the same micro-organism as that present in the airway
c) Positive culture of pleural fluid

• There is fever or a positive blood culture in the absence of another evident source of infection
• The CVC dwell time exceeds 3 days
• Fever abates after catheter removal
• There are signs of local (exit-site) infection.

Exit-site catheter infection is defined as the presence of positive quantitative catheter culture in the presence of symptoms of local infection (erythema, tenderness, induration, or purulence), in the absence of other foci.

Catheter-related blood stream infection (CRBSI) is diagnosed when the same organism is isolated (at higher concentrations – see below) on quantitative culture of the distal catheter segment and from the blood of a patient with clinical symptoms of local or systemic infection and no other source of infection evident.

• Differential time to positivity: a relatively rapid (by at least 2h) onset of a positive culture in blood drawn via the CVC as compared to a paired sample from peripheral blood.
• Quantitative blood cultures: a quantitative organism ratio of at least 5:1 colony forming units (CFU) per ml between paired samples drawn from the catheter hub and peripheral blood cultures respectively.

After multiple trauma, burns, severe sepsis and major surgery, the gallbladder may become inflamed in the absence of gall stones. This inflammation, called acalculous cholecystitis, has an estimated incidence of around 1.5%.

• A wall thickness >3 mm
• intramural lucencies
• gallbladder distension
• pericholecystic fluid
• and intramural sludge

Eigentlich alle.

Drug fever ist eine Ausschlussdiagnose!

• all antibiotics (especially β-lactams)
• anti-epileptic drugs (especially phenytoin)
• antiarrhythmics (mainly quinidine and procainamide)
• antihypertensives (α-methyldopa)
• diuretics
• and stool softeners

myocardial infarction, Dressler's syndrome with pericarditis, thromboembolism, thrombolytic therapy with haemorrhagic complications and antiarrhythmic medication (e.g. procainamide, quinidine), and deep venous thrombosis

• advanced age
• underlying co-morbidity and the extent of trauma and surgery as well as
• prolonged hypotension
• haematoma
• foreign bodies and
• blood transfusion

Staphylokokken und Streptokokken

Reinigen der Wunde, Fremdkörperentferung,Drainage, und Sepsis-Therapie

After stroke or neurotrauma, fever may be associated with more severe brain damage and a worse neurological outcome->rapid assessment

s a neuropsychiatric disorder that may overlap the neuroleptic malignant syndrome. Fever, stupor, mutism, coma, muscle rigidity and autonomic instability are amongst the most prominent features.

• eliminating the underlying causes
• cooling (initially by infusion of cold intravenous fluids – see below)
• rehydration and benzodiazepines
• Intravenous dantrolene sodium to treat muscle contraction (1 mg/kg bolus) which may be repeated during the course of the illness is followed by 4–8 mg/kg per day in 3–4 doses, orally, for 3–4 days as ongoing prophylaxis
• Bromocriptine, other dopamine agonists (levodopa) and amantadine may also be used for neuroleptic malignant syndrome
• Electroconvulsive therapy may be necessary for catatonia if refractory to drug treatment.