(A) Infectious diseases
1. Tuberculosis with fever starting with acute blood-borne disseminated tuberculosis, tuberculous meningitis, infiltrative tuberculosis, and other chronic fever of unknown origin, such as normal or mildly increased or even decreased white blood cell count should be considered as tuberculosis. Most of the primary lesions are in the lungs, and prompt X-ray examinations should be done to help the diagnosis. Acute disseminated tuberculosis (acute cornual tuberculosis) is more common in young children, especially in those who have not received BCG vaccination. In recent years, elderly patients and adults with primary infection have also been seen with rapid onset of fever, high fever in the form of febrile or flaccid fever that lasts for weeks and months with chills, night sweats, cough with little sputum or blood in the sputum, shortness of breath, and dyspnea and cyanosis. Symptoms are often atypical in infants and the elderly. Some cases have a skin rash (tuberculosis rash), and the chest examination is often not positive, but there may be mild enlargement of the liver and spleen. The early stage of the disease (within 2 weeks) is difficult to diagnose because the lung X-ray is often abnormal, and the tuberculin test may be negative (about 50%), especially in the elderly and those with poor health. Fundus examination can find choroidal chestnut nodules or nodular chorioretinitis is good for early diagnosis.
2, typhoid fever paratyphoid fever is common in summer and autumn, in case of persistent fever for more than 1 week, attention should be paid to the possibility of typhoid fever has been changing in recent years, from mild and atypical to heavy fever with a long duration, many complications and resistance to chloramphenicol, etc. in the differential diagnosis must be noted. Multiple positive blood cultures or bone marrow cultures are the basis for confirming the diagnosis. Fertilizer reaction is available for reference.
3, bacterial endocarditis Where sepsis (especially due to Staphylococcus aureus) patients in the course of antibiotic therapy suddenly appear organic heart murmurs or changes in the original murmur, or continuous petechiae or embolism phenomenon, should be considered the disease may be most of the original congenital heart disease (ventricular septal defect, arteriovenous catheterization, etc.) or rheumatic heart valve disease history, a small number of bias before the extraction of tonsils removal, severe The history of gingival infection, urinary tract surgery presents with persistent fever for more than 1 week, accompanied by skin and mucosal petechiae, heart murmur changes splenomegaly, anemia, microscopic hematuria, etc. Blood culture has pathogenic bacteria growth, and echocardiography can find the site of the superfluous organisms.
4.hepatic abscess ①Bacterial liver abscess is mainly caused by biliary tract infection, mostly seen in the left and right lobes, with the left lobe being more common; for infection from the portal vein system, the right lobe is more common. It is characterized by chills and high fever, pain in the liver area, hepatomegaly, pressure pain and percussion pain, and the diagnosis is easier in typical cases. It is more difficult to diagnose when there is prolonged fever and local signs are not obvious; in recent years, the diagnostic conformity rate is 96% with liver ultrasound examination. ②Amoebic liver abscess is the most common and important complication of amoebic dysentery. It manifests as intermittent or persistent fever, pain in the liver area hepatomegaly and pressure, wasting and anemia. It is most common in the right lobe of the liver alone. Diagnosis is confirmed by liver aspiration with chocolate colored pus; amoebic trophozoites found in the pus; positive immunoserology and effective antiamoebic therapy.
(II) Non-infectious diseases
1.Primary liver cancer More than 80% of domestic primary liver cancers are combined with cirrhosis. The clinical characteristics are insidious onset and lack of specific symptoms in early stage, once typical symptoms appear, it is mostly in advanced stage. In recent years, due to the progress of diagnostic methods, small hepatocellular carcinoma (>5cm) can be diagnosed at an early stage, mainly manifesting as pain in the liver area, weakness, abdominal distension and poor nutrition, emaciation, progressive hepatomegaly (hard and uneven surface), jaundice and gastrointestinal bleeding. The general diagnosis is easy when fever is the main complaint, which is difficult to diagnose, and manifests as persistent fever or flaccid fever, or irregular low fever a few may have high fever (such as inflammatory type or diffuse hepatocellular carcinoma) easily mistaken for hepatomegaly or infectious disease. Timely detection of alpha-fetoprotein (AFP), its sensitivity and specificity are conducive to early diagnosis. Where ALT is normal, excluding pregnancy and germinal gland embryonal carcinoma, if AFP is positive for 3 weeks, or AFP > 200ng/ml for 2 months, the diagnosis can be confirmed. If AFP> is elevated and the dynamic curve of weekly ALT decrease is separated, liver cancer is more likely. In addition, elevated r-glutamate transpeptidase (r-GT) alkaline phosphatase (AKP) also has auxiliary diagnostic value. Ultrasound, CT and radionuclide imaging can help to localize and diagnose selective hepatic arteriography (or digital subtraction hepatic arteriography) can detect cancer foci of 1cm, which is a better method to localize small hepatocellular carcinoma.
2.Malignant lymphoma includes Hodgkin’s disease and non-Hodgkin’s lymphoma. It is mostly seen in 20-40 years old, and is more common in men with no clinical symptoms or progressive lymph node enlargement, night sweats, wasting rash or skin itching. Anyone who encounters unexplained lymph node enlargement that has been treated as inflammation or tuberculosis for 1 month and is ineffective; unexplained fever, should consider the possibility of this disease, and the confirmation of diagnosis mainly relies on pathology. Lymph node biopsy, bone marrow aspiration, liver aspiration, ultrasound, CT and other examinations can be performed and differentiated from infectious mononucleosis, lymph node tuberculosis, chronic lymphadenitis with metastatic cancer, rheumatism and connective tissue disease.
Malignant histiocytosis The clinical manifestations of this disease are complex, and fever is a common symptom. Some cases resemble septic typhoid fever. Tuberculosis, biliary tract infection, etc., but after clinical system examination and treatment are not effective, until the late stage of the diagnosis. The main points of differentiation from other acute infectious diseases are: (1) clinical resemblance to infectious diseases but no foci of infection can be found, and pathogenic and serological tests are negative; (2) progressive anemia and significant reduction of whole blood cells; (3) significant degree of hepatosplenomegaly and lymph node enlargement; (4) progressive cachexia as the disease progresses; (5) ineffective antibiotic treatment. For those with prolonged fever of unknown origin, accompanied by hepatosplenomegaly and lymph node enlargement, while the epidemiological data, symptoms and signs do not support acute infection and hematopoietic dysfunction, the possibility of this disease should be considered. If typical malignant histiocytes and a large number of blood cells are phagocytosed in the bone marrow smear or other tissue biopsy material and other diseases are excluded, the diagnosis can be basically established. Therefore, bone marrow smear is an important basis for the diagnosis of the disease. Since the bone marrow damage may be non-diffuse, or because of the small amount of material taken, a negative test cannot be excluded from multiple site examinations if necessary. Superficial lymph nodes may not be excluded if they are negative because the lesions are not obvious. The disease must be differentiated from reactive histiocytosis, such as typhoid fever, cornual tuberculosis, viral hepatitis, rheumatism, SLE, infectious mononucleosis, etc., in which more histiocytes may appear in the bone marrow and even blood cells are phagocytosed. It should be noted that: (1) there is a primary disease; (2) the morphology of the tissue cells seen is more normal without multinucleated giant histiocytes; (3) as the primary disease is cured, the tissue cell reaction also disappears.
4. Acute leukemia Fever may be present, and the diagnosis can be confirmed by blood smear and bone marrow examination. Therefore, in case of clinical fever, anemia, weakness, gingival swelling and hemorrhagic granulocytopenia, timely bone marrow smear examination should be performed.
5.Vascular a connective tissue disease book
(1) SLE: Long-term fever with more than two organ damage blood leukocytopenia should be considered to this disease. It is mostly seen in young women. The clinical features are first irregular fever with arthralgia, polymorphic rash (typically symmetrical butterfly-shaped erythema on the cheek and nose, 60%-80%), increased hematocrit, elevated gammaglobulin, positive urine protein, positive blood lupus cells, positive antinuclear antibodies (ANA), positive anti-double-stranded deoxyribonucleic acid (anti-ds-DNA) antibodies, and positive anti-Sm DNA) antibodies, anti-Sm (Smith antigen) antibodies. It should be noted that SLE can be characterized by high fever without a typical rash throughout the course of the disease.
(2) Polyarteritis nodosa: manifested by prolonged fever with myalgia, arthralgia, subcutaneous nodules (mostly along the vascular course of the lower extremities, or in the form of cords), renal damage, high blood pressure, gastrointestinal symptoms, etc. Diagnosis is mainly based on subcutaneous nodules and muscle (deltoid or gastrocnemius) biopsy
(3) rheumatoid arthritis: typical cases are easier to diagnose juvenile rheumatoid arthritis (Still’s disease), may have chills, fever, transient rash arthralgia is not obvious, lymph node enlargement, hepatosplenomegaly iridocyclitis, myocarditis, increased leukocytes increased sedimentation but rheumatoid factor negative, anti-nuclear antibody and lupus cells are negative.
(4) Mixed connective tissue disease (MCTD): mostly seen in women characterized by clinical manifestations of lupus erythematosus, hardness disease and dermatomyositis with less renal involvement and marked by febrile symptoms. High titers of ribonucleic acid protein (RNP) antibodies positive for antinuclear antibodies help in the diagnosis. Prolonged hypothermia An axillary temperature of 37.5-38°C for more than 4 weeks is considered as prolonged hypothermia, commonly caused by.
1, tuberculosis For the common cause of hypothermia, pulmonary tuberculosis is common, early asymptomatic signs and symptoms prompt chest x-ray examination. Followed by extrapulmonary tuberculosis, such as liver and kidney, intestine, mesenteric lymph nodes, pelvis, bone and joint tuberculosis, etc. In addition to local symptoms, there are often toxic symptoms of tuberculosis, increased blood sedimentation tuberculin test strong positive, anti-tuberculosis treatment has a definite effect, which helps to diagnose the elderly tuberculosis onset symptoms are not obvious, their pulmonary complications, tuberculin test negative easily diagnosed as chronic bronchitis or asthma. Therefore, if elderly people have persistent cough and sputum and easily catch cold, ineffective treatment with anti-inflammatory drugs, low fever and weakness, sputum TB bacilli (smear or TB-PCR) and chest X-ray should be examined promptly. The elderly are prone to the combination of extrapulmonary tuberculosis such as tuberculous meningitis, pleurisy, peritonitis, bone, kidney and lymph node tuberculosis, etc.
2. Chronic renal meningo-nephritis is a common cause of hypothermia in female patients. There may be no obvious symptoms, signs or even no abnormalities in urine examination, with hypothermia as the only manifestation. Timely detection of urine Addi cell count early in the morning for the first time in the middle urine culture and colony count, such as urine leukocytes > 5/HP, positive bacterial culture, colony count > 105 can confirm the diagnosis.
3, chronic focal infections such as paranasal sinusitis, gum abscess, prostatitis biliary tract infection, chronic pelvic inflammatory disease, etc.. Irregular low-grade fever is often accompanied by local symptoms and signs, and the symptoms disappear when the lesion is cleared.
4, AIDS (AIDS) is a systemic disease caused by the human immunodeficiency virus (HlV) that invades and destroys the human immune system and damages multiple organs. It can be transmitted sexually through blood and body fluids. The clinical manifestations are complex, and its basic feature is that HlV causes the human cellular immunity to be impaired so that the body is in a serious, progressive immunodeficiency state, which is complicated by various opportunistic infections and malignant tumors manifested as long-term irregular fever, chronic diarrhea for more than 1 month, ineffective for general antibiotic treatment wasting, unexplained generalized lymph node enlargement, repeated bacterial fungal, protozoal and other infections, combined with epidemiological data Timely anti-HlVP24 shake antigen test.
5, cytomegalovirus infection can be persistent low fever, similar to infectious mononucleosis, viral hepatitis based on anti-CMV IgM test diagnosis.
6, hyperthyroidism Performance of early hypothermia with palpitations, rapid pulse, excessive sweating hyperphagia, wasting, hand tremor thyroid enlargement, local murmur, etc. Test T3T4, rT3, etc. For hyperthyroidism without protrusion, 131I uptake test should be performed to exclude elevated T3 and T4 levels in the blood due to hormonal overflow in thyroiditis.
7. Malignant tumors In middle-aged people with unexplained hypothermia and increased blood sedimentation, attention should be paid to tumor screening, such as primary liver cancer. Lung cancer, kidney cancer and colon cancer, etc.
8, neurological hypothermia Most often seen in young women, obvious in summer. The difference in body temperature between one day and the next is
1, brucellosis Epidemiological data is an important basis for diagnosis, such as the onset of the region, occupation and sick animals (sheep, cattle, pigs) contact history of drinking unsterilized cow and goat milk, eating uncooked animal meat history clinical manifestations of recurrent fever, accompanied by excessive sweating, wandering arthralgia neuralgia, orchitis, liver, spleen and lymph node enlargement, etc. blood, bone marrow culture positive, serum agglutination test 1: 100 see above immunosorbent The test 1:320 or more, can help to diagnose.
Malaria is more common in inter-day malaria and three-day malaria. In case of paroxysmal chills with high fever and profuse sweating, timely blood smear search for Plasmodium vivax in inter-day or inter-2-day cycle can confirm the diagnosis.
3, lymphoma lesions in the internal organs, often manifested as periodic fever (PeI-Ebstein fever type) is seen in Hodgkin’s disease. In some cases, superficial lymph node enlargement is not significant but symptoms appear with deep lymph node enlargement compressing adjacent organs, such as mediastinal lymph node enlargement causing pulmonary atelectasis and superior vena cava syndrome. Timely bone marrow smear examination to find Reed-Sternberg cells or bone marrow biopsy can be helpful for diagnosis.
4, regression fever Clinical manifestations of periodic fever, rapid onset, chills and high fever lasting 2-9d followed by a sudden drop in body temperature, profuse sweating, fever-free period lasting 7-9d and sudden high fever, symptoms reappear, repeated 2-3 times generalized aches and pains, hepatosplenomegaly, jaundice with hemorrhagic tendency in severe cases, combined with the onset season, with The presence of body lice or a history of wildlife cicada bites must be considered to this disease. The diagnosis of ultrahigh fever can be confirmed by finding the regression fever spirochete according to blood and bone marrow smear. Ultrahigh fever can occur when the thermoregulatory center fails to function and can cause serious damage to various tissues and organs of the body, especially brain tissue, causing brain cell degeneration, extensive hemorrhage and deep coma, and death within a few hours, requiring active resuscitation.
1.Heatstroke or pyrexia.
2, central nervous system diseases such as viral encephalitis, cerebral hemorrhage and severe traumatic brain injury in the anterior hypothalamus.
3.Bacterial contaminated blood transfusion reaction.