Infectious diseases : a clinical approach, 3rd Edition by A. Young, D. Spelman, A. Street et al. (eds.)

By A. Young, D. Spelman, A. Street et al. (eds.)

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A regular cycle of fever, usually 21 days, occurs in cyclic neutropenia, and the fever begins at the time of maximum neutropenia. g. in cerebral haemorrhage). What is a rigor? Rigors sometimes occur during the febrile/inflammatory response to infection. A rigor is a severe episode of uncontrollable shivering lasting up to 20 minutes accompanied by striking pallor of face and limbs. It is usually sudden in onset and is often associated with a sense of impending doom, piloerection and dry mouth, but no sweating.

The patient who looks ill requires early resuscitation, empiric therapy and investigations. 2 length of illness. In general, the longer the duration of a symptom the more significant it becomes (for example, prolonged headache, diarrhoea or fever are indications for intervention as most benign infections do not persist). 3 progression of illness. Deterioration in general well-being, and loss of appetite, weight, energy and drive are indications for quickening the pace of investigation. Careful observation may be more appropriate in the absence of prominent symptoms or weight loss; the pattern of illness is more important than its length.

Visits to the doctor or emergency department, especially out of daylight hours, indicate that symptoms were sufficiently severe to trouble the patient. Results of investigations performed during those visits should be sought and documented. The systematic history should include the illness and the patient setting. The illness Onset and duration The date of onset defines the duration of the illness, which is all important in diagnosis and in assessing the need for investigation. In long illnesses, it may be difficult for 12â•… 2 – HISTORY AND EXAMINATION IN INFECTIOUS DISEASESâ•… 13 patients to recall the exact day of onset and the nature of early symptoms that may have great diagnostic value but have since resolved.

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