Professional Documents
Culture Documents
Curriculum Vitae
• Nama: dr. Musofa Rusli, SpPD
• Tempat/ Tgl Lahir: Kediri, 29 Mei 1972
• Pendidikan:
• S1 – Pendidikan Dokter FK UNAIR (lulus 1997)
• Spesialis 1 - Ilmu Penyakit Dalam (lulus 2011)
• Posisi:
• Dosen Ilmu Penyakit Dalam FK UNAIR (Divisi Tropik-Infeksi)
• Kepala Instalasi PIPI RSUD Dr. Soetomo (2017-sekarang)
• Ketua Unit Sistem Informasi (UPeDDI) FK UNAIR (2016 – sekarang)
• Koordinator Surveilans Komite PPRA RSUD Dr. Soetomo
• Anggota Komite Farmasi & Terapi RSUD Dr. Soetomo
• Anggota Tim HIV/ AIDS RSUD Dr. Soetomo - FK UNAIR
• IPCD Komite/ Tim PPI RSUD Dr. Soetomo
• Sekretaris IDI Cabang Surabaya (2017-sekarang)
Musofa Rusli
Dep/SMF Ilmu Penyakit Dalam – Divisi Tropik - Infeksi
FKUA – RSUD Dr. Soetomo Surabaya
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TOPICS
• Definition
• Pathophysiology of fever
• Management of fever
• Fever of unknown origin
• Drug fever
• Role of NLR and procalcitonin
Definition
Fever
• An elevation of body temperature that exceeds the normal
daily variation and occurs in conjunction with an increase in
the hypothalamic set point
• Heat conservation (vasoconstriction) and heat production
(shivering, fat tissue thermogenesis)
• Anatomic variations: rectal > oral > axillar
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Wunderlich’s Maxim
• After analyzing >1 million axillary temperatures
from ~25,000 patients, Wunderlich identified
37.0° C (36.2-37.5) as the mean temperature in
healthy adults.
• Temperature readings >38.0° C were deemed as
“suspicious/probably febrile.”
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Definition
Pyrogens
Pyrogens any substance that causes fever
• Endogenous
• class of biologically active proteins called cytokines pyrogenic
cytokines
• related to activation of TLR
• E.g.: IL-1, IL-6, TNF-α, IFN-γ
• Exogenous
• derived from outside the host
• mainly microbes or their products: toxins
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Definition
Elevated body temperature
• Hyperthermia:
• An uncontrolled increase in body temperature that exceeds the
body's ability to lose heat thermoregulatory center is
unchanged
• Does not involve pyrogenic molecules
• Exogenous heat exposure and endogenous heat production
• Hyperpyrexia:
• an extraordinarily high fever (>41.5ºC)
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Definition
Temperature-pulse relationship
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Patterns:
• Continuous fever: Temperature remains above normal throughout the day and
does not fluctuate more than 1 °C in 24 hours
• Intermittent fever: The temperature elevation is present only for a certain period,
later cycling back to normal
• Remittent fever: Temperature remains above normal throughout the day and
fluctuates more than 1 °C in 24 hours
• Hectic fever sepsis
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Fever Onset
< 1 week Within 1-3 weeks > 3 weeks
Dengue Typhoid fever Tuberculosis
Chikungunya Typhus HIV
Leptospirosis Leptospirosis CMV
JEV Ebola Autoimmune disease
SARS CMV Malignancies
Ebola Rabies
Hepatitis A Acute HIV
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Thrombotic (DVT/PE/MI)
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Treatment of Fever
• Antipyretics:
• Acetaminophen
• NSAIDs side effects !
• Corticosteroids side effects !!!
• Cool damp sponges
• Submersion should be avoided
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TREATING Fever
Antimicrobial Acetaminophen
drugs Corticosteroids NSAIDs
Anti-cytokines Antimicrobial
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drugs drugs
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Complications:
• a state of catabolism detrimental to body
• fluid and electrolyte imbalance - due to sweating and loss of minerals
• high grade fevers can lead to convulsions, brain damage, circulatory
overload and arrhythmia
• increase oxygen consumption COPD, CHD
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Drug Fever
Definition (Mackowiak & LeMaistre, 1987):
• a disorder characterized by fever coinciding with administration of a drug and
disappearing after the discontinuation of the drug
• no other cause for the fever is evident after a careful physical examination and
laboratory investigation
• usually a diagnosis of exclusion
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“Classic”etiology:
• Infections: tuberculosis, infectious mononucleosis
• Malignancies
• Noninfectious inflammatory diseases (eg, vasculitis, systemic lupus erythematosus,
polymyalgia rheumatica)
• Connective tissue diseases (eg, vasculitis, rheumatoid arthritis)
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1. Infections:
• Endocarditis FUO: most common causes
• Tuberculosis
• Abdominal abscesses
• EBV/CMV infections
2. Malignancies:
• Lymphoma
• Leukemia
4. Miscellaneous disorders
• Habitual hyperthermia
• Drug fever
Vanderschueren S. et al. From prolonged febrile illness to Fever of Unknown
• Subacute thyroiditis Origin: The challenge continues. Arch Intern Med 2003;163:1033.
Key Points
• History taking finding source/ site of infection
• Physical examination
• Imaging
• Laboratory tests:
• CBC, urinalisys, BUN/ SC, SGOT/ SGPT, LED, [CRP, lactate,
procalcitonine]
• Blood/ urine/ body fluid culture
• Serology, antigen-based test
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• PCT improves the management of patients with lower respiratory tract infections
and critically ill sepsis patients, as well as patients with UTIs, postoperative infections,
meningitis, and acute heart failure with possible superinfection (i.e., pneumonia)
• PCT-guided protocol shortened length of antibiotic treatment
• PCT is far from being a perfect marker and levels must be evaluated in the context of a
careful clinical and microbiological patient assessment
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Kesimpulan
Thank You
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