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  • Acute Febrile Illness (AFI) Causes

    Acute Febrile Illness (AFI): Causes

    Acute Febrile Illness (AFI) is characterized by a sudden onset of fever and associated systemic symptoms lasting for a short duration, typically less than two weeks. It is a common presentation in clinical settings and can be caused by a wide range of infectious and non-infectious etiologies. Proper identification of the underlying cause is crucial for effective management and treatment. This article provides a comprehensive list of all possible causes of AFI, including rare causes.

    Causes of Acute Febrile Illness (AFI)

    Table 1: Causes of AFI (Including Rare Causes)

    TypeCauseExamples
    Infectious CausesBacterial InfectionsTyphoid Fever, Pneumonia, Meningitis, UTIs, Endocarditis, Brucellosis, Tularemia, Anthrax, Q Fever, Melioidosis, Leprosy, Lyme Disease, Rickettsial infections (Rocky Mountain Spotted Fever, Scrub Typhus)
    Viral InfectionsDengue, Influenza, COVID-19, Chikungunya, Measles, Mumps, Rabies, Hantavirus, Viral Hemorrhagic Fevers (Ebola, Marburg), West Nile Virus, Zika, Crimean-Congo Hemorrhagic Fever (CCHF), Lassa Fever, Nipah Virus
    Parasitic InfectionsMalaria, Leptospirosis, Trypanosomiasis, Toxoplasmosis, Babesiosis, Schistosomiasis, Amoebiasis, Fascioliasis, Filariasis, Echinococcosis
    Fungal InfectionsCandidiasis, Histoplasmosis, Coccidioidomycosis, Cryptococcosis, Blastomycosis, Paracoccidioidomycosis, Sporotrichosis, Aspergillosis
    Non-Infectious CausesAutoimmune DisordersSystemic Lupus Erythematosus (SLE), Rheumatic Fever, Still’s Disease, Sarcoidosis, Vasculitis, Adult-onset Still’s Disease (AOSD), Polyarteritis Nodosa
    Malignancies (Neoplastic)Lymphoma, Leukemia, Renal Cell Carcinoma, Hepatocellular Carcinoma, Multiple Myeloma, Metastatic Cancers, Paraneoplastic Syndromes
    Drug-Induced FeversAntibiotics, Anticonvulsants, Chemotherapy, NSAIDs, Antiarrhythmics, Vaccines, Biologics, Illicit Drug Reactions
    Environmental CausesHeat StrokeHeat Stroke, Hyperthermia due to extreme environments, Neuroleptic Malignant Syndrome (NMS)
    Hyperthermia from ToxinsCocaine, Amphetamines, Anticholinergics, Salicylate Toxicity, Serotonin Syndrome
    Unknown CausesFever of Unknown Origin (FUO)Idiopathic Fevers, Familial Mediterranean Fever (FMF), Adult-onset Immunodeficiency Syndrome (AOIS), Periodic Fever Syndromes

    Pathophysiology

    1. Infectious Causes (Most Common)

    • Bacterial Infections:
      • Pathophysiology: Activation of immune response via endotoxins or exotoxins leading to cytokine release (IL-1, TNF-α).
      • Examples:
        • Typhoid Fever (Salmonella typhi)
        • Pneumonia (Streptococcus pneumoniae, Haemophilus influenzae)
        • Meningitis (Neisseria meningitidis, Streptococcus pneumoniae)
        • Urinary Tract Infections (E. coli)
    • Viral Infections:
      • Pathophysiology: Viral replication causing cell lysis, immune activation, and cytokine storm.
      • Examples:
        • Dengue Fever
        • Influenza
        • COVID-19 (SARS-CoV-2)
        • Chikungunya
        • Measles, Mumps
    • Parasitic Infections:
      • Pathophysiology: Immune response to parasitic antigens; inflammation and tissue damage.
      • Examples:
        • Malaria (Plasmodium spp.)
        • Leptospirosis (Leptospira spp.)
        • Trypanosomiasis (African Sleeping Sickness)
    • Fungal Infections:
      • Pathophysiology: Invasive fungal infections trigger inflammatory responses, especially in immunocompromised individuals.
      • Examples:
        • Candidiasis
        • Histoplasmosis

    2. Non-Infectious Causes

    • Autoimmune Disorders:
      • Pathophysiology: Autoimmune activation causing systemic inflammation and fever.
      • Examples:
        • Systemic Lupus Erythematosus (SLE)
        • Rheumatic Fever
        • Still’s Disease
    • Malignancies (Neoplastic):
      • Pathophysiology: Release of pyrogens from cancer cells or tumor necrosis.
      • Examples:
        • Lymphoma
        • Leukemia
        • Renal Cell Carcinoma (Paraneoplastic syndromes)
    • Drug-Induced Fevers:
      • Pathophysiology: Hypersensitivity reactions or alteration in thermoregulation.
      • Examples:
        • Antibiotics (e.g., Beta-lactams)
        • Anticonvulsants (e.g., Phenytoin)
        • Chemotherapy agents

    3. Environmental Causes

    • Heat Stroke:
      • Pathophysiology: Failure of thermoregulation leading to hyperthermia and systemic inflammatory response.
    • Hyperthermia from Toxins:
      • Pathophysiology: Direct effect on hypothalamic regulation or increased metabolic rate.
      • Examples:
        • Cocaine, Amphetamines
        • Anticholinergic overdose

    4. Unknown/Idiopathic Causes

    • Fever of Unknown Origin (FUO):
      • Pathophysiology: Persistent fever (>3 weeks) without clear etiology despite thorough investigation.

    References

    1. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 9th Edition.
    2. Harrison’s Principles of Internal Medicine, 21st Edition.
    3. Kumar & Clark’s Clinical Medicine, 10th Edition.
    4. Fauci AS, et al. (2020). Harrison’s Principles of Internal Medicine. McGraw-Hill.
    5. Shapiro DS, et al. (2019). Infectious Disease: A Clinical Short Course. McGraw-Hill.
    6. Longo DL, et al. (2019). Fever of Unknown Origin. New England Journal of Medicine.
  • Disseminated Gonorrhea

    Disseminated Gonorrhea

    Disseminated Gonorrhea or Neisseria Gonorrhoeae. Disseminated gonococcal infection (DGI)

    Many of my patients with Gonorrhea( pus per urethra) present with rash , some have joint pain (Gonococcal arthritis)

    (DGI) follows untreated mucosal infection in about 0.5-3 per- cent of patients. Skin lesions are the most common manifestation of DGI and occur in 50-70 percent of patients. The eruption typically appears during the first day of symptoms and may recur with each bout of fever. The skin lesions associated with DGI begin as tiny red papules or petechiae 1-5 mm in diameter, many of which evolve rapidly through vesicular or pustular stages to develop a gray necrotic center, often on a hemorrhagic base. Papules, bullae, pustules, and hemorrhagic lesions may all be present simultaneously. The lesions tend to be scanty but widely distributed. The distal portions of the extremities are most commonly involved, with sparing of the scalp, face, trunk, and oral mucous membranes. Histologic examination will reveal local vasculitis, fibrin deposition, necro- sis, and neutrophil infiltration. Gram-stained smears of material from skin lesions infrequently reveal organisms, although most smears are positive for gonococci when examined by immunofluorescence techniques. Circulating immune complexes may play a role in the pathogenesis.

  • Fever and rash in Thailand

    Fever and rash in Thailand

    Fever and rash in Thailand (part1/2)

    If you have fever while traveling in Thailand or fever with a rash in a tropical country , what can you do? and what’s possible cause? Today I will give you some ideas.
    Fever can be caused by various infectious and non-infectious conditions. The possibilities depend on factors like how many days of the illness (acute or chronic), type of rash, other associate symptoms, and exposure or traveling history. Below are common causes:

    Infections

    Infection can be virus , bacteria or other but most common is virus. in my experience here in Pattaya , tourists concern about Dengue fever but it’s not common one .


    Dengue Fever :

    I will give more details in another post , but if you were here in rainy season ( Approx June till October ) And you had exposed to mosquito , it can be Dengue. Remember that in typical case the fever comes before the rash for 3-4 days.

    Rash: Blotchy or pinpoint red spots (petechiae), often appears after fever subsides.
    Other symptoms: High fever, severe headache, muscle/joint pain, eye globe pain, and bleeding tendencies , poor appetite or even vomiting, tiredness.
    Chikungunya Virus:

    Chikungunya also a virus transmitted by mosquito .

    Rash: Maculopapular rash, usually widespread. Sometimes at the same time of fever , or after few days.
    Other symptoms: High fever, severe joint pain, fatigue, and headache.


    Corona and other Virus

    Many viral disease including Covid and coronavirus , can cause fever with rash

    Rash: Maculopapular, often accompanied by conjunctivitis.
    Other symptoms: Mild fever, muscle pain, headache, and malaise.


    Rubella (german measles)

    Rash: Fine maculopapular rash evenly distributed all body.
    Other symptoms: fever (usually low grade)and rash appear simultaneously at the first day , or no fever , malaise .


    Typhus (Scrub Typhus)

    Rash: Starts on the trunk and spreads to extremities, maculopapular or petechial.
    Other symptoms: Fever, headache, and swollen lymph nodes; eschar at the bite site.


    Measles

    Rash: Starts on the face and spreads downward, blotchy and red.
    Other symptoms: High fever, cough, conjunctivitis, and Koplik spots in the mouth.