Dangerous Fever in the Emergency Department
Preface D a n g e r o u s Fe v e r i n t h e Emergency Department
Emilie J.B. Calvello, MD, MPH Christian Theodosis, MD, MPH Editors
The importance and significance of fever as a sign or symptom of severe illness or severe infection have been known for thousands of years. Long before any type of standardized measuring device was crafted to report temperature objectively, people knew the experience of “fever.” Fever is among the commonest causes of concern among patients seeking health services and is associated with many health emergencies. Here we describe several deadly conditions commonly associated with fever. Topics have been selected for their clinical and educational significance. The material is presented in conventional terms, whereby “diseases” are understood in terms of interaction between hosts, vectors, and the environment. “Fever” is selected as a prime organizing unit for discussion with foreknowledge of its broad scope. When fever is associated with infection, it is because the architecture of the common disease model connects the concepts of host, pathogen, and environment to the possibilities of susceptible host, vector of contagion, and permissive environment. Likewise, noninfectious causes of pyrexia are markedly influenced by vulnerability—otherwise understood as host-specific attributes. With limited expansion, “vectors of disease” can include both endogenous (eg, hypermetabolic states due to endocrine derangements) and exogenous causes of disease (eg, toxins, poisons, drugs). The environment itself can be more or less permissive to the development of several noninfectious disease states. Indeed, hosts can be killed outright by the environment. They can also be injured by identified specific risks that are external to themselves but confined by the environment. This issue of Emergency Medicine Clinics of North America updates the emergency physician on recent advances in the diagnosis and management of sentinel syndromes associated with fever. The content of this issue is organized around pathogenicity, vulnerability, and environmental exposure. Sepsis, the classical dangerous fever,
Emerg Med Clin N Am 31 (2013) xv–xvi http://dx.doi.org/10.1016/j.emc.2013.09.006 0733-8627/13/$ – see front matter Ó 2013 Elsevier Inc. All rights reserved.
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and its management are reviewed in the first article. The broad and mostly infectious differential of fever in the returned traveler is covered in the second article, followed by the rational application of antimicrobials to fever caused by infectious organisms. The next two articles represent fever within the intricate architecture of their physiological causes and effects. The following two articles untangle cases of fever caused mostly by toxic, exogenic, and iatrogenic events. The next three articles are devoted to fevers that cause particular concern among specific groups of people—the immunocompromised, the pediatric patient, and those with recent surgery. Finally, in the last article we cover dangerous fever caused by the exposure of the host to environmental extremes. It is our intent that the content of this issue will be a guide and resource to the emergency physician faced with the conundrum of the complicated patient with undifferentiated pyrexia. We wish to thank the authors who dedicated much time and effort to this project. We also acknowledge with much gratitude the support of Dr Amal Mattu and Patrick Manley throughout the creation of this issue. Emilie J.B. Calvello, MD, MPH Department of Emergency Medicine University of Maryland School of Medicine 6th Floor, Suite 200 110 South Paca Street Baltimore, MD 21201, USA Christian Theodosis, MD, MPH Department of Emergency Medicine University of Maryland School of Medicine 6th Floor, Suite 200 110 South Paca Street Baltimore, MD 21201, USA E-mail addresses: [email protected] (E.J.B. Calvello) [email protected] (C. Theodosis)
Preface D a n g e r o u s Fe v e r i n t h e Emergency Department
Emilie J.B. Calvello, MD, MPH Christian Theodosis, MD, MPH Editors
The importance and significance of fever as a sign or symptom of severe illness or severe infection have been known for thousands of years. Long before any type of standardized measuring device was crafted to report temperature objectively, people knew the experience of “fever.” Fever is among the commonest causes of concern among patients seeking health services and is associated with many health emergencies. Here we describe several deadly conditions commonly associated with fever. Topics have been selected for their clinical and educational significance. The material is presented in conventional terms, whereby “diseases” are understood in terms of interaction between hosts, vectors, and the environment. “Fever” is selected as a prime organizing unit for discussion with foreknowledge of its broad scope. When fever is associated with infection, it is because the architecture of the common disease model connects the concepts of host, pathogen, and environment to the possibilities of susceptible host, vector of contagion, and permissive environment. Likewise, noninfectious causes of pyrexia are markedly influenced by vulnerability—otherwise understood as host-specific attributes. With limited expansion, “vectors of disease” can include both endogenous (eg, hypermetabolic states due to endocrine derangements) and exogenous causes of disease (eg, toxins, poisons, drugs). The environment itself can be more or less permissive to the development of several noninfectious disease states. Indeed, hosts can be killed outright by the environment. They can also be injured by identified specific risks that are external to themselves but confined by the environment. This issue of Emergency Medicine Clinics of North America updates the emergency physician on recent advances in the diagnosis and management of sentinel syndromes associated with fever. The content of this issue is organized around pathogenicity, vulnerability, and environmental exposure. Sepsis, the classical dangerous fever,
Emerg Med Clin N Am 31 (2013) xv–xvi http://dx.doi.org/10.1016/j.emc.2013.09.006 0733-8627/13/$ – see front matter Ó 2013 Elsevier Inc. All rights reserved.
emed.theclinics.com
xvi
Preface
and its management are reviewed in the first article. The broad and mostly infectious differential of fever in the returned traveler is covered in the second article, followed by the rational application of antimicrobials to fever caused by infectious organisms. The next two articles represent fever within the intricate architecture of their physiological causes and effects. The following two articles untangle cases of fever caused mostly by toxic, exogenic, and iatrogenic events. The next three articles are devoted to fevers that cause particular concern among specific groups of people—the immunocompromised, the pediatric patient, and those with recent surgery. Finally, in the last article we cover dangerous fever caused by the exposure of the host to environmental extremes. It is our intent that the content of this issue will be a guide and resource to the emergency physician faced with the conundrum of the complicated patient with undifferentiated pyrexia. We wish to thank the authors who dedicated much time and effort to this project. We also acknowledge with much gratitude the support of Dr Amal Mattu and Patrick Manley throughout the creation of this issue. Emilie J.B. Calvello, MD, MPH Department of Emergency Medicine University of Maryland School of Medicine 6th Floor, Suite 200 110 South Paca Street Baltimore, MD 21201, USA Christian Theodosis, MD, MPH Department of Emergency Medicine University of Maryland School of Medicine 6th Floor, Suite 200 110 South Paca Street Baltimore, MD 21201, USA E-mail addresses: [email protected] (E.J.B. Calvello) [email protected] (C. Theodosis)
