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samenvatting chronische koorts
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samenvatting chronische koorts
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CHRONISCHE KOORTSDEFINITIE
FECI: febris a causa ignota
FUO= fever of unknown origin
Categorie: nosocomial, neutropenic of HIV gerelateerd
Duratie: meer dan 3 weken of 3 ziekenhuisdagen
Nieuwe cut-off: ochtend > 37.2°C of altijd > 37.8°C
Koorts bij temperatuur hoger 38.3°c langer dan 3 weken
Nieuwe oorzaken: HIV/AIDS, nosocomiale infecties, immunorepressie, auto-inflammatoir
Nieuwe diagnostische technieken: serologie, culturen, moleculair, PET, genetica
1
, Circadiaans ritme zorgt voor intra-individuele variabiliteit
Alarmsymptomen
Koorts
Nachtzweten
Gewichtsverlies
OORZAKEN VAN FUO
3 major
1) Infectious (30%)(% gedaald door de jaren)
- Endocarditis, diep orgaan infecties, CMV, EBV, toxoplasma, HIV & SOA, zoönoses,
(extrapulmonary) TB
2) Tumoral (18%)
- (non) Hodgkin lymfoma, lymfoproliferatieve ziekten, hypernephroma
3) Niet infectious inflammatoire ziekten (Auto-immuun, reuma)(23%)
- Artritis temporalis, still ziekte, PAN, SLE
3 minor
1) Habituele hyperthermia (kan bij depressie optreden)
2) Factitious fever (psychopathologie)
3) Drugs gerelateerd (drug fever)
Andere (26%)
- Cirrose, pulmonary embolism, DVT, pseudotumor van lymfeklieren, occult haematoma,
aortic dissectie, chronic fatigue syndrome, macrofaag activatie syndrome, castleman ziekte
ONDERZOEK
Medische geschiedenis
- Profile patient: job, hobbies, contact dieren, familie, seksueel, drugsgebruik, mentaal
Fysiek onderzoek
- Koortspatroon, B symptomen (gewichtsverlies, nachtzweten & koorts)
- Onderzoek zeker: weefsels, lymfeklieren, hepatosplenomegalie, murmurs, abdominale pijn,
botpijn, gewrichten
Serologie (let op vals positieve resultaten)
- Waarschijnlijkheid ziekte afhankelijk van regio & geschiedenis patient
- Bv: brucella, leishmania, borrelia,..
Beeldvorming longen & abdomen
Mantoux test
! suttons law “ go where the money is” !
! uncommon presentation of common diseases > common presentation of uncommon diseases !
KOORTSPATROON
o Permanent:
- Bacteremia
- Endocarditis
- typhoid fever: koorts wordt erger tot plateau wordt bereikt
- abscess koorts
o Cyclisch: malaria (om 3 dagen)
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