AIDS fever of unknown origin: Difference between revisions

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==Workup==
==Background==
Sources of fever vary by stage of disease.  The CD4 count of '''< 200 × 10<sup>6</sup> cells/μL''' is very likely if the ED absolute lymphocyte count is '''< 950 × 10(6) cells/μL''' and '''less likely if the absolute lymphocyte count is > 1,700 × 10<sup>6</sup> cells/μL'''<ref>Napoli AM et al. Absolute lymphocyte count in the emergency department predicts a low CD4 count in admitted HIV-positive patients. Acad Emerg Med. 2011 Apr;18(4):385-9.</ref>


{{HIV CD4 Chart}}


cbc
===CD4 >500===
*Work-up similarly to nonimmunocompromised patients
===CD4 200-500===
*Early bacterial respiratory infection most common
===CD4 <200===
*PCP, central line infection, MAC, TB, CMV, drug fever, sinusitis
*Also consider: endocarditis, lymphoma, histo, crypto
===CD4 <100===
*Consider disseminated MAC
*[[Toxoplasmosis]] (CNS or pulmonary)


lytes
==Differential Diagnosis==
{{HIV associated conditions}}


lfts
==Evaluation==
*CBC
*Chemistry
*LFT
*LDH
*RPR
*[[Urinalysis]]/Urine cultures
*Blood cultures
**Aerobic, anaerobic, fungal
*Crypto
*Toxo
*Coccidiodomycosis
*[[CXR]]
*Stool culture / O&P
*CT
*[[LP]]
**Cell count, protein, glucose, VDRL, cryptocoocal antigen, cytology, toxo, CMV, JC, EBV


rpr
==Management==
 
u/a c/s
 
blood cx aero, anaerob, fungal
 
crypto antigen
 
toxo
 
coccidioides
 
cxr
 
stool cx o/p
 
urine fungus / myocobacteria
 
sputum smear culture fungus /myco
 
 
CT & LP check for:
 
cell count, protein, glucose, vdrl, cryptocoocal antigen, cytology (cns lymphoma), pcr for toxo, cmv, jc virus, ebv (lymphoma)


==Disposition==


==See Also==
*[[HIV - AIDS (Main)]]


==References==
<references/>


[[Category:ID]]
[[Category:ID]]

Latest revision as of 15:17, 2 October 2016

Background

Sources of fever vary by stage of disease. The CD4 count of < 200 × 106 cells/μL is very likely if the ED absolute lymphocyte count is < 950 × 10(6) cells/μL and less likely if the absolute lymphocyte count is > 1,700 × 106 cells/μL[1]

HIV Associated Diseases by CD4 Level

CD4 Count Stage Diseases
>500 Early disease Similar to non-immunocompromised patients (Consider HAART medication side-effects)
200-500 Intermediate disease Kaposi's sarcoma, Candida, bacterial respiratory infections
<200 Late disease PCP, central line infection, MAC, TB, CMV, drug fever, sinusitis, endocarditis, lymphoma, histoplasmosis, cryptococcus, PML
<100 Very late disease Cryptococcus, Cryptosporidium, Toxoplasmosis
<50 Final Stage CMV retinitis, MAC

CD4 >500

  • Work-up similarly to nonimmunocompromised patients

CD4 200-500

  • Early bacterial respiratory infection most common

CD4 <200

  • PCP, central line infection, MAC, TB, CMV, drug fever, sinusitis
  • Also consider: endocarditis, lymphoma, histo, crypto

CD4 <100

Differential Diagnosis

HIV associated conditions

Evaluation

  • CBC
  • Chemistry
  • LFT
  • LDH
  • RPR
  • Urinalysis/Urine cultures
  • Blood cultures
    • Aerobic, anaerobic, fungal
  • Crypto
  • Toxo
  • Coccidiodomycosis
  • CXR
  • Stool culture / O&P
  • CT
  • LP
    • Cell count, protein, glucose, VDRL, cryptocoocal antigen, cytology, toxo, CMV, JC, EBV

Management

Disposition

See Also

References

  1. ↑ Napoli AM et al. Absolute lymphocyte count in the emergency department predicts a low CD4 count in admitted HIV-positive patients. Acad Emerg Med. 2011 Apr;18(4):385-9.
  2. ↑ Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.
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