If cause not evident work top to bottom looking for any clues to an infective aetiology
About
- Useful set of things to check when looking for a septic source
- Clinical signs may be muted in those who are immunocompromised
Aetiology
- Malignancy and non-infective inflammatory conditions also cause pyrexia
Clinical
- Respiratory system: Shortness of breath, Purulent sputum, Cough
- ENT: Sinusitis, Sore throat, Coryzal symptoms
- Cardiac: Murmur, embolic phenomena, clubbing, microscopic haematuria
- Gastrointestinal: Diarrhoea, Abdominal pain, Vomiting
- Skin lesions: Rash (immunosuppression may cause reactivation of Herpes and Varicella), Infected ulcers, Surgical incisions
- Vascular access sites, Are rigors associated with the use of central venous access, Any blood products in the past 24 h?
- Genitourinary: Discharge, Rashes, Dysuria, Loin pain, Frequency, Haematuria
- Neurological: Altered level of consciousness, Odd behaviour, Confusion, Visual disturbance, Weakness, Paraesthesia
Investigations
- Minimum of two new venepunctures for blood cultures
- Cultures from venous access if in situ; do not remove central lines or Hickman lines
without advice from a haematologist
- CXR:consolidation or effusion suggestive of infection
- FBC:what is the patient's current haematological status?
- CRP: initial value may not be indicative of severity but can be used to track progress
- U&Es: renal function may deteriorate and is important for antibiotic choice and dose
- LFTs:any sign of biliary sepsis?
- Echo ? endocarditis
- Coagulation screen as risk of DIC in these patients
- Swab any rashes or sites of infection
- Stool samples for microscopy, culture and C. difficile toxin
- Urine dipstick and MSU
- Sputum sample
- Throat swab
- Viral serology